ACC or PFM?

[Destiny11]

If cost is not an issue, would you recommend PFM or ACC for molars to a patient? What about as a survey crown for RPD?

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[Contach]

ACC? Does that mean All Ceramic?
There are many types of PFM crowns. I'm guessing you are doing shoulder/chamfer finish line on buccal with lingual metal collar.. And I'm assuming you aren't using a captek or noble metal in the PFM..

There are a lot of things to consider. I'll list some:
- Can you see this tooth when the patient smiles? Can you see the gingival margin when the patient smiles? If yes --> Ceramic
- Is the pt a grinder? If yes --> PFM b/c it is time-tested, but full metal or 3/4 metal or something like that would be preferred.
- Patient preference - are they going to be okay with metal on the lingual?
- What kind of ceramics are you using?

 

[Mackchops]

ACC? Does that mean All Ceramic?
There are many types of PFM crowns. I'm guessing you are doing shoulder/chamfer finish line on buccal with lingual metal collar.. And I'm assuming you aren't using a captek or noble metal in the PFM..

There are a lot of things to consider. I'll list some:
- Can you see this tooth when the patient smiles? Can you see the gingival margin when the patient smiles? If yes --> Ceramic
- Is the pt a grinder? If yes --> PFM b/c it is time-tested, but full metal or 3/4 metal or something like that would be preferred.
- Patient preference - are they going to be okay with metal on the lingual?
- What kind of ceramics are you using?

I'd agree with this. PFMs have a long track record for success and would be my second choice (for longevity) behind cast metal. Then monolithic zirconia. Then monolithic e.max. Zirconia is a great material and I think once the literature catches up we'll find out that it's as good as PFMs in the posterior, but we have very little long-term studies on it right now.

Also, it depends on what the patient wants! I had a teacher who would tell patients "if someone's close enough to see your gold tooth back there, they're close enough to not care!" Very true.

Lastly, consider your axial wall height - taking that occlusal down enough for porcelain (full contour or PFM) turns a lot of second molars into flat tops - then it doesn't matter WHAT material you pick because the darn thing's going to fall out before it fails any other way! Metal occlusal or zirconia can help minimize your reduction.