crowns - Gold vs PFM

Started by Floss
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Floss

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Case question - pt comes in needs multiple PFM's #4,5,7,21,28. Also needs crowns on #18 and 30. Would you do them in gold or PFM? 30 has existing PFM that's overbulked. I will be doing them both in gold, just wondering if there's any advantage to doing #30 in gold since it's already been prepped for a PFM
 
Sounds like 30 was not adequately reduced in the first place. You can cut it off and restore with a FGC without reducing any more tooth. The other advantage of gold is that it will not wear the opposing dentition like porcelain. So your two advantages of gold is that it requires minimal reduction and it wears similar to tooth structure. The only disadvantage (and it's a whopper) is esthetics.

Floss said:
Case question - pt comes in needs multiple PFM's #4,5,7,21,28. Also needs crowns on #18 and 30. Would you do them in gold or PFM? 30 has existing PFM that's overbulked. I will be doing them both in gold, just wondering if there's any advantage to doing #30 in gold since it's already been prepped for a PFM
 
yeah, that's what I figure. But the pt doesn't mind gold if ypu can't see it.
 
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Other advantages to gold are better patient comfort when occluding with opposing teeth, and better marginal seal than a PFM with porcelain facial margin. I've also heard a lab tech can create better occlusion on a gold crown than a porcelain occlusal. This has to do with the difficulties in stacking porcelain vs waxing for gold. Needless to say, I doubt most patients would want to show gold. You may want to consider metal occlusal PFMs on the maxillary arch.
 
Most of the gold work that I do in my practice is on males in their 40's or older that tend to be involved in either the engineering or science fields. Looked back at the numbers of crowns I did last year and the percentages of each type and the breakdown was 70% PFM (most of my PFM are porcelain to gold), 28% all ceramic and a whopping 2% full gold.

And yes, most lab techs will openly look forward to when you write full gold crown/inlay/onlay on the lab slip since they know that one of the biggest variables in the success/failure of patient acceptance of a crown, i.e. the shade, is a moot point!

Plus, after seeing many, many well maintained gold restorations on some of my patients that are been in their mouths longer than I've been alive, and still look as good as they did the day they were inserted, as a clinician, you've gotta love gold!
 
Floss said:
Case question - pt comes in needs multiple PFM's #4,5,7,21,28. Also needs crowns on #18 and 30. Would you do them in gold or PFM? 30 has existing PFM that's overbulked. I will be doing them both in gold, just wondering if there's any advantage to doing #30 in gold since it's already been prepped for a PFM

If #3 and 14 aren't presently crowned (porcelain), gold on #18 and 30 would make sense from a "wear on the opposing teeth" perspective. Especially if the patient isn't too old and/or 3 and 14 won't need restoring soon. It would enable you to not prep 30 anymore (in the case it's underprepped).
 
i need a crown on #3. what do you guys recommend.. us lonely first years don't know jack about dentistry yet 🙂
 
ItsGavinC said:
PFM. Esthetics combined with with the strength of the underlying metal.
More specifically, PFM with metal occlusion. Restrict porcelain coverage to the buccal surface so, like jpollei said, you don't develop trouble from enamel/porcelain occlusion.
 
aphistis said:
More specifically, PFM with metal occlusion. Restrict porcelain coverage to the buccal surface so, like jpollei said, you don't develop trouble from enamel/porcelain occlusion.

The only potential issue with that logic may come down to long term esthetics, and I'm not talking about the metal occlussal aspect. What you'll start seeing after you've been around the profession a few years is that the appearance of the porcelain aftre being subjected to yaers of saliva 24/7 and thousands of pigmented meals/beverages tends to loose ALOT of its vitality. And while the day you cement a crown, if the shade is A-2, it won't be A-2 in 10 years, more like a C-3. Lus the adjacent dentition will also change in color over that time frame also(more often these day lighter with everyone and their uncle bleaching their teeth).

For #3, if you truely want the most reliable, long term full coverage restoration, then a full gold crown is the only option!
 
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DrJeff said:
The only potential issue with that logic may come down to long term esthetics, and I'm not talking about the metal occlussal aspect. What you'll start seeing after you've been around the profession a few years is that the appearance of the porcelain aftre being subjected to yaers of saliva 24/7 and thousands of pigmented meals/beverages tends to loose ALOT of its vitality. And while the day you cement a crown, if the shade is A-2, it won't be A-2 in 10 years, more like a C-3. Lus the adjacent dentition will also change in color over that time frame also(more often these day lighter with everyone and their uncle bleaching their teeth).

For #3, if you truely want the most reliable, long term full coverage restoration, then a full gold crown is the only option!

Go gold. Be a pimp, like Hasselhoff.

DrJeff, I learned that porcelain does not pick up stains like composite does, so how does it change shade over the years? I can see how abrasion would take off the surface glaze and that would affect reflected light. Thanks.
 
DrJeff said:
The only potential issue with that logic may come down to long term esthetics, and I'm not talking about the metal occlussal aspect. What you'll start seeing after you've been around the profession a few years is that the appearance of the porcelain aftre being subjected to yaers of saliva 24/7 and thousands of pigmented meals/beverages tends to loose ALOT of its vitality. And while the day you cement a crown, if the shade is A-2, it won't be A-2 in 10 years, more like a C-3. Lus the adjacent dentition will also change in color over that time frame also(more often these day lighter with everyone and their uncle bleaching their teeth).

For #3, if you truely want the most reliable, long term full coverage restoration, then a full gold crown is the only option!
Interesting. Like drhobie said, I'm curious to hear how that process happens.
 
You have to remember that porcelain is stacked in many layers to acheive the final shade. Now after you've brushed the porcelain thousands of times, and basically etched the porcelain with countless acid assaults via the normal simple sugar fermentation process and from acidic beverage consumption over the years, you'll see some loss of the outer layers of the porcelain and a shift in the color.

Think of it this way, when you adjust the porcelain as your seating a crown, you'll see a change in the color most of the time even if you've just barely removed any glaze. Remember to get a crown that's say A-2 in color, it's not just place opaque porcelain over the coping and then add A-2 upto full contour, your lab tech is building that final A-2 shade with many layers of various shaded porcelains. If you ever get the chance to watch a lab tech either custom stain/tint a crown chairside or watch the ceramist build the crown from opaquer up in the lab DO IT, you'll really get a true appreciation not just for what the lab tech/ceramist does, but also how you as a clinicain can achieve better results, not just for indirect ceramic restorations, but also for your direct composite restorations.

What you'll see, especially with female patients (not a sexist thing but women as a whole are way more esthetically conscious than men with repect to their teeth) is that 10 or so years after placement, women will start inquiring about replacing their crowns (especially premolars forward) due to the color shifting of the porcelain and/or their natural enamel. Men on the other hand tend to be more of the "if it ain't broke don't fix it" mantra 😀 😀

And BTW Bill, I'm on my way out the door in about 10 minutes to goto Foxboro to watch Peyton becoming "Poutin" again! 😀 😀
 
DrJeff said:
You have to remember that porcelain is stacked in many layers to acheive the final shade. Now after you've brushed the porcelain thousands of times, and basically etched the porcelain with countless acid assaults via the normal simple sugar fermentation process and from acidic beverage consumption over the years, you'll see some loss of the outer layers of the porcelain and a shift in the color.

Think of it this way, when you adjust the porcelain as your seating a crown, you'll see a change in the color most of the time even if you've just barely removed any glaze. Remember to get a crown that's say A-2 in color, it's not just place opaque porcelain over the coping and then add A-2 upto full contour, your lab tech is building that final A-2 shade with many layers of various shaded porcelains. If you ever get the chance to watch a lab tech either custom stain/tint a crown chairside or watch the ceramist build the crown from opaquer up in the lab DO IT, you'll really get a true appreciation not just for what the lab tech/ceramist does, but also how you as a clinicain can achieve better results, not just for indirect ceramic restorations, but also for your direct composite restorations.

What you'll see, especially with female patients (not a sexist thing but women as a whole are way more esthetically conscious than men with repect to their teeth) is that 10 or so years after placement, women will start inquiring about replacing their crowns (especially premolars forward) due to the color shifting of the porcelain and/or their natural enamel. Men on the other hand tend to be more of the "if it ain't broke don't fix it" mantra 😀 😀

And BTW Bill, I'm on my way out the door in about 10 minutes to goto Foxboro to watch Peyton becoming "Poutin" again! 😀 😀
Excellent, thanks for the info.

And, I nearly forgot! I don't expect you'll see nearly as much of Peyton tonight as you will of Edge. I just hope the Pats squeak into the playoffs this year so we can get another crack at you in the Dome. 😀 😉
 
aphistis said:
More specifically, PFM with metal occlusion. Restrict porcelain coverage to the buccal surface so, like jpollei said, you don't develop trouble from enamel/porcelain occlusion.

Personally, with my limited knowledge, I don't think porcelain occluding with enamel is *that* big of a problem. At least, perhaps not nearly as big as some professors make it out to be. Assuming the patient doesn't have any type of parafunctional activity happening, I'd say it's a fairly minimal problems.

On the other hand, if the patient likes to brux to their heart's content, there may be issues.
 
ItsGavinC said:
Personally, with my limited knowledge, I don't think porcelain occluding with enamel is *that* big of a problem. At least, perhaps not nearly as big as some professors make it out to be. Assuming the patient doesn't have any type of parafunctional activity happening, I'd say it's a fairly minimal problems.

On the other hand, if the patient likes to brux to their heart's content, there may be issues.

Wait till you see a patient whose got an over bulked lingual of a PFM on 8 or 9 and what it does to the lower anteriors after a few years of even "normal" functional motions, then you'll really see how abrasive porcelain can be and how carefull you need to be woking out the occlussion.
 
I've had a PFM on #6 thru #9 for the last 10 years. The incisal edges of 24 thru 27 have more wear than I'd like to admit. I went to see the ortho residents to get a consult, and mulling over my options. The porcelain used 10 years ago was supposedly more abrasive than current porcelain.
 
The majority of crowns I did in Dental school were gold. We had a predominant military faculty and they pushed for amal and gold restorations. In private practice there are few requests for either so i would try to do as many composite and PFM restorations.
I did a Gold #5 for a RPD. It looked horrible. your pt will probably flash gold when he smiles.
 
rocknightmare said:
i need a crown on #3. what do you guys recommend.. us lonely first years don't know jack about dentistry yet 🙂
Gold--much less abrasive on your opposing tooth. Non need for a traditional PFM, though (esthetics don't matter on #3).
 
jpollei said:
Gold--much less abrasive on your opposing tooth. Non need for a traditional PFM, though (esthetics don't matter on #3).

It would actually depend on your patient's smile and how much of the arch he/she shows. Many patients display 3 and 14 when they smile. Molar to molar veneers are not unheard of.
 
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Case question - pt comes in needs multiple PFM's #4,5,7,21,28. Also needs crowns on #18 and 30. Would you do them in gold or PFM? 30 has existing PFM that's overbulked. I will be doing them both in gold, just wondering if there's any advantage to doing #30 in gold since it's already been prepped for a PFM

From a lab stand point if patient doesn't mind I always push for gold crowns due to longevity, non abrasive. If not then pfm over full zirconia due to aesthetics. Advantage to do gold over that prepped pfm tooth would be that I make the gold crown thinner since the pfm was bulky. Even after removing the pfm crown u might now be able to reduce the prep and maybe that's why the crown is bulky.

P.s I'm a lab owner.