Helping Your Patient Choose Between Restorations
A patient may need a crown for any number of reasons, but before you move forward with treatment, it’s important to consider all the material options available. The one chosen will impact the restoration’s appearance – and therefore your patient’s appearance – longevity, and functionality. Two choices that deserve ample discussion include layered zirconia and full zirconia, both of which are durable, natural-looking, and biocompatible.
Helping Your Patient Choose Between Restorations
After you’ve had the conversation about how restoration will improve your patient’s oral health, it’s time to review the different materials available. This discussion might start with the topic of zirconia, a biocompatible substance favored in artificial joints for its strength and durability. In dentistry, it’s heralded for providing an aesthetically pleasing appearance. Although relatively new, this material is quickly gaining popularity.
Its development came as the need for a non-metallic dental material became increasingly obvious; prior to zirconia, patients often chose porcelain fused to metal (PFM), which revealed the metal base as a dark line right above the gums. Zirconia, derived from the metal zirconium, is naturally white like teeth and comes in two varieties. The first is full zirconia, the other is layered zirconia.
Advantages of Layered Zirconia and Full Zirconia
Zirconia largely mimics the properties of ceramic materials, can be stained to identically match real teeth, and provides a great base for a porcelain finish. It also:
- Requires less tooth removal
- Is less brittle than most other materials
- Provides a strong degree of translucency
- Will reflect the color of neighboring teeth
Metal crowns may be made from a variety of alloys, including gold, platinum, and nickel-chromium. All can withstand the wear and tear involved with chewing and biting and rarely chip or break; for this reason, they are often used for molars in the back of the mouth. The primary concern with metals is appearance. They don’t match other teeth and therefore stand out. In addition, some patients are allergic to metals and cannot have them in their mouths.
Restorations made of this material tend to be less expensive than others. The trade-off for saving money is they tend to fracture and/or erode, are less durable than metal or zirconia, and usually last just around five years. They are, however, viable solutions for patients on a budget.
All-Ceramic or All-Porcelain
Both of these choices easily match natural teeth colors and are ideal for patients with metal allergies. Many times, patients choose ceramic or porcelain for front-teeth restorations because they blend so nicely with nearby teeth. But there is a drawback: these crowns are not as strong as their metal counterparts (or zirconia) and are susceptible to chips and cracks.
Porcelain Fused to Metal
As mentioned earlier, this has been a strong go-to contender for many years and works for both front and back teeth. The primary concern is the dark metal line that tends to show near the gums. The metal can also be revealed if the porcelain chips or breaks off, forcing patients into another treatment.
Speak Plainly With Your Patient
The material used will depend on several variables, including the location of the tooth to be restored. For instance, it doesn’t make sense to put a metal restoration in the front of the mouth because of its ready visibility. Nor is layered zirconia appropriate for crowns on anterior teeth, but full zirconia is. Porcelain is likewise ideal, but zirconia, which is milled, provides more even margins with few, if any, imperfections.
Posterior teeth must be similarly handled. The force of chewing at the back of the mouth tends to be much greater than at the front, and crowns need to be durable enough to meet daily demands. Metal and zirconia are both dependable and can be placed with confidence. Patients will have to choose between these materials depending on their aesthetic goals and individual budgets.
The point is that speaking plainly with your patient will allow you to manage expectations and provide the desired outcomes. Patients should know that every restoration requires ongoing maintenance and will need to be replaced at some point. This open line of communication ensures a patient knows what to expect and helps you bridge the gap between function and appearance.
We’re going to return to the concepts of function and aesthetics here because they tend to comprise the greatest patient concerns. It is possible to achieve both, but the patient must receive all information available and be made aware of the limitations of restoration materials. Porcelain, for example, is more brittle than natural teeth and, if it breaks, can create sharp edges that may damage nearby teeth.
Some patients are less concerned about aesthetics and simply want a crown that will withstand the test of time. Metal is and continues to be the longest-lasting option but, again, placement will always play a part. Providing guidance in a way that addresses patients’ concerns will help you achieve optimal outcomes.
Review Your Patient’s Habits
It’s important to know your patient and understand his or her habits. Those who clench and grind their teeth must be given special consideration, as porcelain is not an ideal fit. Zirconia is the best match because it’s strong enough to endure such motion. Prior to the advent of this material, gold posed the best option but wasn’t always a top pick with patients because of its outstanding visibility.
Think About Sensitivity
Because so many patients grapple with tooth and gum sensitivity, this needs to be a factor in choosing the appropriate restoration material. Porcelain is known for reducing sensitivity to hot and cold temperatures, whereas metal can sometimes exacerbate it. Zirconia is similarly beneficial in reducing sensitivity, as it’s an inert material and poses no side effects in patients.
Whether your patient is considering layered zirconia, porcelain, metal, or full zirconia, the point is the same: your guidance will ensure he or she chooses a material that is compatible with overall treatment goals. Give thought to factors like the crown’s placement, the patient’s habits, and his or her individual concerns. For more help in choosing the right restoration material, contact Team Prudental Laboratories & Milling Center today.