What type of crown is the best for me?

 

The short answer is there is no one best crown for every situation, but more and more dentists are opting for all ceramic crowns.... either Zirconium or lithium dislicate. They are used in different clinical situations. Please be aware that This post is not intended to be a deep dive into the subject, but may answer may questions about all ceramic crowns

So what be the appropriate indications for using the different types of ceramic crowns ( full thickness milled zirconium , Porcelain fused to Zirconium, full thickness lithium disilicate( pressable or milled),  and lithium disilicate layered with porcelain. How to make sense of all these choices? Ok , lets try and clarify the different options and which is best in different situations. 

Presently, monolithic zirconium crowns are the most commonly made crowns by dentists nationwide. These come in three Primary types; High opacity, medium opacity and high translucency. The opaque version is somewhat stronger and fracture resistant than the other two and is primarily used for restoring molar teeth, since strength and not esthetics are a patients primary concern.  For most premolar teeth the translucent type is chosen unless the teeth holding the crown has a cast metal post or a large amalgam core. In that event a more opaque version of the zirconium restoration is probably a better choice. 

While some dentists are using a protocol that allows the use of composite cements and bonding to lute in these crowns, most dentists are using resin modified cements for luting these restorations, since they are easier to use and the clean up of excess cement is easier.

If greater esthetics is desirable for a zirconium crown, the decision can be made by the dentist and the lab to coat the buccal and occlusal with porcelain.  These crowns are termed porcelain fused to Zirconium. While these are highly esthetic, they are less strong than any of the full thickness zirconium crowns.

Lithium dislicate is often used in the anterior region, since these are highly translucent and. can be customized with either micro or macro layering on the labial surface of these crowns. While these are best luted with composite cements, some dentists opt for resin modified glass ionomer cements due to their ease of use.  It should be noted that  these crowns are considerably stronger when luted with composite cements as opposed to the resin modified option.

Sometimes for shorter tooth preparations , lithium disilicate is a better choice since bonding may be a more secure luting option  since short preparations may have compromised  retension especially when other types of dental cements are employed.

For patients with a deep bite who need an anterior crown,  zirconium may be the best choice for a crowns lingual surface, because it is more fracture resistant when compared to either porcelain or lithium disilicate.