What is a Porcelain Fused to Metal Crown?
Porcelain fused to metal crowns (POMs) have long been considered the gold standard for the repair of damaged teeth. This type of design has been and continues to be the most common type of crown or bridge done in dentistry for 35 years. Porcelain on metal crowns (same as fused to metal) are cast metal crowns which have a porcelain covering over it. The tooth colored ceramic is baked on top of a metal alloy base called a coping for the ultimate in strength. The metal base is thin, strong, and fits perfectly over the prepared teeth.
The baked on porcelain layer is 1.5 mm to 2 mm thick. It is fashioned to have the same anatomy and optical characteristics as a natural tooth. The porcelain layer is tough, and withstands chewing forces very well. You could look at them as a hybrid between all porcelain and all metal crowns.
POM Metal Choices
The dentist will choose what type of metal to use depending on the quality level of the office. The choices go from low quality and cheap chrome-cobalt to expensive gold alloys. High noble gold alloys are the highest quality choice due its accurate fit and bio-compatibility.
Choosing Porcelain on metal instead of all porcelain
Although all porcelain crowns are strong, there are many times when a POM version is a better choice. The POM crown is stronger and more versatile in many clinical situations. It is often used when destructive night grinding is a problem or when long span bridges are needed. This type of crown can take more chewing force than all porcelain versions. The longevity and esthetics of these restorations will vary significantly depending on the quality level of the dentist and lab technician team that makes it. Absolutely fabulous esthetic results can be achieved with porcelain on metal crowns if your dentist works with a true ceramic artist.
Advantages of a porcelain fused to metal crown
- They can save your tooth!
- The underlying metal support makes your crown stronger and more durable.
- They have a very high rate of success in the long run. The track record for these crowns is 70 years.
- POMs are a preferred choice when long bridges are required and night grinding is a problem.
- POMs made with a high noble metal substructure are very bio-compatible. When the dentist chooses gold as the metal substructure, it is totally non-reactive and does not irritate gum tissue or bone. As long as the fit is good, the tissue will be very healthy.
- They can be cemented even when the tissue is unhealthy. The delivery process is much less complicated and usually can be done without novacaine. Porcelain crowns require bonding with gum tissue management. If the tissue is unhealthy, it is difficult to get a perfect seal.
- Fewer issues with sensitivity after they are delivered into the mouth
Disadvantages of porcelain fused to metal crowns
- A high quality metal based crown is more costly because the lab fee is higher to get the same level of esthetics as a porcelain crown. The popularity of POMs is declining in favor of “all porcelain” types of crowns. All porcelain versions without a metal base are easier to make pretty at a lower lab fee price point.
- A porcelain fused to metal crown is totally opaque to light. It will not transmit light down the root of the tooth. Lighting a non-restored natural tooth will brighten the gum below. The light travels down the root. The bright root brightens the gum above it. If the gum is thin, it is more translucent to what is below. When there is a POM is on the tooth, no light is able to illuminate the gum area and the resulting darker gum can be very visible in some patients smile.
- The porcelain from the porcelain on metal crown can chip off when you bite on very hard foods.
- At least 2mm of enamel has to be removed for a POM. The more natural tooth structure that remains the better.
QUALITY LEVELS and COSTS of a POM crown: Non-precious vs. high noble gold
Depending on what market niche your dentist operates in determines what your porcelain-on-metal restoration will look like. The average American dentist will contract with a lab to make your cap for about $155. This cost is usually hidden and rolled into the fee for service that the dentist charges you. An average crown will have a medium quality ceramic fused or baked over a base metal (non-precious alloy or low noble) coping. It will approximate the shape and coloration of a natural tooth. The dark metallic coping will be exposed at the margin or edge yielding a dark or black line at gum. For $60 more, the dentist could request a “porcelain butt joint margin” so if or when the gum receeds, an exposed metal margin will not appear.
Because all the lab costs are rolled into the price of the service, patients are rarely informed of
what their dentist is selecting and prescribing for them. An inexpensive dental office might pay as little as $35 as a total fee for a mass production laboratory which is often offshore to make your restoration. At this level of quality, the coping will be an inexpensive non-precious alloy and the ceramic will be more opaque. Cheaper alloy does not cast well and will not fit as intimately and has less bio-compatibility.
What makes a Porcelain Fused to Metal Crown High Quality?
Dr. Fondriest uses high-noble gold alloys under the veneering ceramic of his restorations. Gold has a warm color that is easier to mask with the ceramic. needing less porcelain means less tooth reduction is required to make it attractive. Noble gold alloys will cast better producing a much better fit and it is far more bio-compatible. High quality labs charge the dentist over $700 for a POM but if your particular case has complexity or many teeth are being done at the same time the laboratory costs to the dentist can rise to $1500 for each restoration. At this level of quality, PFMs can mimic nature’s beauty.
Dr Fondriest is a Nationally recognized and highly sought after cosmetic dentist. He serves clients from throughout the United States