Sometimes a tooth breaks down enough from decay that we need to replace the entire outside of a tooth. As dentists, we tell patients that we need to put a “crown” on a tooth. The procedure involves removing the outer hard enamel from the tooth along with part of the inner structure, called dentin, in an effort to eliminate decay. Through a series of appointments, a new outer crown or shell is fabricated to restore the part of the tooth that needed to be removed. Patients typically have the option of tooth-colored ceramic crowns versus all gold crowns for this type of restoration.
Ceramic or PFM crowns require more tooth structure to be removed from the tooth than all-gold crowns. It is also known that the longevity of a tooth is directly related to the amount of tooth structure remaining. Let’s make the length, width and height of the crown of a lower first molar 10mm, 10mm, and 7.5mm respectively. Applying the dimensions needed for a ceramic PFM crown restoration, there is approximately a reduction of 56%. For a gold crown, the volume of tooth removed is only about 27%, allowing a difference of 29%. If we base our decision for a restoration by how much tooth structure we want to keep, then the conservative choice is gold.
-Anthony Bianchi, Penn ’16