I have been talking to my dentist about what to do to restore my smile. I have significant wear on my top teeth, and a gap between my two front teeth that has bothered me most of my life. Before I talked to my dentist about this, I did all kinds of research on the different kinds of available treatments, especially looking at different kinds of porcelain crowns. I really think–and my dentist confirmed this–that porcelain crowns will be the best way to fix my teeth.

The thing is, we don’t agree on what kind of porcelain crowns would be best. Both my dentist and his partner say they will only do porcelain fused to metal crowns. Everything I have read makes me believe that porcelain fused to metal crowns will not look as nice as I want them to look when we are done. Their reasoning for this is that I sometimes grind my teeth, and can’t stand wearing a night guard. They both say that the all ceramic Zirconia crowns like I want are not strong enough to last if I continue to grind my teeth. Both my dentist and his partner have impressive credentials, which is the main reason I chose them.

In your experience, do all ceramic crowns like Zirconia tend to sustain damage if used on an occasional grinder? It is not all the time, just intermittent.

I have waited a really long time to get this done, but I just can’t get excited about the porcelain fused to metal crowns. My dentist is all ready to get it done, but I think they will look fake, and I don’t want to spend that amount of money on something that is not exactly what I want.

I could really use your help on this.

Thanks,

Jerry in Indianapolis

Dear Jerry,

I think you’re going to need a second opinion. The Zirconia porcelain crowns that you mention are indeed very strong, certainly strong enough to withstand great stress. If your teeth grinding is not constant or severe, they might well work as a great option for you. An added bonus is that the all-ceramic or all-porcelain veneers can be made thinner than porcelain fused to metal crowns, and so less of your natural tooth structure has to be removed to place the crowns.

It is possible that despite the impression credentials your dentist and his partner take more of an engineering approach to restoration rather than an artistic one. It is also possible that your grinding problem is worse that you think it is. I strongly encourage you try again with the mouth guard. Teeth grinding can cause very serious, life-long issues.

In either case, if you are determined to go with the Zirconia crowns, then you would be best served to seek another dentist. It is always a bad idea to push a dentist to do something he does not want to do. For whatever reason, your dentist and his partner are not comfortable with the Zirconia crowns, and you are fortunate that they have the professional integrity to be completely honest with you about this. Insisting on a treatment plan your dentist is not comfortable with often ends badly, so if you are certain the Zirconia crowns are what you want, you’ll need to find a dentist who is comfortable placing them in your situation.