When I started dental school at USC in 1982 , gold crowns were considered the best in dental restorations . There were many kinds of gold crowns like ¾ crowns , 7/8 crowns , onlays and full crowns . Our instructors praised the perfection that could be achieved with gold and they praised the longevity these restorations had when made properly . For many years metals were the only substances available for making dental crowns and gold was the best among the metals .
Most people in the 50’s and 60’s and even 70’s didn’t mind the look of gold in their mouth and in some parts of the world the gold was considered a status symbol .
By the early sixties, however, there was already a demand for crowns that looked more natural. People wanted a more “real” look in their mouth and the “Pirate look” of gold was considered unattractive. Porcelain fused to metal crowns (PFM) started to become more popular during this era but were mostly used for front teeth where gold was absolutely not tolerated . These crowns basically had a metal core with porcelain baked on top of it. They first baked an opaque layer of porcelain on the core to mask the grey of the metal and then baked layers of body and incisal porcelain on top of that to give the crown the shape and color of a tooth. Cosmetically this was a great improvement over the gold crown and by the late 80’s most crowns being made were Porcelain fused to metal crowns .
As time progressed and people’s esthetic expectations grew , the porcelain fused to metal crown was no longer cosmetic enough . Patients complained about the dull none vibrant look some of these crowns had as well as the grayish color that showed by the gum line from the underlying metal in the crown . Some patients didn’t want to have any metal in their mouth and wanted an alternative to the PFM . This is when the new generation of crowns were developed without metal in them .These crowns were collectively reffered to as Zirconia crowns and were divided into different classes which I will not bore you with .
As the new millennium kicked off, the metal free crowns were becoming more mainstream , names like Lava , Cerec and Impress were the leading brands .Patients enjoyed the more natural look the Zirconia crowns offered with a more 3-dimensional appearance to the crown instead of that flat look and gone were the gray lines along the gum . The gum tissue also seemed to prefer the absence of metal and people had less bleeding around the metal-free crowns .
During the past 25 years ,I have seen my practice go thru the phases I described above .I cemented my last gold crown over 15 years ago because patients did not want the gold look anywhere in their mouths anymore. For the longest time PFM crowns were the standard crown of my practice , until” smile makeovers” became popular and once again the status quo was not good enough anymore .Patients demanded more and more natural looking crowns and that slowly pushed metals out of the picture . Today , one third of all crowns I seat are Zirconia type while the rest are the latest generation of PFM .The reason for this is simply the cost factor ; Zirconia crowns are 30% more expensive. In another 10 years I believe that metal in crowns will disappear just like silver fillings .
If you have good gold or PFM crowns in your mouth I don’t suggest you replace them with new Zirconia variety .But if you are not pleased with the esthetics , have decay under the old crowns or have constant bleeding around your old crown then I would suggest looking into metal-free Zirconia crowns . I think you will like what you see .
