FIXED PROSTHODONTICS

Types of Crowns

Dr Elena Hotinski
BDSc (UWA), DClinDent (Pros)
Specialist Prosthodontist
@drelenahotinski
 Types of Crowns
1. Full Gold Crowns (FGC)

2. Metal Ceramic Crowns (PFM / PBM)

3. All Ceramic Crowns

• Lithium Disilicate / Glass Ceramic (e.g. E.max)
• Monolithic Zirconia
• (PBZ)

4. (Partial Crowns / Inlays / Onlays / Veneers)

5. Endocrowns

6. Vertical Crown Preparations

7. Surveyed Crowns
 Types of Crowns
1. Full Gold Crowns (FGC)

2. Metal Ceramic Crowns (PFM / PBM)

3. All Ceramic Crowns

• Lithium Disilicate / Glass Ceramic (e.g. E.max)
• Monolithic Zirconia
• (PBZ) Not covered in
this lecture
4. (Partial Crowns / Inlays / Onlays / Veneers)

5. Endocrowns

6. Vertical Crown Preparations

7. Surveyed Crowns
 Full Gold Crowns
• Used for teeth that require full coverage and
aesthetic demands are low
• Can mask very dark / black underlying tooth structure
• Retainer for posterior bridgework
• Abutment teeth for partial dentures (surveyed crowns)

• Extremely long lasting

• Excellent for high load situations (e.g. bruxers) as
they can’t fracture
 Full Gold Crowns

• Advantages:
• Superior strength
• Longevity superior to all other fixed restorations
• Conservative preparation
 Full Gold Crowns
• Disadvantages:
• Not tooth coloured (‘inferior’ aesthetics)
• Any type of crown preparation involves removal of
healthy tooth structure
• Potential adverse effects on the pulp and
periodontium

• Shouldn’t be carried out if a more conservative

restoration is possible (e.g. onlay)
Preparation of Full Gold Crown

Supplementary retention
groove can be added for very
short teeth (either on mesial /
distal or buccal / lingual)
FULL GOLD CROWNS

Indications Contraindications Advantages Disadvantages

Posterior, high load locations Anterior teeth / any teeth Superior strength, longevity, ‘Inferior’ aesthetics / display of
(e.g. bruxers) visible in smile and marginal fit metal

Intact thick buccal or lingual

Can mask very dark / black Very expensive (high lab
RCT’d teeth wall (more conservative
underlying tooth structure costs)
restoration may be possible)

Partial denture abutment teeth

No chipping / fractures
(surveyed crown)

Single teeth or posterior

bridgework
 Metal Ceramic Crowns
• Used for teeth that require full coverage and
aesthetic demands are significant but an all
ceramic crown is not appropriate
• Very deep sub gingival margins (use of metal
margins in these areas often best)
• Very dark / black underlying tooth structure
• Long span or posterior bridgework
• Abutment teeth for partial dentures
(surveyed crowns)
 Metal Ceramic Crowns
• Advantages:
• Combines strength of an all metal crown with the aesthetics
of ceramics
• Can be used in high stress situations (e.g. parafunction)
with metal occlusal surface
• Can look very natural and aesthetic with a good lab
technician
• Easier preparation than partial crowns
• Proven longevity with a large amount of supporting
literature
 Metal Ceramic Crowns
• Disadvantages:
• Significant amount of tooth reduction required
• Buccal margin often has to be placed subgingivally for
aesthetic reasons
• Aesthetics not as good as all ceramic crowns
• Can appear slightly greyish and more opaque (not as
translucent)
• Difficult shade selection
• Need good laboratory support
 Preparation of Metal
Ceramic Crown

“Winged” Preparation “Wingless” (Preferable)

METAL CERAMIC CROWNS

Indications Contraindications Advantages Disadvantages

Large pulp chamber on vital Superior aesthetics compared Removal of substantial tooth
Moderate aesthetics required
tooth to full gold crown structure required

Very deep sub gingival Intact thick buccal wall Can mask very dark / black Veneering porcelain is brittle
margins (consider onlay) underlying tooth structure and subject to fracture

RCT’d teeth that are severely When more conservative Shade selection can be
Well established track record
discoloured restoration is possible difficult

Inferior aesthetics compared

Partial denture abutment teeth
to all ceramic crown
Long span / posterior
Expensive / high lab costs
bridgework

Very difficult to polish once

porcelain has been adjusted
(lab needs to reglaze)
 All Ceramic Crowns
• Highly aesthetic
• No underlying metal
• Most closely resemble natural tooth structure in colour and
translucency

• Final appearance of glass ceramics (e.max) can be

influenced by the colour of the core, the colour of the
underlying tooth structure, and different coloured cements
• Main disadvantage is susceptibility to fracture
• This risk is reduced with modern resin bonding and higher
strength materials
 All-Ceramic Crowns -
e.max

• Advantages:
• Superior aesthetics due to excellent translucency
• Lack of metal reinforcement means slightly more
conservative prep than metal ceramic
 All-Ceramic Crowns -
e.max
• Disadvantages:
• Reduced strength without metal substructure**
• More significant tooth preparation required on proximal and
lingual aspects
• Material is unforgiving if tooth is under prepared
• Can fracture due to brittleness or sharp internal line angles
• Colour may be incorrect if underlying tooth structure
shines through
• If ceramic is adjusted and not polished properly, can cause
wear of opposing teeth over time
 All Ceramic Crowns

• Modern Methods of Fabrication:

1. Heat Pressing

2. Slip Casting

3. Milling
 All Ceramic Crowns

• Modern Methods of Fabrication:

1. Heat Pressing

2. Slip Casting

3. Milling
Method of Fabrication
e.max press

https://www.youtube.com/watch?
v=ooRPBw4Zj60
Preparation of All Ceramic Crown
ALL CERAMIC CROWNS - E.MAX

Indications Contraindications Advantages Disadvantages

When superior strength is

Reduced strength compared
High aesthetic requirement warranted and metal ceramic Best aesthetics
to metal ceramic crowns*
crown is more appropriate

Heavily restored teeth,

Thin teeth bucco-lingually or Good tissue response, even Proper preparation extremely
preferably with remaining
very short teeth with sub gingival margins crucial
enamel

Slightly more conservative of

RCT’d teeth with post/cores Insufficient coronal tooth
buccal wall than metal Brittle nature of material
but not severely discoloured structure for support
ceramic crowns

Can only be used for single

Favourable distribution of Unfavourable distribution of
crowns or anterior 3-unit
occlusal load occlusal load / bruxism
bridges
 All-Ceramic Crowns -
Monolithic Zirconia
• Very high flexural strength, fracture toughness, and
modulus of elasticity compared to other ceramics
• Very opaque material
• Core material and cement colour have no effect on
final appearance
• Can mask discoloured underlying tooth structure

• Monolithic = one solid piece of material

• No veneering material therefore no problems with
fracture of the veneering ceramic
 All-Ceramic Crowns -
Monolithic Zirconia
• Advantages:
• Can have very good aesthetics
• Extremely high strength and fracture toughness
• No veneering ceramic over the top therefore no
problems with chipping
• Can be a very conservative preparation
 All-Ceramic Crowns -
Monolithic Zirconia
• Disadvantages:
• Very opaque (limited translucency)
• If you need to do chair side adjustments, MUST
polish it properly otherwise can be very abrasive to
opposing tooth
• Can’t be bonded to tooth structure as reliably as
glass ceramics
• Still awaiting long term studies on performance
 All Ceramic Crowns

• Modern Methods of Fabrication:

1. Heat Pressing

2. Slip Casting

3. Milling
 All Ceramic Crowns

• Modern Methods of Fabrication:

1. Heat Pressing

2. Slip Casting

3. Milling
Method of Fabrication
Monolithic Zirconia
 Preparation of Monolithic Zirconia Crown

• Margins:
0.3mm -
• 0.3-0.5mm shoulder or
heavy chamfer

Minimum • Occlusal:
0.5mm
• 1mm non-functional cusps

• 1.5mm functional cusps

• Absolute minimum 0.5mm

https://www.southerncrossdental.com.au/useful-information/tooth-preparation
ALL CERAMIC CROWNS - ZIRCONIA

Indications Contraindications Advantages Disadvantages

Posterior crowns with aesthetic Insufficient coronal tooth Good aesthetics with Very opaque and
requirement structure for support experienced technician monochromatic

When superior strength is

Good tissue response (very
warranted but not enough space Need superior aesthetics? Proper polishing crucial
biocompatible)
for metal ceramic (short teeth)

RCT’d teeth that are moderately More conservative preparation

discoloured than metal ceramic crowns

Single crowns or bridgework Superior strength

Unfavourable distribution of
Very cheap / low lab cost
occlusal load / bruxism
 Shade Taking for Glass Ceramics

Must take a natural die / stump shade for

any e.max restorations.
 Shade Taking for Glass Ceramics

Different shades of resin cement are available to make minor changes to the final - Transparent
colour of all ceramic (e.max) restorations. There are equivalent shades of try in - Yellow
pastes to test first before final bonding. - Opaque
- White
 Endo Crowns
• Alternative option for restoring very broken down root canal
treated molars using the pulp chamber for extra macro-
mechanical retention
• Fabricated from a single block of ceramic material (usually
e.max) that is bonded with resin cement (micro-mechanical
retention)
• Useful in very short, broken down molars where there is
limited interocclusal space
• Not suitable for anterior teeth or premolars
• Easier clinical procedures (preparation / impression) than
normal crowns but can be more difficult to temporise
Sedrez-Porto et al. 2016;
Biacchi et al. 2013
 Preparation of Endo Crown

Occlusal reduction
at least 2-3mm 90° butt
joint margin

Supragingival enamel Smooth internal line angles

margins wherever possible (can block out undercuts
with composite)

Flat pulpal floor with 6° internal taper

sealed radicular spaces of pulp chamber
(not mandatory to extend
into root canals)

Einhorn et al. 2019

Vertical Crown Preparations

• Also known as “vertipreps”

• Crown preparation without a defined margin or
finish line
• Finished to a knife edge or feather edge,
also called ‘shoulderless’
• Lab technician chooses where to put the
margin in close consultation with the dentist
Prepare supra- 15° angulation to Creation of vertical
gingival finish line eliminate first 1mm of plane between crown
crown emergence and root
Vertical
Preparation

Agustin-Panadero et al. 2016

Vertical Crown Preparations
• Advantages:
• Preservation of more tooth structure in cervical area
• Therefore often used for periodontally compromised
teeth
• Seemingly more simple, faster preparation and impression
procedure
• Final margin can be finished at various different levels
without compromising fit of margins
• Often guided by level of gingival tissues
• Less prone to have a micro gap at margin
Vertical Crown Preparations
• Disadvantages:
• No long term evidence to support supposed benefits
• Small number of lab studies and case reports only
• Extremely technique sensitive
• Need excellent laboratory support and communication
between dentist and technician
• Technician cannot differentiate between tooth structure
and core material on model
• Often end up with crown margin finishing on filling
material
 Surveyed Crowns
• Teeth that are planned to serve as abutments for a new partial CrCo dentures are sometimes
prepared for crowns before the commencement of denture fabrication
• Indications:
• Necessary to restore a broken down tooth to serve as partial denture abutment OR
• Natural tooth that is to be a partial denture abutment cannot be altered to provide:
• Suitable path of insertion

• Adequate retentive area

• Favourable contour (reciprocal area or guide plane)

• Rests in desired areas

• Favourable occlusal relationship

• Final crown incorporates a guide plane, rest seat and undercut based on partial denture
design
• Need to dictate the location of each of these features on lab form

• Usually metal ceramic crowns with partial denture features in metal

Chandler, Brudvik & Fisher 1973

Questions?