Dr. Zev Kaufman explains the different dental materials and techniques available to fix teeth with crowns, veneers, and bridges:

Hello, and welcome to a New York Dental Minute. I am Dr. Zev Kaufman
Some questions are quick to ask, but take a long time to answer properly. A great example of this is: what are all the available dental materials to create a veneer, crown or bridge restoration? Brace yourself, to answer properly, this will take a little while!
The most long-term studied restoration method is a Porcelain Fused to Metal crown (PFM). It works great, easy to remove when needed, and when quality work is done, can be very aesthetic. On a compromised tooth, with a root canal and a post and core, the PFM crown is an appropriate restoration. There are techniques of preparation by the dentist and crown fabrication by the technician that allow us to hide the metal underneath.
As technology evolved and aesthetic demands increased, dental materials have greatly improved. In addition, over the years, concerns have been expressed about the bio-compatibility of metals. These concerns, so far, have not been substantiated. However, the compatibility discussion drives the development and research of dental materials.
Dental history is full of very aesthetic materials which did not withstand the test of time, as they frequently cracked and fractured in patients' mouths.
In the past decade, ceramic materials such as Empress 2, e Max, and others, have proven to be, not only highly aesthetic, but also fantastically durable. However, in high stress areas of the mouth, these materials are still not quite as durable as the old, time-tested PFM crowns.
Enter zirconium, (zirconium oxide-zirconia) which is metal that is white and not gun-metal-gray (like PFM alloys). Zirconium is very strong and can be used in titanium alloys for dental implants, as well as a substructure for traditional porcelain veneering as in the old time-tested Porcelain Fused to Metal crowns. Zirconium can opaque any materials used underneath, such as gold or composite post and core, as well as a discolored teeth. In addition, with the advent of Computer Aided Design -- Computer Aided Milling (CAD-CAM), we can mill crowns, in a three dimensional milling machine, out of zirconium blocks, ceramic blocks, and any other needed dental material.
These recent technological developments are creating a buzz in the dental industry, and are definitely the future. However, technology cannot substitute for proper diagnosis and decision making.
I still find that the most versatile restorations in large dental reconstructions, involving multiple teeth and bite changes, to be the Porcelain Fused to Metal crowns. Be it Noble, or High Noble metals (gold/silver alloys) or zirconium. Once the fit of the substructure is confirmed, they can be veneered with traditional (Feldspathic) porcelain to achieve natural looking results. In less load bearing situations, such as front teeth and with patients who do not exhibit a high stress environment or when minor tooth preparation is called upon, e-Max can be used for maximal aesthetic effects. Full zirconia crown are problematic when removal is called upon. The removal of full zirconia crowns by cutting them with regular means (high speed drill) can cause damage and problems, since the metal is so incredibly hard. These crowns also look more opaque and less natural. Best uses for full zirconia crowns are under very specific conditions or in implant retained restorations, which are screwed in into place and can be readily removed without grinding and risk.
Life is full of choices, and ultimately, the choice of materials is left up to your dentist. Your dentist is ultimately responsible for the work, and like you, the patient, is most interested in the longevity, aesthetics and durability for your particular situation.
Turns out that communication is vital dental tool.
So now You know,
From Prosthodontics & Implant Surgery of Manhattan, where people come in with missing teeth and leave with winning smiles, I am Dr. Zev Kaufman

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