Gold or full zirconia better choice?

[StayPuft]

Hi!

I need to have my crown replaced soon and would like some advice. It's a porcelain over zirconia crown on #18, L bottom rear molar. Prior to this one, I had a full zirconia crown there, but the dentist shaved it too thin and I ended up with a perforation on the surface...so had to have it done over by a new dentist, who recommended the porcelain over zirconia because she feels full zirconia is too hard and abrasive on opposing teeth. Fast forward about 5 years and the porcelain portion has now chipped away on it.

My current dentist is recommending I now go with gold since it's a rear molar and gold has the best track record. I'm not too keen on having a gold crown, even if it's in the back of my mouth. What do you think about doing full zirconia again instead of gold and just asking her to make sure it's not shaved too thin? Would like some honest advice from dentists, please. What would you do if it was your mouth?

 

[Kennethk]

Go with gold if they keep adding the same they keep having to reduce more of the natural tooth if it snaps again.

 

[StayPuft]

Go with gold if they keep adding the same they keep having to reduce more of the natural tooth if it snaps again.

So, if I choose full zirconia, they'd have to trim my natural tooth down more? But, if choose gold, they won't?

 

[MattKW]

1. Gold alloy is the best; I had my lower 1st molar crowned with gold alloy 3 ya. Gold alloy can be very thin and will not fracture, unlike ceramics. The downside is that the price of gold is very high if you go for a high noble (gold) alloy; I had PontoLloyd G with 84% gold ( 20 carat).
2. High Noble (≥ 60% noble metal, ≥ 40% gold), Noble (≥ 25% noble metal), and Base Metal (< 25% noble metal).
3. I used to only offer high noble gold alloy crowns for my private patients when crowning 2nd molars because the teeth can be quite short and I want to keep as much natural tooth as possible.
4. I now supervise dental students in a teaching hospital for public patients (free treatment), and they have changed to a 2% gold alloy, ArgenMill Au2. Not as dark a yellow as a high noble alloy, but acceptable.
5. Before cementing ANY crown, the bulk of any adjustments should be done in the mouth and checked with calipers. If the crown is getting too thin, then the tooth has been under-prepared and the natural tooth should be adjusted and a NEW crown made.

 

[Kennethk]

So, if I choose full zirconia, they'd have to trim my natural tooth down more? But, if choose gold, they won't?

Not so much the point I was making but I can see the confusion. Gold has a higher risk of not breaking, zirconia can. If the dentist keeps reducing base for a zirconia crown and having to add more fillment you'll eventually be left with no supporting structure leading to a implant. Gold has evident proof of lasting 15+ years. To add I'm not a dentist but have many years experience getting my teeth rehabilitated with crowns. Just recently had a zirconia bridge fail due to poor structure. I've had offices tell me I could be a dentist. The general public actually seems to think gold crowns look cool they'll know it's different obviously but function is important.

 

[MattKW]

Any final chairside adjustments to ceramic crowns before cementing will make them weaker to fracture resistance, no matter how well they're polished after the adjustment. This is more likely with zirconia than other ceramics because zirconia can only be weakly bonded (glued) to the natural tooth.
Gold alloys are much easier to adjust/polish and the fracture resistance is unchanged. I've never seen a gold alloy crown fracture; it simply isn't possible.

 

[Kennethk]

Any final chairside adjustments to ceramic crowns before cementing will make them weaker to fracture resistance, no matter how well they're polished after the adjustment. This is more likely with zirconia than other ceramics because zirconia can only be weakly bonded (glued) to the natural tooth.
Gold alloys are much easier to adjust/polish and the fracture resistance is unchanged. I've never seen a gold alloy crown fracture; it simply isn't possible.

Not to highjack is a gold base over porcelain color possible much like pfm?

 

[MattKW]

The metal alloy used under the PFM can be anything you want, but high noble alloys will be better for biocompatibilty. Usually there is less gold content in a PFM and more platinum and palladium (also noble metals) to help match the thermal expansion of the porcelain. Thus, you will often see that the alloy is a silvery colour.