Dr Anthony Mobasser is a porcelain crowns expert in Los Angeles CA, since he has completed over 8000 crowns successfully, which are functioning, looking incredibly beautiful, and most importantly lasting over 30 years in his patients mouths and still functioning beautifully. His Los Angeles private dental practice, which caters to Hollywood stars and Beverly Hills celebrities is known for his artistry in designing knock out smiles with the use of porcelain crowns if need be. He has earned reputation of dentist to the stars when it comes to full mouth reconstruction with crowns and veneers to transform a mediocre smile to a red carpet ready smile. For many years, patients’ demands have been increasing for improved aesthetics in dental ceramic restorations, particularly in the area of front teeth that require Porcelain crowns or caps. The idea of “All Natural Crowns” has seen growing demand. Ceramic crowns do not show metal substructures under them as opposed to PFM (porcelain fused to metal) crowns, and they can be stronger than PFM crowns, if using Emax or Zerconia type porcelain.
Per Dr Mobasser it is important for patients to know that some ceramic crowns such as lava or zerconia, are metals, but they are ceramic metals. Because they are ceramic metals, they are white opaque in color, and it is not always the best solution to use for front teeth, unless the dentist is working also with a skilled ceramist. Zerconia porcelain, however can mask discolored metal posts, or other dark areas of the tooth, in most occasions, but not 100% due to previous root canal procedure. As of 2017 Zerconia can be milled, and can not be pressed, also the zerconia crowns are usually cemented and can not be bonded, if the retention of the prepared tooth is compromised, the dentist can not bond, and only cement, meaning the crown can come off. This is one negative feature in regards to zerconia for either partial coverage restorations or full coverage restorations such as zerconia or lava crowns, on the plus side, they are extremely strong and fracture resistant if they are made monolithic.
Another type of porcelain crown is Emax (lithium disilicate) crown, in which they are also a ceramic metal and extremely durable, however they are not as opaque as zirconia but translucent, so if the underlying color of the prepared tooth is dark, they will show the color through, however they are still amazingly strong and nice if the color of underlying prepared tooth is natural dentin. Emax crowns can be cemented or bonded which is an advantage over lava (zerconia) crowns, and they tend to be more natural looking as opposed to the bright white look of lava or zerconia crowns.
Types of Porcelain Crowns:
PFM or porcelain fused to metal crowns do contain metal substructures such as gold, precious, or non-precious metals for strength, and still to this date there is place for them in cosmetic dentistry if done properly. They are best to mask the dark color of the metal posts, or dark color of tooth structures. PFM crowns will block out 100% the underlying color of the tooth, as compared to the ceramic crowns.
The use of what type of porcelain crown, is of utmost importance. With the advent of lithium Disilicate, Zerconia, and leucite porcelain crowns, Empress or Authentic crowns each are indicated for a specific reason. Per Dr Mobasser each have their own indication, depending on numerous factors which relates to cosmetic and function..
Make sure to ask Dr Mobasser which type of crown best fits your needs, after a complete evaluation?
Dr. Anthony Mobasser has incorporated dental crowns including LAVA, EMAX , BRUX ZIR where no metal substructure is required, and the strength is not compromised; however EMAX, Lava, or bruxzir must be used judiciously, as the individual’s bite, compatibility and the cosmetic needs and the occlusion play major factor for choosing the correct crown to last a long time.
Generally speaking, zirconia crowns are stronger than E-max crowns, however Emax crowns are prettier and more translucent than zerconia, to top it off, the most aesthetic porcelain is leucite reinforced, or feldspathic porcelain, but they are the weakest in strength! That is why an expert dentist must evaluate your bite (occlusion) AND your cosmetic needs, prior to deciding which type of crown is best for you!
Zerconia Crowns such as lava are also used on dental implant abutments for strength mostly, and the biggest benefit is preservation of tooth structure, and require less preparation of the tooth structure, which is the biggest plus, however they DO NOT LOOK VERY AESTHETIC, since they are more opaque material and reflect the light. The patient’s bite, opposing teeth, and the grinding and bruxing habits of the individual must be considered before choosing a Zerconia crown, which can damage and wear down the opposing tooth consequently a night guard or a splint becomes a must.
What about the gums symmetry prior to having Crown Procedure?
If the gums of your front teeth are asymmetrical, It is vital and highly advisable to have gum recontouring surgery or gum sculpting prior to having your front crowns done! specially if you have a high lip line , in which your gums partially shows.
If you elect not to have gum contouring done with the surgeon, even the most beautiful crowns, will not look good and will show different lengths, although the edge of crowns are even! Ask Dr Mobasser if you are a candidate for gum contouring prior to having your crowns done?
Types of dental porcelain crowns:
1- Feldspathic porcelain crown, which is salt and liquid technique, that goes in the oven to fabricate the porcelain layer. Great skill is required by the ceramist, they look great, and it takes much more man hour by the ceramist to produce that crown.
2- Pressed porcelain crowns (meaning waxed by dental ceramist), which can be done with lithium disilicate(Emax porcelain), or leucite reinforced porcelain (looks great, not as strong compared to monolithic zerconia). Usually zerconia is not pressed but milled in cad cam machines digitally.
3- Milled Cerec crowns, such as cad-cam technology which can still be done with Emax, Zerconia, or leucite reinforced porcelain.
Patients must understand, that Emax crowns are more translucent in nature, and does not reflect light, as much as Zerconia or Lava, so Emax tend to be more on the gray side vs the Lava or Zerconia crowns which are bright. Zerconia or Emax crowns are so strong that if the bite on them is slightly off, it can cause discomfort to the nerve of the teeth. They are extremely hard to remove or redo after they are inserted on the tooth.
As far as color matching to your existing dentition: Emax also does not hide the underlying color of your existing tooth, that is why they do not block out cast post metal restorations well, and the metal can show thru. The great benefit of Emax and Zerconia is their strength which is 5 times stronger than regular porcelain, at the same time they can wear the opposing natural teeth! and if they are bonded to your tooth it is not easy for any dentist to remove these crowns, to repair for recurrent decay or for any reason to redo them. If the lava or Zerconia crowns are not adjusted to the patients bite, that can cause pain to the tooth or possibly cause a root canal problem. These materials do not wear down like your natural teeth, and can cause the force of your bite to cause damage to the nerve of your teeth.
Leucite reinforced porcelain crowns such as Empress crown, or Authentic crown, are great to color match, to the adjacent teeth, and work very well, but they are definitely not as strong as Emax or lava Zerconia crowns. It is beauty vs strength.
It is best to consult with Dr Mobasser to see which type of crown best fits your needs and wants. The bite of individual patient, whether he or she is a grinder, the alignment of existing teeth, the color of adjacent teeth, your oral hygiene habits, and the cosmetic dentistry needs of the individual will determine which type of crown best fits their needs.
Indications for porcelain crown:
A dental crown or ceramic cap is usually indicated due to cracked or fractured tooth, and when there is not enough tooth structure to hold a large filling or a ceramic inlay or onlay. Usually on the large mercury fillings or even in large composite tooth colored fillings, micro leakage causes recurrent decays under the fillings which is not evident even in the xrays, if the support of the tooth is compromised due to remaining tooth structure,or weaker walls of your tooth, it is at that point that dentist may suggest a dental crown. Dr Mobasser recommends highly that all the existing fillings to be removed and a new build up placed if you happened to need a dental crown to restore your tooth.
Dental crowns are usually recommended after the tooth had undergone root canal therapy, since there is no more blood supply to the tooth and the tooth is brittle and dry in which can crack if not protected with a dental crown or ceramic crown.
How much is the cost of dental crown or porcelain crown?
The average cost of crowns in Los Angeles, Beverly hills CA, ranges from $1750 up to $4500 or higher. Each cosmetic dentist have a different skill set and knowledge when it comes to porcelain crown or any dental crown, consequently the cost of each ceramic crown differs from one dentist to another dentist. Not all crowns are equal from one dentist to another , as mentioned the experience of the dentist, and the knowledge to use what type of crown, and his dexterity is very crucial to the success , beauty and longevity of the crown. The second factor is the laboratory he uses, and specifically the master ceramist he uses contribute to the cost factor. Just like the dentist, the skill set of the master ceramist and his experience is vital. the third factor depends on the material he uses to have your crown bonded or cemented to your tooth, for long lasting results. The low cost can start anywhere from $500 to north of $4500, depending on above. the preparation of the crown requires special skill set for the crown not to come out of his patients mouth and at the same time look amazing and function right for many years to come. It is very important for each patient to visit the dentist and have proper consult and records taken prior to just asking for a price. A bad crown can cost you much more on the long run after multiple redo, or possibly not much can be done for it if there is over preparation of teeth.
Porcelain Crown vs Porcelain Veneers
Conservation of your tooth structure is directly related to how long the restoration will last. Typically crowns require 360 degree shaping (removal of tooth structure) and preparation of the tooth. However porcelain veneers (in the hands of a top expert cosmetic dentist) require much less surface shaping by the dentist; hence anytime the tooth can be restored via porcelain dental veneer vs porcelain dental crown, this method is preferred. The more tooth structure is removed, the more flexible the tooth can become and cause fracture of the stiff material such as porcelain. Also keep in mind that if for some reason the porcelain veneer failed, the individual still can have the tooth turned to a crown. However, if the tooth is prepared for any type of crown, there is no way to revert to a porcelain veneer.
Crowns are generally made of porcelain or have a veneer of porcelain on their surface (porcelain Veneer crowns), so that the crown’s color can be matched with the rest of your teeth. Some dental crowns or caps are constructed in a manner where their full thickness is porcelain. These crowns can possess a translucency which makes them the most cosmetically pleasing of all of the different types of dental crowns. They can be a good choice for front teeth due to their natural appearance.
The benefit of dental Crowns are that they can be cemented or bonded to natural tooth to enhance the shape, color or length of the tooth. Crowns are an aesthetic and durable alternative for the treatment of cracked teeth, space issues or tooth size discrepancies. What’s more, they can correct minor problems of alignment,as well as tooth shape or color.
Bond the crown or cement the crown?
That depends on how much tooth structure is left? If porcelain is bonded to the tooth structure, it will become one with the tooth structure. the technique to bond the crown to the tooth structure requires more time and it is more technique sensitive, depending on the preparation of the tooth structure if it is below the gum line, or above the gum line. Cementing crowns are much easier, however the dentist must make sure that there is enough retention of the prepared tooth structure for the crown to last a long time!
As of to-date, Zerconia crowns can only be cemented vs Emax crowns which can be both cemented and bonded.
If a front crown, needs to be redone, what is the best porcelain option?
To replace one front crown is one of the most challenging treatment for any cosmetic dentist.
If your tooth has been root canal before, and does have a post, that even makes it harder for the cosmetic dentist. The only way to block the color underneath 100% is to use a porcelain fused to metal crown, and modify that with all porcelain margin not to show any discoloration.
If your tooth is not dark underneath, no root canal, then possibly Emax crown (lithium disilicate) is a good fit. The Emax crowns are more translucent and more natural looking, they are not bright and opaque, as opposed to Zerconia crown or lava crowns. Zerconia is a white extremely hard metal! Lava or Zerconia crown is a white metal extremely strong, however they will not match your teeth if you do have translucency on your adjacent teeth.
Lava or Zerconia will be a restoration of choice for an implant supported porcelain crown, due to the strength, but they are so bright and white in which it is not recommended for natural looking smiles. Make a consultation appointment, at that appointment your bite and occlusion will also need to be analyzed to see which type of crown will benefit you the best.
All crowns is done with unparalleled perfection at Dr. Mobasser’s dental practice in Los Angeles. The custom crown, depends on both aesthetics and function of each individual patient, he loves to provide the best crown for your needs, so they look natural white and feels so good that you may forget you ever had a bad tooth. Modern, innovative technology, and finding the root cause of your problem is an integral part of Dr. Mobasser’s dental practice.
How much does a dental crown cost?
Dental crown cost depends on the knowledge and the expertise of the treating dentist and the complexity of the case. The price usually varies depending if the crown is in front of the mouth or the back teeth, and do you show gums upon smiling? What is the track record of the dentist? How many ceramic crowns has he done? and how long on average his crowns last?
The expert dental Laboratory, and the master ceramist working with the dentist can significantly increase the price, since custom work such as shaping and exact matching of the color to the adjacent teeth, can vary the cost of your porcelain crowns. The cost of crowns can also vary on the number of crowns needed, the complexity of the case, the material cost, cosmetic needs, your bite ( occlusion ) and the original health of the tooth needing crown.
Also depending on your location, the cost of porcelain crowns varies. For instance the cost of average dental crown, by an average dentist in Los Angeles is about $2000. Your best option is to see an expert dentist to get it done right the first time so you do not loose time, headache and more costs to redo your crown.
The cost of crowns is also dependent on the amount custom work required by Dr. Mobasser and his Master ceramist, to match colors, give you natural proportional shape to match your face, lips to provide you your dream smile. The cost can also depend on the complexity of each crown, depending on the color, shape, the bite, the color of original tooth prior to starting, the bite and occlusion, and how fast you need to get your new crown is vital, some want their crown in few days some do not mind waiting a month.
If the crown needs to be redone, the cost varies depending on what type of porcelain was used. Generally to redo a zerconia or an E max crown costs more than to redo a regular crown, due to the amount of time required to cut off these stronger crowns. If you had a post and root canal, in front tooth and you are not happy with the dark color showing through, the cost to redo that crown is more. If you do require a crown a comprehensive evaluation is needed prior to determining what type of crown best fits your needs.
The huge array of new materials and innovative techniques has eliminated the pain and discomfort of dentistry of the past. The ability to turn a badly broken down mouth, or worn out dentistry into a healthy mouth is one of the most gratifying services for Dr Mobasser. Through exceptional, keen eyes, vision, and his knowledge of over 30 years in dentistry, Dr. Mobasser is able to give patients another chance to enjoy their teeth for many more years, and to provide that celebrity smile you always dreamed of to last a long time.
How to choose the best Color for my Crowns?
You must be happy with the color of crowns you are getting. That is why the cosmetic dentist will have a consult with you regarding the final color you desire. Once the color is selected you get exactly that color YOU selected. Now if for any reason you do not feel comfortable with final color you selected, ask your dentist if they can be altered, which may be additional cost.
In general,the final color depends on 3 main factors:
1-The preparation of the teeth by your dentist
2-The porcelain material selected, and
3-The artistic ability of the master ceramist!
Some crowns such as Empress, or Emax may show a lot more translucency, compared to Zerconia crowns or Lava crowns, which they reflect light, and they look whiter and more opaque. Having said that the shaping of your teeth by your cosmetic dentist is vital, for the ceramist to block out enough room for the final color of porcelain. In some cases the cosmetic dentist might not sacrifice your tooth structure, not to damage the nerve of your tooth, in those cases the cosmetic dentist might be sacrificing the cosmetic, but caring more about the health of the tooth, to avoid Endodontic treatment.
What to do if I need a crown and possible root canal?
No worries, crowns can be repaired if root canal access is needed. Having said that, it depends on how picky you are as far as repair to your crown (after root canal was done), with dental bond, in which can discolor vs you want to have an untouched porcelain surface. However, if the dentist or cosmetic dentist is predicting a possible root canal and you do not have pain or discomfort, usually the patient does not want to do root canal first UNTIL a discomfort arises, and you have been informed.
If Endodontic treatment is needed, going through the crown to have an access opening for a root canal is simple for an experienced dentist or Endodontist, there should be no shattering of the crown, and it can be REPAIRED only. If you are ok with that and it is not visible, the majority of patients accept that and usually do the root canal when symptoms arise. If however, you want your new crown not to be repaired then do root canal first.
One other note, your dentist will definitely inform you if you must do root canal due to an infection, those cases it is a must to do root canal prior to placing your crown, since the health of your tooth is involved, and there is clear cut infected nerve, vs border line root canal therapy.
Porcelain Crowns Before & After pictures:
Above pictures, shows before and pictures of ceramic crowns. The teeth were short, but lengthened with dental crown, also the internal staining of teeth were corrected using hand stacked porcelain. Crowns was used due to decay and tetracycline teeth staining in conjunction with short Front teeth, and worn out teeth due to bite, Patient was a grinder and had clenching habit and a strong ceramic crown restoration was necessary, to make the front teeth younger looking.
Why My Crown Keeps Coming Out? What Can Be Done?
These are the 6 major reasons why your crown keeps coming off:
1-The number one reason for dental crown keep coming off is lack of retention, and tooth structure to hold the crown without the cement.
your tooth might have been over prepared period, and if there is not much tooth structure left the crown keeps popping off, there are possible ways to correct the underlying tooth structure.
2- There could be decay, eating away the tooth structure, and yes a tooth that has been crowned can get cavity, coming from the root, or possibly all the decays have not been cleaned up.
3-Your crown fit is not perfect and it is not fitting your tooth properly.
4-Your bite on the crown is not adjusted, you are putting extra excessive forces on the crown while chewing, and the occlusion on the crown is wrong.
5-your crown has been cemented vs bonded to the tooth structure, or possibly you have a post and root canal which was not fabricated properly. Note that Feldspathic porcelain needs to be Bonded, Emax crown can be both cemented and bonded, and cerec zerconia crowns are safer to be cemented.
6- Your crown length and width can not be supported by the root and prepared tooth! meaning it is bulkier than your original tooth, if your crown is bulky and the tooth is not prepared properly by the dentist the crown will exert unnecessary pressure on the tooth causing it either to come off, get loose or possibly damage the nerve.
Note: If you have a temporary crown, and it came off and you can not reach the dentist, it is best to put the crown back in, or get temporary cement from pharmacy to cement in, till you see your dentist! If you do not, the tooth can shift and compromise the final crown cementation.
Pain under new crown with root canal tooth?
If you have pain after placing a new crown on a root canal tooth upon chewing, the best dental treatment is to see your dentist for possible bite (occlusal) adjustment, and an xray. Usually after bite adjustment the pain subsides, however if the root canal was not properly done, usually after placing a new crown, especially with the more stronger crowns, such as E max, or Zeronia crown, the tooth can flare up, and even cause infection, and make a chronic infection with no pain turn to an acute painful infection. Meaning a tooth that had no pain or discomfort, got agitated due to new biting forces. An expert dentist must always anticipate this problem when crowning a tooth with unsatisfactory root canal, so that is why he will usually refer you to an Endodontist to redo an unsatisfactory root canal prior to placing a new crown.
If You do have sensitivity to hot and cold, it is very possible that an adjacent tooth or an opposing tooth may need dental treatment, in which this can be verified by xray, and clinical examination.
Porcelain crown for tooth implant Beverly Hills: