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Milled vs. Handcrafted All-Ceramic Crowns

Milled Crowns vs. Milled plus Handcrafted All-Ceramic Crowns

Top-Rated Surgical Prosthodontist Serving Chevy Chase, Bethesda, Arlington, & the greater Washington DC explains the difference between milled crowns and milled plus handcrafted all-ceramic crowns

All-ceramic crowns and bridges provide the potential for enhanced aesthetics, depending upon how they are fabricated and by whom. What are the primary types of all-ceramic crowns, what are the limitations restricting their use, and what is the preferred alternative crown type? Overall, the types of restorations provided by the prosthodontist or general dentist and why they do so are things you should consider before choosing a provider. In the following discussion, all-ceramic porcelain is understood to be either zirconia or disilicate.

At Elite Prosthetic Dentistry, we have a strict protocol as to which types of crowns you receive for your particular condition:

  1. Milled plus handcrafted all-ceramic crowns and bridges and teeth that need splinting (as long as they are three to four teeth or less) (Fig. 1)
  2. Porcelain fused to high noble metal crowns for any major reconstruction requiring the most accurate fit and splinting of multiple teeth together (Fig. 2)
  3. Fully milled anatomic crowns in the non-aesthetic zone where we require greater strength for our patient who is a severe grinder or where we require resistance to wearing down the dentition with a resulting loss of vertical dimension (which can make you appear older)
  4. Milled anatomic crowns with custom porcelain added to the outside surface for a natural appearance

At Elite Prosthetic Dentistry, the difference between the appearance of porcelain fused to metal vs all-ceramic crowns is not a major issue, since our in-house technician is able to compensate with the proper look or appearance (see Fig.1 and Fig. 2). In short, we have complete control over the process to consistently create “simply natural, simply radiant” crowns under all circumstances.

In this summary, our experts at Elite Prosthetic Dentistry will elaborate on some of the differences between milled and milled plus handcrafted ceramic crowns, alternate approaches, and how you can discover which approach is best for you.

What are All-Ceramic Crowns and Bridges, and What are their Limitations?

Every all-ceramic crown and bridge has a zirconia or disilicate (ceramic) base milled by a CAD/CAM machine. As such, they:

  • Must have stringent controls on the milling “tolerances” to create the most accurate fit
  • Should not be used as a bridge or splint having more than three teeth together, or the appliance will not fit
    • For larger bridges or splints, porcelain fused to a precious metal must be used
    • The technology for effectively using all-ceramic bridges/splints covering with more than three or four teeth in a row has not been developed at this time
  • Should not be used on severely broken-down teeth, unless the crown margin is on sound tooth structure rather than the build-up material and can be accurately impressed or scanned

Milled Crown

One popular method of fabricating a crown involves a computerized milling (CAD/CAM) machine, a device that cuts the restoration out of a solid block of material. This produces what is known as a milled crown.

Milled crowns also present unique advantages, some of which include:

  • Faster and easier to fabricate in the lab
  • Less expensive to fabricate

However, there are several limitations to understand when considering choosing a provider who makes milled crowns:

  • They can be harder to customize to make them biocompatible with the surrounding soft tissue.
  • If the crowns have been milled too loose, refining the bite before cementation is difficult.
  • The color can only be altered using surface stains.
  • The translucency cannot be altered to match the adjacent teeth

Types of Milled Crowns and Their Indications

  • Complete crown CAD/CAM milled out of a single homogeneous block of ceramic material
    • The completely milled crown is very strong and is very effective with maintaining jaw arch integrity when crowning molars and some premolars
      • However, the crown has a uniform shade and translucency, unlike natural teeth, and can make front teeth appear artificial
    • Difficult to match to the coloration and translucency of adjacent teeth
  • CAD/CAM milled crown with hand-crafted buccal (outside facing) porcelain for custom aesthetics
    • Provides significantly more natural appearance with additional strength of the completely milled crown on the biting surface
  • Milled coping plus hand-crafted crown upon which the technician hand-crafts the porcelain
    • With this method, the “ceramist” applies different types of porcelain that have slightly different shades or translucency, which mimics the natural teeth

Milled Plus Hand-Crafted

Making “hand-crafted” crowns means masterfully crafting crowns by hand using different porcelains on an all-ceramic base (coping). Our highly skilled in-house technician fabricates these crowns with the utmost precision and attention to detail.                        

Before
After

Hand-crafted all-ceramic crowns offer numerous benefits, including:

  • Superior aesthetics: more life-like
  • Color is internal for a 3D effect
  • Precise control of translucency to the individual’s coloration and translucency requirements

Despite the many benefits that hand-crafted crowns offer, they can:

  • Cost more than milled crowns
  • Often take longer to produce

However, having an in-house laboratory makes the process in our office efficient as well as top-quality, making this option ideal for the patient. Our in-house laboratory grants total control of the crowns’ aesthetics and quality, allowing us to increase efficiency and reduce your number of office visits.

Dr. Gerald Marlin

Simply Radiant, Simply Natural

Dr. Gerald Marlin is a leading specialist in implant, cosmetic, and restorative dentistry. One of the only prosthodontists with an on-site lab, Dr. Marlin has been voted “Top Dentist” by his peers for more than 20 years in a row in Washingtonian Magazine’s annual “Best Dentist” survey, and is considered the most experienced prosthodontist in the D.C. area.

Porcelain Fused to High Noble Metal Can Last Longer

In addition to all-ceramic crowns, porcelain crowns fabricated on noble metal copings offer a great option. Crowns that include high noble metals are at least 50% composed of noble metals, which include gold, platinum, palladium, and silver. Noble metals interact well with human tissue and hold up to oxidation and corrosion better than other metals. The higher the percentage of noble metals, the less likely it is to corrode or oxidize. This is the “tried and proven” type of crown and bridge restoration and is a must restoration for any bridges and splints greater than three-four units that are splinted together.

Before
After

What Approach is Right for You?

Award-winning prosthodontist Dr. Gerald Marlin is widely regarded as one of the top prosthodontists in the Washington DC metro area due to his consistently outstanding dental work, including countless beautiful results with crowns and bridges. Dr. Marlin’s clinical and laboratory expertise directly translates to more durable and longer-lasting restorations, something our many satisfied patients can attest to.

By working closely with our in-house technician, Dr. Marlin maintains total control of the aesthetics, along with a precise fit. This approach allows our team to achieve superior aesthetics with unmatched longevity, regardless of the type of material, whether porcelain fused to high noble metal or all-ceramic.

If you are interested in learning which type of crown is best for you, we invite you to meet with Dr. Marlin for an in-depth consultation to see how you can achieve a “simply radiant, simply natural” smile. Contact us today to schedule an appointment. Our team of experts looks forward to meeting you soon.

Problem-Solving Prosthodontics

Meet Dr. Gerald Marlin

Award-winning prosthodontist Dr. Gerald Marlin delivers advanced dental care and world-class treatments to everyone who enters our comfortable and welcoming office.