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A lot of people think that a crown is a crown, and a cleaning is a
cleaning. If all crowns are equal, why not go to Mexico or Eastern
Europe for your dentistry? You wouldn't, because there is a vast difference in the finish of the dental work, and quality of the materials used, and the time and
care that is put into the experience
This is why some dentists charge
$250 and some charge $2500 for a crown. People know why a car can cost
$10,000 and a car can cost $60,000 or more--you are getting a better
product when you pay more. After reading this, you will hopefully
understand why not all crowns are created equal.
The economics of dental crowns
When you pay a dentist for a crown, the dentist prepares the tooth by reducing it to fit a crown, and takes an impression. The impression usually goes to a dental lab, and a temporary usually goes on your reduced tooth. The lab makes a crown for the dentist to seat on your tooth, and charges the dentist a lab fee of between $40 and $240 dollars. Your crown fee includes overhead, the dental lab fee for making the crown, and some profit for the doctor. Most doctors (including myself) try to limit their lab fees to 15% of the crown fee. So if a crown fee is $500, then we try to limit the lab fee to $75. If a crown is $1000, then we try to limit the lab fee to $150.
Most crowns are PFMs, or Porcelain Fused to Metal. A cast metal coping, or understructure, gives strength, retention and stability to the crown. Porcelain is added to the crown to provide shape, appearance and function. A dentist can control the cost of crown fabrication by selecting different metals and porcelain types.
This is what you are usually getting with a sub $500 crown:
Predominantly base metal - Mostly non-noble, inexpensive metal is used for the coping (understructure) of the crown. Cheaper alloys may contain nickel, a metal which can cause allergic reactions in some people. More expensive noble metals do not oxidize, corrode or rust easily.
One shade of porcelain - cheaper dental labs cut corners by making the whole tooth one color. Look closely at natural teeth--the untrained eye can see at least two if not three colors in a front tooth. The trained eye can see many more.
Little or no translucency - cheaper dental crowns look like chiclets because unlike natural teeth, they have no translucency at the edges.
Metal front margins - the infamous gray line at the gum line which appears a year or so after the crown is seated. That is because gums can and often do recede, revealing the gray metal line. This isn't a problem with back teeth, but it's devastating on front teeth.
Less than forty five minutes of doctor time; likely less than 30. This is based on the going salary rate for a dental associate of 1 year's experience. In order for an office to do sub $500 crowns profitably, there should be at least three patients in chairs at any one time.
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