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.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.
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.
High noble metal - much higher than 50% noble metal content by weight. At our office, we do not use anything less than 70% noble metal content, unless it's metal free crown. Some alloys use a lot of gold, imparting a yellow color to the metal. "Yellow gold" type porcelain crowns give a nice warming affect to the gums. They are sometimes marketed under the brands Captek or Bio2000. At higher concentratons of gold, the yellow from the gold can yellow the porcelain--a problem for people who aren't Vita A1, A2 or A3. (tooth shades are a whole other article)
No metal at all - in some cases, you can fabricate a crown with no metal at all. This is done by using zirconia in place of the metal (marketed by 3m as Lava), or using stronger porcelain materials (marketed as Empress or Procera. Metal free crowns (aka all-ceramic crowns) tend to cost $100 to $200 more than metal reinforced porcelain crowns (aka porcelain fused to metal crowns, PFMs).
More shades of porcelain - A well made porcelain crown is a continuous blend of several colors and translucencies. It should look like a tooth, not like a white chiclet.
More translucency - adding a fine translucent blend is not more expensive in materials, but it takes more time and a more seasoned lab technician. That's why discerning dentists pay more for their lab fees.
Porcelain front margins - Lab technicians can make the front edge (margin) of the crown in porcelain instead of metal. That eliminates the gray line in front of the tooth, and the grey darking of the gums over time. The trade-off is more time, more expense, and relatively poor seal compared to a metal margin. Usually porcelain margins are placed in the front, so the poorer fit is compensated for by the better hygiene. (People brush better in the front than the back) I have not observed a higher rate of failure for porcelain margin crowns.
Ceramic crowns do not have a gray line problem because they contain no metal.
More doctor time - If there is more revenue per crown, then the doctor does not have to see as many patients, and can afford you more attention.
If you are on an HMO and need a crown, one of two things will be proposed:
I certainly don't recommend skimping on dental care, but I truly hate the bate-and-switch games of the HMO clinics. That's why I turned down $50,000 a year for two days a week to work for one of them. After two days of working for one, I would rather give up dentistry than to sell my soul for a few dollars.
Slightly. The average porcelain fused to metal crown fee in this area is around $900-$1000, and PPO fees for crowns (in the plans that we participate in) vary from $500 to $800. Some doctors always use cheapest lab possible, profiting more when the crown fees are higher.
As far as our office is concerned, we budget the best crown that the crown fee allows--15% is budgeted towards crown fabrication. If we have a coupon for $50 off a crown, we don't pocket the difference; we use it to upgrade the patient's crown to a higher quality one at no additional cost to them.
Listen to what the doctor has to say, and how he or she says it. If it sounds defensive, think twice. If the answer sounds too slick, like a car salesman, also be cautious. It's your mouth, so make sure you always get honest and trustworthy answers from honest and trustworthy people.
For additional information, please also read What's Your Crown Fee?