Three main materials
When a tooth needs a crown, three main materials are available today: full ceramic made of lithium disilicate, zirconia (zirconium dioxide) and classic metal-ceramic. All three are clinically established, all three have specific advantages and disadvantages.
The times when every crown was fabricated from metal-ceramic are over. Today the material choice is oriented to tooth position, expectable loading and aesthetic requirements. This article explains the three materials and when what makes sense.
Lithium disilicate (full ceramic)
Lithium disilicate is a glass-ceramic high-performance mass that has been used in dentistry since the 2000s. The best-known representative is e.max from Ivoclar Vivadent.
Properties:
- Very good light transmittance, close to the natural tooth structure
- High flexural strength, sufficient for most loadings in the front tooth and premolar area
- Biocompatible, no metal ion release
- Very good bonding to the tooth substance
Indication:
- Front tooth crowns with high aesthetic requirements
- Premolar crowns
- Inlays, onlays and veneers
- To a limited extent posterior tooth crowns with not extreme loading
Limits:
- Limited with very strong bite loading (grinding, clenching)
- Not the first choice for multi-unit bridges in the posterior area
Zirconia (zirconium dioxide)
Zirconia is a ceramic material made of zirconium dioxide, introduced into dentistry from the 2000s. Today widely used for crowns and bridges.
Properties:
- Very high strength, significantly higher than lithium disilicate
- Biocompatible, no metal ion release
- Available in translucent variants (for aesthetic requirements) and in opaque variants (for high strength)
- Machine fabrication possible (CAD/CAM), precisely fitting restoration
Indication:
- Posterior tooth crowns with high loading
- Multi-unit bridges
- Implant crowns, often combined with lithium disilicate veneering in the visible area
- For patients with metal allergy or with preference for metal-free restoration
Limits:
- Early generations were less translucent, which limited aesthetics in the front area. Modern variants have significantly improved.
- With very high aesthetic requirements in the front area, lithium disilicate or a combined restoration can be better.
- Bonding to tooth substance is less good than with lithium disilicate. With bonding specific conditionings are needed.
Metal-ceramic
The classic metal-ceramic crown consists of a metal framework veneered with ceramic. It was used for decades as the standard in crown and bridge prosthetics.
Properties:
- Very long clinical experience, since the 1960s
- Very high strength
- Proven for multi-unit bridges and for posterior tooth crowns with high loading
- Usually cheaper than full ceramic alternatives
Indication:
- Posterior tooth crowns where aesthetics is not priority
- Multi-unit bridges in the posterior area
- Patients with cost pressure and without metal reservation
Limits:
- In the front area often aesthetically less optimal because the metal framework can shine through the ceramic veneer or become visible at the gum margin
- Metal allergies, especially against nickel and partly against palladium
- Low light transmittance, which makes aesthetic adaptation difficult
- Current trend in dentistry goes toward metal-free restorations, which is why metal-ceramic is decreasing in share
Comparison by criteria
Aesthetics
Lithium disilicate: aesthetically close to the natural tooth. Very good choice for front teeth.
Zirconia (modern): with translucent variants aesthetically very good, especially for posterior teeth. In the front area very good but not quite reaching the brilliance of lithium disilicate.
Metal-ceramic: often visible in the front area, dark line at the gum margin possible. Less relevant in the posterior area.
Strength and resilience
Lithium disilicate: sufficient for front teeth and premolars, limited for heavily loaded posterior teeth.
Zirconia: very high, suitable for all positions including multi-unit bridges.
Metal-ceramic: very high, long clinical experience with bridges over multiple units.
Biocompatibility
Lithium disilicate and zirconia: fully biocompatible, no metal ion release. Suitable for patients with metal allergy.
Metal-ceramic: usually well tolerated, in rare cases allergies against components of the metal alloy.
Lifespan
With proper use all three materials last over ten years with survival rates above 90 percent. Longer lifespans of 20 years and more are common with good oral hygiene and without extreme loading.
Costs
Range across Switzerland, without concrete Resident prices:
- Full ceramic (lithium disilicate or zirconia): typically CHF 1,500 to 2,200 per crown
- Metal-ceramic: typically CHF 1,200 to 1,700 per crown
- Full metal (gold): similar or slightly higher than metal-ceramic, depending on gold price
More on the general cost structure in the article on health insurance at the dentist.
Decision matrix by constellation
Front tooth crown with high aesthetic requirements
Recommendation: lithium disilicate or zirconia (translucent variant). Both aesthetically very good, lithium disilicate has a slight advantage in brilliance, zirconia the advantage of higher strength.
Posterior tooth crown with normal loading
Recommendation: zirconia or metal-ceramic. Both proven. Zirconia is the metal-free option, metal-ceramic is often more cost-effective.
Posterior tooth crown with grinders or clenchers
Recommendation: zirconia (opaque variant) or metal-ceramic. Both have very high resilience. With intensive bruxism patients additionally a nightguard for protection.
Implant crown
Recommendation: zirconia or full ceramic with individual adjustment. With implant crowns the material choice also depends on the implant suprastructure. We discuss the optimal combination in the initial consultation.
Multi-unit bridge in the front area
Recommendation: zirconia with veneering in the visible area. Strength of zirconia plus aesthetics of the veneering.
Multi-unit bridge in the posterior area
Recommendation: metal-ceramic or full zirconia. Both proven. Full zirconia for metal-free restoration, metal-ceramic for cost optimization.
Patient with metal allergy
Recommendation: full ceramic (lithium disilicate or zirconia). All ceramic materials are metal-free.
Root-treated tooth
Recommendation: depends on substance loss. With moderate substance loss an onlay can suffice, with greater substance loss a crown is indicated. More in the article Inlay versus crown.
What has changed in recent years
Trend toward metal-free restorations. Patients more often ask for biocompatible materials, practices more often recommend full ceramic. Metal-ceramic is chosen more cautiously.
Improvement of zirconia aesthetics. Early zirconia generations were opaque and aesthetically limited. Modern translucent zirconia are aesthetically very good.
Digital fabrication (CAD/CAM). Both lithium disilicate and zirconia are today usually manufactured by machine. The fit accuracy is very high, the lab effort smaller than with classic lost-wax technique.
Chairside fabrication with CEREC. In some practices individual crowns are fabricated directly in the practice and inserted in one session. Saves time but is depending on material and indication not optimal for all restorations.
How we proceed at Resident
In the initial consultation and after findings we discuss your aesthetic expectations, your bite loading and your history with allergies or reservations. On this basis we recommend the material that fits best for your constellation and your expectations.
We use predominantly full ceramic (lithium disilicate and zirconia) and metal-ceramic. Full metal crowns made of gold we use on request and with specific indications.
You receive a written cost estimate with detailed listing. When two materials are medically valid, we prepare two separate cost estimates for comparison on request. More in the article on the written cost estimate.
Arrange an appointment at your location for the assessment and material choice consultation.