Crowns and Bridges — Zirconia, Porcelain, and What Goes Where

It depends what matters to you, and what’s in your mouth. A fixed bridge (All-on-4 or 6) feels closest to natural teeth: it doesn’t move, doesn’t cover the palate, and you clean it in your mouth. It needs 4–6 implants and bone to hold them, and it costs more. An implant overdenture is a denture that locks onto 2–4 implants with attachments: it doesn’t move when you eat, needs no adhesive, and comes out in the evening for cleaning. It’s cheaper, needs fewer implants and less bone, and gives better support to the lips and cheeks — a real advantage for someone whose face has “sunk”. The downside: in the upper jaw it covers part of the palate, and the attachments need maintenance. Quite a few patients who could technically have had a bridge chose the overdenture, and rightly so. We decide together, on the CT, by your habits and budget.

Usually we combine, by area. Monolithic zirconia — a crown or bridge from a single piece — is the strongest, so it goes on molars, long bridges and anyone who grinds. The newer generations already look very good, but they’re still a little less translucent than a natural tooth. Porcelain on zirconia — a layer of porcelain over a zirconia core — is the most aesthetic, for front teeth and the smile zone; it’s a bit more delicate, so it doesn’t suit every position. E.max (lithium disilicate) gives a very natural translucency and suits a single front crown or veneers. Porcelain fused to metal still exists, but we hardly use it — because of the grey line that can show at the gum. You’ll see the recommendation on the provisional bridge before the permanent one is made.

Without implants — a few weeks to two months: diagnosis, a provisional restoration on the teeth, adjustments, then the permanent. With implants — 4–9 months, because after surgery we wait for the implants to fuse with the bone: two to four months in the lower jaw, four to six in the upper, and that can’t be hurried. With a bone graft or an open sinus lift — up to a year. What’s important to know: you have teeth the whole way through. You never walk around without; there are provisionals that work and look good, and with immediate loading they’re screwed onto the implants on the day of surgery. The number of visits itself isn’t large — most are short, and the long ones are the surgery and the fitting of the provisionals. The full timetable is written into the quote.

We give the teeth back the length and the bite height they’ve lost — and protect the result. When teeth wear down over years, the face “shortens”, the front teeth disappear from the smile, and sometimes the jaw aches. The rehabilitation: crowns or veneers that bring the height back up, sometimes on the whole mouth and sometimes on the back teeth only with a light adjustment at the front — depending on how much has worn and where. First we do it in provisionals: you live with them for a few weeks, we check chewing, speech and looks, and adjust. Only then do we copy to zirconia. And then the part without which it all comes back: a night guard. The grinding doesn’t go away because of the rehabilitation, and the guard is what protects the new crowns. If you know you grind, say so at the consultation — it changes the choice of material too.

Without implants: usually 6–8 visits over one or two months — diagnosis and scans, approving the digital preview, preparing the teeth and fitting the provisionals (the long visit, a few hours), a check-up or two on the provisionals, try-in and approval, and delivery of the permanent. With implants: you add the surgery and the healing months in between, but the number of visits itself doesn’t grow much — the one-week, one-month and three-month check-ups are short, about a quarter of an hour each. The long ones are two: the surgery, and the fitting of the provisionals or the try-in of the permanent bridge. All the visits are at the clinic you chose, with the same team. You get the full visit schedule, with an estimated length for each one, in writing with the quote, so you can plan work and holidays around it.

Sometimes, yes. When the wear is moderate and mostly on the back teeth, we can raise the bite with crowns or veneers on the back teeth only, and adjust the front teeth with light reshaping or composite. It depends how much has worn, where, and how the jaws meet. When the wear has already reached the front teeth, when the face has “shortened” and the lips are drawn in — it’s the whole mouth, and there’s no way round it: a partial raise would create an uneven bite, and all the force would go onto the teeth that weren’t treated. So our rule: test it in provisionals first. We raise the bite on provisional teeth, you live with it for two or three weeks, and we see whether the jaw agrees, whether you speak comfortably, whether it looks right. Only then do we decide how many teeth really need touching, and make the permanent.

Our provisionals are your new teeth in a trial version: same shape, same shade, same height — in a different material, acrylic or composite instead of zirconia. They’re made to the digital plan, not shaped by hand in the chair, so they look the way the result is meant to look. People go to weddings in them. The differences there are: they’re a bit less glossy, they pick up stains if you drink a lot of coffee, and they can break if you bite something hard — and then we repair them in the chair. They exist precisely to test things in real life: chewing, speech, how it looks in photos, what bothers you. Everything you tell us about them — “the front ones are too long for me”, “the shade’s too light” — goes into the permanent. Once it’s copied to zirconia, changing it means a new bridge.

Well, and without giving either of us up. We do the rehabilitation — implants, bridges, crowns, implant overdentures. Your family dentist carries on with what’s outside our field: routine cleanings, fillings, root canal treatment, whitening, and any natural tooth that was left out of the rehabilitation. At the end of treatment we send them a summary letter with what was done, which implants (with the implant passport), and how to clean around them. If they want to talk to us directly — gladly, and sometimes it helps, before root canal treatment on a tooth next to an implant, for instance. The yearly check of the implants and the bridge is done with us, because you need to know the bridge to take it off and clean underneath. A routine clean at theirs doesn’t clash with that.