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Base Metal Crowns

Posted Jan 11 2009 5:44pm 5 Comments


Apart from pedodontists, is anyone routinely doing base metal or non-precious crowns? I have never done one in my entire career and really have trouble finding any indication in which one should be placed. I understand that the lab bill is higher for a precious high noble metal or PFM crown, but its worth it. I promise. Here are some reasons why:

1) Studies show that nickel, chromium, and beryllium ions leech from the metal coping into the oral environment. Obviously, this is not a good thing. (Leaching of nickel, chromium, and beryllium ions from base metal alloy in an artificial oral environment. J Prosthet Dent. 1992 Oct;68(4):692-7.) These elements pose a potential risk for allergy or toxicity.

2) Base metals do not cast as accurately as high noble metals. Bottom line, gold is more accurate. Obviously, accuracy of casting is directly proportional to the fit of the restoration which is directly proportional to long term success of a fixed restoration. (Casting accuracy of a nickel and beryllium-free cobalt-chromium alloy for crown and bridge prostheses and resin-bonded bridges. Swed Dent J. 1985;9(3):105-15.)

3) Base metals can lead to adverse periodontal affects. Studies have shown that cast base metals are cytotoxic to the fibroblasts of the periodontal ligament. While polishing can help alleviate this, cytotoxic effects have still been observed. (Reaction of fibroblasts to various dental casting alloys. J Oral Pathol. 1988 Aug;17(7):341-7.)

So basically, a base metal crown can cause allergy/toxicity, won't fit as well, and can cause adverse periodontal effects. Why in the world would you want to cement one of these restorations into your patient's mouth? Would you want one in your mouth? There are studies that show these crowns compare with high noble restorations at the 4 year mark but there are no studies showing similar success at a longer range. The bottom line is these restorations will not last as long as high noble restorations, all things being equal.

Some of my colleagues will rebuke with "But the managed care program's fee schedule is so low, I have to do base metals." My response...get off that plan. Its not worth it. Be out of network and do dentistry the correct way.

If anyone can contribute to this, please do in the comments!

Comments (5)
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Currently, (June 2009) Delta Dental's list of copay fees for its individual insurance "DeltaCare USA" shows that a crown of "porcelain fused to predominantly base metal" (D2751) is the SAME cost ($325) as "porcelain fused to noble metal." Yet there is another "porcelain fused to high noble metal" that is $100 more ($425). Any comments on the noble vs high noble?
High noble crowns have more gold in their alloy, raising the cost to the lab, doctor, patient, and insurance company.  High noble crowns are more biocompatible than noble crowns.  
I cannot even find a dentist to perform the D2751 even out of my area. I would like to have access to articles containing information sent to dentists stating to not perform this procedure. Need help ASAP as tooth was already prepared and denied insurance coveage!

Well, had i known the difference as told I honestly would have not even considered the idea of having metal crowns.  But as it is I know have 13 and boy do I have problems.  My gum line is receding and my teeth are achy.  Not to mention the bad breath I now have.  As my daughter described it: "as  if something is dying".  Woff that's all I can say.  Flossing and brushing seem to irritating it more even thought I use an electric toothbrush and have very lilttle pressure on my teeth and gums.  What to do? Shall I treat it as dry mouth or take some enzymes? HELP

Get off the managed care plan? This is what the Government offers! Why would the government offer procedures that one cannot find a provider willing to perform and would eventually cause more harm? Perhaps if I could afford insurance, I could get a better procedure done. With the economy the way it is, the government needs to get rid of the substandard procedures and care enough to allow it's people to get adequate care!
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