This article is meant to educate you, the consumer, on how to “shop” for a crown. Let’s say you break a tooth, it isn’t hurting but both friends and family have assured you that you will need a crown. What should you do? Well, most of you would start by calling your dentist and make an appointment.
After some discussion with your dentist you decide on getting a porcelain crown. What you may not know is that there are dozens of different kinds of porcelain crowns. Most commonly for a back tooth porcelain crowns are fused to metal alloys. These are called porcelain fused to metal crowns or PFMs. The metal 
alloys used can differ greatly. There are predominately base metal, noble metal and high noble alloys used with crowns. The PFMs made with predominately base metal are significantly inferior. The alloy doesn’t bond to the porcelain as well and there are elements that commonly cause allergic reactions such as nickel. The PFMs that use noble metal are also inferior to high noble because of the potentially allergic content of the alloy.
Did you know that at least 40% of the crowns done in the Portland metro area are made in CHINA! The numbers are increasing fast and I’m fairly confident that the patients aren’t aware of it. There is not a “made in China” label on the crowns and I doubt that your dentist is going to tell you. I think we are at the point that it makes sense for the patient to ask the their dentist where the crowns are made and specifically what kind of alloys are being used. The advantage for the dentist is that the lab bill for the crown will be about 1/3 of the cost compared to a high noble PFM crown made in a local dental lab, but the quality and make up of the PFM made in China is NOT regulated despite what the dentist may tell you.
If you have decided that you want a crown that has no metal in it there are also many options- zirconia based, Emax single pressed or layered or Cerec crowns to name a few. And, if you want the cadillac restorative material?? That would still be gold.
There are many variations to the above mentioned crowns and they can be tailored to your specific needs. The main point is, talk to your dentist about where the crowns are made, what they are made of and the advantages and disadvantages of each.
My personal philosophy is this. Use the best labs for any given procedure in the USA. For crowns, there are several state of the art labs in Portland that stand up to any in the world as far as quality. The lab I have used for the last 15 plus years is called Cosmetic Dental Specialties. I use them not because they are the cheapest but because I think they are the best. Every crown I have ever had made has always used the best possible materials i.e. high noble alloys. There have been times that all porcelain crowns had to have copings made in Switzerland because they had the only scanners but that isn’t the case anymore.
