For many years I have participated in and listened to the conversation about what type of posterior crowns people are placing, porcelain fused to metal or all porcelain. Before the development of stronger porcelain materials that also meet our esthetic demands, and our ability to use them as monoliths, there wasn’t much steam in the debate. In those days porcelain fused to metal was the clear leader. This trend has been shifting based on the conversations I hear over the last five years. In my personal practice I do still place PFM restorations, but the number I place is diminishing rapidly. Just this week I recommended a crown and the patient asked “will it be the kind with this black line?” as she pointed in her mouth at a lower molar. This is becoming more and more common in my experience, patients esthetic goals have increased along with our ability to deliver better outcomes.
I had the privilege to hear Dr. Michael DiTolla lecture this afternoon. In addition to being very entertaining, he shared truly valuable information. One of the things I learned is that I am not alone in increasing the number of all porcelain crowns I seat compared to PFM. Michael shared data from Glidewell Dental Laboratories. In 2007 PFM represented 61% of the posterior crowns they made as compared to 29% for all porcelain. In 2010 these numbers had changed dramatically to 45% for PFM and 47% for all porcelain. The numbers reflect what I believe is a growing trend toward using all porcelain as our posterior restorative material of choice. Lithium Disilicate (E-max) and Monolithic Zirconia (BruxZir) have increased our confidence that all porcelain is strong enough to withstand the forces in the posterior and not fail prematurely. We can meet our patients request to not have any metal in their restorations, and meet their esthetic expectations.
I believe there are clinical situations for which both of these restorations work, and others where one or the other may be preferable. In my hands instead of a debate it is a matter of having choices.