new crown - 2740 vs 2750?

[lent...@no-spam-gmail.com]

Another question for the pros....last year, I needed a crown on #20, and they
used 2750 - porcelain fused to noble metal. Now they want to redo a 9 ear old
crown on #4, but they are using 2740 - porcelain/ceramic substrate. Any reason
for the difference? I wonder since if I'm not mistaken, both teeth are in the
same position, relatively - i.e, they are both pre-molars. Is it because one's
on top, the other the bottom? Should I even look a gift horse in the mouth?
(2740 is much cheaper, since my insurance lets them add $150 to my copay for any
noble metal crown, such as 2750). (It's not a cosmetic issue for me, since it
is barely seen when I smile). So I'm happy to pay a lot less for 2740, if there
are no other concerns.

Just wondering if there are any issues I need to consider.

[Steven Bornfeld]

Why is the crown being redone?
To my mind the primary reason for doing an all-ceramic crown in lieu of
a porcelain fused to metal would be cosmetic. My lab did give me a
rationale for using full monolithic zirconia--it could be done with less
reduction of tooth structure. But since the tooth has previously been
crowned, this isn't an important difference. Zirconia is a strong
material, but early zirconia was fairly opaque. Sometimes it would be
veneered with porcelain to improve the appearance. There are more
natural-appearing zirconias now, but my understanding is that they give
up a little strength compared to the early monolithic zirconia crowns.
Honestly, at this point either one should work fine, and if cosmetic
considerations aren't important then to my mind there isn't much basis
on which to prefer one over the other.

Steve

[lent...@no-spam-gmail.com]

The crown has been bad since it was first done (by a previous dentist). It
already had a crown there for about 10 years, and this was a replacement after a
root canal. Sadly, he left margins on the top all the way around, and (I
surmise) badly formed the build-up/buckle (not sure of the terminology) making
the crown stick way out to the side, when previously you could run your finger
along all the teeth and it would be a straight, uninterrupted smooth run. I had
gone back twice to complain, and the dentist wouldn't concede anything amiss..
So I left that dentist for another, and the new one agreed it was a piss-poor
job, and needed to be redone. I decided to wait until it got worse or failed
outright, not wanting to make a second investment so soon.. When that dentist
moved away soon thereafter and I came to this office (about 5 years ago), the
push for a new one began again, with the new dentist also aghast as to how bad
it was. Again I put him off, but now he's moved to another office 40 miles away,
and the new dentist I've seen has come forward with the new code, thus my
considering just getting it done with the much cheaper copay.

I did some reading up since my post, and I see that I really probably have
nothing to worry about, just as you proffered. It might be just a generational
thing as to the practitioners, as the last dentist was probably late 40s, while
the new one is only 30. Perhaps that's the product she most recently learned
about and uses most often. While I normally wouldn't see her for another year,
I'll check in at the next perio and see if I can get a couple minutes with her
to discuss it further. It doesn't hurt that she's smokin' hot. :)

Thanks as always.

[lent...@no-spam-gmail.com]

On Mon, 25 Jun 2018 12:51:37 -0400, Steven Bornfeld
<dentalt...@earthlink.net> wrote:

Turns out I had read the treatment plan wrong. It had the line for the ceramic
crown, and the line for the build-up. It then had a line that said "Optional
cosmetic crown upgrade" for an additional $300 copay (insurance company pays
zero). Of course, I assumed that meant I could add some type of cosmetic upgrade
if I wanted to pay an additional $300, which of course I wouldn't want to do
since this tooth isn't even visible. Thus, my original happiness that this was
going to cost me so much less than the normal 2750 crowns of the past.. Well,
now I find out that that "optional" line wasn't optional at all - it was
mandatory. Typical money-grab, and contrary to the insurance plan they have
contracted to honor. The only add-ons my plan allows are the $150 per crown for
noble metal ones. Yet they say the ceramic is much more expensive than the 2750
ones, so they are adding the $300.

Of course, I checked with the insurance company, and they say they aren't
allowed to do that, that they must honor the copays for the codes they are
using. So, since the dentist says she only does ceramic crowns now, and refuses
to use porcelain/metal crowns anymore, she is essentially 'forcing' me into
something much more expensive, and against the rules at that. Seems to me this
is just a way to keep the fees increasing.

Insurance company offered to call them and/or have me file a grievance, but any
of those steps will force me to leave them anyway. So I'll be moving on,
especially since I also need a crown on another molar, and I just can't see
spending an additional $600 that I don't need to.

[Steven Bornfeld]

Sometimes the lab fees ARE higher for ceramic crowns. Still, if this
is a contract dentist, she is bound by the fees of the contract. She is
certainly within her professional rights to prefer all-ceramic, or to
discontinue porcelain/metal crowns. She is still bound by the contract,
and if she can't live with that there are ways to discontinue the contract.
Of course she'd certainly lose the stream of new patients, so she
probably wouldn't do that.
You're probably doing the right thing by moving on.

Steve