Ultimate Dentist’s Guide to Porcelain Fused to Metal Restorations

Ultimate Dentist’s Guide to Porcelain Fused to Metal Restorations image

Find out how porcelain fused to metal restorations can benefit your patients and your practice in this PFM crowns and bridges guide for dentists.

From all-ceramic to the latest aesthetic zirconia, dental restoration techniques and materials have advanced rapidly. But there’s still an important place for porcelain fused to metal restorations. They may be more cost-effective than all-ceramic restorations and are fully compatible with the latest digital workflows.   

So, what is a porcelain fused to metal crown(or bridge? Put simply, porcelain fused to metal (PFM) is a type of dental restoration commonly used to repair damaged or decayed teeth. It combines both metal and porcelain materials to create a restoration that is both durable and aesthetically pleasing. 

Porcelain fused to metal crowns, bridges, and implant-supported prostheses typically offer excellent strength and durability and, if cared for properly, a PFM crown can last for many years. 

However, despite the clear benefits of PFM restorations, most dental labs no longer make them. Avant Dental is different. We pride ourselves on designing and manufacturing superior quality PFM restorations that benefit your practice as much as your patients.

Streamlined digital workflows are reducing chairside time for PFM restorations, and a high degree of clinical predictability supports dentists to achieve consistent results. 

Porcelain fused to metal restorations also give practices the opportunity to offer a wide range of cost-effective restorations that may be more budget friendly than all-ceramic or zirconia alternatives.  

However, there are some key considerations dentists should think about before progressing with porcelain fused to metal crowns or other PFM restorations. First and foremost is the need to identify any known metal allergies or sensitivities the patient may have. 

Also take the time to discuss the patient’s aesthetic expectations and balance their expectations against any budget limitations that may rule out typically more expensive all-ceramic or zirconia alternatives.    

Like all restoration treatments, proper tooth preparation is crucial, as is paying close attention to precise marginal fit and designing PFM restorations with the appropriate occlusal contacts for the patient’s individual dentition. 

What is a porcelain fused to metal crown, and what are the key advantages of PFM restorations? 

Strength and durability: The metal substructure in a PFM crown or other restoration provides excellent strength and durability to withstand the biting forces and wear and tear associated with chewing and speaking. This makes porcelain fused to metal restorations  suitable for both anterior and posterior teeth. 

Aesthetic appearance: PFM restorations are typically a good choice for visible teeth. The porcelain crown can be shade-matched to match the patient’s existing teeth for a natural and aesthetically pleasing result.

Biocompatibility: The metal used in porcelain fused to metal restorations is often a noble metal like gold, or non-noble alloys. These metals are generally well-tolerated by the body, which makes them a safe option for many patients.

Customisation: PFM restorations are custom-made to fit the patient’s unique dental anatomy. This customisation ensures a proper fit and alignment to restore proper oral function.

Longevity: PFM restorations can last for many years. But it’s important to remind patients that regular dental hygiene and care is required to maximise the lifespan of PFM restorations. 

Versatility: PFM restorations are versatile and can be used for various dental applications, including crowns, bridges, and implant-supported prostheses.

Marginal Fit: PFM restorations can be designed with precise marginal fit. This reduces the risk of microleakage and secondary decay.

How can porcelain fused to metal restorations benefit dental practices?

Clinical predictability: PFM restorations have a long history of clinical success, and offer a high degree of predictability in terms of clinical outcomes. This tends to instil confidence in the dental team.

Streamlined workflow: It’s generally quite simple to establish workflows for creating and placing a PFM crown or other restoration, which can increase the efficiency of treatment processes and reduce chairside time.

Laboratory support: Avant Dental is one of the few remaining full-service dental labs that still make PFM restorations. We support efficient digital workflows and our expert technicians assist dentists with treatment planning and PFM design to ensure the best possible clinical outcomes.   

Cost-effectiveness: Compared to some all-ceramic restorations, porcelain fused to metal restorations may be more cost-effective. This can make them a practical option for patients who have budget constraints or limited insurance coverage.

What are the key considerations for dentists when selecting porcelain fused to metal crowns and other PFM restorations for their patients? 

Patient health and allergies: Assess the patient’s overall health, with particular focus on identifying any known allergies or sensitivities to metals or other dental materials. This information can influence the choice of metal alloy and porcelain composition.

Location in the mouth: PFM restorations are typically ideal for high-stress areas, such as molars, where durability and resistance to wear and fracture are critical. However, in less demanding areas, such as premolars or canines,  dentists might consider all-ceramic or zirconia restorations, which may offer better aesthetics with no metal margin near the gumline.

Cost and insurance: Consider the patient’s financial situation and insurance coverage. PFM restorations can be more cost-effective than all-ceramic alternatives, but insurance coverage may vary.

Tooth preparation: Proper tooth preparation is crucial for the success of PFM restorations. Dentists should ensure that there is enough space for the restoration, including proper occlusal clearance and reduction, while preserving the tooth’s structural integrity.

Marginal fit: Precision in creating the margin and ensuring a tight fit is crucial to prevent microleakage and reduce the risk of secondary decay. Poor marginal fit can compromise the longevity of the restoration.

Occlusion and function: Evaluate the patient’s occlusion and functional requirements. PFM restorations should be designed to maintain proper occlusal contacts and function effectively during biting and chewing.

Laboratory selection: Choose a reputable dental laboratory with experience in fabricating PFM restorations, such as Avant Dental, to ensure high-quality work and consistent results.

Material selection: Avant’s expert technicians help dentists select the appropriate metal alloy for the substructure based on the patient’s oral health, occlusion, and any potential metal allergies or sensitivities. 

Shade and colour matching: Achieving a natural appearance is essential for patient satisfaction. Avant’s technicians are highly trained in selecting the porcelain shade and colour that most closely matches the patient’s natural teeth.

Can dentists receive technical support or guidance from the dental laboratory when working with PFM restorations? 

Absolutely! Dentists often receive technical support and guidance from dental laboratories when working with PFM restorations. Collaboration between dental practices and dental laboratories is essential for ensuring the successful design, fabrication, and placement of PFM restorations. 

Many modern dental laboratories use digital intraoral scans and computer-aided design and computer-aided manufacturing (CAD/CAM) techniques to design and manufacture PFM restorations to meet precise patient specifications. 

Avant, for example, can provide valuable input during the treatment planning phase, and help dentists select the appropriate materials, design, and treatment approach for specific patient needs. 

Dental lab technicians are also skilled in customising porcelain shades and colours to match the patient’s natural teeth, and communicate closely with the dentist to achieve the desired aesthetic outcome.

Dental labs can also assist in ensuring precise marginal fit and proper occlusal contacts, which are essential for the longevity and functionality of the PFM restoration.

But check that your dental lab has stringent quality control processes in place to ensure the highest standard of work. Avant technicians, for example, perform checks on the restoration to confirm it meets the required specifications before it is delivered to the dental practice.

What are the future advancements and trends in the field of PFM restorations that dentists should be aware of? 

Digital technology is playing an increasingly significant role in the creation of PFM restorations. Digital workflows centred around digital scans and CAD/CAM design and manufacturing processes are enhancing precision, efficiency, and patient comfort.

Advances in metallurgy are also leading to the development of new, high-performance metal alloys that may enhance the longevity and durability of PFM restorations, while minimising concerns about metal allergies or sensitivities.

Likewise, new porcelain materials and layering techniques are being developed to achieve more natural translucency, improve colour matching, and enhance the overall aesthetics of PFM restorations. 

Ongoing efforts are also being made to minimise the visibility of the metal substructure in PFM restorations, especially near the gumline. 

And it’s important to remember that with greater access to information, patients are becoming more involved in their dental treatment decisions. Be prepared to communicate with patients about the various restoration options, including the benefits and limitations of PFM restorations.

Avant Dental is a full-service dental laboratory. To find out more about working with us on porcelain fused to metal restorations, please email contact@avantdental.com.au or phone 1800 287 336.

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