98.5% Five Year Survival: Types of Dental Crowns in Canada
Dental crowns come in six main types: all-metal, porcelain-fused-to-metal (PFM), all-ceramic (zirconia and lithium-disilicate), resin/composite, stainless steel, and temporary crowns. The real choice usually comes down to strength versus appearance versus cost, and location in the mouth often decides it for you. If you’re covered under the Canadian Dental Care Plan, know upfront that crowns require preauthorization and come with strict frequency limits, so plan the conversation with your dentist accordingly.
TL;DR:
Monolithic lithium-disilicate crowns have a five-year survival rate of approximately 98.5%, outperforming veneered options in chip resistance and long-term durability.
Metal crowns are the strongest, best suited for back molars that endure heavy chewing, but they are less popular for visible front teeth due to esthetic limitations.
Crowns on natural teeth benefit from the CDCP coverage restrictions, which limit the number of crowns covered over multiple years, whereas implant-supported crowns are not eligible for coverage.
Preparation techniques vary by material, with metal crowns requiring minimal reduction, while ceramic crowns need more shaping to prevent chipping and ensure strength.
For patients with metal allergies or bruxism habits, all-ceramic crowns are often preferred, with zirconia offering durability and lithium-disilicate delivering better translucency for front teeth.
Table of Contents
Types of Dental Crowns Explained
Every crown does the same basic job: it covers a damaged tooth completely, restoring shape, strength, and bite function. What separates one type from another is the material underneath, and that material determines how the crown looks, how long it survives, and how much force it can absorb.
All-metal crowns (gold alloys, base metal alloys) are the toughest option on the list. They resist wear almost indefinitely and require the least amount of tooth reduction during preparation, which is why dentists still reach for them on back molars where chewing force is highest and nobody sees the tooth anyway.
Porcelain-fused-to-metal (PFM) crowns bond a ceramic layer over a metal substructure. You get a metal core for strength and a tooth-colored surface for appearance. The tradeoff is real: the porcelain veneer can chip at the edges over time, and a thin gray line sometimes shows at the gumline as gums recede.
All-ceramic crowns now dominate most new crown placements, largely because CAD/CAM milling has expanded durable all-ceramic options well beyond what was possible a decade ago. Two materials lead this category:
Zirconia — extremely strong, available as monolithic (solid block) or veneered (zirconia core with a porcelain layer on top).
Lithium-disilicate (often called e.max) — more translucent than zirconia, closely mimics natural enamel, and suits front teeth where light needs to pass through the material the way it does through real enamel.
Monolithic designs (solid ceramic, no separate veneer layer) chip far less often than veneered versions, simply because there’s no bonded porcelain layer to fracture off.
Resin or composite crowns are the budget option, usually reserved for temporary use or short-term restorations, since they wear down and stain faster than ceramic or metal. Stainless steel crowns show up almost exclusively in pediatric dentistry or as emergency full coverage on a badly broken back tooth before a permanent restoration goes in. Temporary crowns, made from acrylic or composite resin, protect the prepared tooth while the permanent piece gets fabricated. They’re intentionally softer than the final crown, so a little wear during that waiting period is expected.
How the Materials Actually Perform: Survival and Failure Rates
Monolithic ceramic crowns now perform on par with metal-ceramic restorations over the long term, a finding that has quietly reshaped which crowns dentists recommend for heavily loaded teeth.
By the numbers: A systematic review and meta-analysis tracking single-crown outcomes found five-year survival rates of 98.5% for monolithic lithium-disilicate crowns, with monolithic zirconia and metal-ceramic crowns landing in a comparable 96.8% to 97.3% range.
The bigger story isn’t survival alone, it’s how crowns fail. Veneered restorations, where a porcelain layer sits over a ceramic or zirconia core, chip at meaningfully higher rates than monolithic designs. Separate clinical outcome research on all-ceramic crowns confirms the same pattern: monolithic lithium-disilicate produced fewer complications and a lower chipping proportion than veneered zirconia in mid-term follow-up.
Two practical rules fall out of this evidence:
Posterior teeth (molars, premolars) generally do best with monolithic zirconia. It withstands heavy chewing force without a veneer layer that can chip away.
Anterior teeth (front teeth, where esthetics carry more weight) often do better with lithium-disilicate or a carefully layered ceramic, trading a little strength for translucency that looks convincingly like enamel.
Zirconia’s biggest downside isn’t fracture risk, it’s the opposite problem: because it’s so hard, it can wear down the opposing natural tooth over years of contact if the surface isn’t properly polished and adjusted.
Do You Actually Need a Crown?
Crowns are indicated when a tooth has lost roughly half or more of its structure, has a deep crack threatening to split further, or needs protection after a root canal. A tooth that’s just been treated endodontically needs to heal properly before a crown goes on top of it, not before.
Not every damaged tooth needs full coverage, though. Smaller defects often do better with a more conservative fix:
Filling — small to medium cavities where enough healthy tooth remains.
Inlay or onlay — moderate damage that’s too big for a filling but doesn’t require full coverage.
Veneer — cosmetic front-tooth issues with the underlying structure still intact.
Crown — significant structural loss, deep cracks, or post-root-canal protection.
Pro Tip: Ask your dentist to show you the actual percentage of tooth structure remaining on the X-ray before agreeing to a crown. A crown versus filling comparison sometimes reveals that a smaller restoration would have worked just as well, and it would have cost less and preserved more of your natural tooth.
What Happens During the Crown Process
Getting a crown is a two-visit process for most patients, though same-day milling has changed that timeline in some clinics.
Preparation and scan or impression. Your dentist shapes the tooth to make room for the crown material, then either scans it digitally or takes a physical impression.
Temporary crown placement. A soft acrylic temporary covers the prepared tooth while the permanent crown is made, either in an off-site lab or milled in-office.
Wearing the temporary (typically 2 to 3 weeks). Avoid sticky or hard foods on that side, and skip flossing aggressively around it since temporaries can dislodge more easily than the final restoration.
Cementing the permanent crown. Your dentist checks the bite, adjusts as needed, and cements the finished crown in place.
If a temporary comes off entirely or you notice increasing pain, swelling, or looseness at any point, call your dentist rather than waiting for the scheduled visit.
How Long Crowns Last, What They Cost, and CDCP Coverage Rules
Permanent crowns typically last between 5 and 15 years, and well-maintained monolithic ceramic or metal crowns often run longer than that. Longevity depends on material choice, bite force, hygiene, and whether you grind your teeth at night.
Cost varies with material, lab fees, and whether the tooth needs a root canal or post first. A detailed cost breakdown explains what drives the price up or down case by case.
Brush and floss around the crown margin daily to prevent decay at the edge.
Wear a night guard if you grind, since bruxism accelerates wear on any crown material.
Get checked at routine cleanings so small issues get caught early.
CDCP essentials: The Canadian Dental Care Plan covers single-unit crowns with preauthorization required. Limits: a limited number of crowns may be covered per client over a multi-year period, including restrictions on crowns per tooth within several years. Implant-supported crowns are excluded entirely.
How to Choose the Right Crown With Your Dentist
Walking into a consultation with the right questions makes the decision faster and the outcome better.
Confirm the tooth’s location and function. A back molar under heavy chewing load has different priorities than a visible front tooth.
Ask whether monolithic or veneered design fits your case. Monolithic tends to chip less; veneered can look more natural in some anterior cases.
Ask about lab-fabricated versus in-office milled crowns. Same-day milling saves a visit but isn’t available for every material or situation.
Confirm the bonding protocol, especially for zirconia. Zirconia crowns need specific bonding and removal techniques due to the material’s hardness.
Request documentation for CDCP preauthorization. Your clinic should provide a treatment plan and cost estimate before submitting for approval.
Pro Tip: If you clench or grind your teeth, mention it before your dentist picks a material. It changes the calculation more than almost any other factor.
Mersal Dental’s Approach to Crown Planning
At Mersal Dental, the priority is preserving as much natural tooth structure as possible while planning for long-term function, not just a quick cosmetic fix. That means same-day options when appropriate, fast handling of crown pain or biting discomfort within 24 to 72 hours, and direct insurance billing alongside CDCP preauthorization support so patients aren’t navigating paperwork alone. Bring your questions about material choice and bite function to the consultation.
Preparation Techniques Differ by Crown Material
The way your dentist shapes your tooth changes depending on what the crown is made of, and this isn’t a minor technical detail, it affects how much natural tooth structure you keep.
All-metal crowns need the least reduction of tooth structure, sometimes as little as 0.5 millimeters of clearance, because metal itself is strong even in thin sections. PFM crowns need more reduction, generally around 1.5 to 2 millimeters, to leave room for both the metal substructure and the porcelain layer on top without making the crown too bulky or wearing thin at the biting edge.
All-ceramic crowns sit in between, but the specific ceramic matters. Monolithic zirconia can sometimes be prepared with slightly less reduction than layered ceramics because it doesn’t need a separate esthetic veneer, though most dentists still aim for at least 1 millimeter of clearance to ensure adequate strength. Lithium-disilicate crowns generally require a defined, rounded preparation shape without sharp internal angles, since sharp corners create stress points where the ceramic is more likely to crack under bite force.
The preparation margin design (where the crown edge meets the natural tooth) also shifts by material. Metal crowns tolerate a thin knife-edge margin. Ceramic crowns need a more rounded, chamfered margin to distribute stress evenly and avoid chipping right at the edge, which is one reason a crown “redo” using a different material sometimes requires additional tooth reduction the second time around.
Crowns on Implants Versus Crowns on Natural Teeth
A crown that sits on top of a dental implant works differently from one that sits on a natural, prepared tooth, even though both look identical once finished.
On a natural tooth, the crown bonds or cements directly onto tooth structure that still has a root, a periodontal ligament, and some natural give under biting pressure. On an implant, the crown attaches to a metal abutment screwed into the jawbone, either by cement or by a small screw accessed through the crown itself. There’s no periodontal ligament involved, so implant crowns transmit bite force more rigidly, which is one reason implant sites sometimes need slightly different occlusal (bite) adjustments than natural teeth do.
Material choice still applies to both situations. Zirconia and lithium-disilicate both work well on implants, and the same strength-versus-esthetics tradeoffs from earlier apply. The major difference is coverage: the CDCP explicitly excludes implant-supported crowns from its benefit, while crowns on natural teeth remain eligible for coverage with preauthorization. If you’re weighing an implant crown against a natural-tooth crown for cost reasons, that coverage gap deserves a place in the conversation with your dentist, not an afterthought after treatment has already started.
Metal Allergies, Bruxism, and Other Personal Factors That Affect Crown Choice
Your medical history and habits narrow the list of appropriate crown materials before esthetics even enters the conversation.
Metal sensitivities rule out base metal alloys and often push PFM crowns off the table too, since the metal substructure sits close to gum tissue and can trigger contact reactions in sensitive patients. All-ceramic crowns, whether zirconia or lithium-disilicate, contain no metal and sidestep this issue entirely, which is part of why they’ve become the default recommendation for patients with a known or suspected metal allergy.
Bruxism (teeth grinding or clenching) changes the calculation in the other direction. Heavy grinding puts sustained, repetitive force on a crown that mimics the effect of years of normal chewing compressed into a shorter timeframe. For a patient who grinds, a polished monolithic zirconia crown paired with a night guard tends to hold up better than a veneered ceramic crown, where the porcelain layer is more vulnerable to chipping under that repeated load. Skipping the night guard after getting a crown is one of the more common ways patients shorten a restoration’s working life without realizing it.
Bite alignment and opposing teeth also matter. If the crown will bite against a natural tooth rather than another crown, a highly polished zirconia surface reduces wear on that opposing enamel. If you have several missing teeth or heavily worn dentition already, your dentist may recommend an occlusal adjustment plan alongside the new crown, not just the crown itself.
Long-Term Function Matters More Than a Quick Fix
Crown selection should protect the tooth for the next decade, not just make it look good tomorrow. Strength and preserved tooth structure matter more than picking whatever seems fastest or cheapest in the moment. Talk through your specific case with a licensed dentist before deciding.
— Mersal
Get a Crown Consultation With Mersal Dental
Crown planning involves matching material to tooth location, explaining monolithic versus veneered options honestly, and handling CDCP paperwork to assist with preauthorization rules. Some dental practices offer same-day treatment options, direct billing to insurance including CDCP and IFHP, and accept new patients across general and restorative dentistry.
Booking starts with an exam and a clear treatment plan, including a cost estimate and any preauthorization paperwork your coverage requires. If a crown broke, fell out, or is causing pain right now, same-day and emergency appointments are available. Visit the Crowns & Bridges page to see the full range of restorative options, or head to the services overview to book a consultation and get a personalized recommendation for your tooth.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
What is the best type of dental crown to get?
There’s no single best crown for every tooth. Monolithic zirconia tends to work best for back molars under heavy chewing force, while lithium-disilicate often suits front teeth better because of its translucency, and both perform comparably to metal-ceramic crowns in five-year survival data.
Which dental crown is the most expensive?
All-ceramic crowns, particularly lithium-disilicate and premium zirconia restorations, generally cost more than PFM or stainless steel crowns due to material and lab fees. Exact pricing depends on the tooth, lab costs, and whether a root canal or post is needed first; a full breakdown is available in this cost guide.
What kind of crown lasts the longest?
Monolithic lithium-disilicate crowns showed the highest five-year survival rate in recent research at 98.5%, with monolithic zirconia and metal-ceramic crowns close behind in the 96.8% to 97.3% range. Real-world lifespan still depends heavily on hygiene, bite force, and whether you wear a night guard if you grind your teeth.
What is better than a dental crown?
For teeth with less severe damage, a filling, inlay, onlay, or veneer often preserves more natural tooth structure than a full crown while still solving the problem. A crown becomes the better option once structural loss is significant, a crack threatens the tooth, or the tooth needs protection after a root canal.
How much do dental crowns cost at Mersal Dental?
Current pricing for crowns and bridges is available directly on the Crowns & Bridges page, since cost varies by material and case complexity. The clinic offers direct insurance billing and CDCP support to help clarify what your coverage applies to before treatment begins.
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