My dentist is recommending porcelain fused to metal for two lower three crown bridges for my back teeth. He says that it is a stronger material than all ceramic. So he is saying he is upgrading that to porcelain fused to metal and wants to charge me 20% above the PPO contract rate for all ceramic, for upgraded crown materials. So I have three questions that I am hoping you can help me with.
1) Which type of crown would you recommend that is less likely to crack?
2) My dentist is labeling the 20% upcharge as “lab fees,” but my insurance does not cover that. Can a dentist charge above the PPO contract rate? Can he also refuse to do the standard crown? The standard crown is covered by my insurance, and I’m just not sure I can afford the upgrade. He is an “in-network provider,” and I really don’t want to switch dentists.
3) I also have porcelain upper bridges on each side of my mouth, so my last question is, will it cause cracking having a stronger material grinding against a softer material?
Jeff from Minnesota
It sounds to me like your dentist is playing some games with the insurance fees. First, I want to make sure you and the readers understand what PPO stands for. PPO stands for preferred provider organization, and it is a network of dentists that have agreed with the insurance companies to offer discounted fees to the subscribers of the plan.
Let’s talk about your first question. I’m guessing that your dentist is using procedure code D6740 – retainer crown porcelain/ceramic. Ceramic is important because the porcelain isn’t strong enough on the back teeth; it will crack when chewing. There are ceramic bridges available now that are strong enough to serve as a bridge on back teeth, where porcelain isn’t strong enough.
Your dentist is definitely playing games with the terminology because the fee upgrade would typically be in the other direction. Porcelain fused to metal, while it is a little stronger than the newer ceramics, would be a lower fee than the all-ceramic crowns. Besides that, I’m sure that your insurance company recognizes the codes for porcelain fused to metal crowns. A typical code would be D6751 – retainer crown porcelain fused to noble metal. So it sounds like your dentist does not want to accept the insurance fee for a porcelain fused to metal bridge and has thought of this clever work-around, which seems very unethical to me.
Also, your dentist should not make it mandatory to upgrade. That seems like a violation of his insurance contract. If he has some upgrade he wants to offer, that should be optional to you, not mandatory.
As far as the high-strength ceramic, it is definitely strong enough for a bridge on the back of your teeth. The porcelain fused to metal is a little stronger but not necessary.
To answer your third question, they will not crack being different materials on the top and bottom, but they will wear. If one surface is a little more abrasive than the other, the one will wear the other. It would be best to have the same material on both.
It is important that you trust your dentist and understand it is your right to say no to the upgrade.
This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.