Marta arrived with a handwritten note from a friend: «zirconia is best, only take zirconia.» She was ready to pay 1400 euros. I checked her mouth, it was her sixth lower molar, well hidden by the lip when she smiles. Aesthetically nobody would notice. I offered porcelain-fused-to-metal for 650 euros with guaranteed 15-20 year longevity. She agreed, paid half as much, and got exactly what she needed. Four years later she came back for a second crown, this time actually on a front tooth, and there I placed E.max.
I tell this story often because most patients believe «more expensive equals better». It does not. The right crown is the right material for the specific tooth. On a back tooth, zirconia offers little advantage over porcelain-fused-to-metal: aesthetically invisible, twice the price. On a front tooth, the opposite is true, E.max or veneered zirconia is a must.
German dentistry uses four main crown materials. Let me walk you through when each one makes sense.
Four Materials. Four Different Stories
Metal Crown (NEM / Base Metal Alloy)
The most affordable option from a chromium-nickel or chromium-cobalt alloy. No aesthetic appeal, but extremely durable. Mainly for posterior teeth. Cost: €300–500.
Porcelain-Fused-to-Metal (PFM / Metallkeramik)
Metal core covered with tooth-coloured porcelain. For decades the gold standard. One drawback: over time a dark metal collar can become visible at the gumline. Cost: €600–900. Lifespan: 15–20 years.
Zirconia Crown (Zirkondioxid)
Fully metal-free, biocompatible, nearly indistinguishable from natural teeth. Flexural strength 900–1,200 MPa. According to a systematic review in the Journal of Prosthodontics, 5-year survival rate: 93.3–100%. Cost: €900–1,500. Lifespan: 15–25 years.
E.max (IPS e.max Lithium Disilicate)
Product of Swiss company Ivoclar. Flexural strength 500 MPa. less than zirconia, but the most natural optical appearance. Ideal for front teeth. 5-year survival rates: 95–100%. Cost: €900–1,200. Lifespan: 10–15 years.
| Material | Cost | Lifespan | Aesthetics | Strength |
|---|---|---|---|---|
| Metal (NEM) | €300–500 | 10–20 yrs | Low | Very high |
| PFM | €600–900 | 15–20 yrs | Good | High |
| Zirconia | €900–1,500 | 15–25 yrs | Excellent | High |
| E.max | €900–1,200 | 10–15 yrs | Superior | Medium-high |
What Does German Health Insurance (GKV) Pay?
The GKV pays a Festzuschuss. a fixed subsidy, regardless of the material you choose. The reference treatment (Regelversorgung) is a metal crown.
Base Festzuschuss 2024: €251.87 (60%)
Bonusheft 5 years: €293.85 (70%)
Bonusheft 10 years: €314.84 (75%)
The same amount is paid whether you choose metal for €300 or zirconia for €1,400.
Decision Guide: Simple Rule
| Situation | Best Choice |
|---|---|
| Back tooth, barely visible | PFM or monolithic zirconia |
| Front tooth, aesthetics matter | E.max or veneered zirconia |
| Metal allergy | Zirconia or E.max only |
| Limited budget | PFM |
| Bruxism (teeth grinding) | Monolithic zirconia |
Step-by-step procedure
A crown is typically placed across two appointments, 7-14 days apart:
- Appointment 1 (1.5-2 hours). Local anaesthesia. The tooth is prepared with a diamond bur (1.5-2 mm of structure removed all around). Impression taken (silicone or digital 3D scan). Temporary plastic crown placed. Impression sent to the dental lab.
- Lab work (7-14 days). The technician fabricates the crown from the impression. In CEREC practices the crown is milled directly in 1-2 hours, saving the second appointment.
- Appointment 2 (30-60 minutes). Temporary off, permanent crown try-in. We check colour, shape, and bite. If everything fits, the crown is bonded with permanent cement. If something is off, the crown goes back to the lab for adjustment.
Adaptation takes 1-3 days. The first few days the tooth feels strange, then the brain adapts and you no longer notice.
Bonusheft: save thousands of euros
The Bonusheft is a small yellow booklet given by your dentist. It is stamped once a year at your check-up. Costs nothing, but radically affects GKV coverage on future prosthetics:
- No Bonusheft: Festzuschuss 60 percent of Regelversorgung, around 252 euros per crown.
- 5 years Bonusheft: 70 percent, around 294 euros.
- 10 years Bonusheft: 75 percent, around 315 euros.
Sounds small, just 40-60 euros per crown. But with 5-6 crowns plus a bridge plus an implant later in life, the difference adds up to 500-1000 euros. For Härtefall (low income), GKV can even cover 100 percent of Regelversorgung. Regular check-ups are one of the cheapest «investments» in your future dental care.