D2991 Dental Code: Restoration of a Crown with High Noble Metal -

Dental restorations play a crucial role in preserving oral health, functionality, and aesthetics. Among the various procedural codes, D2991 stands out as a specialized treatment involving the restoration of a crown using high noble metal. Unlike porcelain or zirconia crowns, high noble metal crowns offer unique advantages in durability, biocompatibility, and longevity.

This comprehensive guide explores every aspect of the D2991 dental code, including its clinical applications, procedural steps, benefits, cost considerations, and comparisons with alternative treatments. Whether you’re a dental professional seeking in-depth knowledge or a patient considering this restoration, this article provides valuable insights to help you make informed decisions.

Table of Contents

2. Understanding the D2991 Dental Code

The D2991 code, as defined by the American Dental Association (ADA), refers to:

“Restoration of a crown with high noble metal—typically involving at least 60% noble metals (gold, platinum, palladium) and a minimum of 40% gold content.”

This code is classified under fixed prosthodontics, meaning the crown is permanently cemented onto a prepared tooth or implant.

Key Features of D2991:

Material Composition: High noble metal (≥60% noble metal, ≥40% gold).
Application: Used for posterior teeth (molars and premolars) due to strength.
Biocompatibility: Highly compatible with gum tissues, reducing allergic reactions.

3. Indications for D2991 Restoration

A D2991 crown is recommended in cases where:

✅ Tooth decay or fracture compromises structural integrity.
✅ Large fillings weaken the tooth, requiring reinforcement.
✅ Bruxism (teeth grinding) demands a highly durable material.
✅ Patients prefer long-lasting restorations over aesthetic-focused options.

Contraindications:

Patients with metal allergies (rare with high noble metals).
Those prioritizing cosmetic appearance (metal crowns are more visible).

4. Types of Crown Materials: Why High Noble Metal?

Material Type	Composition	Pros	Cons
High Noble Metal (D2991)	≥60% noble metal (gold, platinum, palladium)	Extremely durable, biocompatible, long-lasting	Metallic appearance, higher cost
Porcelain-Fused-to-Metal (D2740)	Metal base with porcelain coating	Aesthetic, strong	Porcelain may chip over time
Zirconia (D2750)	Ceramic-based	Highly aesthetic, strong	Less flexibility than metal
Full Gold Crown (D2790)	100% gold alloy	Superior longevity, minimal tooth removal	Very high cost, noticeable metal look

Why Choose High Noble Metal?

Superior Strength: Withstands chewing forces better than porcelain.
Minimal Wear on Opposing Teeth: Softer than enamel, reducing abrasion.
Longevity: Lasts 20+ years with proper care.

5. Step-by-Step Procedure for D2991 Restoration

Step 1: Diagnosis and Treatment Planning

X-rays and impressions are taken.
The dentist evaluates if the tooth can support a crown.

Step 2: Tooth Preparation

The tooth is reshaped to accommodate the crown.
A temporary crown may be placed.

Step 3: Impression and Lab Fabrication

A dental lab custom-makes the high noble metal crown (takes ~2 weeks).

Step 4: Crown Placement

The permanent crown is cemented using dental adhesive.
Bite alignment is checked.

Step 5: Follow-Up

Adjustments are made if discomfort occurs.

6. Benefits of High Noble Metal Crowns

✔ Durability: Resistant to fractures and wear.
✔ Biocompatibility: Rarely causes allergic reactions.
✔ Precision Fit: Minimal marginal leakage.
✔ Long-Term Cost-Effectiveness: Fewer replacements needed.

7. Potential Risks and Complications

Allergic Reactions (rare, but possible with certain metal alloys).
Galvanic Shock (if another metal restoration is present).
Aesthetic Concerns (visible metal in smile zone).

8. Cost and Insurance Coverage for D2991

Average Cost: $1, 000-$ 1,500 per crown (varies by location).
Insurance Coverage: Many plans cover 50–80% of the cost.

9. Comparing D2991 with Other Crown Codes

Code	Description	Best For
D2991	High noble metal crown	Durability, posterior teeth
D2740	Porcelain-fused-to-metal	Aesthetics + strength
D2750	All-ceramic (zirconia)	Highly aesthetic cases
D2790	Full gold crown	Maximum longevity

10. Patient Considerations: Who Is an Ideal Candidate?

Patients needing molar or premolar restorations.
Those with heavy bite forces or bruxism.
Individuals prioritizing longevity over aesthetics.

11. Maintenance and Longevity of High Noble Metal Crowns

Brush and floss regularly.
Avoid chewing hard objects (ice, hard candy).
Schedule dental check-ups every 6 months.

With proper care, these crowns can last 20–30 years.

12. Common Myths and Misconceptions

❌ “Metal crowns are outdated.”
✅ Fact: They remain one of the most durable options.

❌ “Gold crowns cause allergies.”
✅ Fact: High noble metals are hypoallergenic for most patients.

13. FAQs

Q1: Is a D2991 crown worth the cost?

Yes, due to its exceptional durability and longevity, it’s a cost-effective long-term solution.

Q2: Can I get a high noble metal crown on a front tooth?

It’s not recommended due to its metallic appearance; porcelain or zirconia is preferred for aesthetics.

Q3: How long does the procedure take?

Typically two visits (preparation + placement), spaced 2–3 weeks apart.

Q4: Does insurance cover D2991?

Most plans cover it partially, but check with your provider.

14. Conclusion

The D2991 dental code represents a high-quality, long-lasting crown restoration using high noble metals. Ideal for posterior teeth, it offers superior strength, biocompatibility, and durability compared to other materials. While it may not be the most aesthetic option, its clinical benefits make it a top choice for patients prioritizing functionality and longevity.

D2991 Dental Code: Restoration of a Crown with High Noble Metal