Some patients want more than a standard white smile. Keith, 34 from Britain, arrived at International Plus asking for gold dental crowns on his canines, a signature look he had wanted for years. This case study documents how our restorative team honored that request while treating hidden biological problems, then blended custom gold on two canines with 24 zirconia crowns into one natural, functional smile. Since 2014, International Plus has treated more than 200,000 patients from over 140 countries and Keith’s case shows how a cosmetic wish becomes a health-first rebuild.
Key Takeaways
- The challenge: Keith requested gold on canines 13 and 23 but the examination revealed worn old fillings, gum asymmetry and teeth needing root canal treatment.
- The solution: A staged rebuild: gingivectomy on 11 and 21, new core build-ups, root canals, then 24 zirconia crowns plus custom gold dental crowns on the canines.
- Technical highlights: 24 zirconia crowns in shade 0M3 and a Plus 5 tooth form with gold restorations on 13 and 23 matched in shade, form and occlusion.
- The outcome: Gold and zirconia read as one design; Keith kept the signature gold look on a healthy, functional foundation.
Keith’s Story: A Request for Gold
Keith, 34 from Britain, came to International Plus with one clear request: gold restorations on the upper canines. Gold is a durable and biocompatible metal used in dentistry for over 2,000 years because the material is gentle on opposing teeth. Keith wanted gold on teeth 13 and 23 as a personal signature in the spirit of our golden smile design work, not a full mouth gold set. During the first consultation, our team listened to the aesthetic goal and then examined the whole mouth. The examination changed everything. Behind the cosmetic request, our restorative team found worn old fillings and several teeth needing treatment before crown work. Gold restorations remain a documented option in modern prosthodontics, noted in a 2017 Cochrane review (Poggio et al., 2017). Keith arrived expecting a quick cosmetic case and learned the smile needed a health-first rebuild. For such a specific request, our Diagnostic Council reviewed the records before approving a combined gold and zirconia design.
Diagnosis: Hidden Problems Behind a Cosmetic Request
A dental examination is a structured check of teeth, gums and bite, not just tooth color. For Keith, our team took radiographs and a full intraoral assessment before touching the smile. The findings were clear: worn old fillings on lower molars 36 and 46, uneven gum levels on upper incisors 11 and 21 and teeth needing root canal treatment. A cosmetic request had turned into a restorative plan, the same health-first order behind our multidisciplinary rehabilitation cases. Old, worn fillings leak over time and undermine any crown placed on top so replacement came first. Gum asymmetry on teeth 11 and 21 would spoil even a perfect crown so a gingivectomy was planned to level the contour. Comprehensive diagnosis before aesthetic work reflects standard restorative practice, described in a 2022 review in Dental Clinics of North America (Sabbah et al., 2022). In our practice, we treat biology before beauty because a crown is only as sound as the tooth beneath.
Why Combine Gold Dental Crowns With Zirconia?
Gold dental crowns are cast restorations made from gold alloy, valued for strength and a precise marginal fit. Combining gold dental crowns with zirconia in one smile is a technical challenge because the two materials differ in color and translucency. For Keith, our restorative team placed custom gold on canines 13 and 23 and high strength multilayer zirconia on the remaining teeth, the ceramic used across our full mouth zirconia crown cases. Gold alloy and metal-ceramic crowns show excellent long term survival, confirmed in a 2015 systematic review in Dental Materials (Sailer et al., 2015). Gold suits patients who want durability and a signature look but gold does not copy a natural tooth shade, which is why zirconia covers the visible smile zone. The restorative team matched every gold surface to the zirconia in form and occlusion so the two materials read as one design through digital smile design rather than two separate treatments.
Treatment: Gingivectomy, Root Canals and 24 Zirconia Crowns
Treatment followed a strict order so each stage supported the next. First, a gingivectomy on teeth 11 and 21 leveled the gum line for a symmetric frame; gingivectomy is the precise removal of excess gum tissue. Second, the worn old fillings on molars 36 and 46 were removed and rebuilt with new core build-ups. Third, root canal treatment was completed on teeth 11, 21, 36 and 46 to remove damaged pulp. Finally, the restorative team fitted 24 zirconia crowns in shade 0M3 and a Plus 5 tooth form, plus custom gold on canines 13 and 23. Root-filled teeth restored with full crowns show improved survival per a 2021 review in the International Endodontic Journal (Bhuva et al., 2021). Esthetic gingivectomy is well documented, including a 2024 report in Cureus (Qali et al., 2024). In the Istanbul case, our team sequenced every step before a single crown was cemented.
| Stage | Procedure | Teeth involved |
| 1 | Gingivectomy for symmetric gum contour | Upper 11, 21 |
| 2 | Old filling removal and new core build-ups | Lower 36, 46 |
| 3 | Root canal treatment | 11, 21, 36, 46 |
| 4 | 24 zirconia crowns, shade 0M3, Plus 5 form | Both jaws |
| 5 | Custom gold restorations, shade and occlusion matched | Canines 13, 23 |
The Result: One Natural Smile in Gold and Zirconia
Keith finished treatment with a single, natural smile blending gold and zirconia. The 24 zirconia crowns in shade 0M3 restored the visible teeth while the custom gold on canines 13 and 23 gave Keith the signature look requested at the first visit. Function and occlusion were verified so the gold and zirconia meet evenly during chewing. Monolithic zirconia crowns show high survival in tooth-supported cases, confirmed by a 2022 meta-analysis in the Journal of Prosthodontic Research (Leitão et al., 2022). The real success was biological: hidden problems were solved before the aesthetic finish so the gold dental crowns rest on a healthy foundation. Patients can compare outcomes in our digital smile gallery and our Turkey teeth guide. As with every case International Plus publishes, individual results may vary and only a personalized consultation can determine the right plan. Keith’s smile reflects a system backed by Ministry of Health authorization and 5,504 verified Google reviews at 4.8 out of 5.
Frequently Asked Questions
What are gold dental crowns made of?
Gold dental crowns are cast from gold alloy, a mix of gold with metals such as palladium and silver for added strength. The alloy is durable, biocompatible and gentle on opposing teeth. Gold crowns are often chosen for back teeth or as in Keith’s case as a signature aesthetic feature on the canines.
Can gold and zirconia crowns be combined in one smile?
Gold and zirconia crowns can be combined when each restoration is matched in shade, form and occlusion. In Keith’s case, custom gold sat on canines 13 and 23 while zirconia covered the visible smile zone. Careful digital planning lets the two materials meet evenly during chewing and read as one coherent design.
Why was a gingivectomy needed before the crowns?
A gingivectomy removes excess or uneven gum tissue to create a symmetric frame for the teeth. Keith had uneven gum levels on upper incisors 11 and 21, which would have unbalanced even perfect crowns. Leveling the gum line first meant the final zirconia crowns sat in proportion and looked natural.
Do gold dental crowns look natural?
Gold dental crowns do not copy a natural tooth shade so they are chosen for durability or as a deliberate signature look rather than to blend in. In Keith’s smile, gold was placed only on the canines by request while zirconia in shade 0M3 restored the visible teeth for a natural overall appearance.
How many crowns did Keith’s smile use?
Keith’s smile used 24 zirconia crowns in shade 0M3 with a Plus 5 tooth form, plus two custom gold restorations on canines 13 and 23. The number reflects full coverage of both jaws. The exact count in any case depends on how many natural teeth are present and need restoration.
Reviewed by Dr. Abdurrahim Ulu
References
- Poggio CE, et al. Metal-free materials for fixed prosthodontic restorations. Cochrane Database Syst Rev. 2017. PMC6486204
- Sabbah A, et al. Smile Analysis: Diagnosis and Treatment Planning. Dent Clin North Am. 2022. PMID 35738730
- Sailer I, et al. All ceramic or metal-ceramic tooth-supported fixed dental prostheses: survival and complication rates. Dent Mater. 2015. PMID 25842099
- Bhuva B, et al. The restoration of root filled teeth: a review of the clinical literature. Int Endod J. 2021. PMID 33128279
- Qali M, et al. Gingivectomy for esthetic crown lengthening: a clinical report. Cureus. 2024. PMC11614317
- Leitão CIMB, et al. Clinical performance of monolithic CAD/CAM tooth-supported zirconia restorations: systematic review and meta-analysis. J Prosthodont Res. 2022. PMID 34615842
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This content is written, reviewed, and approved by the International Plus Medical Review Board to ensure clinical accuracy and adherence to strict editorial standards. All medical information is regularly monitored, audited and updated in light of the latest scientific advancements.
However the information provided here is for general informational purposes only and cannot be used for self diagnosis or making individual health interpretations. Results of medical treatments depend on individual anatomy and the unique healing process of each patient. This information should not replace a personal consultation with a qualified healthcare professional. To understand the best options for your specific needs and to receive a personalized treatment plan, we invite you to book a free consultation with the expert medical team at International Plus.
Dr. Alper Çağlayan Sarraf directs the oral surgery unit at InternationalPlus Istanbul, focusing on demanding cases that draw patients from every corner of the world.
