High
tech is all the rage and it does affect dentistry. If it weren’t for computers, iPhones, tablets
and the internet, where would we all be? Some love it, and others hate it.
I assume the difference is whether your “toys” are working or not. But these are really more than “toys,” they
have become part of our everyday life. The one thing I have learned over the
years however is that there is a place for technology, and other places where
the old tried and true methods work better. For example when my kids were
little and they got a new hand held calculators that were available at the
time, they thought that they were great. But I would constantly drive them
crazy by doing mathematics calculations on my old slide rule faster than they
could push the buttons on their calculators. Now to be honest, I have not used
my old K + E Log Log Duplex slide rule for some years as I have learned to use
computers just as they did. But I believe the concepts of old versus new is
still valid. Now what does that have to do with dentistry? I am sure you have
heard advertisements for a new process in which they can do crowns (caps) in
one visit. It utilizes digital scanners, that we already use (Itero), with a
milling machine attached These offices can mill a new crown out of a solid "block" on the spot without having to
send the impression off to a laboratory. This means not having to deal with temporary crowns and need to return in a few
weeks for a second appointment. Sounds great doesn’t it? But as always there must be a catch, and indeed
there is. You can only mill certain materials and today those materials fall
into two categories. The first one is one of the new “super composites” which are basically
hardened plastic tooth colored filling material. The second material is a new
ceramic material called E-max, which does look great, but is not nearly as
durable as many of the other materials that we have used for years. Therefore,
especially on the molars, you are risking cohesive failure of the material in a single visit crown just
for the convenience of avoiding a temporary crown. I don’t know how you feel
about it, but I don’t like Novocaine shots that much. So redoing a new crown because
it broke is not my idea of fun. Therefore, although we use the latest technology
for scanning images for crowns, until the manufacturers develop new "blocks"
with a wider range of restorative materials, in my opinion milling a crown on
site is not the best option for the vast majority of our patients, especially on
their molars, which take a tremendous amount of force and are prone to mechanical failure. I will watch for continued improvements however and will jump on the band wagon if possible.
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