Thursday, April 9, 2015


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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