Dr. Sam, Angela DDS, Nebula D: would you recommend going to offices that offer "1 hour crowns"?

emmalue has given an excellent answer, to which I will (of course) add some thoughts. First of all, I do not do CEREC. In the early days, it was not that great. Today, I think it is a fine restorative service, but as I am over 50, I do not think it makes sense for me to put $100,000 into the equipment. I'd have to double my crown fee to even think about paying for this. I think I'd really enjoy doing CEREC crowns, but I just can't pony up that kind of money.





CEREC seems like a great thing if several conditions exist. It requires a very specific preparation and not all teeth lend themselves to a proper preparation for CEREC. Or any number of other all-porcelain restorations, for that matter. CEREC also somes in a monochramatic block of porcelain. It can be superficially stained to give it some of the characteristics of tooth shading, which varies from the gums to the biting edge. To me, this limits its application to the back teeth. Personally, even if the surface staining was exquisite, I would not want a crown on a front tooth where the shade would be subject to wear and abrasion. Maybe emmalue will add to her answer to tell me that these concerns are unfounded, but CEREC recognized this problem and introduced a new product that is actually finished in the dental lab to address the issue. This defeated much of the idea behind the "one hour" crown, though.





I am assuming that the one hour crown advertised is a CEREC. ANYONE can make an acrylic or stainless steel crown in an hour, so just be sure it is indeed CEREC.





My summary: CEREC is a fine restoration when it is properly applied by a qualified dentist. I would accept one in my own mouth. I would have concerns about placing one on the "front six" in the upper arch, due to esthetic limitations. Ask your dentist how he deals with that.

Dr. Sam, Angela DDS, Nebula D: would you recommend going to offices that offer "1 hour crowns"?
I hope you don't mind if I answer this, since I am not a dentist.





I worked in an office that offered crowns manufactured on-site by CEREC which is a brand name of a CAD/CAM process.





It works like this: First, a three-dimensional picture is taken of the existing tooth. Then, the tooth is prepared the way any crown is - by removing decay and making a nice, clean prep. Another picture of the prepared tooth is taken. Both images are fed into a computer which contains a vast database of teeth.





The before and after pictures are compared with the database and the dentist then begins to design the crown to fit the patient's mouth. The design process can be done by a trained assistant (I even did a few just for practice), and then the doctor checks it out. Contact, occlusion, anatomy can all be seen in 3-D before the tooth is sent to a milling unit which does the actual manufacture.





In the milling unit, a porcelain block is inserted and the machine begins grinding away according to the specifications fed to it by the computer design program. It takes about 20 minutes to mill.





After the finished crown is removed, a polish is applied and the restoration is fitted to the patient's prepared tooth.





A well-trained dentist can do the prep and design quickly and the finished product is beautiful! Fit is perfect and the patient does not have to endure an impression, two weeks with a temporary, or a second "seat" appointment.





IF the dentist is qualified on the equipment, it can be great. The dentist can send the claim in immediately and get paid sooner, no time wasted at a non-productive delivery appointment...everybody wins.





The equipment is very expensive - around $100K when all is said and done. The individual blocks are around $35 each compared to a lab fee of $100 to $200 per crown, so you can see it would take some time to get a return on the investment.





I'll be interested to see what the dentists have to say about "1 hour crowns." From an office manager's perspective, I loved it. I do realize this technology is not for every doctor due to price and learning curve.





Edited to add: Dr. Sam's concerns are valid. There are a few dentists who use CEREC for anterior restorations, but they are in the minority. The newer versions are more user friendly, but they still depend on the provider's willingness to accept the technology. I agree that it makes more sense to a younger practice who will see the ROI over a period of years. My opinions reflect those of a front-office person whose job is made easier by this type of restoration. While I love technology, I'm not one to embrace any "new-fangled" thing that comes along. Somebody has to convince me it will make my job (or someone else's) easier.





Second edit: the price of doing a crown should not increase. The savings in lab fees and the second visit should offset the initial investment in equipment. Keep in mind, as Dr. Sam says, not all teeth can be done this way. You can't fire your lab just yet. I know some practices who have lowered their fees since doing CEREC, but many do not.
Reply:i'm a dental assistant and we use the CEREC technology in our office. Our patients love it. The procedure usualy takes over an hour but either way, its still a single visit. We're not comfortable with doing huge cosmetic cases in the anterior of the mouth as the shades of porcelain offered aren't great shades for front teeth. All of our other restorations looks great as we are able to stain and glaze the porcelain in our furnace. We also use the CEREC to do inlays and onlays to replace large silver fillings. Patients also love watching us design the restorations that we'll be putting in their mouth. They're just as good as any other crown you recieve from a lab, if not better since the dentist can control the contours and overall design of the restoration.