Same Day Crowns in Prescott Arizona

Since moving my practice to Prescott from Rancho Mirage, California, I have discovered that there are many more dentists providing same day crowns here in Arizona than there were in my California community.

Same day crowns involve scanning your prepared tooth, in your mouth, then transferring that scan information to a computer which then controls a milling machine as it cuts the porcelain to the appropriate shape. Laboratory crowns involve an impression of your prepared tooth (although a scan could be sent to the laboratory, as well). The impression is sent to the laboratory that then makes a model of your tooth. A laboratory technician then designs the crown from the various materials available.

Before getting into what I do and why, take a look at this list of advantages and disadvantages of same day crowns (such as Cerec) and laboratory designed crowns.

Same Day Crown

Laboratory Crown

Your tooth will be scanned in your mouth. No temporary necessary. You wait several hours until the dentist or his trained assistant designs the crown.

An impression is necessary. You will wear a temporary crown for 1-3 weeks. The impression will be used by the laboratory to make a model of your teeth. Then the crown will be designed from the appropriate ceramic materials.

Fit varies considerably with the skill of the operator. Various studies show significant differences between scanner and milling systems.

Fit varies considerably with the skill of the operators.

Colors and opacity are limited to two basic materials (zirconium and lithium dislocate) of porcelain blocks that are available and stocked by the dentist. If the dentist has a porcelain oven, the crown may be stained on the surface.

A wide variety of ceramic materials and custom colors and opacities is available. Most materials can be colored internally as well as on the surface.

There is a large initial investment in the scanner and milling machine and software. This is amortized over time by the dentist. If technology changes, the dentist must invest again or use outdated technology.

Dentists have additional expenses of materials, especially impression materials. Laboratories serving a significant number of dentists are better able to invest in new technologies as they arrive.

The average cost per crown is lower until you count the dentist’s time involved in producing the crown.

The average cost to produce a crown is higher until you count the dentist’s time not used in producing the crown.

The fit of a crown milled in the office cannot be checked outside the mouth.

The fit of a custom designed crown or a crown milled based upon a model can be checked outside the mouth.

The dentist must devote a significant amount of time to learning to operate the design system for these crowns.

The laboratory technician is a full-time specialist in the materials used and design of crowns. A given laboratory may have multiple technicians that specialize in each material.

I make many of my treatment decisions based on what I have seen over many years of dental practice. So, no matter what a scientific study shows, when I have witnessed more poor fitting “same day crowns” than custom fitted crowns, that sways the way I practice. My belief is that (with some exceptions) there are some dental offices motivated by cost savings and that those offices do not demand the high standards of other offices. With that said, I do have my laboratory apply milling procedures on some crowns. These are mostly implant crowns that are fitted to a pre-made part called an implant abutment. At any rate, they can be checked for fit with the model.

Because of the limited colors and opacities of blocks of materials available for same day crowns, it is very difficult to match a front tooth with all of its various colors. To make up for this, these crowns are sometimes stained on the surface. Real teeth do not have these surface stain, but have internal colorations. These colorations are best matched by a technician who can build a tooth in layers. Where color is not a consideration, such as on the back molars, then same day crowns are more acceptable.

Two reasons given for doing same day crowns are convenience and not having to wear a temporary. Unless you are in town for just a few days, it is not that convenient to sit around half a day, then have to get numb again to place your same day crown. Also, many dentists or their assistants do not make very nice temporaries. This is an area that I take pride in. In fact, many patients claim that they would be happy just wearing the temporary. Of course, we don’t allow that!

If a dentist uses same day crowns it may be that he or she has been convinced of cost savings or marketing potential. These are not reasons I would want as a patient for the material choices that go in my mouth. Rather, I would want long term service and wonderful color matching. That does not mean all dentists who take impressions end up with perfect results. There is a huge difference in the quality and cost of crowns put out by different laboratories. That is the subject for a later article.

RS

Author
Rob Strain DDS