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Same Day Onlays Crowns

  • At SofTouch Dental you can receive a ceramic crown, overlay, onlay, and/or veneer in a single visit. This is made possible by our Cerec. Cerec is type of CAD-CAM system. CAD-CAM has been around in dentistry for a few decades now, and has gotten better every year. The traditional way of receiving a permanent ceramic restoration takes two visits. At the first visit, the damage to the tooth is removed and the tooth is prepared and finalized for the type of restoration it will receive: at our practice they are minimally invasive partial coverage restorations such as overlays, onlays, and veneers – the only time we typically do crowns is when we are replacing them.
What Is Biomimetic Dentistry?
  • Once the tooth has been finalized and prepared an impression would be take. This would involve using a wet-‘goopy’ material in an impression tray placed in the mouth over the prepared tooth. Once set, this impression is taken out of the mouth and sent to the dental laboratory. Meanwhile, a temporary restoration would be placed in the patients mouth until the restoration was completed at the lab and sent back to the office. This often takes 2-3 weeks. The patient would then come back, have the temporary removed and the final restoration placed.
  • With the Cerec system, there is no wet impression or temporary and patients can receive their permanent ceramic restoration same day. After preparing and finalizing the tooth an optical impression is taken with a scanner. A scanner is essentially a video camera that reproduces a highly accurate 3-D model on a computer. Instead of being sent to the lab, the dentist designs the permanent restoration chair side. Once the design is finished, it is sent to a “mill” in another part of the office. The mill acts similarly to a CNC machine. It grinds out the restoration design from a solid block of ceramic. The ceramic block is often not in the final hardest state so that it is easier to grind/carve the ceramic into the desired shape. When the mill is finished, the restoration is glazed and characterized, much like pottery, and then put in a high temperature oven to glaze and harden the ceramic. After the firing, the restoration is cooled and processed for delivery to the patients mouth. Since the process is accomplished in the office in the same visit a temporary is not required.

1

There are a lot of advantages to doing this type of dentistry in a single visit. The dentist has more direct control over the process and any unforeseen errors can be addressed right away and corrected. By becoming their own lab, the dentist must analyze the digital model as if they were the lab, any issues in the margin, missing data, improper room for material thickness, etc. can all be addressed with the patient still in the chair and re-scanned if necessary. One of the worst appointments in dentistry is for a patient to come back weeks later, get numb again, and then find out the restoration does not fit – a new impression will need to be taken and even more time to wait for a permanent restoration. Not only is this minimized because the dentist is taking on the role of the lab while the patient is still in the chair, but if errors in fabrication do occur, the restoration can be remade during that visit if the patient has the time. The most obvious advantage is that there is no second visit and the patient does not have to wear a temporary – which often break while waiting for their permanent restoration.

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A disadvantage is that these appointments can be long. A visit with a Biomimetic Dentist is already longer due the increased time setting up proper isolation and the advanced adhesive techniques they utilize. Instead of receiving a temporary and leaving, the patient has to wait for the ceramic to be designed and fabricated. Depending on the material used and difficulty of the case this can take an additional 30-90 minutes. While this is down time for the patient where they can watch TV or use their mobile phone as opposed to being directly worked on, it still can feel like a lot of time “in the chair”. After fabrication, a new appointment – the delivery appointment – is essentially started. Following Biomimetic & Advanced Adhesive delivery protocols this appointment can take anywhere from 30-60 minutes for a quality result. In short, the extra time for fabrication and delivery can be around 1.5-2 hours in addition to the time required to prepare the tooth. For some patients, a single visit of 2.5-4 hours is worse than two visits breaking up that time in the chair. At our practice we like to give the patient the option for Same Day Delivery or Multiple Visits, which ever makes them the most comfortable. What we don’t want to do is rush on the back end and wind up with a sub-par result after all that work on the front end.’