What is Cerec technology and how does it benefit me?

There are only a few choices to make when we restore teeth: we can use the silver mercury fillings, the white plastics, gold, or ceramics.  The silver mercury restorations are not being done in this office anymore.  Though they supposedly lasted quite a long time, 10-15 years, the material tends to expand and shrink with temperature changes in the mouth.  This thermal cycling most often fractures the supporting tooth structure and leads to eventual catastrophic failure and tooth breakage.  Often times, the damage to a tooth under the silver filling has to be quite extensive before the evidence shows up on an x-ray.  Clinically we look for wear and color change as indicators that the mercury filling is going bad, but often times the damage has already been done.  Thats why Dr. Holtery believes that these reported mercury filling lifetime averages of 10 to 15 years are misleading, and that they actually begin to fail much earlier, but the visual evidence is not there for the dentist to detect it.

The white plastic restoratons are the fillings most dentists are now using.  However, these restorations have a limited lifetime of about 7 years.  As the depth and width of these  fillings increases, the chances of these fillings going bad increases proportionately.  We can detect the failure on these much easier because x-ray beams can penetrate these restorations, unlike the big mercury ones.  Also clinically, when decay sets in, the color changes are higly contrasting and much easier to detect.  

So what did we do in the past, and most dentists currently doing?  When the cavity or damage in the tooth is much too large, we would crown the tooth, or grind the tooth down 360 degrees into a shortened 'stump' and place the crown over the tooth to restore everything properly.  The materials we would use would be porcelain, gold,  or a metal substructure covered with porcelain: commonly known as a crown or cap. 

With the new CEREC technology in our office we can eliminate most crowns from our treatment considerations.  The above picture illustrates the concept.  The 2nd molar above looks fine initiallly. Theres a small dark spot on the top of the tooth, it doesn't hurt and is not sensitive, and the patient is unaware of the damage taking place.  Lack of pain is never an indicator of the presence of disease: heart disease doesnt hurt until the heart attack occurs, cancer does not hurt until it typically has progressed into its more advanced stages.  Most cavities do not hurt or give any sign of their presence.  When we prepare the tooth and remove the decay and destroyed enamel we are left with quite a large hole. This tooth almost needs a root canal!  Most dentists would have shaved down the rest of the enamel and capped the tooth or placed a plastic filling that would be doomed for early failure.  We use our CEREC technology to scan the tooth into the computer and design the missing ceramic piece, this design is then sent to the computer milling machine and the missing piece to the puzzle is cut out of a ceramic block.  This inlay/onlay is then cemented into placed the same day with no need for temporaries and a second visit, and the tooth has been saved without overpreparing it for a full crown. 

Most dentists can do these onlays/ inlays, but they involve a 2 week wait for the laboratory to make the ceramic piece.  The issues with a two week wait can be patient sensitivity, lost temporaries, and more chair time to cement the lab made onlay.  These possibilities make many doctors choose the crown for these 'middle ground' teeth to eliminate the complications and inconveniences for both doctor and patient. 

Not all crowns can be done in one visit and the circumstances vary from patient to patient, but we have been able to raise the standard of care to another level! Lets look at the biological considerations of same day CEREC's.

Think of dentistry and fillings as minor surgery.  We are in fact cutting open human tissue, removing disease, and then closing the open wound, just like a surgeon does.  When we create this open wound and then place a temporary crown on the tooth we invite the possibility for postoperative infection.  Just like infection is bad after surgery, infection while in the temporary can lead to hyper tooth sensitivity, and pulp death.  The treatment for this is root canal therapy!  What we have found is that when we have the tooth properly sealed with a final restoration the same day, the bacteria from our mouths have little to no chance to contaminate this wound.  When we sterilze and keep the tooth dry during your procedure, we are eliminating bacterial contamination of dentin and have found that the incidence of root canal therapy after treatment  has decreased dramatically! 

Without a doubt the CEREC restoration has provided our office with a new standard of care and we will continue to invest in these technologies as they help us elevate the quality and convenience for our patients!