quarter 4
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2012
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cerecdoctors.com
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51
Michael Scoles | Issaquah, Wash.
In response to Baron Grutter:
Therein lies the rub
in being a healthcare provider. It’s a business,
but the business of making money can directly conflict with
ideal care for the patient. It does suck that we do not make as
much money. I might do BUs on 5 percent of my crowns. I’m
not gonna do a procedure that isn’t necessary anymore. We
still put the B/U on every tx plan, and every time I don’t do it,
I tell the patient I saved them$300 and they think I’m a hero.
Use it as a positive marketing tool: “Mrs. Smith, because of
this amazing technology, we don’t have to do the build-up
and we will save you money.” Mrs. Smith replies, “Gee doc,
you truly are amazing, I am going to tell all of my friends to
come see you.”
In response to Michael Ravens:
Respectfully
disagree. Can’t stand to look at naked preps! Love
the beautiful 3-D CEREC images with proper coronal domes
and slick shoulders. Crownlays yes, but with caoh and glass
ionomer base. I think it just makes for BETTERdentistry! The
color video and photos without BUs look plain sh*&^y! I’mnot
going to under-salemy professional high standards. But again,
that’s what makes the world go ’round, we’re all different!
Patrick O’Connor | Sligo, Ireland
When you say build-ups, do you mean like post
and core, and you are doing endo crowns instead?
What is meant by “build-up” in the USA?
Karl Schneck | Medford, Ore.
In response to Jeffrey Caso:
If I get my UCR crown
fee, then I might not charge the BU. But, if I take
a cut for a cheap insurance company, then I usually charge
for the BU.
Gordon also said POST build-ups after RCTwere best. I’ve
heard both sides before, always did post BUs myself, and it
was nice to hear Gordon confirm I’m doing the right thing.
Greg Keene | Lafayette, Colo.
I consider a build-up anything needed to make a
uniformly shaped prep. Whenever I put bonding
agent and flow-able composite on a tooth (for whatever
reason), it’s a build-up. I’m building up the tooth to allow for
a uniform crown.
Crownlay is a whole other thing. It’s hard to do a b/u on
these the way I prep them. I place an MOD box form in the
central groove area to allow the prep to index somewhere
when I seat it. These are crownswith no build-up orMODBL
onlays. Same fee for crown or for surface onlay in my office.
Michael Scoles
Karl, you are assuming that Gordon is correct.
Michael Ravens | Reading, Mass.
I do significantly less build-ups now with the
CEREC. I hated having to stop and do a build-up.
I save time and there probably is a small material savings. We
routinely tell the patient that the CEREC saves them from
the build-up and saves them $300.
I have also doubled the number of crowns I do, and that
is not because I treatment plan any differently. We have had
a huge response to same-day service. I never realized how
many people put off crowns due to multiple appointments/
temporaries. They always say it’s the money, but I think
subconsciously it was everything else.
As far as a build-up, I don’t see many positives. It makes
your porcelain thinner, takes time and increases the number
of variables for failure. You go: tooth, bonding agent, build-
up, bonding agent, resin cement, bonding agent, crown; or
you can go: tooth, bond, resin, bond, tooth. Simple and clean.
It does not aid in retention because a build-up is only as
strong as the dentin bond to it. Your retention comes from
prep height and/or enamel bonding.
Brent R. Browning | Houston
Thomas Kauffman | Atlanta
I remember a CD that Gordon Christensen
did several years ago discussing this topic. He
discussed vital and non-vital teeth, and the options available
for each. In the vital category, I have always been a little fuzzy
on what, exactly, the indications for vital restorations are
Kent Mosby | Coeur Dalene, Idaho
In response to Michael Scoles:
I do as Mike does.
Patients love it when I give them a break on the fee
afterweagreedon theprice. Youcan’t beat referrals fromthose
patients. It does not matter what your fee is. They “know” that
you are honest and not looking to make a car payment.