52
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cerecdoctors.com
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quarter 4
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2012
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d i s c u s s i o n f o r m
Thomas Kauffman
The reality is that none of us can really present
hard data that can verify significant differences in
clinical success of milled ceramics with a thin, tooth-rough-
ened interface (dentin to ceramic/silanated surface) when
compared against a smooth resin surface (liner thin or base
thick) with dentin-resin-ceramic/silanated surface.
I am somewhat a captive to 38 years of being trained to
Marc Kaufman | Jefferson Valley, N.Y.
Anyone milling posts with their CERECs?
Alex Botvinnik | Des Plaines, Illi.
In response to BaronGrutter:
Have you ever looked
at your process from your patients’ perspective?
Bradley Sutton | Pocatello, Idaho
I’m with Tom and Michael in that I don’t feel the
necessity or the benefit of rebuilding something
in resin that I am getting ready to rebuild as functionally, if not
better, in porcelain. With regards to Brent’s opinion that non-
built-up preps are “sh—y” looking, I would challenge him to
look at some of the wonderfully smooth and flowing preps on
Brent R. Browning
In response to Bradley Sutton:
Took the challenge,
looked again....still look sh—y! Sorry, but preps
with artistry looks healthier and, to me, ARE healthier!
Michael Scoles
Brent, physics doesn’t support your statement. If
you leave the axial walls slightly irregular (like the
old MO amalgam that came out) and not fill it in, you get more
mechanical retention. If the top of the prephas a few lumps and
bumps, onemore place to resist bucco/lingual displacement.
How many times have we done build-up then, when our
prep is complete, there is zero b/u material on the top, and
just a sliver on the interproximal axial walls?Was that a good
service to the patient? This is why I rarely do them. IMO,
they don’t do anything to help my patient.
and which material choices are appropriate. He discussed
the differences of liners versus build-ups, and the appropri-
ateness of fees for each of these. Years ago, the typical pre-
full coverage crown technique was to use either cemented
or friction-retained ss or titanium pins with either amalgam
or composite core materials followed by full-coverage tooth
preparation for full gold or ceramometal restorations. At that
point, we had basically zinc phosphate cement, and were
beginning to see the new generation of glass ionomer and
polycarboxylate cements.
Fast forward to current materials and techniques of partial
and full-tooth etching, along with the current resin cements
that do not rely on traditional box mortise/bevels/grooves/
retention, and resistance tooth preparation guidelines for
success.
Today, I rarely feel the need to use an increased bulk of
material for strength or retention when restoring a vital tooth,
and do not report or charge for a procedure not necessary or
performed. I really cannot remember a proposal where the
presented plan for review included a liner or build-up, anterior
or posterior tooth. That leads me to conclude that most of us,
with the accuracy of milled ceramics, feel the need for strength
or retentive purposes to add additional layers of “liners/bases”
between the dentin and restoration. Such an approach would
on the surface appear to only weaken the dentin/restorative
bond strength. If that is an accurate statement, then the addi-
tion of a thicker material interface would be unnecessary.
To alter the insurance reporting component of procedures
of treatment based on the particular insurance carrier’s
particular reimbursement, or to provide additional proce-
dures performed and billable in one instance, and not in
another, is at the very least quite concerning and, in a worst-
case scenario, fraudulent and professionallymost dangerous.
the pre-op/post-op thread and still say the same. Are we doing
dentistry so that the patient is happier withwhat the tooth looks
likeunder thecrown, or arewedoingdentistry so that, in theend,
the patient has a better outcome? I understand that sometimes a
traditional build-up isnecessary, andIwouldbe right there in the
front toargue that not placingonewouldbe irresponsibleat least,
but to do a treatment on a tooth simply so that it looks prettier to
us beforewecompletelycover saidbuild-up isprettycrummy for
the patient. And there it is—another personal opinion thatwon’t
change a single thing about anything. As Brent stated, “That’s
what makes the world go ’round.” We all have differences of
doing the same things. Baron, in the end, I think the best way for
you todo it is theway thatmostmakes you feel like you are doing
your very, very best for your patients.