56
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cerecdoctors.com
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quarter 4
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2012
Michael Scoles
In response to Charles LoGiudice:
I couldn’t agree
more, Chuck!
Michael Scoles
I know that Lava crowns sucked because it was
critical to have an equal thickness of porcelain or
the porcelain would fracture off the coping. [I] hated those
things. I’m not sure e.max falls into the same group as feld-
spathic porcelain?
Baron Grutter
Lol, this topic has been great. I knew I’d be stir-
ring the bee hive, but didn’t expect this sort of
response. Good discussion. Now, I’ll explain a little better
how we operate with this respect.
My hygienists/DAs know that I want a BU tx planned
under the following circumstances:
Endo Tooth: I almost ALWAYS remove all previous fillings
and/or build-ups when treating a tooth, unless I personally
placed the previous restoration and feel extremely confident
that there should be no reason to question it. Therefore,
whether it’s a virgin tooth or a tooth that had an RCT a few
years ago, if I’m now crowning it, I’m going to do a BU.
Crown Replacement: As I tell my patients, I can’t see
through that metal crown on the X-ray. So, there’s no way to
know for certain what I might encounter. Therefore, we tx
plan a BU just in case I need it. (That’s not the way I word it
to my patients.)
Otherwise, myHyg/DAs will ask each time if the toothwill
need a BU. If I look at the X-ray and see an existing filling
very near the pulp or perhaps a tooth with an MOD and a
cusp that is completely undermined with decay, I will likely
tell them yes (maybe 40 percent of the time). Still, we prob-
ably only do/charge for BUs on these teeth 25 percent to
50
percent of the time. Most of the time, I have that same
discussion with my patient about how we didn’t have to do
that BU after all. Sometimes, I also throw in the note about
howusing the CERECmade it necessary. All in all, that prob-
ably only accounts for the 25 percent of my crowns.
I will say, though Dr. Chuck doesn’t like it, that I do think
there’s some sense to the “uniform thickness for easier
removal” concept. Fact is, I’m still at the very beginning of
my career. I sometimes think that with e.max, we are over-
engineering to a point that it might really come to bite us in
Michael Scoles
Baron, that’s the beauty of our profession, there are
15
ways to do each thing. We’ve all thought of this;
you titled it well. I charged twice as much for my build-ups
than a crown cost me at the lab; it does hurt the bottom line,
no doubt. But I think this technology has reduced a step, and
that is progress.
Philip Uffer | Maryland
I am definitely doing less build-ups; and, in fact,
have thought the same thoughts as the orig-
inal post: “I am getting $200 less because I am not doing
build-ups.”
I also let the patient know that this is actually savingmoney
because there is no build-up most of the time (as some other
posters pointed out).
I tell the patient that if there is a very large filling, I may
need to fill a portion of it (so I charge a filling fee instead of a
build-up fee if it is 1-3 surfaces).
Most of the time, when I get rid of all the restorative mate-
rial, that leaves just enough clearance (no room to add restor-
ative stuff!!).
So yes, I am doing build-ups much less.
(
If it had endo, I do a build-up).
the next 10-20 years — when people who got decay in the
first place come back to have things replaced. Maybe it’s not
such a bad idea to build in a manufactured escape hatch.
Particularly, if you’ve already got 2 mm of occlusal thick-
ness and 1 mm of axial, do you really need any MORE thick-
ness? Is having a BU underneath really going to hurt the
cause?
Anyway, I suppose I’ll just continue what I’mdoing. I don’t
feel like I’m ever doing a BU that I wouldn’t want done on
myself. Just wanted tomake sure I wasn’t missing something
obvious to everyone else.
One additional comment. My endo teeth always
get a composite core, with build-up if neces-
sary, to seal the pulp chamber and canals against the future
ingress of bacteria.
Charles LoGiudice
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