November 1, 2006
by Elliot Mechanic, DDS, BSc.
CROWNS MAKING A SEAL VS. CROWNS HELD BY RESIN?
The jury is still out. Only the test of time will tell. Will new technology outperform the old standard? Are the oldies still the goodies?
Today’s revolution in dental materials is driven by public demand. People want natural looking white teeth containing no metal. “Metal is bad”. Show me the proof!
Something tells me that for my mouth I would usually prefer a crown that binds and is difficult to remove, even before cementation to one that is passively floating and 100 percent dependent on resin bonding.
Technicians are working with CAD/CAM and microscopes obtaining extremely precise and accurate margins. However, will these crowns be in our patient’s mouths for as long a time as the 30 year old crown and bridge that we see on a daily basis in our offices? Rarely do crowns with minute inaccuracies fail as they are sealed with cement. They fail due to poor treatment planning, iatrogenic execution and poor oral hygiene on the patient’s part resulting in re-decay. Even the latest and greatest of new materials will not succeed if fundamental requirements of dentistry and home care are not respected.
We are living in the golden age of dentistry and much of the new technology is absolutely mind boggling. However, we must be careful not to jump aboard any ship too quickly. We must learn the materials available to us, when and where and whom to use them. Should we choose feldsphatic porcelain, pressed ceramics, zirconia, alumina, in-office CAD/CAM or are we better off using the porcelain fused to metal standard on this particular patient or in this particular area of the mouth? There are many factors to consider: occlusion, traumatic forces, oral hygiene, etc., etc., etc.
Once upon a time, I owned a part of a restaurant which was modeled on the Hard Rock Caf. My other partners were ecstatic when we hired an executive chef from New York’s famous Tavern on the Green restaurant, who had just moved to Montreal. He could flamb chateaubriand, make a glorious sabayon and decorate a table with extravagant ice sculptures. I wondered….. Could he make a hamburger?
Dr. Elliot Mechanic practices esthetic dentistry in Montreal, Canada. He received his Bachelor of Science (1975) and Doctor of Dental Surgery (1979) degrees from McGill University. Dr Mechanic is the Editorial Board member, Cosmetics, for Oral Health Journal.