After More Than 5,000 Same-Day Restorations, Here’s Where I Think CEREC Works Best
When patients find out that we can make a permanent dental crown in our Coral Gables office in a single visit, one of the first questions I usually get is some version of: “Is a same-day crown as good as one made by a dental lab?”
My answer is yes, in the right situation.
I started using CEREC in 2018, and since then I have completed more than 5,000 same-day restorations. I started with the CEREC Omnicam scanner and later transitioned to Primescan. Along the way, I completed the CDOCS restorative curriculum and extensive continuing education in restorative dentistry, occlusion and comprehensive treatment planning.
After that many cases, one of the most important things I have learned is that owning CEREC does not mean every restoration should be made with CEREC.
For certain cases, I think it is one of the best tools we have in modern restorative dentistry. In other situations, I would rather work with a talented laboratory technician.
Here is how I make that decision.
Where I Think CEREC Really Shines
My favorite use for CEREC same-day dentistry is a single posterior crown, meaning one of the premolars or molars in the back of the mouth.
These are cases we see regularly: a tooth with a very large old filling that has fractured, a cracked tooth that is becoming painful when chewing, decay underneath an existing restoration or a tooth that has lost enough structure that another filling is no longer a predictable solution.
When a dental crown is the appropriate treatment, CEREC allows us to prepare the tooth, digitally scan it, design the restoration and fabricate the final ceramic crown here in our office.
For a busy patient, that can make a meaningful difference.
Many of our patients work in Coral Gables, at the University of Miami, in Brickell or elsewhere around Miami. Others live nearby in Coconut Grove or South Miami. Taking time away from work or family for dental appointments is not always easy.
If I can provide the quality of restoration I am looking for without asking that patient to return for another appointment, I think that is a significant advantage.
But the convenience only matters if I am happy with the dentistry. Speed should never be the reason to compromise the result.
For One or Two Posterior Crowns, I Usually Prefer CEREC
After using the technology for years, one- and two-unit posterior cases are probably where I feel CEREC provides the best combination of efficiency, predictability and control.
I also like having control over the entire restorative process:
- I prepare the tooth.
- I scan the tooth.
- I design the restoration.
- I evaluate the contacts and bite.
- We mill the restoration in our office.
- I see the crown before it ever goes into the patient’s mouth.
If there is something I do not like, I can change it.
That does not mean a laboratory cannot make an excellent crown. Great dental technicians do incredible work. It simply means that for relatively straightforward posterior cases, I do not necessarily need to send the case somewhere else and bring the patient back another day to achieve the result I want.
The Technology Has Improved, but Experience Still Matters
I started with CEREC in 2018, and the technology has changed significantly since then. I have also changed as a dentist.
There is a learning curve to digital dentistry. Buying a scanner and milling machine does not automatically make someone good at CEREC dentistry, just as buying an expensive camera does not automatically make someone a good photographer.
You still need to understand tooth preparation, restorative materials, bonding, occlusion, contours, contacts and how the restoration fits into the patient’s entire bite.
I have completed the CDOCS restorative curriculum as well as Spear core curriculum workshops in occlusion, worn dentition, anterior restorative dentistry, full-mouth restorative dentistry and facially generated treatment planning.
That education affects how I use CEREC just as much as the technology itself.
The computer can help me design a crown. It cannot decide whether that crown is the correct treatment for the patient in the first place.
Sometimes the Best CEREC Crown Is No Crown at All
This may be the most important point.
Just because I can make a crown in one visit does not mean a tooth needs a crown.
I practice fairly conservatively. If a tooth has a relatively small area of damage and the remaining tooth structure is strong, I would rather preserve that healthy tooth structure and restore it with a filling when appropriate.
As the amount of damaged or restored tooth structure becomes larger, particularly when a substantial portion of the tooth is compromised, I become more concerned about fracture. Cracks can also change the equation significantly.
There is not a magic percentage that determines treatment for every tooth. The location of the damage, the patient’s bite, existing restorations, cracks and many other factors matter.
That is why I do not believe the first question should be, “Can we make a CEREC crown?”
The first question should be, “Does this tooth actually need a crown?”
Only after answering that question do I decide how I want the crown made.
When Would I Choose a Dental Laboratory Instead?
We have the ability to fabricate restorations in our office, but there are situations where I specifically choose not to.
The biggest example is a complex cosmetic case involving multiple front teeth.
Matching a single front tooth can be one of the hardest things we do in restorative dentistry. When several anterior teeth are being restored, or when we are making significant changes to someone’s smile, I may want a specialized dental laboratory technician involved.
A talented ceramist works with dental ceramics every day and can concentrate on subtle details involving translucency, surface texture, characterization, tooth position and how several restorations work together across a smile.
If I believe involving that technician will produce a better result for a particular patient, that is what I am going to recommend.
Having CEREC gives me another option. It does not obligate me to use it.
Front Teeth Are Different
I have used CEREC successfully for anterior teeth, including situations where a patient has broken a front tooth and needs it restored quickly.
But anterior dentistry requires a different level of aesthetic consideration.
Your back molars need to look good, but nobody is studying the translucency of your second molar when you smile. Your two front teeth are a different story.
Small differences in shape, length, color, surface texture and translucency can be noticeable.
That means the decision between an in-office CEREC restoration and a laboratory restoration is not simply about which technology is “better.” It depends on the tooth, how many teeth we are treating, what the neighboring teeth look like and what we are trying to accomplish.
For larger cosmetic cases, we may also use tools such as digital smile design to help plan the overall result.
What About a Dental Emergency?
This is another area where having CEREC in the office can be extremely helpful.
We regularly hear from patients who have broken a tooth unexpectedly. We make every effort to see dental emergencies promptly so we can evaluate the problem and determine what needs to be done.
Sometimes that patient has an important meeting coming up. Sometimes they are traveling. Sometimes they simply do not want to spend the next couple of weeks worrying about a broken tooth.
When the tooth is restorable and a crown is the appropriate treatment, there are situations where we can evaluate the problem and provide the final restoration that same day.
There are also situations where I intentionally slow things down.
For example, I can perform root canal therapy, build up the tooth and make a CEREC crown during the same visit when appropriate. But if a patient came in with significant symptoms, I may prefer to give the tooth some time and make sure those symptoms are resolving before the patient makes the investment in the final crown.
Could I make the crown that day? Sometimes, yes.
Do I always think I should? No.
That distinction is a good example of my overall philosophy toward dental technology.
Same-Day Dentistry Should Be About More Than Being Fast
I was born and raised in Miami and have spent most of my life around Coral Gables, Coconut Grove and South Miami. One of the things I enjoy about practicing in Coral Gables is how many of our patients are trying to fit dental care into already busy schedules.
Our office is surrounded by businesses and neighborhoods, and we regularly see patients who work at the University of Miami, in Coral Gables and in Brickell. Coconut Grove and South Miami are also nearby.
For those patients, eliminating an unnecessary second dental appointment has real value.
But I have never wanted Minorca Smiles to become an office where efficiency means rushing.
We do not double-book our doctor schedule. I typically work from one treatment column while one hygienist sees patients in hygiene, and I still personally see our hygiene patients when they are here. We make a point of staying on schedule.
CEREC fits well with that philosophy.
The goal is not to see more patients. It is to accomplish more for the patient during the time they have already set aside to be here.
What 5,000+ Restorations Have Taught Me
If I had to summarize what I have learned since starting with CEREC in 2018, it would be this:
Technology is most valuable when you stop being impressed by the technology itself and start understanding exactly when to use it.
- For a single damaged molar, CEREC is often my first choice.
- For one or two posterior crowns, I use it routinely.
- For certain emergencies, it can turn what traditionally required multiple appointments into a much simpler experience.
- For complex cosmetic rehabilitation involving multiple front teeth, I may intentionally choose a specialized laboratory technician.
- Sometimes, after examining the tooth, my recommendation is that the patient does not need a crown at all.
That is the benefit of having different options available.
The objective is not to find a reason to use the machine. The objective is to choose the treatment and workflow that I believe gives that particular patient the best result.
Frequently Asked Questions About CEREC Same-Day Crowns
Are Same-Day Crowns as Good as Lab-Made Crowns?
They can be. For the right case, particularly one or two posterior teeth, I routinely use CEREC because it allows me to control the preparation, digital scan, design, contacts, bite and final restoration in our office. For more complex cosmetic cases involving multiple front teeth, I may recommend working with a specialized dental laboratory instead.
Can I Get a Permanent Crown in One Visit?
In many appropriate cases, yes. CEREC allows us to digitally scan the prepared tooth, design the restoration and mill the ceramic crown in our Coral Gables office. Whether a same-day crown is appropriate depends on the condition of the tooth and the type of restoration needed.
Is CEREC Good for Front Teeth?
CEREC can be used successfully for front teeth, but anterior dentistry requires additional aesthetic considerations. Color, shape, translucency, surface texture and the appearance of neighboring teeth all influence whether I recommend an in-office restoration or laboratory fabrication.
Can a Root Canal and Crown Be Completed on the Same Day?
It can be done in appropriate situations. However, if a patient comes in with significant symptoms, I may prefer to allow some time after root canal treatment to make sure those symptoms are resolving before placing the final crown.
How Long Does a CEREC Crown Last?
There is not one lifespan that applies to every crown. Long-term success depends on factors such as the condition of the underlying tooth, the patient’s bite, restorative material, oral hygiene, grinding or clenching and how the restoration is designed and placed.
How Much Does a Same-Day Crown Cost?
The cost depends on the tooth and the treatment required. The first step is determining whether the tooth actually needs a crown and whether a same-day CEREC restoration is appropriate. After evaluating the tooth, our team can explain the recommended treatment and associated costs.
Considering a Same-Day Crown in Coral Gables?
If you have a broken, cracked or heavily restored tooth, the first step is determining how much healthy tooth remains and what treatment will best protect it.
At Minorca Smiles in Coral Gables, Dr. Raymond del Castillo has used CEREC technology since 2018 and has completed more than 5,000 same-day restorations. Our office is also convenient for patients coming from Coconut Grove, South Miami, the University of Miami, Brickell and surrounding Miami communities.
If a crown is appropriate, we will explain whether we recommend making it with CEREC in our office or using a dental laboratory, and why.
To schedule an evaluation, call 305-443-4713 or contact Minorca Smiles today.