Are Same Day Crowns Worth It? The (Not So) Ugly Truth About Dentistry
So your local dentist advised that you need a crown and is now offering to do it ‘same day’ for you--what is this, what’s the benefit, and most importantly, why should you care? A ‘same day crown’, a CEREC crown, or a milled crown, are all terms for a crown created using a computerized mill in the office. The mill cuts the crown out of a solid block of material based upon specifications generated from a digital impression taken of the prepped tooth. The milling process typically takes about thirty minutes to complete, give or take, but is dependent on the specific mill in use. The most famous and widely used mill is CEREC, which is the mill manufactured by Sirona dental. However, many competing companies have recently entered the space. For complete accuracy, mills are not limited to crowns. Things like veneers, abutments, and onlays can also be milled in-office.
The obvious benefit here is time; your permanent crown can be placed in the same appointment as the crown prep is performed, without the need for placement of a temporary crown. This saves the patient time, but it also saves the dentist time because the patient no longer needs to come back for a second appointment.
So if you are saving the dentist time, and the crown can be made in the office, it should be cheaper, right? Since we pride ourselves on our transparency, we want to be transparent here as well. A mill and the associated hardware needed to fabricate a crown in the dentist's office currently runs into the six figures. That cost needs to be covered somehow, so while there is some cost savings to the dentist if a sufficient number of crowns are placed in a month, it’s much more of convenience play for the patient.
What are the drawbacks? Well, this is actually a somewhat controversial topic in dentistry, so this is my opinion based on the technology currently available, which is rapidly changing in this space. If you are reading this a year from now, the situation may not be the same. With that caveat in place, the primary drawback is that the quality of a milled crown is highly dependent on the skill of your dentist. It’s possible to obtain a result comparable to that of a lab, both aesthetically and functionally, when performed by a highly skilled dentist, but again, this is not always the case. While it seems most dentists claim to be “the best”, logic would dictate not all of us can be.
Should I get a same day crown?
For the best possible result and color match, we typically recommend a crown fabricated by a lab if the restoration is being done on a front tooth (e.g. an incisor or canine). Because most people are not as concerned with the aesthetics of a back tooth, it’s not as critical here. However, while not particularly popular these days, a gold crown is still largely considered the gold standard (no pun intended) when it comes to a functional restoration. Some recent research suggests that modern materials may have started rivaling gold crowns in terms of longevity, however, the official verdict is still out.
What to watch out for as the patient
Milled inlays and onlays are far more expensive than a filling would be for a patient, and unfortunately, there are some out there that will over diagnose in this area for the additional revenue. Because the cost of a mill is largely fixed, the more work you do with it, the cheaper the mill becomes to operate per unit created. The business-minded folks would call this economies of scale. While there are a slew of valid reasons an inlay or an onlay can be needed, it’s always okay to question someone when it comes to your health or the health of a family member. Ensure your dentist is clearly articulating and showing you why the inlay or onlay is needed. Your dentist should be showing you x-rays and images detailing this. If you feel rushed at all, or if you still don’t feel comfortable in the diagnosis, seek out a second opinion.
Where is the technology going?
Milling is becoming a big thing in dentistry, with things like surgical guides for dental implants now able to be milled. Significant improvements have been made in the speed and quality of the finished product. However, if I were to make a bet, I would wager the future of this space is in 3D printing. The major challenge currently facing 3D printing is the limitations of the materials, primarily durability and aesthetic qualities; they also need to be cleared for intraoral use by the FDA. That said, I believe rapid improvements will be seen in this space. I believe the first area 3D printing will take off is the in-office fabrication of clear aligners for orthodontics, similar to Invisalign.