Have you been to your dentist lately? If so, you may have noticed that the office has some new machines that are transforming traditional dentistry. Tech-savvy dentists are adding 3D imaging systems that let them create custom caps for their patients in a single visit. Those of us who have had caps done years ago can appreciate the difference between the experience then and now.
When I had to get a tooth capped seven years ago, I had to schedule two dental visits a couple of weeks apart. During my first appointment, I had to have an impression made to serve as the mold for a cap to be created in a lab. I also got a temporary cap that had to last until the real cap arrived and could be cemented into my mouth. My dentists favored a particular lab in California, so the cap took close to two weeks to arrive. Once it was at the office, I was able to come in for my second session. The temporary was removed, and the final cap was installed.
What a difference a few years can make. A few months ago, that same tooth developed an infection and required a root canal retreatment and a new cap. Though the root canal entailed three visits, at least the cap took only one, thanks to the 3D imaging software and milling machine my dentist acquired recently. According to a Custom Automated Prosthetics post, my dentist is among the 10-15% who have adopted "in-office milling solutions" that let them fit and install these caps in one office visit.
Being of an inquiring mind, I asked my dentist quite a lot of questions. I even took pictures a few weeks later when my husband had to get a cap done. My dentist told me that, after being exposed to the technology in tradeshows and reviewing the different options, he decided on the CEREC Chairside Solution from the German company Sirona.
The system includes the CEREC Bluecam, which captures the topography of teeth in a few seconds. Those images are transferred to a software program that uses algorithms to show the shape of a cap tailored for that particular tooth. The dentist can modify this in much the same way you can modify images in Photoshop -- extending, shortening, or otherwise modifying things. The system uses colors to show where placement would be too close or loose. I requested as tight contact with the adjacent teeth as possible, so he built my cap out as much as he could without hitting the red zone.
Once the dentist is satisfied with the shape, he puts a small ceramic cube into the machine that mills it down to size. The process takes about 11 minutes with drills working on two ends. The machine splashes a lot of water in the process to keep the work-piece from getting too hot. After the cap is finished, the dentist performs a quick manual check by asking the patient to bite down gently. He then applies some finishing agent and sets the cap in an oven to bake for about 15 minutes. The color starts out pinkish or pure white but comes out of the oven more tooth-like. Once the cap has cooled, it is cemented into the mouth, and the patient is all done.
In addition to the benefits of saved time and skipping the step of temporary dental work, these caps are supposed to be more durable than the metal ones that are covered with a veneer of porcelain. I certainly hope so, because the cap I had to replace was made of that combination. Its decay may have contributed to the infection that required a root canal in the first place.
As good as the milled caps are, my dentist admitted that nothing tops gold, though you'd be hard pressed to find someone who offers it at the current prices. He told me he's had patients with gold dental work done in the Korean War era that still holds up today. The reason is that the precious metal's expansion and contraction rate matches up perfectly with natural teeth -- something none of the other materials do, no matter how close they come.
The caps made in-house may fall short of "the gold standard," but they are still a major improvement over the old process. Dentists are finding the investment in the equipment pays off by reducing dependence on a lab. And patients are happier to walk out of the office without having to return for a second visit. That's certainly worth a toothy smile.