A tale of two dentists?


Today, one of my technicians spoke to me on the phone about digital dentistry.I had called him to tell him that one of the molar zirconium crowns fit so well, I had trouble getting it off the tooth after my try in. It took me 10 minutes of tugging before it popped out. I didn't try it in again, but instead cemented it immediately with a permanent cement.

I explained that I found that my digital crowns were fitting really well and usually required little adjustment ( usually only to modify the bite as needed). He told me that often he gets the opposite complaint; Milled crowns that were digitally impressioned don't fit as well as analogue versions (pressable ceramics).

He told me the story of two dentists he knew, who invested in a digital scanner together. Both had been sending him work for years. One was producing impeccable crowns preps and took beautiful silicone impressions and the other, not so much because he was always in a rush. Somewhat unsurprisingly, the former dentist complained less about the fit of his dental restorations.

Now both dentist are still sharing the same office and now are also sharing a digital scanner.The same pattern is holding true. The first dentist hardly ever complains about needing adjustments, but the second dentist still continues to have the same sort of complaints.

Truth be told, analog dentistry can sometimes better handle poor preparations, since the lost wax technique can be manipulated to allow crowns to be fabricated even for  some poorly prepped or impressioned preparations. Waxups can be adjusted so that they will allow seating both on  the die and the patients tooth, while milled emax or zirconium can be more unforgiving.

I guess what they say about computers is true of digital dentistry; Garbage in garbage out? It's the information that we give the computers that makes for useful outcomes. In this case if we make a good prep and take the time to capture an accurate digital impression, one  where the finishing line is well defined and is captured, our restorations will be more easy to fit and we will have fewer do-overs.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/11/a-tale-of-two-dentists.html - http://lspindelnycdds.blogspot.com/

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