More information: When I started practice, "Denturists" were still in practice, dentists who did nothing but extract teeth and replace with artificial "Partial" or "Complete" dentures, preying on the myth that all people would eventually lose their teeth. As many of the owners of these appliances will tell you, there is no substitute for your natural teeth. We have seen many trends over the years, from the forced retirement of the "Preceptorship" Denturists, to dentists claiming to be "Gnathologists", "Reconstructionists", "Cosmetic Dentists", and the current buzzword is "Esthetic Dentistry". Just look at all of the ads in the Yellow pages. Buyer Beware, because there is still no substitute for what God gave you, your very own natural teeth.

There are several checkpoints that I suggest in this website concerning dentistry and the patient trying to determine the ability of a dentist. "Esthetic Dentistry" implies that the dentist can make your smile appearance better. If all the dentist can show you is a photo album full of artificial crowns, in my opinion, it may be time to pack up and RUN. If the only thing you have in your tool box is a hammer, then everything looks like a nail.

Everyone has differing abilities. In my hands, one of the fastest, simplest, most lucrative, and least challenging things to do would be to cut the tooth down into a nub with "butt" margins with an electric high torque handpiece, take an impression, have the lab construct a crown, and then cement that crown. (I don't do that. Another story, later). Or, if I could afford it, I would use a CERAC machine to construct the crown in my office, but considering that I can "double bond" most of the teeth that dentists are placing a $1000 CERAC crown  with "butt" margins on, I can't afford the $80,000 investment for the two or three teeth a week that would qualify for a true CERAC crown.  (Do the math). Amazingly, if the only thing the dentists has in his tool box is a CERAC machine, then everything looks like a CERAC restoration.

I attended the very first CERAC class more than two decades ago. I made the decision then that the best thing for my patients would be a variety of procedures that included a full range of restorative procedures, including 3/4 crowns, lingual retained 3/4 crown esthetic bridges, and double bonds. This radically restricted the number of teeth that would qualify in my practice for CERAC restorations, and makes my investment into a CERAC machine financially unfeasible. Regardless, I have serious reservations about true full crowns with certain types of margins used in common with CERAC restorations. Because of stress transfer, crowns with these margins tend to fracture the tooh off at the margin more frequently. I have placed thousands of crowns over the years, but the vast majority of these corwns have a "feathered" margin that is more technique sensitive to do, but the first crown and the first bridge I did in 1971 using these techniques are still in place !

Bottom Line, for the last 25 or so years, we have bonded THOUSANDS of teeth that may qualify for "CROWNS" in other practices, resulting in a savings of untold MILLIONS of dollars in our opinion and experience in unnecessary procedures for our patients. The best sales method for "selling" a patient on dentistry is to take a high resolution camera and show the patient how bad teeth look like after several years into an "amalgam" restoration". I use this magnification as an educational tool, but the procedure I recommend is based on what I think is best for the patient, rather than what is based on my pocket book. If the tooth shows a visible, leaking, fracture line, the odds in our practice in that tooth ending up "restored" with a crown is approximately one-in-five. The majority of the time I prefer to wait until I can look into the tooth and see what the inside of the tooth looks like, before making the decision to destroy massive amounts of healthy tooth structure to put a crown over the tooth. Most often, we can "double bond" the tooth for a reliable, long lasting restoration. 

Another thought: If "Silver-Amalgam-Fillings" generate 70% of all future dentistry, what is the dentist who is recommending that you have crowns on those teeth with "Silver-Amalgam-Fillings" recommending for your children? The American Dental Association still defends this method of "restoration" ("mutilation"?) for decayed teeth. There are other, more reliable methods of restoring teeth than gutting a tooth of massive amounts of healthy tooth structure and stuffing it full of metal. What warranty is your children's dentist willing to put on those teeth that may comprise 70% of future dentistry? And why doesn't the ADA put a stop to the 1891's style "GV Black" dentistry?

There are instances where crowns or "caps" are unavoidable. However, if you feel you are being pressured to have your teeth veneered or crowned and you do not feel comfortable with your situation, call us for a free second opinion. We have done second opinions at no cost to the patient since I started in practice. The rules are that I absolutely do not want to know in advance what the other guy's opinion is/was. I need a good set of X-Rays to work from; either mine or theirs (there is a charge for mine) and I will give you my honest opinion. Another rule is that I absolutely refuse to get involved in a law suit against another dentist initiated from my second opinion, unless it is to go in defense of that dentist, so buyer beware.

jtr