Cosmetic Dentistry Natural 1-Visit Porcelain Crowns/Veneers

[thornhilldentist1]

Many cerec websites claim that cerec material is superior to lab made ceramic-but since there are so many possibilities for cerec, doesn't this mean we need to continually ask what material the dentist is using?

[DrSimonRosenberg]

@thornhilldentist1 Yes there are a number of CEREC materials, but I mostly use Vita Mark II and Vita Trilux Forte blocks which are the closed to human tooth strength, hardness and grain size. I also use eMax CAD which is a Lithium Disilicate which is three times harder than Vita porcelain.

[gatitoroulette15]

What would you sugggest a Bridge or a tooth implant... I had my bridge done twice and it broke now I don't know if i should do it it again since the tooth next to it is so small from all the drilling to re-shape it. Im afraid I'll loose that tooth too from all this drilling should I just get a tooth implant I think it's better off like that then loosing another tooth :(

[leela194]

Can you lighten crowns (make then whiter)?

[DrSimonRosenberg]

Sky Radio on American Airlines interviewed me & played it on flights as a Business News channel in June 2007. I paid for it & used it this slide show. There are a very wide range of dentists in the US and "better" is subjective. CEREC creates occlusion from several databases or can reproduce existing occlusion. Embrasures & all contours are controlled via the CAD/CAM software. Polished CEREC & Gold are equivalent and smoother than glazed.The milled & polished ceramic has infinite points.

[DrSimonRosenberg]

@hannahnashleyfan That is great to hear! Now be sure to keep up with any other needed dental care and be sure you are flossing and brushing effectively each day.

[DentalTommy]

WoW, very modest from you Doctor, all that continuity answers, I read them all and they were too informative, I'm Californian studying my dental senior year abroad !! I love dentistry and love who perceive dentistry as their life, having it as their best hobby. So what's your specialty ? I'm really craving specializing in Cosmetics! is it available in the states as a main branch or you gotta enter prosthodontics or/and Operative first ?

[DrSimonRosenberg]

@DentalTommy I am a Maxillofacial Prosthodontist having received my training at Memorial Sloan-Kettering Cancer Center in New York. I did a general practice dental residency first. In the US, the focus on cosmetic dentistry is not a specialty recognized by the ADA, but many dentists choose to take continuing education and further training at a variety of institutions to further their skills in making a cosmetic improvement in their patients' smiles and appearance.

[ALFOHOR]

PRICE RANGE PLEASE?

[DrSimonRosenberg]

In my office $1600 - $1800 but fees vary with location, overhead, etc.  Labor, rent, etc. are higher in Manhattan than the other NYC boroughs or around the country

[June253]

What are the price ranges on these sort of things!!

[DrSimonRosenberg]

In my office $1600 -$1800

[zerohourgenerals]

should we trust dental student to clean our teeth for free?

[DrSimonRosenberg]

Dental students are selected for admission to Dental School based on both academic ability and manual dexterity. They should be fine to do a cleaning at most dental schools.

[DrSimonRosenberg]

Modern dentistry is based on making sure it doesn't hurt. Injections are effective to numb up the teeth for fillings and you should do fine. Let me know how it went!

[fptak]

Why not a composite filling in these small preps?

[DrSimonRosenberg]

Composite expands/contracts 3 times the amount of natural tooth (dentin and enamel). Think about a meal with hot soup, ice water/tea/soda, a hot entree and vegetables, and a cold dessert. You cycle your teeth from 40 to 110 degrees many times each day and as the composite expands and contracts, it pulls away from the tooth structure and leaks fluid and bacteria in the microgap. Most composite fillings last 3-9 years and when they fail, a large filling needs to be placed or root canal done.

[JesusChristRulesYOU]

the mercury and metal fillings are better because they are more durable, and the stuff in the video looks cheap and not as good as silver or other metal fillings.

[YOUIHATE420]

wow my left molar broke in half about a year ago,would this work for puttin that tooth back togather..?

[DrSimonRosenberg]

CEREC is the most precise and tooth-conserving method to treat fractured teeth

[YOUIHATE420]

Ah thank you for info doctor! ill definitly be looking into it asap,im tired of my tooth cutting my tounge

[alilazmo]

does porcelain fall off after years ,or with hard biting.

and is it useful for those with thin teeth with stain .thanks

[DrSimonRosenberg]

Patients who clench or grind their teeth can fracture almost any filling material (except perhaps all gold full-crowns due to high elongation characteristic of dental gold alloys). There are dental ceramics such as Zirconia and Lithium Disilicate ceramics that are many times stronger than regular dental porcelains. They also work well with thin teeth and due to their opacity, they hide underlying stains quite well

[alilazmo]

thanks

[Dollaboy667]

How much is the normal cerec procedure?

Can you "Replace Fill-ins" (Sorry, im not keen on "Dental talk"

What about tooth decay and stuff. Is cerec like a one stop shop for anything not needing surgery?

Price is most important.

[DrSimonRosenberg]

Price varies from dentist to dentist. Only 8% of dentists in the USA have invested in the training and cost of this equipment. In most offices, a CEREC crown, onlay, inlay or veneer is priced similar to the same procedures which normally require two visits and an anesthetic shot (needle) both times. You can call my office in New York City for my fees at 212 988-8822 or get more details on my website DrSimonRosenberg . com

[fiamm100]

Platinum Teeth?

[DrSimonRosenberg]

Platinum is used in many ways with crowns, but my presentation is on all-porcelain CAD/CAM precision-milled CEREC crowns, onlays and veneers. Platium foil was used to make Porcelain Jacket crowns in dental labs and there are both all-metal crowns and porcelain-fused-to-metal crowns made with alloys, where platinum is mixed with other metals to give the technician the properties he desires.

[tornadosteve1]

dr. how long does your platinum last.. Ur work is state-of-art..

[DrSimonRosenberg]

The restorations shown are NOT Platinum, they are all porcelain ceramics.

Plantinum is a white-silvery shiny metal that is "precious" because it generally does not tarnish or react with the usual chemicals.

[Gnoknosaj]

Ok-One last thing.

Do you believe that you are able to create restorations using cerec that are as appealing aesthetically as your typical lab made?

also, is it possible for you to deal with metamerism when making cerec crowns? If so, is the type of block more important, or the painting?

thanks again

[DrSimonRosenberg]

We work hard to match color. Guided by our training & our experienced "eye," we evaluate the adjacent teeth we are matching & the shade of the prepared tooth "stump" that will contribute to how the final restoration looks. We also use the Vident EZ-Shade calibrated spectrophotometer, by the manufacturer of the Vita Mark II and Trilux, and their Vita Porcelain Oven to do custom staining when needed.

Metamerism is a problem that varys in all crowns. Evaluation & knowing the materials is key!

[Gnoknosaj]

Thanks, I actually posted another comment but it didn't get through.

There are claims that cerec restorations are superior to lab made due to hardness,etc.

What are the disadvantages from a functionality point of view?

Because there are so many different materials that can be used with cerec, isn't this statement just a little too general?

Also you can stain ,which is great-but what advantages do lab made restorations have over your cerec ones when you can stain them yourself?

[DrSimonRosenberg]

There are different materials are available for milling with the CEREC & inLab systems. The advantage of factory manufacted blocks that are milled, is that the porcelain is uniform throughout the restoration. If the dentist needs to adjust the porcelain he can repolish it and no voids, air bubbles or stress fracture lines are present when the crown is cemented. Expansion, wear and color stability match that of tooth. Compared to all-porcelain lab-made crowns there's no functional disadvantage

[DrSimonRosenberg]

The above relates to research and clinical experience with Vita Mark II and it's multilayered Vita Trilux blocks. Ivoclar makes Empress porcelain blocks (which used to be called Procad) and they have greater translucency as the trade-off of slightly more brittleness (prone to fracture in heavy occlusal force situations). They are excellent for Veneers/Laminates on anterior teeth as they simulate enamel more than dentin and draw the natural richness of color from the underlying tooth stucture.

[DrSimonRosenberg]

There are other blocks from 3M and Sirona that have slightly different characteristics of color, translucency and hardness and are all excellent. The individual dentist will use his judgement, training and clinical experience to select the best materials for the clinical situation. I still send selected crowns to my commercial labs when the situation would be best for the patient's situation.

[DrSimonRosenberg]

RE:staining, there is simple surface staining and characterization. The stains are painted on the surface with a glaze & the crown is fired in a porcelain oven. This technique is used routinely by labs and by select CAD/CAM dentists.

A 2nd technique is to cut back porcelain & build up characterization. This is a much more involved process & is done by the finer dental labs & a more select group of CAD/CAM dentists. It's much more time consuming, more expensive, but very natural & life-like!

[redflag186]

italian dentistry is better...nothing complicated

[DrSimonRosenberg]

But is it biocompatible, with characteristics that nearly duplicate real tooth structure in hardness, wear resistence, color, translucency and expect it to last 20+ years. With CEREC Vita Porcelain, you can expect that, as well as the closest fit of the margins, now and in the future.

[Gnoknosaj]

Hi Dr,

after all your detailed answers, I know that choice of material obviously counts dealing with aesthetics. When dealing with certain dentists, most of them offer just one type of all porcelain crown/inlay, whilst another has different porcelain crowns/inlays at different prices(from about 60% of the typical cost to about 110% such as empress, zirconia, etc.)

[Gnoknosaj]

He claims that the cheaper ceramic is weaker, and that the more expensive types are stronger. However, most internet pages seem to suggest that ceramic is ceramic and that does not give any indication as to what type is stronger/weaker. Do you agree with this statement?What in your opinion, is the best brand for inlays?crowns?

Does brand/make give a big difference in colour match when dealing with small/medium inlays?

Thanks for your time!

[DrSimonRosenberg]

There are indeed differences in ceramics. There are porcelains that vary in characteristics of appearance and adherence to various metals that are hand stacked and condensed by the dental lab technician. The price of these porcelain to metal crowns vary from low cost from China, Taiwan, etc to 5-7 times that cost for American/European labs with highly trained technician using the finest materials from certified dental materials suppliers and with associated high overhead of urban-based labs.

[DrSimonRosenberg]

The all ceramic restorations are currently divided into all-porcelain (with many variations in formulae) to ceramic core (usually Zirconia based) with porcelain layered over it. In the all porcelain group are technician layered porcelains versus factory made porcelain blocks that are custom milled using computer aided design and manufactoring (CAD/CAM). The former group can have more individualization but is weaker as ther porcelain is not uniform and has voids which factory manufacture avoids

[Gnoknosaj]

Thank you for the quick response. I'm unsure what you mean by adherence to various metals, though?

Also, many cerec websites claim that cerec material is superior to lab made ceramic-but since there are so many possibilities for cerec, doesn't this mean we need to continually ask what material the dentist is using?

Also, you meantion that you are able to stain the cerec restorations.From what i've read,

[DrSimonRosenberg]

Porcelain fused to metal crowns & restorations have a thin (.5 mm) thimble of metal that fits the tooth. Porcelain is layered over it. There is a very reflective opaque layer to hide the metal and then layers with various color density and translucency to simulate dentin and enamel of natural teeth. The bond of different brands of porcelain vary with the wide variety of metals used. The ADA generally classifies the metals according to the nonprecious, low precious and high precious metal used

[Gnoknosaj]

this is normally quite a quick job- what are the aestethic advantages for your patients having lab made restorations over cerec?

[DrSimonRosenberg]

Advantages of CEREC over Lab-Made Porcelain:

One Visit, No Temporaries to fall off, No gloppy impression materials, no second visit anesthesia shot, no second visit travel time and time out of work, more precise margins (due to direct recording of actual teeth and no impressions to distort, models that expand on setting, lab technique variables, foil seperating layer,porcelain shrinkage, etc)and more uniform predictable material since blocks are factory made (labs add layers of powder-liquid.)

[DrSimonRosenberg]

Empress is one type of porcelain that is injection molded and generally needs to be cut back with porcelain layered over it. Zirconia is very hard when fully cured, so it is fabricated in a soft state and then further fired. That can be done with stacking the zirconia or by scanning the teeth or model of the teeth and CAD/CAM milled. Zirconia cores are harder than metal, are now very esthetic, but with extra steps are more costly.

What is recommended depends on patient's individual factors!

[allth3s4me]

Most of my teeth have been heavily drilled and I have those ugly amalgam fillings all over them and I need (cosmetically) something like crowns to cover the teeth to resemble the natural look. What should I do?

[DrSimonRosenberg]

I don't mean to be short, but diagnosis can not be done over the internet. You should see a dentist to diagnose how much tooth is left and what your options are. You will need a full set of x-rays and a comprehensive exam. If you are near New York City, I would be happy to see you. If not the Academy of CAD/CAM Dentistry acadcamdent dot com is a good place to find dentists trained in CEREC technology. We have focused our practices on high technology and any member would be a place to start.

[juliedoaz]

so, what is the different bettwen lumineers , crown, and veneers? thanks

[DrSimonRosenberg]

Veneers are thin coverings of the side of the tooth facing the lips or cheek and the biting edge of the tooth. They can be made with CEREC CAD/CAM system in the office or in a lab with either stacked (layered) porcelain or an injection molded system of porcelain. Lumineers is a proprietory name (like Kleenex is to tissues)for veneers made by one lab in northern California -- they can be made with stacked or injection molded porcelains. Crowns cover all or most of the tooth structure.

[Gnoknosaj]

is it possible to get cerec to look as good as a lab restration?

i've found that plastic composite restorations seem to blend in better than cerec shade wise for some reason....

also, how do you overcome metamerism

?

[DrSimonRosenberg]

The newer blocks have a blend of color/translucency from the incisal to cervical of the tooth, we can do a much better job of matching teeth. Ivoclar's Empress CAD Multi(shade), Vita's Triluxe Forte and the new Sirona blocks (made by Vita with the Mark II porcelain but following a differant shade schema) add to the selection choices. If the tooth is highly characterized with white craze lines, areas of white or yellow-brown calcification defects then custom staining will be needed.

[DrSimonRosenberg]

Metamerism is a problem with any porcelain (cerec or lab layered) as it is the property that different materials show different colors depending on the spectrum of light hitting it. Daylight is a broad even spectrum, while incandescent bulbs are yellowish and fluorescent bulbs are harsher in the blue-green spectrum.

[Gnoknosaj]

thanks....but do you have any technique to overcome/minimise this?

thanks again

[Gnoknosaj]

Hi again, is metamerism an issue with inlays?

Because, as stated before, composite fillings tend to blend in well in all lighting situations. Temporary composite crowns however, do not.

So would inlays in general blend in as well as composites or would they generally have the same issue with lighting?

Thanks again

Why is this?

[DrSimonRosenberg]

Most inlays and onlays blend with good cameleon effects when the color changes are not too drastic. The Ivoclar Procad, Empress CAD and Esthetic Line Vita blocks are very translucent, while the Sirona and Vita Mark II blocks are have more opacity and the Ivoclar LT (low translucency) Blocks are the most opaque and work to hide amalgam stains left in hard dentin beneath the cavity prep.

[DrSimonRosenberg]

I tend to use Vita Mark II, Vita Trilux (with 3 layers of translucency and color saturation) or the newer Ivoclar Empress CAD blocks with a continuous gradation from translucent with little color to more opaque and color saturated toward the gingival). I routinely use Ivoclar MultiLink translucent dual cure cement for posteriors and anterior full porcelain crowns.

[DrSimonRosenberg]

For anterior veneers or restorations where I need to change the lightness or darkness (value) of the porcelain,Ivoclar Appeal light cure cement (which comes in translucent and then 1+,2+,3+ to lighten the restoration's value or -1,-2,-3 to lower the value)helps with matching the Value, which tends to be more important than Hue and Chroma.

[PikaShuXZero99]

hey doctore, how much does it cost though?

[DrSimonRosenberg]

In my office the cost for a CEREC one-visit crown or onlay is the same as a lab-fabricated porcelain to hign noble metal (high gold content)crown or gold onlay. Veneers that require more expertise cost about 13% more whether I use CEREC in-office one-visit technology, my local lab (Harrison Dental in Harrison, NY), DaVinci Labs (of Extreme Makeover and The Swan fame who do an incredible job) or Lumineers (with their no prep design that works in limited cases in my office experience)

[Tooth4U]

well, the dentists are trying to eliminate the lab technician. Wait till you need a custom shade take on an anterior he he

[DrSimonRosenberg]

I know that we have been going back and forth on CEREC vs Lab. I have no argument with you or the excellant lab work you show on your website. As you can see from my reply to another question, I use both CEREC and Dental Labs and charge the same so the profession fee is not an issue -- the choice is up to my patients. I evaluate which I think is best for their situation evaluating many factors. I have recommended the Lab options for my patients with very characterized teeth.

[DrSimonRosenberg]

I stock over 100 differant shades from several manufacturers including Vita, Ivoclar and 3M & 5 differant cement systems with several shade and opacity options to best match the restorations I make to the patient's adjacent teeth. There are also some shades of teeth where I know that the CEREC system will no work without custom staining and I recommend the lab approach from the start.

[DrSimonRosenberg]

If I find that I can not satisfy the esthetics, then I have taken precise impressions, used the Vita EasyShade computer to measure the shade, verified it with shade tabes, then taken photographs calibrated with The Spyder 2 Pro software so that the printed photo is a true-color match and the technician has the best data (visual) with which to work on giving me the best match.

[DrSimonRosenberg]

I am also at the stage where I am making room in the office to do custom staining which I have done in the past and have updated my skills with several staining courses. I will still keep the lab option open to me, but having a porcelain oven in the office will also add the potential for other millable ceramic materials that require oven firing for strength -- bridges are in the forseeable future with the CEREC system.

[Tooth4U]

the new cerac technology is coming online now, that creates much better results then that of the last three years. Trilux blocks by Ivoclar, Amherst NY. To see what only a tech can do,Ubassy dot com

[Tooth4U]

so upon close observation it is indistinquishable to the rest of the mouth, or quadrant.

[DrSimonRosenberg]

Every dental professional such as you and I struggle with the problem of metamerism, which is the property that when you match the shade of one object to another using differant materials (porcelain to simulate natural tooth) they may match in one lighting situation (daylight) but not match under incandescent or fluorescent lighting situations in doors. Custom staining can characterize porcelain teeth to match their neighbors better, but patients request white fillings & whiter teeth.

[Tooth4U]

that 'drawing' is dependent on the camelion effects of transluceny inheirant in the porcelain ( zirconian_) cerac material itself, which to date is very limited if at all . Whereas, the technician can particular to case include the appropriate material specific to each case and in so doing bring blend and luminescense to the finished restoration.

[Tooth4U]

Cerac failures are numerous. They look like blobs lol, not teeth. They only mimick what a tooth should look like, anatomy is horrible if there at all and they are extremely limited to only a few colors. Nothing like a Dental Technician and Lab for this work, not an in house computer.

[DrSimonRosenberg]

Failure is possible with lab crowns or CEREC. The dentist's skill, crown design, tooth prep, accurate impression, fit of crown to tooth are key. Over 35 factors/errors are introduced in lab fabrication. A CEREC dentist controls entire lab phase from laser-assisted optical impression to accurate virtual model for designing restoration on the computer to the milling yielding a restoration with a 50 micron accuracy; the restorations fit closer than anything done with a impression sent to a lab.

[DrSimonRosenberg]

As a prosthodontist, I'm proud of anatomy/occlusion in my restorations-CEREC or lab. Labs put exquisite anatomy & staining into restorations. Video shows excellant anatomy; most patients hate stained grooves/dark coloration. Vita Porcelain layered by labs is more brittle/harder/rougher than tooth. CEREC Vita factory made porcelain blocks are uniform, void-free, & expands/wears same as teeth; with natural tooth enamel translucency drawing color from dentin/adjacent teeth/gum tissue.

[Slydevil34]

very interesting, I might use this method

[DrSimonRosenberg]

Thank you. If you are in the New York City area I would be happy to offer a complimentary short consult to review your situation. If you are looking for a high technology dentist who uses CEREC you can go to the Academy of Computerized Dentistry of North America website acdna dot com or the SIRONA (manufacturer of CEREC technology) at cereconline dot com and click on Dr Locator tab on the top.