I've been a GP for 30 years. When I was doing PFMs and full coverage metal crowns, I would get 15-20% ends through the crown. Since 2010, I have been doing single appointment bonded Cerec crowns. I only do ends through crowns 1-2% now (even that number might be high) Were talking 1000s of crowns here. I've wondered what's going on here. If anything, the occlusal reductions are deeper with the Cerec. The gingival margins are more conservative and usually on enamel margins and mostly supra gingival. I'm telling you, I never do endos through crowns anymore. I think that its the temporization - purely a guess. I'm not about to do a study to find out. Nothing has changed - fractured cusp, large restorations, etc are the same indications. The first 20 years were Zinc phosphate cemented. The last while was resin bonded glass ionomer. I think its the temporaries. As an aside, the crowns from Cerec are way, way, way better. Rarely do I adjust the occlusion . I always had to adjust occlusion on PFMs and gold. Cold sensitivity always, now never. I'm not selling Cerecs. I'm just saying. BTW, my fees suffer because I am placing a better restoration and not doing endos through crowns.
It's an interest hypothesis. Of course, I've heard some people argue that Cerec has caused more unnecessary crowns than anything else in dentistry. Previously, crowns were only done on severely beat up teeth; today, with Cerec machines, there's more pressure to place crowns resulting into more crowns than larger fillings. That may be why less pulpitis with Cerec crowns; it's possible that those teeth would have previously been simply filled rather than crowned. Therefore, less pulpitis in total number of crowns as the number of pulpitis dilutes out due to too many crowns! That's of course a hypothesis by some, including Dr. Christenson.
I suspect that those claiming unnecessary crowns are being placed with Cerec are not Cerec doctors. Actually, Cerec system makes inlays and onlays too. In actuality more enamel is conserved with Cerec and the crowns are more conservative than PFMs, or the like. I'm not on the Sirona payroll. I can tell you truthfully that I have done nothing differently in which teeth are getting crowns during my 30 years. Again, fractured cusps, wide isthmus, cracked tooth syndrome, fractured incisal edges, 3 or more surfaces involved. So in my practice, I deny that assertion. All my crowns have had predetermination of benefits before patients proceed (keeping me honest, lol) I don't have production goals. My associate of 6 years has been doing Cerec right out of the gate and although her numbers are lower, I can't think of one tooth that has had irreversible pulpits requiring endo through the crown. Two dentists that both agree that we are not doing endos through crowns. Our sample size, I believe, is significant. As the saying goes, "I don't know it for a fact. I just know it to be true"
Rather than considering an elective pulpectomy before a crown prep, what's your opinion on electing for a pulpotomy instead? Surely, by removing the bulk of the coronal pulpal tissue you'll be dampening the post-operative inflammatory response after a crown prep reducing post-operative pain and risk of necrosis, whilst preserving the radicular pulp.
This technique may very well be a future consideration; however, in the USA, at the present time, a pre-prosthetic adult pulpotomy is not considered a Standard of Care procedure and would be deemed negligent in a court of law if it fails after the crown and the patient decides to sue.
You are just too good doc.Can u pls make a video on Shall we cut vital tooth for bridges without performing root canals if the tooth are vital and asymptomatic or it's better to perform root canals first and then do crown preparations?
Dr. Nasseh. I am a Mexican orthodontist member of the AAO, but I love watching your videos, I have watch them all, they are very interesting and teach me so much. I apologize if I offend you with this question but, do you happen to know anyone that has an Orthodontic blog with the same quality content you have?
Hello Dr!!!!!!! I'm an endodontist and I'm learing to speak english😑😁. I love your videos in you tube, because I learn enghish and endodontics. ❤❤ I'm facinated with Tecnology and the new materials.... I wish I had an ultrasonic someday.....but they are very expensive in Argentina.
Very nice video doctor👌 in your opinion a virgin teeth with some degree of pain and a periapical lesion observed radiographically should undergo a RCT?
Hey dr. Al, I'm sorry to ask so many questions, but your videos are so well done, they just spark endless curiosity. What is your opinion of desensitizing agents such as Gluma? I'm asking you to open up a can of worms, I know. Does it have any merit? Instinctively, I'd feel reluctant to apply such an agressive (cytotoxic?) solution onto any tissue, but it is widely used. Is there any serious research for or against its use? Thank you
.....very nice presentation..thanks a lot for you Dr.---pleas i have 2 question 1-is there difference between anterior and posterior teeth in this concept?? --q2-i have prepared lower 2nd molar very conservative but its flar up--analgesic has no effect so i go on and did endo. what is the cause
What about pre endo build up ? I know its not the subject of the video but I need to know if I should remove the composite of the build up after finishing my endo treatment or just add more composite after sand plasting of the old one ?
Great question! It really has to do with the quality of the old filling and the presence of micro leakage. Ideally, remove as much as possible is the quality is questionable. Cheers!
Iam eternally grateful for this
Thanks alot for sharing your experience
I've been a GP for 30 years. When I was doing PFMs and full coverage metal crowns, I would get 15-20% ends through the crown. Since 2010, I have been doing single appointment bonded Cerec crowns. I only do ends through crowns 1-2% now (even that number might be high) Were talking 1000s of crowns here.
I've wondered what's going on here. If anything, the occlusal reductions are deeper with the Cerec. The gingival margins are more conservative and usually on enamel margins and mostly supra gingival. I'm telling you, I never do endos through crowns anymore.
I think that its the temporization - purely a guess. I'm not about to do a study to find out. Nothing has changed - fractured cusp, large restorations, etc are the same indications. The first 20 years were Zinc phosphate cemented. The last while was resin bonded glass ionomer.
I think its the temporaries. As an aside, the crowns from Cerec are way, way, way better. Rarely do I adjust the occlusion . I always had to adjust occlusion on PFMs and gold. Cold sensitivity always, now never.
I'm not selling Cerecs. I'm just saying. BTW, my fees suffer because I am placing a better restoration and not doing endos through crowns.
It's an interest hypothesis. Of course, I've heard some people argue that Cerec has caused more unnecessary crowns than anything else in dentistry. Previously, crowns were only done on severely beat up teeth; today, with Cerec machines, there's more pressure to place crowns resulting into more crowns than larger fillings. That may be why less pulpitis with Cerec crowns; it's possible that those teeth would have previously been simply filled rather than crowned. Therefore, less pulpitis in total number of crowns as the number of pulpitis dilutes out due to too many crowns! That's of course a hypothesis by some, including Dr. Christenson.
I suspect that those claiming unnecessary crowns are being placed with Cerec are not Cerec doctors.
Actually, Cerec system makes inlays and onlays too. In actuality more enamel is conserved with Cerec and the crowns are more conservative than PFMs, or the like. I'm not on the Sirona payroll.
I can tell you truthfully that I have done nothing differently in which teeth are getting crowns during my 30 years. Again, fractured cusps, wide isthmus, cracked tooth syndrome, fractured incisal edges, 3 or more surfaces involved.
So in my practice, I deny that assertion. All my crowns have had predetermination of benefits before patients proceed (keeping me honest, lol) I don't have production goals.
My associate of 6 years has been doing Cerec right out of the gate and although her numbers are lower, I can't think of one tooth that has had irreversible pulpits requiring endo through the crown. Two dentists that both agree that we are not doing endos through crowns. Our sample size, I believe, is significant.
As the saying goes, "I don't know it for a fact. I just know it to be true"
I make a ton of inlays and onlays with Cerec. I do
More vital pulp therapy now that I have access to Cerec than I did prior to having it.
Rather than considering an elective pulpectomy before a crown prep, what's your opinion on electing for a pulpotomy instead? Surely, by removing the bulk of the coronal pulpal tissue you'll be dampening the post-operative inflammatory response after a crown prep reducing post-operative pain and risk of necrosis, whilst preserving the radicular pulp.
This technique may very well be a future consideration; however, in the USA, at the present time, a pre-prosthetic adult pulpotomy is not considered a Standard of Care procedure and would be deemed negligent in a court of law if it fails after the crown and the patient decides to sue.
You are just too good doc.Can u pls make a video on Shall we cut vital tooth for bridges without performing root canals if the tooth are vital and asymptomatic or it's better to perform root canals first and then do crown preparations?
Dr. Nasseh. I am a Mexican orthodontist member of the AAO, but I love watching your videos, I have watch them all, they are very interesting and teach me so much. I apologize if I offend you with this question but, do you happen to know anyone that has an Orthodontic blog with the same quality content you have?
Thank you for your kind words. Unfortunately, I'm not familiar with a similar channel on Ortho.
Hello Dr!!!!!!! I'm an endodontist and I'm learing to speak english😑😁. I love your videos in you tube, because I learn enghish and endodontics. ❤❤
I'm facinated with Tecnology and the new materials.... I wish I had an ultrasonic someday.....but they are very expensive in Argentina.
Happy to hear that Debora! Best wishes to you! :)
Very nice video doctor👌 in your opinion a virgin teeth with some degree of pain and a periapical lesion observed radiographically should undergo a RCT?
Thankyou for sharing knowledge :)
Hey dr. Al, I'm sorry to ask so many questions, but your videos are so well done, they just spark endless curiosity.
What is your opinion of desensitizing agents such as Gluma? I'm asking you to open up a can of worms, I know.
Does it have any merit? Instinctively, I'd feel reluctant to apply such an agressive (cytotoxic?) solution onto any tissue, but it is widely used. Is there any serious research for or against its use?
Thank you
Good question Michael! Should be a video! ;)
@@AANasseh you're the greatest! Thank you!
.....very nice presentation..thanks a lot for you Dr.---pleas i have 2 question
1-is there difference between anterior and posterior teeth in this concept??
--q2-i have prepared lower 2nd molar very conservative but its flar up--analgesic has no effect so i go on and did endo.
what is the cause
Thank u a lot for info and knowledge u gave
Good evening sir,
How to repair perforation at apical or middle third of tooth?
Hi dr nasseh how r u I have a question about the excessive seller byeond apex oxide zinc ogenol can affect the healing after rct thnk u
What about pre endo build up ? I know its not the subject of the video but I need to know if I should remove the composite of the build up after finishing my endo treatment or just add more composite after sand plasting of the old one ?
Great question! It really has to do with the quality of the old filling and the presence of micro leakage. Ideally, remove as much as possible is the quality is questionable. Cheers!
Plz dr nasseh take care of ur health
It seems u r tired
I know, right?!! I've been exhausted! Thank you for noticing!!
This is what happens when you burn that candle on both ends! LOL! ;)