ceramic inlay / crown question

[jimyoung182]

Hello,
  I had a checkup with a new dentist today (I moved and he was highly recommended).

One molar, which has a very large amalgam filling from a previous dentist, has a large crack and discoloration down one side of the tooth. The dentist recommended a ceramic crown (he has some device in his office which can make the crown while-we-wait). The tooth currently does not cause any pain.

The next tooth over also has a very large amalgam filling. The tooth looks healthy, but the filling looks old (its maybe 7 years old), and possibly needs to be replaced. Because of the size of the filling, my dentist suggested a ceramic onlay, noting that replacing with another filling will require extra bits of tooth removal, and over the next 30 years or so the tooth will slowly get weaker. (i'm still young ;) )  The onlay would last longer and thus help the tooth last longer.

The quoted price was $1200 CAD per tooth.. The dentist appeared very professional and concerned about conservative tooth repair / long term benefits. Do the above recommendations make sense, and do the prices seem reasonable? Its just that I'm a grad student with poor benefits, and want to be careful before spending so much money

thanks

Jim

[mike1105]

the treatment seems reasonable. the fees sound quite high. I personally do not like resotrations made in the office. i am not sold on that technology. the fees are high because more than likely you are helping to pay the lease payments on that very expensive machine. to me, and again this is my opinion, there is no substitute for a very accurate traditional impression, and a deliberate, talented laboratory technician who wont settle for less than the best he can do.

the "in the office" machine method is attractive to the dentist for the following reason:
1. no lab fees
2. less schedule time per procdure (1 visit instead of 2)
3. it's fast for the patient also.
4. It is new technology which can help sell dentistry, and justify the high fee.

in my opinion, it is not "better"-- it is "bells and whistles" dentistry to me.

[sandwiches]

if a root canal needs to be performed under an onlay, can it be drilled into, like you can with a crown? Or do you need a whole new onlay?

[mike1105]

every tooth is different. it depends on how well YOUR onlay fits. I just do not like these ceramic onlays. I like even less these machines that make them in the office. In my mind it seems they cannot be done as well as they can in a good lab with a good technician and a good impresssion.

[lee2732]

Mike,
     You have been helping me with my onlay issue in the other thread.  My onlay was built in the office, I guess by the Cerac machine as well.  Do you think that could be the root cause (pun kind of intended)?  You have been commenting generically on onlays... now that you know my onlay was built in office, does that add any additional information for you?

[Jerome Bogin, D.D.S.]

The machine is Cerac. The tooth is scanned by a computer and the restorations are produced while you wait. I have no  difficulty in conserving tooth structure but I also feel if it ain't broke don't fix it. That is a philosophy that may not be shared by all my fellow dentists.If there is no decay then I do not feel it is necessary to treat the tooth. As far as the fees--that is very subjective but it does sound a bit high.