FAQ's & Guideliness For Dental Crowns

Dental crowns can provide you with a great option for repairing damage done to your teeth. The following questions are commonly asked to cosmetic dentists by patients at their initial dental crown consultation:

What are dental crowns?
A dental crown, also known as a dental cap, is used to cover a damaged tooth and restore the tooth's strength and durability. Dental crowns cover the entire portion of the tooth visible above the gum line. This is different from a filling which only covers a portion of the visible part of a tooth.

Why would I need a dental crown?
There are many reasons why a dentist would recommend a crown including:

• Cracked teeth
• Fractured teeth
• An anchor is needed for a dental bridge to replace a missing tooth
• To cover a tooth that has had a root canal
• Fragile teeth
• Cosmetic purposes

A crown can fix a tooth that is misshapen or discolored. If you have been unhappy about the way a tooth looks, then a crown could be the answer to your problem.

How does a dentist make a dental crown?
A dentist creates a dental crown over the course of two dental appointments. During the first appointment, he will remove most of the outside surface of the tooth which will later be replaced by the crown. This is known as shaping the tooth. Once the tooth is shaped, the dentist will take several impressions of the tooth and other areas of the mouth. These impressions are sent to a dental technician who uses them to make a perfect fitting permanent crown. At the end of your first appointment, the dentist will attach a temporary crown to your tooth. During the second appointment, the dentist will attach the permanent crown to your tooth.

Is it painful to get a dental crown?
Getting a crown is a relatively painless procedure. The dentist uses a local anesthetic to numb the areas of the mouth being treated.

What are the different types of crowns?
There are three different types of crowns. They are:

• Gold Crown
• Porcelain Crown
• Porcelain-Fused-to-Metal Crown

Which crown is right for me?
This is a question for your dentist to answer. When you schedule a consultation visit, your dentist will discuss the various costs associated with a crown, the best type of crown for you, and also financing options.

Source: Questions about Dental Crowns

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Dental Implants & Dental Dentures

How do you know what is best for you and your future? Cosmetic dentures or dental implants both solve the same problem: fixing your missing teeth. You need to look at the big picture.

Cosmetic Dentures:
Cosmetic dentures are simply replacements of missing teeth. The false teeth can replace all the upper teeth or all the lower teeth (known as full dentures), or parts where groups of teeth are missing (called partials). The prosthetic teeth can be made from plastic or even porcelain. Today’s cosmetic dentures not only function, but also look aesthetically pleasing.

Cosmetic dentures are removable, nonpermanent structures which use denture adhesive to keep them in place during the day. You remove them and clean them at night.

Dental Implants:
By contrast, dental implants are a permanent solution to the problem of missing teeth. They are attached to the jawbone by the use of implanted anchors. The anchor sits below the gum line.

Titanium posts are attached to the anchors. These posts function like the teeth roots. They sit above the gum line.

Finally, a prosthetic tooth crown is attached on top of the post.

Because the implant is made of titanium, it integrates with the jawbone (called osseointegration), forming a functional and structural bond that can withstand the high-stress force that chewing creates.

Advantages of Dental Implants over Cosmetic Dentures:
When comparing cosmetic dentures and dental implants, dental implants are the preferred solution because they have several advantages:

• Aesthetics – dental implants are the closest thing to your natural teeth because they are anchored in your mouth in a duplication of the way your natural teeth are anchored in, so they look, act, and feel like the real thing.
• Confidence – dental implants look and feel like your natural teeth so they make you feel confident because you feel natural. They also don’t impede speech because they fit in your mouth the same as your natural teeth do.
• Facial stability – because dental implants provide the same support for your face as natural teeth, they can reduce or eliminate wrinkles that you may have gotten when teeth were missing. Also, they stabilize the face by holding it up so it doesn’t appear sunken. It’s almost like a face lift because sunken faces make people look much older then they actually are.
• Functionality – dental implants improve your ability to chew food because they can withstand almost as much biting and chewing force as natural teeth
• No teeth are sacrificed – dentures may require some teeth to be pulled, and partial dentures may use neighboring teeth as anchors, thus necessitating that some of those teeth be altered to support the partial denture
• Reliability - since dental implants look and function just like natural teeth, they offer you the ability to relax and feel more confident without worrying whether they will fall out. You just care for them like your natural teeth. You don’t need special cleaners or adhesives.

When looking into dental implants or cosmetic dentures, look for a cosmetic dentist that offers both accuracy and precision in both the diagnosis of missing teeth as well as the treatment solution. The combination of these tools allows him to completely envision the placement of your implants in a realistic, three-dimensional setting and create a surgical map which guides him in placing the dental implants.

Cosmetic dentures can look very good when they are designed correctly. However, when looking at the big picture, you can see that dental implants are the preferred treatment because of their advantages over cosmetic dentures.

Source: Cosmetic Dentures or Dental Implants

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All About Dental Crowns: When & for Whom

Latest Dental News: Dental crowns not everyone’s cup of tea: a dentist

While a cavity is never something anyone wants, this can be fixed with a filling. But what can you do when your teeth are cracked, broken, or worn down? In cases like this, a dental crown may be what is required. A dental crown is a cap placed over a tooth to restore it in size, shape, and strength, or to improve its appearance. They are needed to:

• Restore a tooth that is already broken or worn down
• Protect a weakened tooth from decay and breakage, or to hold the parts of a broken tooth together
• Cover severely discolored or misshapen teeth
• Cover a dental implant
• Cover and support teeth that have large fillings when there isn’t much of a tooth left
• Hold a dental bridge in place

What Does Crown Placement Involve?
Obtaining a crown usually means you’ll need two dental visits. During the first visit, your dentist will examine your tooth and ready it for the crown. The second visit centers on crown placement.

Visit one will involve x-rays of the affected tooth and gum to determine the extent of decay. Sometimes a crown may not be sufficient. In this case you will typically receive another procedure, the root canal. If a crown is indeed your solution, your dentist will begin by filing away the tooth’s decayed portion.

Next, your dentist will create an impression of the tooth using paste or putty. They will provide a protective temporary crown for use while your permanent crown is fashioned, which typically takes two to three weeks. The type of material used for the permanent crown depends on the decay’s extent. Less severe cases require all-porcelain. Severe decay may require filling material to provide additional support. The most frequently used materials for dental crowns are:

• Porcelain-fused-to-metal
• All-porcelain
• Gold

During your second visit, your dentist will place your permanent crown.
Waiting for Your Permanent Crown

Go easy on your temporary crown while waiting for the permanent crown by:

• Avoiding flossing your teeth in an upward motion; move side-to-side instead
• Avoiding “sticky” foods, such as gum and caramel.
• Avoiding hard foods, such as raw carrots.
• Chewing mainly on the side of your mouth without the crown.

Once your permanent crown is placed, difficulties may occur, but this is not very common, and most are easily remedied:

• Sensitivity to hot and cold – Your dentist may recommend a toothpaste for sensitive teeth
• Pain from a too-high bite – This can be rapidly corrected at your dentist’s office
• Chipped crown – A composite resin can sometimes easily repair a chipped crown depending on the extent of the chip
• Crown falls off – Take good care of the crown; your dentist may be able to reseat it
• Allergic reaction to crown – Very rarely, patients allergic to the porcelain or metal used to make the crown

Source: Dental Crowns an Easy Placement

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Getting a traditional dental crown requires two visits to the dentist. On the first visit, an impression of your teeth is made and the tooth is prepared by shaving it down. The impression is then sent to a laboratory while you wear a temporary crown, typically made of some type of plastic. On your second visit, the temporary crown is replaced by the durable crown.

CEREC stands for Chairside Economical Restoration of Esthetic Ceramics. This new technology - available in the offices of some cosmetic dentists - enables the CEREC-equipped dentist to mill and fit a crown during the same visit. CEREC's “Computer-assisted design—Computer-assisted manufacture" or “CAD-CAM” technology produces a pure ceramic crown while you wait. The laboratory step in the process is eliminated, as is the temporary crown, and the inconvenience and cost of a second visit.

How does it Work?

The damaged tooth is prepared by applying a thin layer of reflective powder directly on the tooth’s surface. A 360-degree image of the tooth is then generated by a special camera and transferred to a computer where the dentist can edit the image to fit the individual needs of the patient.

A ceramic block is placed in the milling chamber once the image is prepared, and within minutes the crown is milled and ready to place.

CEREC’s Advantages:

• CEREC are made in one visit, saving time and eliminating inconvenience
• The potential discomfort of a temporary crown is eliminated
• CEREC crowns have no metal in them
• The technology can also be used for fillings. Porcelain is more durable than typical white composite fillings
• The initial investment in the technology is expensive. However, it can save money over the long run because there is no extra lab technician fee for the dentist, and only one appointment is required, not two

Are there Disadvantages?

CEREC crowns are milled out of a single block of ceramic. This can become problematic when matching them with the subtle color gradients of natural teeth. Although some companies are now making ceramic blocks with a color gradient, the cosmetic dentist needs a good deal of training, skill, and talent in order to create a natural-looking crown with this technology.

Source: CEREC - Dental Crowns in One Visit

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Latest & Advanced Cosmetic Dentistry Treatments Eliminated Dental Fear

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The Fear

Misplaced fears like Guerra's aren't uncommon. In a new consumer survey by the American Association of Endodontists (AAE), nearly half (48.5 percent) of survey respondents said they perceived root canal treatment as "excruciatingly painful," and ranked the treatment just below a spinal tap in terms of discomfort.

The Reality

But these perceptions don't reflect the realities of modern treatment, something that patients are realizing firsthand.

In fact, a separate AAE study showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than those who haven't had the treatment.

The expertise of endodontists, the dentists who specialize in root canal treatment, combined with anesthesia and advanced technologies, has made root canal treatment a procedure that can be as routine as having a cavity filled.

The treatment usually lasts a half hour and has a 95 percent success rate in saving abscessed or infected teeth.

The Better Choice

When patients are told the interior of their tooth is badly infected and requires treatment, they have three choices: extraction of the tooth with no replacement, extraction and replacement with an implant, or root canal treatment.

Patients who extract the tooth and do not replace it can have a difficult time chewing, have an increased risk of gum disease and their teeth may shift. Extraction with implant replacement involves having a prosthetic tooth screwed into the jaw.

Root canal treatment is the only option that preserves the natural tooth. "It's always best to save the natural tooth," says AAE President John S. Olmsted, D.D.S., M.S. "Nothing looks, feels or functions like them."

Despite these facts, the myths surrounding root canal treatment continue-and extend beyond concerns about pain. Many people believe that root canal treatment is expensive compared to other options, when it actually costs hundreds and hundreds of dollars less than getting an implant.

Root canals generally require one visit for the treatment plus another for the placing of a crown on the tooth, whereas placing an implant typically requires multiple surgeries.

Life After Root Canal Treatment

Root canal treatment removes the damaged pulp, or soft inner tissue containing nerves and blood vessels, from the tooth, and then the endodontist cleans, fills and seals the canals. The tooth is then restored with a permanent filling or other restoration, allowing it to once again function normally, often for a lifetime.

"I had horrible pain before I had root canal treatment," said Guerra. "Now my tooth is pain-free."

Guerra is just one of the 17 million people each year to have a natural tooth saved by root canal treatment-and to realize that the myths about root canal treatment just aren't true.

Source: Endodontists Demystify The Feared Root Canal

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Many people endure years of mental anguish over the condition of their teeth. The teeth are very much a focal point of one’s face, so when a person is embarrassed to show his teeth he can become self conscious and ultimately lack self confidence. With the advances in cosmetic dentistry, today adults can dramatically change the appearance of their smile without investing years of time in traditional orthodontic treatments, such as metal braces or retainers.

Dental veneers are now used by countless cosmetic dentists as a quick, safe, easy and generally painless way to create beautiful smiles. Veneers are ultra-thin shells made of either porcelain or composite resin that are custom made to fit over the front of existing teeth. Most patients find that their porcelain veneers are extremely durable and resist stains. Because veneers are produced to match your own unique teeth color, they appear very natural. Cosmetic dentists can use veneers to fix one problem tooth or an entire mouthful of teeth.

What tooth conditions can be fixed by dental veneers?
Genetics play a large role in the condition of one’s tooth health. From tooth color to the propensity for cavities or gum disease, heredity will dictate, to some extent, how your smile will take shape. Teeth can also become unattractive due to an injury, poor oral hygiene or because they can shift as we age. Dental veneers can correct problems such as:

• Discolored or stained teeth
• Misshaped teeth
• Crowding of teeth
• Large or small gaps between teeth
• Crooked teeth
• Chipped or broken teeth

How are dental veneers applied?
In porcelain veneers, first the cosmetic dentist removes a small amount of tooth enamel to accommodate the thin porcelain shell. Once the teeth have been prepared for the shells, a cast is made of the teeth. A dental lab produces custom-made veneers that will perfectly fit your teeth and provide a seamless bond. The new veneers are then permanently bonded to the teeth to create a natural-looking smile.

Composite resin veneers can also create beautiful smiles; however these materials may not be as resilient as porcelain. These veneers are shaped and molded in the office and bonded to the teeth with a special light and polished. Usually this can be accomplished in one office visit.

Dental veneers require little to no anesthesia.

Besides the aesthetic reasons, are there other advantages to dental veneers?
Even if you have good oral hygiene practices, the condition of your teeth may work against you. Settling for one (or even a mouthful) of crooked teeth can lead to greater dental problems. For example, it can be extremely difficult to properly floss and brush teeth that are crooked. The areas missed by brushing can lead to tooth decay, cavities, gingivitis, gum disease, etc. Teeth that are chipped or crooked can even wreak havoc on your ability to properly bite down, leading to headaches or muscle aches.

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Healthy Teeth & Gums Gives You A Healthy Smile

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Diabetes, stroke, heart and renal vascular disease, and obstetric complications all have one thing in common - they are linked to the state of a person’s oral health. Research has shown that there is a link between periodontal (gum) disease and several major systemic illnesses such as those listed above.

Gum Disease

Periodontal disease is the term used to describe a group of inflammatory diseases that affect the supporting structures around the teeth. “Gingivitis” involves only the gums and “Periodontitis” affects gums and bone and other supporting tissues.

A film of plaque containing lots of bacteria forms around the teeth constantly. If plaque is removed daily through brushing and flossing, bacteria will not affect the gum tissues. But if plaque is left undisturbed for several days, the increased amount of bacteria starts infecting the gums. In response, our body mounts an inflammatory defense against the bacteria. Antibodies are also formed against the bacteria. These inflammatory products then spread to other parts of the body. Hence periodontal disease creates an oral wound that allows entry of bacteria.

Pregnancy and Oral Care

The products of inflammation affect other organs of the body. For example, prostaglandins, formed when the body tries to defend itself against bacteria, cause smooth muscle contraction. In pregnant women, this may cause premature contraction of the muscles of the uterus and lead to preterm delivery. Premature babies have a lower birth weight and are known to have more developmental problems and allergies. In addition, a higher rate of miscarriage is possible in women with periodontitis.

Pregnant women are also known to complain about bleeding gums due to the increased levels of estrogen and progesterone hormones which make the gums more sensitive to inflammation. However, if plaque or calculus have been removed prior to pregnancy and maintained at low levels during pregnancy, then little inflammation and bleeding would occur.

Diabetes and Gum Disease

Diabetics should also be aware of the state of their gum health. They are more susceptible to infections, including periodontal infections. They also take longer to heal from such infections. Periodontitis is far more common in diabetics compared to non-diabetics.

Diabetics who have untreated periodontal disease will find it difficult to control their blood glucose level due to insulin resistance. Both periodontal disease and diabetes are chronic diseases that develop slowly. To most people, there are also no obvious, outwards signs in the early phases of both diseases. However, since diabetes is known genetically to occur in families, susceptible persons can take early steps to monitor the health of their gums and prevent or delay the onset and severity of diabetes.

Mouth and Body Connection

Gum inflammation has been linked to other diseases, including heart disease. Inflammation of the inner lining of blood vessels increases the chance of formation of the atheromatous plaque that causes hardening of the vessel and eventually blocks the vessels, cutting off blood flow.

Long term studies have shown that periodontal disease occurs before cardiovascular disease and is strongly linked to strokes. Strokes occur when the atheromatous plaque becomes unstable, breaks off and lodges in the finer vessels of the brain.

Other organs affected by periodontal inflammation include the liver, kidneys and lungs. The liver is the major organ that receives, processes and detoxifies products of infections from other parts of the body. In the process, the liver releases more products that have further adverse reactions on other organs. This negative effect can be reduced through treating periodontal disease by scaling and deep cleaning together with the use of antibiotics.

The same bacteria that cause gum disease have been implicated in infections of the lungs, leading to pneumonia. Poor oral health has also been linked to chronic obstructive pulmonary disease, a lung disease in which the lungs are damaged, making it hard to breathe.

Scientific reports have shown that even bone joints like the shoulder, knee or hip can become infected and inflamed when a person has severe gum disease. It is strongly recommended that a person seek a detailed, thorough dental treatment to clear all possible sources of infection before undergoing major surgery involving the bone joints and other organs.

The soft tissues of the mouth, of which the gums form a part, show tell-tale signs of other systemic diseases too. For example, persons with HIV have suppressed immunity. Bad infections of the gums may occur, with swollen, ulcerated gums being common.

Diseases of the blood such as leukaemia, anaemia and thrombocytopenia, also show up in the gums. Leukaemic patients have over production of white blood cells which can cause swelling and bleeding of the gums, and increase susceptibility to infections. This can progress to bone loss and cause teeth to loosen.

Medical Treatment and Lifestyle

Other medical treatments can compromise oral health. For example, after a liver transplant, the patient has to take medication to prevent rejection of the new liver. Such medication has been associated with increased swelling of the gums and loss of the bone around teeth. Meticulous oral hygiene with regular professional cleaning helps reduce such occurrence. Sometimes, the excessive gingival growth needs to be excised too.

Smoking is linked to more severe periodontal disease. Tobacco has many components that are detrimental to the body, including the gums and bone. A smoker also has an altered immune response. They are more susceptible to periodontal disease and respond poorly to treatment. The longer the exposure to tobacco, the worse the outcome.

Prevention

Knowing the close connection between gum health and systemic health (the health of the rest of the body), prevention is a practical, cost effective and relatively easy option.

• Ensure that good oral hygiene is maintained through regular and proper tooth brushing (at least twice a day) and regular flossing;
• Keep twice yearly appointments with the dentist to ensure that gums and teeth are healthy;
• Address any outstanding dental problems promptly rather than waiting for the pain or discomfort to be unbearable before going to the dentist; and
• Take sufficient amounts of Vitamin C daily - excessive deficiency of Vitamin C leads to defective formation and maintenance of collagen, the cells that form the underlying structure of gums and skin

Taking care of one’s mental health is also important, since stress causes an increase in cortisol, decreasing one’s immune response to bacterial challenge. Being stressed out may also cause a person to neglect basic oral hygiene care, thus leaving more bacterial plaque around the gums.

Our body is a living system. Infections in one organ can cause problems in other remote organs. No disease can be treated in isolation without considering its effects on other potential diseases.

Source: Healthy Gums and a Healthy Body - The Mouth and Body Connection

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Shakespeare said that “one may smile, and smile, and be a villain.” Hamlet was obviously going through something that few of us ever have or will, but a villainous smile still holds true today. When we imagine what separates the smiles of heroes from the smiles of villains, we get two very different pictures. Those heroes’ pearly whites, straight and even, evoke strength and confidence. The villain is another story. Crooked or missing teeth, certainly not white (brown, probably), and maybe even longer teeth to show some kind of evil nature. So, where do your teeth fit in these descriptions? Most likely, you’re somewhere in between.

While a smile with white, evenly straight teeth is what most people desire, the wear and tear of age, the food and drink they consume, as well as simple genetics may keep them from this. In fact, perfectly nice people may be uncomfortable that their teeth make them look a little more evil than they are. And this can affect self-esteem and confidence. The quality of life of some people may suffer because they are so concerned about the state of their smiles and their teeth, or are in actual physical pain due to a bad bite. For people like this, and perhaps even you, a cosmetic dentist can change all of this with a smile makeover.

Rather than a simple tooth whitening procedure, a smile makeover may involve several cosmetic treatments. The smile makeover can restore issues of:

• Broken or chipped teeth
• Crooked teeth
• Gapped teeth (diastema)
• Long or uneven gums
• Missing teeth
• Stained or discolored teeth
• Uneven teeth
• Overall appearance of smile

Virtually any problem you have with your teeth can be improved with a smile makeover. Changing the length, width, shape, and color of your teeth is possible through the use of:

• Porcelain crowns – When damage or decay to your teeth is extensive, the cosmetic dentist may recommend these. Porcelain crowns are either all-porcelain or porcelain-fused-to-gold. They have a natural appearance and are placed over the broken, decayed, or damaged teeth.

• Porcelain veneers – These are made from dental porcelain or composite resin and are placed over severely damaged or discolored teeth. They can also correct gaps and stained fillings. They are extremely thin and custom-made, giving your teeth a bright, new appearance.

• Porcelain inlays/onlays – These caps are similar, but more conservative than crowns. They are used to correct moderately broken or chipped teeth, as well as to fill gaps between teeth when the damage is not severe enough to warrant a crown. They can also replace old or damaged amalgam fillings.

In addition to porcelain crowns, veneers, inlays and onlays, other cosmetic procedures may be required. Orthodontia, gum recontouring (getting rid of “gummy smiles”), bridges, and tooth whitening are also possible. Sometimes the problem is a bad bite that may cause serious pain and migraines. This is due to temporomandibular joint disorder (TMD), which affects one of the biggest nerve clusters in your body. In this case, a cosmetic dentist who practices neuromuscular dentistry may help end the pain that has plagued you for months, years, or even decades.

A smile makeover can give you a smile that can change your life. Beyond the aesthetically pleasing look, correcting many of these problems will put you on the road to good oral health, and an overall healthy outlook on everything around you – something every hero needs.

Source: A Smile for Everyday Protagonists

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Cosmetic dentistry has become more popular in the recently years with the improvements in dental techniques and materials. Many people have taken advantage of cosmetic dentistry to "enhance their smile".

What is cosmetic dentistry?

Cosmetic dentistry is the procedure to improve the appearance of teeth. With the recent developments in dental techniques and dental materials, cosmetic dentistry has made it possible for many people to have better looking smile.

Do you need cosmetic dentistry?

You might consider cosmetic dentistry if you have one of the following conditions with your teeth: gaps between teeth, cracks or cavities, broken or crooked teeth, stained or discolored teeth, uneven teeth, chips or rough spots.

Things to know when considering cosmetic dentistry

If you are considering cosmetic dentistry, you should keep the following facts in mind: First of all, cosmetic dentistry is costly and usually not covered by dental insurance. Some procedures might cost you over $1000 per tooth. You should make sure you can afford it because you do it. Also, the procedure might need to be repeated every 10 to 15 years because some materials used in cosmetic dentistry might not last very long.

What type of services are included?

Cosmetic dentistry includes many types of services such as porcelain veneers, tooth whitening, fresh breath treatment, metal-free fillings, crowns, bridges, restorative cosmetic dentistry, instant orthodontics, etc.

If you want to enhance your smile, cosmetic dentistry could be your choice.

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A New Jewel Discovered For Dental Crowns

Restoring a tooth has been done by labour-intensive methods dating from the 18th century - until now

Computers have altered many professions; now it's cosmetic dentistry turn. Yes, frightened patients will still face the drill. But when it comes to designing and manufacturing a crown, implant, bridge or dentures, dental implants computers are beginning to replace painstaking manual methods. The basic design of the typical crown - metal bonded with porcelain - dates from the 18th century. This is a sector ripe for reinvention.

Most patients probably have no idea how much individual labour goes into restoring even a single tooth: each piece is bespoke. Take a crown. Traditionally, once the tooth has been prepared, cosmetic dentist pours gunk into two jaw-shaped trays into which the patient bites down to create impressions. These are sent off to a lab along with the dentist's instructions.

The die is cast

On arrival, dental stone is poured into the impressions and left to harden. A pin is placed at the tooth being worked on (the "die") and others in the underside of the stone model, and a base is then poured on to it. Once set, the model is cut with a split saw or fine diamond disc so that the die can be removed for working. The pins mean it can be put back in precisely the same place. The technician then uses the die to build up a wax pattern 0.4mm to 1mm thick, in the shape that will ultimately be cast in metal. "The first thing I had to do as an apprentice," says Chris Everingham, the retiring founder of Creative Dental lab in London, "is wax tooth-carving, so I learned the anatomy."

The finished pattern, embellished with a prong, or "sprue", is placed into a metal casting ring, which is filled with material called "investment". Once that's hardened, heating the ring to 850C burns off the wax, leaving the pattern's empty shape behind. The ring is mounted in a spinning machine, and centrifugal force pushes molten metal into the empty space, recreating the wax pattern in metal. Knock away the investment, remove the sprue, and there's the basis, or "coping", for your crown.

From there, the crown is hand-painted with porcelain, first with an opaque layer to blot out the darkness of the metal, and then with successive layers of shades chosen to match the patient's own teeth. The finished crown is fired at 930C and sent back to the dentist for installation.

You hope. Anything destined for a patient's mouth must be precisely made to within 20 microns. Gaps attract saliva, which can wash out the cement holding the crown in place, turning the gap into a haven for bacteria and decay.

But even a lab that can afford lengthy finishing times - Everingham estimates his maximum output at 60 crowns a month - can't be perfect; impressions may have tiny bubbles or smears. It is these imperfections that computer technology is beginning to address.

About 18 months ago, labs such as Creative and nearby Ken Poland, which supplies cosmetic dentistry to the Channel 4 TV show 10 Years Younger, began buying 3M's Lava system. Poland's Steve Pope makes the traditional stone model, but then scans the model and creates the coping digitally using a virtual "wax knife" and automated software. When Pope, a former aircraft engineer, builds a bridge on screen, it looks as hard as working in wax; this profession is being reskilled, not deskilled.

The data file is sent to a milling centre, in this case, Poland's own. There, the Lava software takes the file and assigns it to a barcoded block of zirconia. Cured at 1,500C, it becomes a hard, strong material that can be tinted by soaking and to which porcelain will bond. Pope says it's better than metal: zirconia is bio-compatible and used in hip and knee replacements. The block is placed in the milling machine, and the computer translates the data file into cuts to produce the actual coping. Then the coping is cured for more than 11 hours. From there, the porcelain is applied by hand. Pope is particularly impressed by the software's ability to calculate precisely how much extra to allow to compensate for shrinkage in the curing process - between 23% and 26%.

Magic wand

The next stage is eliminating the impressions. At the New York offices of Dr Steven Alper, an oral scanner reads the movements of a wand inside the patient's mouth. The wand captures 3D video of the patient's upper and lower jaw, as well as the outside bite pattern. "I can see if I need to fix something," says Alper. "For example, for a crown prep you have a margin around the tooth, and it's hard to see on the patient. You only have one or two views, and they're all white and small. On the screen you can look really close."

Turning the image to various angles on his touchscreen, Alper found a hole. He rescanned that section, filled out an onscreen prescription, and sent the file to the lab electronically. Simultaneously, the data goes to a facility that uses it to generate the physical model in resin. The die is sectioned in manufacturing, eliminating the imprecision of saw cuts.

All of this eliminates time waiting for materials to harden, cure or cool. More importantly, everyone agrees the software does a better job of getting as tight a fit as possible. "It won't cure everything," says David Coppen, chairman of the Harley Technician Study Club, which saw the scanner demonstrated in London last week, "but this is the future."

A new jewel in dentistry's crowns