Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, discusses one-visit crowns. She is the author of the best selling book, Age with Style: Guide to a Youthful Smile & Healthy Living.

John Maher: Hi. I’m John Maher, and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health, and author of the best-selling book Age with Style: Guide to a Youthful Smile & Healthy Living. Today, our topic is one-visit crowns. Welcome, Dr. Nammy.

Dr. Nammy Patel: Hi, John. How are you?

Typical Number of Visits to Get Crowns

John: Great, thanks. Dr. Nammy, if I go to my general practice dentist, how many visits does it typically take to get crowns?

Dr. Nammy: Well, John, it can take sometimes two to three or more because you’re working with an outside lab. What that means is that you come in the first time, and then they numb you up. You prep the tooth. They give you a temporary and then you go away for about two to three weeks. Then you come back, they try to cement the crown. Sometimes it’s not perfect, so they have to take a new mold and then resend it out, so another two weeks later they’ll come back and they’ll get a crown hopefully that fits properly for you.

One-Visit Crowns: How is it possible?

John: Okay. You do things a little bit differently, and you manage to do crowns in one visit. How do you manage that?

Dr. Nammy: We have an amazing software. It’s called CEREC 3D. What it does, it mills a crown in the same day. Earlier, I spoke about something that can take up to three visits, getting numbed up three different times, and then taking up to about five to six hours. In our practice, we can do the same thing in about an hour and a half to two. What we do is take a mold of the tooth with a 3D scan. After we take a mold, we prep the tooth, and then we have a machine on-site that actually mills out the crown.

John: How does that work? Is it almost like a 3D printer that you see where it’s printing the crown or is it actually carving it from a little block of some material?

Dr. Nammy: It is. It is carving it out. It’s kind of like Michelangelo’s chisel. You start with a big rock and you start with a cube of porcelain and milled porcelain with small, small, small compressed particles. And there’s burs that come through and they carve it out so that there is a crown that fits your tooth to the nanometer.

John: Is that the same material that I would get if I went to another dentist and got a crown, except that you’re doing it right there in the office, or is it a little different?

Dr. Nammy: You actually get a better material doing it in the office. The main reason why is the material’s usually porcelain, and when it’s sent to a lab, what they do is they bake it in layers. What happens is that they’ll put a layer of porcelain. They’ll bake that. They’ll put another layer of porcelain and then another layer of porcelain on top of that. When the lab does it, there’s a higher risk for fracture versus when they’re done in the office. Because the particles are so tightly compressed and we’re carving it from the outside in, you don’t have those little air bubbles in between the layers, and so you have a more denser or stronger material that lasts longer.

Benefits of One-Visit Crowns

John: Talk a little bit more about that in terms of the strength of this material and the long-lastingness of it. How much better is it than a regular crown?

Dr. Nammy: That is the only thing that I do in my practice. The main reason for that is because the CEREC or E-MAX material is really great, because what it does, it actually resists bacteria, so it actually helps avoid gum disease. It also makes sure that you have things that last in the mouth for a very, very, very long time. I have some that have been in the mouth for about 15 years now.

The other thing is that the quality or the tensile quality of the porcelain is really wonderful because it doesn’t wear the opposing tooth down. What happens sometimes in dentistry is it’s a material thing. There’s materials that are stronger than your tooth structure and materials that are weaker than your tooth structure. When you’re chewing and grinding, the materials that are not as strong as your tooth structure get worn away versus some of the porcelains are really too strong.

What they do is they pound your opposing tooth down so it actually leads to problems down the road versus the milled porcelain. The beauty of it is, when it’s tested in the lab, and we actually check how strong is it, how strong is it to natural enamel, and it’s actually the exact same strength as natural enamel. You won’t have the opposing tooth that’s being worn down or you don’t have additional breakage of teeth, which is really nice.

John: Okay. What are some of the other advantages of getting crowns done in one visit?

Dr. Nammy: Well, number one, no multiple shots. You’re not having to go in two or three times getting numbed up. Also, a time. Who wants to spend five hours at the dentist when you can get the same work done in about an hour and a half to two hours and walk out of there feeling really, really comfortable?

The last one is quality. The quality of restoration is really awesome. It lasts a long time. It’s super comfortable. It looks good. It’s very lifelike. And that’s also another part, because a lot of times when you use a lab, the color will come back, it’s not perfect. You have to send it back again. And then you have to go through that entire cycle of molding, remolding, and things of that nature versus here, you know right then and there if the color’s not perfect, we can change it right out and go ahead and give you a restoration. That may take another half hour longer, sometimes an hour and a half to two, might take two and a half, but it’s still done in the same visit, in the same day, and you have something that you’re happy and satisfied with.

John: That’s great information, Dr. Nammy. Thanks again for speaking with me today.

Dr. Nammy: Oh, wonderful, John. Pleasure to speak with you as well.

John: And for more information about Green Dentistry, visit the website at sfgreendentist.com or call 415-578-9347.