PDF Version - Glidewell Dental Labs

ut to try and buy time with less-invasive procedures —
giving the pulp chamber a chance to become smaller,
giving the dentinal tubules a chance to become smaller, and
saving that more invasive procedure for their later years.
When you do so, you minimize the number of root canal
treatments that are required later, you minimize the amount
of replacements that have to occur with crowns and the like.
We will always, within my lifetime, I believe, have the need
for full-coverage crowns. I’ve got one that my daughter put
in my mouth just four years ago. It was an upper second
molar that was a virgin tooth, but it succumbed finally to
the “dental student syndrome.” Namely, when I was a junior,
a senior student had to take out impacted wisdom teeth in
order to graduate, and I became the volunteer. The student
wasn’t the sharpest knife in the drawer and took out some
of the buccal plate over my second molar, and I’m sure he
leaned that elevator on that root. Later, bacteria got in that
crack and it was discovered, much later, probably about
eight years ago, when the tooth abscessed and became a
sinus infection and all the rest. If you’ve got a tooth like
that, or you’ve got a molar that’s taking a heavy load, or a
tooth that’s had root canal treatment — you’ve got to put
crowns on those kinds of things.
MD: Of course! And I know you don’t hate crowns. I know that
what you don’t like is the overuse of full crowns as the easy
way out, or kowtowing to what the patient’s insurance might
pay. Did you go with cast gold on that crown?
DF: It’s solid cast gold on this upper second molar.
MD: Good choice! We like to see that. That’s becoming an
endangered species in the laboratory today. I guess part of
that is gold hitting $1,700 an ounce. It’s also patients giving
some pushback about having gold in their mouth — even on a
second molar — which is kind of crazy, especially after we tell
them it’s the best material we’ve ever had in dentistry.
DF: Well, when you said, “Good choice, that’s what we like
to see,” the truth is at the end of the day, you can’t even
see it, Mike! (I’m teasing you a little based on the meaning
here.) But, yes, it’s true: if nobody is going to see it, you
can’t beat it. That being said, I am impressed with how
zirconia continues to improve. In fact, boy, with the cost of
metals and the like, thank goodness we’ve got materials like
zirconia that are evolving to where they are.
MD: Right. Let me share some numbers with you. In 2007,
66 percent of the crowns that we fabricated here were PFM
crowns and 23 percent were all-ceramic crowns. If you look
at 2011 and the first half of 2012, and PFMs have gone from
66 percent to 20 percent, and all-ceramics have risen from
22 percent to 68 percent of the restorations, and it’s because of
zirconia and lithium disilicate. It’s shocking to me, and even
to us as a laboratory, to see how quickly dentists have changed
their allegiance and have been willing to kind of drop the
PFM. It has been an amazing transformation largely pushed
on by zirconia and dentists being somewhat satisfied with the
material because they continue to order it.
Let me ask you about one other thing I find fascinating about
you: your drive to find a cure for dental caries. I don’t think
there could be a higher mission on the planet, and least in the
dental world, than to tackle something like this, and I don’t
hear anybody else really talking about this. In fact, I saw in
a recent article that the city of Phoenix is thinking about not
fluoridating their public water supply. Can you tell me how
your drive to find a cure for dental caries is going?
DF: The progress has been slow. Not because of the
technology, but because of regulatory constraints that we’re
up against with the FDA. We have a technology that we feel
can go a significant distance on this. We’re being very active
on it, and we feel like we’re making some good inroads
relative to explaining the technology to the FDA. It’s a little
device that in the first human studies — four kids in a lower
social economic group for which oral hygiene is pretty
low — was shown to decrease caries 76 percent. If we can
reduce caries 76 percent, we can reduce the incidence of
the abscessed tooth 95 percent, which is exciting to me.
But, yes, we’re still battling that.
That being said, and I don’t know if I told you this last
time or not, Mike, but if we could bring about a cure to
caries today, we’d still need more dentists. I mean, when
you consider that in our country before the recession, onethird
of our fellow Americans couldn’t afford to go to the
dentist except for emergency treatment. When you consider
that teeth are like tires — they’re good for so many miles,
and then the treads wear out, the sidewalls give out. When
you consider the jobs of the Western world, there’s hardly
42 www.chairsidemagazine.com