Expert: Zev Kaufman, D.D.S. - 2/20/2009

Question
Dear Dr. Kaufman,

I came from a developing country and did not take good care of my teeth until I came to U.S. I have very crowded teeth and seven mental crowns, two of them (#14 and 15)are under one crown. I have three questions for you:
1. I was told by my dentist that cerec crown is superior and they are much better than PFM crown. I am not really convinced since it does not have any metal in it. What do you think about it? Do you think captek is a necessary upgrade?

2. I have wisdom tooth #32 and it never bothered me. I was told by the general dentist I need to have it taken out and he can do it without referring me to somebody else. Do you think I should do it?

3. My husband has a front tooth that needs implant (post was broken and currently has a crown over the tooth). Can you recommend a good doctor in Orlando, FL area?

Sorry for so many questions - I really don't have good teeth and seldom had good luck with dentists. Thanks, Jasmine

Answer
Dear Jasmine:
I will answer your questions in order...
1.  Cerec is NOT as good as a regular porcelain fused to high-noble metal crown.  The technology for cerec crowns is just now "up-and-coming."  It takes a very careful doctor to do a cerec crown that can rival a properly made conventional crown.  Cerec is usually good for people who want their crown "right away", not having to wait for the laboratory to fabricate a regular crown and come back for an insertion visit about two weeks after the crown preparation.  Captek is also, excellent technology, but the track record for teeth in the back of the mouth, where the stresses of chewing are greater, is not any better than a regular crown.
The best crown for the back of the mouth, especially if no-one can see the tooth, is a full gold crown.  It has no porcelain to break, and it requires less tooth preparation.
2.  I have no problems with a general dentist extracting wisdom teeth.  However, if you have access to an oral surgeon, who is the specialist in this area, you will increase the chances that the extraction is performed in a more successful manner, with less pain and complications.   If there are complications, the oral-surgeon is the proper person to handle them.  You can locate an oral surgeon on www.aaoms.org.
3.  As to your husband... Yes I can recommend a good doctor, but I would rather do it in private over the telephone.  You can also locate a Prosthodontist in your area on www.prosthodontics.org.

I do have a few recommendations for you:
1. In general, like in medicine, a general dentist is a good person to go to, if you need regular dental care.  However, if you have a complicated situation, or require, advanced work, such as crown and bridge, dentures, cosmetic dentistry, implants, etc. the best person to turn to is the specialist in restorative/cosmetic/implant dentistry--the Prosthodontist.   The problem is availability.  There are only about 3000 prosthodontists in the country and most are in metropolitan areas.  The Prosthodontists are usually more expensive than your general dentist, but when you go to a specialist, you know that the work will be performed to the highest standard.  (don't get me wrong... there are plenty of excellent general/family/cosmetic dentists out there, but unfortunately, you, as a consumer, cannot evaluate who is good, and who is not so good.)
2.  For your husband, it is even more important to go to a Prosthodontist, if you can since, an implant in the front could be quite complicated to do and, again, it is better to go to the most qualified person.
3.  Please feel free to call me at the office.  My information is on www.DrZevKaufman.com  212-758-2758.  I will gladly refer you to a colleague in Florida.
Have a great weekend,
Dr. Zev Kaufman