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View Full Version : Greedy Dentists or State of the Art?


Trinopus
11-14-2014, 02:57 PM
My sister needs dental crowns. She's been to three dentists now who say they no longer use the porcelain-on-metal variety, but insist on the composite (?) variety.

The trouble is that her insurance will pay for half the cost of porcelain-on-metal, but only $200 toward composite. (This seems very odd to me, but I'm only quoting what she said.)

So: are the dentists being greedy, pressuring her to get something more expensive? Or has the state-of-the-art changed, and the insurance company needs to catch up with the times?

Are porcelain-on-metal crowns still a viable dental technique, or is that as obsolete as wooden teeth and gutta-percha dentures?

(She's asking her insurance company for clarification...but she asked me...and I know that the SDMB is a fount of nearly-all knowledge!)

Robot Arm
11-14-2014, 06:21 PM
I know a guy who makes crowns. I can ask him next time I see him, but I think he's got a vested interest in the porcelain-on-metal type, so I can't promise he'll be complete unbiased.

He also plays the bagpipes. And curls. Interesting guy.

kunilou
11-14-2014, 07:21 PM
Unless the dentists have their own labs, and are therefore able to make money off the materials as well as the procedure, how does using one type of crown instead of the other benefit them?

I mean one dentist, sure, it's easy to question motives. Two dentists, well, it could be coincidence. But by the time three dentists give you the same answer I think you're looking at a trend.

SeaDragonTattoo
11-14-2014, 07:35 PM
My dentist charges the same no matter which crown I get. I had two done a couple years ago, and I was originally quoted for porcelain over metal. He said all-porcelain (or composite, whatever the one is that's the same color throughout) wasn't appropriate for me because of my bruxism, which was the cause of needing crowns in the first place. I would clench and grind too much for the all-white ones to stand up to it. I then asked him couldn't I have a similar issue with porcelain on metal, with the porcelain possibly cracking or wearing down to metal in the most worn areas? He said that's possible. So I went with gold. My two lower, furthest back molars are gold now and I couldn't be happier with them. But no matter which of the three I went with, same price and same coverage from my dental insurance.

My conclusions about dental insurance from my own experience (and three levels of plan available to me) and what I've read about here on the SDMB, are that it has a lot of catching up to do, and coverage plus what they think dentist charge are dismally behind the times. I pay $20 a month for insurance and if I'm lucky maybe 50% of my yearly preventive care is covered. Less if I need work done.

Trinopus
11-14-2014, 08:56 PM
Unless the dentists have their own labs, and are therefore able to make money off the materials as well as the procedure, how does using one type of crown instead of the other benefit them?

I mean one dentist, sure, it's easy to question motives. Two dentists, well, it could be coincidence. But by the time three dentists give you the same answer I think you're looking at a trend.

You're probably right. When my sister asked me this, she jokingly said that it sounded like a conspiracy theory (and she doesn't like those any more than the rest of us here!)

. . . He also plays the bagpipes. And curls. Interesting guy.

Cool! My previous dentist (now retired) used to run for Congress for the Libertarian Party every two years. He knew he wasn't going to win, but he liked "showing the flag." (It would have been hilarious if he'd actually won!)

rsat3acr
11-14-2014, 10:21 PM
Dentist here. For the most part we no longer use the porcelain metal crowns. The newer ceramic substrate crowns are usually better. They are less likely to fracture and require a little less removal of tooth. Also the discoloration on the edge from the metal isn't there.

In some cases gold is still the best option but most people don't want it.

We charge the same for each except for the difference in lab fee that is added on.

GrumpyBunny
11-14-2014, 10:30 PM
Dental insurance isn't anything to go by. All of it sucks, and they really don't want to pay for any restorations beyond fillings.

Dentist here. For the most part we no longer use the porcelain metal crowns. The newer ceramic substrate crowns are usually better. They are less likely to fracture and require a little less removal of tooth. Also the discoloration on the edge from the metal isn't there.

In some cases gold is still the best option but most people don't want it..

I have a gold crown on a back molar. Been there about 20 years. I hope to keep it for 20 more. (I have a small mouth, and when I smile people only see the front few teeth.) :)

I have a ceramic crown that was put on a tooth after a root canal and only had a mm or two of healthy tooth showing outside the gumline (a previous dentist had fucked up the previous crown, and decay set in under it, hence pain and root canal). It looks perfect. I'm happy with it.

Trinopus
11-14-2014, 10:43 PM
Dentist here. For the most part we no longer use the porcelain metal crowns. The newer ceramic substrate crowns are usually better. They are less likely to fracture and require a little less removal of tooth. Also the discoloration on the edge from the metal isn't there.

In some cases gold is still the best option but most people don't want it.

We charge the same for each except for the difference in lab fee that is added on.

Thank you for the information. I'm definitely feeling reassured that there isn't a conspiracy...or even real greed...going on. It sounds like our insurance company needs to update their policies, if they're covering the older process much more favorably than they're covering the new.

I'll ask my sister what she thinks of gold. I believe it's a molar, so it wouldn't show very much. (Well, she does love to laugh!)

Thank you, every one and all. I'm a lot more comfortable now.

(My sister thanks you too!)

rsat3acr
11-15-2014, 09:15 AM
Thank you for the information. I'm definitely feeling reassured that there isn't a conspiracy...or even real greed...going on. It sounds like our insurance company needs to update their policies, if they're covering the older process much more favorably than they're covering the new.

I'll ask my sister what she thinks of gold. I believe it's a molar, so it wouldn't show very much. (Well, she does love to laugh!)

Thank you, every one and all. I'm a lot more comfortable now.

(My sister thanks you too!)

The insurance companies don't want to change because it means more money for them. It is called downcoding, they substitute a a cheaper insurance code for what was actually done. Of course if dentist claimed a different code than what was actually done it is called fraud.

FWIIW I have gold crowns on four of my molars, and it is the only thing I'd put on my own molar. Teeth that show a lo,t premolars and anterior, I'd do porcelain.

susan
11-15-2014, 11:40 AM
All of it sucks, and they really don't want to pay for any restorations beyond fillings.
Says you. I'm happy with my dental, and especially happy with my recent root canal/composite crown, which were made affordable by having coverage.

GrumpyBunny
11-15-2014, 11:58 AM
Says you. I'm happy with my dental, and especially happy with my recent root canal/composite crown, which were made affordable by having coverage.

Then you are lucky indeed.

SeaDragonTattoo
11-15-2014, 01:23 PM
I know a guy who makes crowns. I can ask him next time I see him, but I think he's got a vested interest in the porcelain-on-metal type, so I can't promise he'll be complete unbiased.

He also plays the bagpipes. And curls. Interesting guy.I would be interested in his answer. When I asked my dentist about gold for my molars, he said that's what the people who make them still think is the best material for molars. He didn't put gold down as first choice because of all the cosmetic dentistry he does, apparently most of his clients go for white. I'm not vain enough to opt for porcelain if gold will last longer.

rsat3acr
11-15-2014, 02:25 PM
I would be interested in his answer. When I asked my dentist about gold for my molars, he said that's what the people who make them still think is the best material for molars. He didn't put gold down as first choice because of all the cosmetic dentistry he does, apparently most of his clients go for white. I'm not vain enough to opt for porcelain if gold will last longer.

like I said as a dentist,gold is what I'd put on my molars. My wife however refused gold on her second molar and I placed porcelain/metal. This was 10 years ago.

BrotherCadfael
11-15-2014, 06:04 PM
I have a couple of gold crowns, which I got about ten years ago. The dentist prepared my teeth, made a mold, sent it out for fabrication, and put on a temporary. A couple of weeks later, I went back and he installed the gold crown.

Recently, I had to have one replaced. This time, they prepared the tooth, took a bunch of pictures, did some cool 3D modeling on a CAD workstation, hit SEND, and a very cool milling machine carved the crown out of ceramic while I watched. Total time from walking in the door to walking out with a new crown? 110 minutes.

Total cost? $600, about half the cost of gold.

How does it feel? Pretty much like the natural tooth.

Trinopus
11-15-2014, 08:05 PM
BrotherCadfael: Nifty! That sounds like the future is here! We may not have flying cars...but we have computer-carved dental crowns. Especially nice that the price is low.

(Personally, I'm very glad to be of the Flouride generation. My gnashers aren't perfect, but they're pretty damn good. At my age, my father did not have even one whole tooth left.)

rsat3acr
11-15-2014, 08:10 PM
I have a couple of gold crowns, which I got about ten years ago. The dentist prepared my teeth, made a mold, sent it out for fabrication, and put on a temporary. A couple of weeks later, I went back and he installed the gold crown.

Recently, I had to have one replaced. This time, they prepared the tooth, took a bunch of pictures, did some cool 3D modeling on a CAD workstation, hit SEND, and a very cool milling machine carved the crown out of ceramic while I watched. Total time from walking in the door to walking out with a new crown? 110 minutes.

Total cost? $600, about half the cost of gold.

How does it feel? Pretty much like the natural tooth.

$600, that is way below national averages. You sure that wasn't just your part? Most insurance pays 50% on crowns and $1200 is much closer to national average.

Never heard of any dentist with a CAD/CAM that charges less than average, most charge more.

Tom Tildrum
11-16-2014, 07:28 AM
We charge the same for each except for the difference in lab fee that is added on.

That means that the ceramic one is more expensive to the patient (or insurer), yes? How much is the difference?

rsat3acr
11-16-2014, 09:20 AM
The lab fee difference is something like $30.

Tom Tildrum
11-16-2014, 01:05 PM
Ah, OK. That's nothing then. I was thinking that if the overall cost of the one was a few hundred more than the other, it might make a difference to the insurer.

BrotherCadfael
11-16-2014, 02:53 PM
$600, that is way below national averages. You sure that wasn't just your part? Most insurance pays 50% on crowns and $1200 is much closer to national average.

Never heard of any dentist with a CAD/CAM that charges less than average, most charge more.
I have dental coverage, but it doesn't pay much. The $600 was my share but i doubt insurance paid more than $200.

rsat3acr
11-16-2014, 03:03 PM
That is still pretty inexpensive, we charge something like $900 and are the least expensive around.

samclem
11-16-2014, 03:51 PM
I have dental coverage, but it doesn't pay much. The $600 was my share but i doubt insurance paid more than $200.

Why do you think your insurance only paid about $200? I'll wager they paid more.

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