It’s All in the Details

New digital scanner delivers greater accuracy for a perfect fit.

The art class that Carmine Forte taught at Red Bank Regional High School in Little Silver, New Jersey, for so many years was slightly different than a lot of traditional art classes in that it didn’t offer students a chance to learn how to draw, paint or sculpt.

Photo by Jordan Pysz.

Carmine Forte

“I taught crafts like ceramics, enameling and jewelry design,” Carmine explains. “I also taught students how to cut and shape stones, and how to solder and cast in metals. Except, we didn’t cast in gold and silver. They’re too expensive. So we cast in pewter instead.”

Carmine might not have taught casting in gold and silver during his classes, but that didn’t keep him from casting in those metals himself. In fact, he once cast a gold crown that his dentist later placed on a lower bicuspid.

“The dentist I had back then and I became very close friends,” the 69-year-old explains. “So when I needed a crown for that one particular tooth, I asked him if he would make a second impression for me and give me a chance to make the crown myself, which I did.”

Carmine, who retired from his job as an educator at age 55 and moved to Florida in 2005, is still wearing that crown. Unfortunately, some other crowns, including one capping a right upper molar, haven’t held up as well.

“For a while, whenever I chewed something, especially gum, I could feel a little movement in this four-tooth bridge that I had on that side,” Carmine reports. “So the last time I was in for a cleaning, I asked the dentist to take a look at it.”

Carmine’s dentist is Joseph H. Farag, DMD, of Port Charlotte Dental Care. Carmine has been seeing him for a couple years now, and he still considers the day that he discovered Dr. Farag to be one of his “lucky days.”

“I had a regular dentist here for several years, but he wasn’t available when an abscess developed in one of my teeth,” Carmine says. “When I called my insurance company and asked about a new dentist, they sent me to Dr. Farag.

“I say that I was lucky because Dr. Farag is top-notch. He really knows his stuff. I’ve been seeing him for a couple of years now, and when I brought this problem with the bridge up to him, he looked at it and said, Yep, there’s a problem there.

Increased Comfort

The problem was that the bridge was only being held on by two teeth. For better support, Dr. Farag suggested creating a new bridge that would be supported by three teeth. One of those teeth needed a new crown.

In creating the new crown and bridge, Dr. Farag earned even more appreciation from Carmine, because he used the new CEREC Primescan, a digital intraoral scanner that offers dental professionals the most detailed scans yet.

The CEREC Primescan also increases comfort for patients, because it completely eliminates the need to create impressions out of silicone or alginate, which can be sloppy and cause some people to gag.

Photo by Jordan Pysz.

Carmine’s new bridge immediately passed
the bubble gum test.

“We still have the silicon in our office, but for the vast majority of cases now, we’re using the new scanner because everything about it is so far superior to anything that we’ve been able to use before,” Dr. Farag explains.

“This scanner is really amazing. The field of view that it offers is much larger, so we don’t need to be in the mouth moving around as much as we did with older scanners when we’re creating the impressions, and the resolution is much higher.

“It can pick up the surface of the tooth through any saliva or moisture that’s on the tooth, which provides much greater accuracy in the creation of crowns and bridges, and that, of course, leads to a much better fit for the patient.

“Also, the processing power of this scanner is up to date, so crowns and bridges are created much quicker. For example, if we’re creating anything from a crown to a three-unit bridge in-house, we can complete that patient’s restorations in a single visit.

“And we’re finding that the fit on the crowns and bridges that we’re making from this scanner is exceptional. That’s a very important aspect that cannot be overlooked, because the fit and the marginal seal are absolutely imperative.

“When you cast something from a mold, there are imperfections and irregularities because the end of the tooth may not be where the technician believes it to be from looking at the mold. That’s how you end up with open margins. Dentists see that all the time, where a patient comes in and the margins on a crown aren’t lined up properly. If you don’t have a good marginal seal or a good fit on that crown, it can cut short the life of the restoration.

“We don’t get that problem with this digital scanner, because it’s scanned in color. You can see the tooth is white and the tissue is pink, and the lab technician knows exactly where the margins should be. There is no guessing.”

Passing the Test

For anything larger than a three-unit bridge, Dr. Farag uses the Primescan to create the impression, which is sent electronically to a lab. The prosthetic is developed at the lab and recreated using a 3D printer in the dentist’s office.

That’s the process Dr. Farag followed in creating the four-unit bridge for Carmine, who had the crown made in Dr. Farag’s office and was fascinated by the technology that allowed the restoration to be completed in one visit.

“This process is so much better than what they used to do, where they would put that goop in your mouth and you had to bite down on it,” Carmine says. “That stuff always tasted terrible, and you had to fight that gag reflex. It was no fun at all.

“Dr. Farag did an excellent job. He’s very precise about his work and takes his time to do everything right. – Carmine

“But with this digital scanner, they scan your teeth with this wand that’s about the size of an electric tooth brush. There’s a camera at the end of the wand that takes thousands of images that pop up on a screen right in front of you.

“Once they’re done with that, they fine tune the images, and you wait for about an hour. While you’re waiting, they make the crown and color it to match your other teeth perfectly, and they ‘pop’ it in, cement it in place and you’re done.”

Carmine said a similar process was followed for his four-unit bridge. The only difference was that the bridge was created in a lab. He returned for a second visit to have it secured to the anchor teeth. As it was with the crown, the result was exceptional, Carmine raves.

“I wanted to put that bridge to the test right away, because I was dying for an apple,” he says. “So right off the bat I had an apple, and the bridge passed the apple test. Then I had a steak and eventually chewed some bubble gum. The bridge never moved.

“I haven’t had a problem with that bridge. Dr. Farag did an excellent job. He’s very precise about his work and takes his time to do everything right.
He’s very professional.

“In fact, Dr. Farag’s entire staff is very professional and also very cordial. You don’t get that at some of those franchise dental places that they have around the state, so I happily recommend him to anyone. You won’t go wrong going to see Dr. Farag.”

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    • Port Charlotte Dental Care

      Dr. Farag provides a full range of quality, caring dental services to the Port Charlotte community. He looks forward to hearing from the viewers of the Florida Health Care News website. For more information or to schedule an appointment, pl... Read More

    • Joseph H. Farag, DMD

      Joseph H. Farag, DMD, earned his Doctor of Dental Medicine degree from the University of Florida College of Dentistry, Gainesville, FL after completing his undergraduate degree at Florida Atlantic University, Boca Raton, FL. Dr. Farag served an... Read More