Peter Gardell That is the question... that has come up from time to time, a difficult one to answer with an absolute.
Placing cores are a billable service that many dentist do, especially helpful for the practices that are members of managed care. It was a helpful method to help with retention of our crowns.
Now with all ceramic restorations we have to ask if cores are necessary. Rella Christensen has talked about fractures on all ceramics and how the majority of these failed restorations occurred in teeth that had cores. There is another thing we have to think about with all ceramic restorations. We are bonding these restorations in, so does it make sense to add another layer of material into the mix? Why add material at the expense of ceramic thickness?
For my personal preference it gets down to milling performance. Our milling chamber does a great job at producing quality restorations quickly and easily for our patients. It delivers fantastic fits time after time. But it can be aggressive with the milling of the intaglio to guarantee these fits. The overmilling that can occur can be the difference between a restoration of proper thickness or one that is below the threshold
Due to this sometimes I will help the system by using a light cure material to remove steps and to smooth transitions. This saves me from removing more healthy tooth structure to remove a small defect. Saves the milling chamber from overmilling areas, risking a thin restoration, or getting a spot of binding.
By using the slice tool we can go through the proposal and see how by smoothing the transition we can cut down on the overmilling that we would have had without placing a core.
So the answer to the question to core or not to core is... it depends on each case needs to be evaluated carefully. Not just whether you can bill for it but whether spending the time to place it will increase the strength and the longevity of the restoration.
