By: Howard Farran, DDS, MBA, MAGD
Publisher, Dentaltown Magazine

One of the things I learned in earning my master’s degree in business administration from Arizona State University is your business’ cost structure is designed from the start. If you have a restaurant and decide each table should have a fresh tablecloth, you just added $1.50 to every table served. If you decide to go without a tablecloth, you just saved a $1.50 on every table served. Southwest Airlines stopped serving meals to become the lowest cost provider in air travel. IKEA furniture does not pay its employees to assemble its furniture because it knows its customers have more time than money and would rather assemble the furniture at home to save more money.

So, let’s say your next patient needs an onlay. The restoration is too big for a composite filling, I do not place amalgams and there is too much tooth structure left to warrant a crown. If I decide to place an all-porcelain onlay, I will have designed a higher cost restoration that does not last as long as gold. To seat an all porcelain onlay I will need to anesthetize the patient with Septocaine, place a rubber dam, possibly pack retraction cord, and set up my chair-side chemistry set. I think I am pretty fast after 20 years and I would still need half an hour to do all of this. All of these high-cost variables were designed from the start. The shorter longevity of this restoration was designed from the start. This patient perceived a need or want for an aesthetic health compromise. This patient chose color connected light transparency over longer-lasting, more opaque restorations.

Now if I make a decision to go with a porcelain-to-metal onlay, which for me is always Captek, I have designed a lower cost restoration that lasts longer. I spoke with Rella Christensen about this at length and there is no question porcelain to metal is always stronger than all porcelain. I can seat a porcelain-to-Captek gold onlay in 15 minutes every time. I will not have to anesthetize the tooth with Septocaine, I will not need to place a rubber dam, and I can seat this with 3M RelyX Glass Ionomer Cement in a few minutes with fast and easy clean up. All of these low-cost variables were designed from the start. The longer longevity of this restoration was designed from the start. This patient did not need nor want an aesthetic health compromise.

I still do not understand all the hoopla about all-ceramic restorations. I just do not see a lot of gorgeous young women coming in needing crowns and onlays. Nearly all of my patients needing crowns and onlays are over 40 years old. Nearly all of the men I have ever seen in my life over 40 years old do not show any posterior teeth when they talk or smile. Why would I trade strength and longevity for light transparency in a 60-year-old man with a liver spot the size of Rhode Island on his head? If the patient were young and as cute as my wife, yes, I would utilize the cosmetic hoopla that I learned at the Las Vegas Institute. But for the other 90% of my practice, I am going with porcelain-to-metal Captek, which is lower in cost, longer in survivability, has less propensity to fracture, is faster to seat, etc.

I think Captek is fantastic. You can use it just like regular porcelain-fused-to-metal. But unlike traditional alloys, Captek will never have dark lines, will repel plaque and help prevent recession, is more esthetic and fits better than anything else I have ever used. When prescribing a PFM, I can’t think of a good reason to use anything other than Captek.

Captek should be viewed as a reduction in seating time over all-ceramic restorations, with a decrease in remakes when compared to all-porcelain restorations. Captek crowns have better long-term health and predictability for the patient, which all adds up to increased long-term profitability, and ultimately a happier patient.