Ep. 634 - Hero or Hitman: The Case for Crowns Over Compromise

Are you doing too much with composite when a crown might be the better long-term solution? This common clinical dilemma affects treatment outcomes across thousands of dental practices.

Dr. Jen Derse brings unique insights as Chief Clinical Director overseeing 40 DSO dental practices at Espire Dental. A 2005 graduate of Marquette University School of Dentistry, she has focused on cosmetic and restorative dentistry throughout her career, with extensive experience in clear aligners and digital workflows. Dr. Derse serves as a mentor at the prestigious Kois Center in Seattle and has lectured internationally on restorative dentistry, cosmetics, and case presentation. Her post-graduate education includes Harvard Business School Online CoRE and McKinsey Leadership programs, combining clinical excellence with business acumen.

This episode examines the critical decision-making process between composite restorations and full crowns, exploring how remaining tooth structure, occlusal forces, and material science should guide treatment planning. Dr. Derse shares insights from analyzing treatment patterns across multiple practices, revealing common mistakes and offering evidence-based protocols for optimal patient outcomes. The discussion emphasizes cusp protection strategies and the paradigm shift from cohesively retained to adhesively retained restorations.

Episode Highlights:

• Treatment planning ratios reveal that doctors often attempt four-surface composite restorations when crowns would provide superior long-term outcomes, particularly when more than one-third of the distance from cusp tip to cusp tip is compromised. The key principle involves protecting cusps through occlusal coverage rather than attempting complex composite buildups that may fail within several years.
• Digital impression accuracy depends heavily on achieving hemostasis during scanning procedures, as blood contamination affects light refraction and dimensional precision. Retraction paste with neutral pH prevents post-operative sensitivity compared to acidic hemostatic agents, while maintaining clean, dry margins throughout the scanning process.
• Crown preparation efficiency can be achieved through systematic three-burr protocols, reducing chair time from typical 10-minute preps to under seven minutes without compromising quality. This approach becomes critical during quadrant dentistry cases where patient fatigue and anesthesia duration impact treatment success.
• Material standardization within practice teams significantly improves efficiency and reduces remake rates by ensuring consistent handling protocols and assistant familiarity. The transition should occur gradually, starting with composite materials, then bonding agents, followed by cements and burr selection to minimize workflow disruption.
• Adhesively retained restorations allow margin placement in enamel rather than requiring subgingival extension, improving long-term prognosis while enabling more conservative axial reduction. This paradigm shift favors materials that can be seen through radiographically for ongoing caries detection over opaque alternatives like zirconia.

Perfect for: General dentists, DSO practitioners, and dental team members seeking to optimize crown treatment planning, improve digital workflow efficiency, and implement standardized material protocols for enhanced practice productivity.

Discover how evidence-based crown protocols can transform your treatment outcomes and practice efficiency.