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I have virtually eliminated porcelain-fused-to-metal (PFM) restorations from my practice.

The advances in porcelain technology (see post here) and resin cements (see post here)have inspired great confidence in myself to no longer rely on PFMs as my first line of defense.

I probably don’t have to convince you of the advantages of all-ceramics restorations.

No silver margins and more lifelike esthetics are reasons enough to want more all-ceramics for your patients.  And yes, the strength of these restorations is good, but you must choose your material wisely (e.g. zirconia VS lithium disilicate).

Also, a major advantage of all-ceramic restorations is that the margins can be placed equi-gingival or supra-gingival.  There’s no need to prepare a subgingival margin to hide the metal.  Supragingival margins are much kinder to the gingiva and more hygienic.

So if you’ve done a bunch of all-ceramic restorations and are liking what you see, how do you turn the tides and bring more of them into your practice?

(1) Know your codes and fees

Check with your lab to find out how your bill is going to be affected.  Make sure your fees (insurance or fee-for-service) are adequate to cover your time and materials.  Some insurance companies will only cover a PFM and the difference will be owed by the patient.  Fine, whatever.  Just check all of this beforehand so you and your patient don’t get surprised.

(2) Present the options to patients honestly

You have a speech for presenting a composite resin VS an amalgam, right?  It probably covers the differences in esthetics and how insurance coverage works.  Well, it’s the same thing for PFMs and all-ceramics.  My speech goes something like this:

“We can do two types of crowns for you.  The first is the traditional metal and porcelain crown.”

At this point, I show the patient an example of one somewhere else in their mouth or a picture on my computer.

“The other kind of crown is made out of a special porcelain and doesn’t need any metal underneath.  Both options are strong and will hold up great.  The only difference is the fee.”

I then describe how the patient’s insurance will work or explain the difference in my private fees.  The key is to be honest about fees and not make a big deal about it.  This is not a high-pressure sale; I’m not selling anything.  I am simply presenting a patient with their options.  The only time I will really make a case for an all-ceramic restoration is in the esthetic zone, for obvious reasons.

And as they say, a picture is worth a thousand words.  Show your patients a picture of both kinds of restorations so they can make an informed decision.

(3) Train your team

After you’ve finished your case presentation and the patient has accepted treatment, the last thing you need is to have a untrained member of your team say the wrong thing: 

“A ceramic crown?  Oh, your insurance isn’t going to cover that.” 

No good.  Make sure everyone on your team, and I mean everyone, understands your new philosophy.  Discuss how patients will benefit from a more modern restoration.  Review any insurance or financial concerns.  This is an opportunity to get your team to be proud of the advances your making in your practice.