Same-day smiles — what chairside CAD-CAM actually is

Media item: segment on same-day restorative dentistry

This page records the media item. Third-party content is the property of its publisher and is not reproduced here.

What follows is general information on chairside CAD-CAM dentistry — the technology behind a crown made and fitted in a single appointment — written for someone deciding whether it suits them. The service pages are Same-Day CEREC Restorations and Dental Crowns.

The problem it solves

A conventional crown historically took two appointments over two or three weeks:

1. First visit: the tooth is prepared, an impression taken, a temporary crown cemented, and the case sent to a dental laboratory.
2. The interval: the temporary is worn. Temporaries are made from provisional materials and are, by design, less strong and less well-sealed than the final restoration. They come off, they leak, and they are the source of most of the inconvenience in crown treatment.
3. Second visit: the temporary is removed, the definitive crown tried in, adjusted and cemented — and the tooth must usually be anaesthetised a second time.

Chairside CAD-CAM removes the interval, and with it the temporary, the second injection, the second appointment and the second course of time off work. Everything you need to know about Smile Solutions CEREC technology covers the same workflow.

The workflow, step by step

1. Preparation. The tooth is prepared conventionally — decay removed, the tooth shaped to receive the restoration. This step is unchanged, and it remains the step that determines the outcome. The technology does not prepare the tooth; the dentist does.

2. Digital scanning. An intra-oral camera captures the preparation, the opposing teeth and the bite as a 3D model. No impression material, which matters for anyone who gags. Scanning takes a few minutes and can be repeated immediately if a section is unclear — a real advantage over conventional impressions, where a defect is often only discovered at the laboratory. Our Technology lists what is in the surgery.

3. Design. The restoration is designed on screen: margins, contour, contact points with the neighbouring teeth, and the occlusal surface, checked against the recorded bite. This is a clinical judgement supported by software, not an automatic output.

4. Milling or printing. A block of ceramic is milled to the design in the practice, typically in the order of ten to twenty minutes depending on the material and the unit.

5. Finishing. Depending on the material, the restoration may be crystallised or glazed in a furnace, then characterised for shade, tried in, adjusted for the bite, and bonded.

The materials

The common chairside ceramics, in plain terms — What types of dental crowns are available? sets out the same list for laboratory work:

• Feldspathic and leucite-reinforced ceramics — excellent optical properties, well suited to conservative anterior work, less strong.
• Lithium disilicate — the workhorse for single crowns and onlays; a good balance of strength and appearance; usually crystallised in a furnace after milling.
• Zirconia — the strongest of the common options, used where clearance is limited or forces are high, historically less translucent though modern generations have improved.
• Resin-ceramic hybrids — more forgiving to mill and adjust, and kinder to opposing teeth.

Material selection is a clinical decision driven by how much tooth remains, where in the mouth it sits, how you bite, and whether you grind. How much does a dental crown cost in Melbourne? Materials compared puts costs against each choice.

Where same-day genuinely shines

• Single crowns and onlays on prepared or cracked posterior teeth — see Why does a cracked tooth hurt so much?, How will my cracked tooth be treated? and Chipped or Cracked Teeth.
• After root canal treatment, where a cusp-covering restoration should not be delayed — an unrestored endodontically treated tooth is at real risk of fracture.
• Conservative onlays rather than full crowns, because digital design makes partial-coverage preparations easier to execute, and preserving tooth structure is the single most valuable thing restorative dentistry can do. How long do dental fillings last? and Porcelain fillings and composite fillings cover the smaller end of the same spectrum.
• Patients who gag on impression material.
• Anyone for whom two appointments and a fortnight in a temporary is a genuine obstacle.

Where a laboratory is still better — said plainly

Same-day is not universally superior, and any page claiming otherwise is selling something.

• Multiple anterior units, where shade matching, layering and characterisation by a skilled ceramist produce a better aesthetic result than a monolithic milled block. A technician's hand still beats a mill for front teeth in most cases. See Porcelain Veneers, Same-Day Porcelain Veneers and What is the difference between porcelain crowns and veneers?
• Full-mouth rehabilitation and complex occlusal reorganisation — Complex Dentistry.
• Bridges and implant-supported work of any span — Dental Bridges and Dental Implants.
• Difficult shade cases, including matching a single central incisor — the hardest task in dentistry. How can I improve my smile with porcelain veneers and crowns? covers the aesthetic planning.
• Removable prosthodontics, which remains laboratory work — Dentures and Prosthodontists.

A practice with an on-site laboratory can offer both, and the honest position is that the two are complementary rather than competing.

Related pages: Our Technology, In-House Laboratory, General Dentistry, Understanding your treatment, Price Guide, The crowning glory, You can now get same-day porcelain veneers, and the rest of the media record.

Common questions

These are the practical questions worth asking before agreeing to a single-visit restoration, with what the published evidence does and does not say about each.

‘Is a crown actually needed, or would an onlay or a filling do?’

Coverage is not always required, and this is the question that saves the most tooth. It is also a question the evidence answers only partly, which is worth knowing before you are told it is settled.

The European Society of Endodontology's 2024 position statement on cracked teeth is direct about the limits: "There is no clear evidence on the most suitable restorative treatment approach" to manage a cracked tooth. What it does report is a difference in direction — cracked teeth managed with direct bonded composite restorations "may be more likely to require root canal treatment and/or further repair of fractured restorations compared with" those managed with cuspal coverage restorations, and the reported incidence of needing endodontic treatment after restorative management "has been reported to be between 7.7% and 20%". So coverage is not fashion; it changes the odds.

It is equally clear that coverage is not automatic. The statement says the decision "must be tailored to each patient's unique characteristics, rather than taking a ‘one fits all' approach", and names the factors that push towards a cuspal coverage restoration: the extent of the crack, a history of spontaneous pain, moderate or significant decay, existing direct restorations, pain on biting, the volume of residual coronal tooth structure, proximal contacts, and indirect factors including the bite and any grinding or clenching habit. Those are the terms in which to ask. If the answer to ‘why a crown rather than an onlay?' does not mention how much sound tooth is left and how you bite, it has not been answered. See Tooth Fillings.

‘What material, and why that one for my tooth?’

A fair question with a good clinical answer and a weak evidential one, and we would rather be straight about the gap.

The clinical reasoning is sound and is set out above: how much tooth remains, where in the arch it sits, how much clearance there is for the restoration, how you bite, and whether you grind. Lithium disilicate is the usual choice for a single crown or onlay; zirconia where forces are high or space is tight; a resin-ceramic hybrid where adjustability matters.

The gap is in the numbers. We can find no independent survival data for chairside-milled ceramic restorations in the sources we rely on — no systematic review, no cohort study, no guideline that puts a percentage at a year point on a crown milled in a surgery rather than made in a laboratory. Where a page quotes a figure like ‘90% at ten to fifteen years' for a same-day restoration, ask where it comes from. The honest position is that the materials are well established and the workflow is not separately quantified in the literature we can verify. So the useful question is not ‘what is the survival rate' but ‘why this material for this tooth, and what would change your choice?'

‘How much tooth is being removed?’

Crown preparation is irreversible, and this is the point at which to slow down.

The comparison that puts it in scale comes from a laboratory study weighing idealised preparations on anterior teeth: an all-ceramic crown preparation removed 64% to 70% of the coronal tooth structure by weight, and a metal-ceramic crown 71.9%, against 8.2% to 30% for the range of porcelain laminate veneer designs. The authors' own summary was that veneer preparations required "approximately one-quarter to one-half the amount of tooth reduction of conventional complete-coverage crowns". Two qualifications belong with those figures: the study was in vitro, on artificial typodont anterior teeth, and the percentages are by weight of the crown of the tooth, not of surface area. It ranks the designs; it does not predict your tooth.

The relevance to same-day work is indirect but real. Digital design makes partial-coverage restorations easier to execute than they used to be, which means ‘crown or onlay' is a live question rather than a formality. The principle the same laboratory authors were working from is the one to hold onto: "The conservation of sound tooth structure helps preserve tooth vitality and reduce postoperative sensitivity." Ask which design is planned, and why not the smaller one.

‘What are the item numbers and my out-of-pocket cost?’

Same-day treatment is billed on the same ASDS item numbers as conventional work; ‘same-day' is not itself an item. Ask for the numbers, the total, what is excluded, and what a laboratory-made alternative would cost for comparison.

There is a structural reason this cannot be skipped. Australia has no national dental fee schedule, so there is no published reference price to measure a quote against. The Australian Dental Association's own 2022 fees survey found "considerable variation in the fees charged within and between states", and a submission to the Senate inquiry into the value and affordability of private health insurance described the consequence for patients as "conflicting diagnoses and widely varying quotes for unpredictable dental fees", with "no consumer guidelines to ascertain the reasonableness of dental fees charged" — an argument put to an inquiry rather than settled policy, but an accurate description of the gap. What makes two quotes comparable is the item numbers and the exclusions, in writing, from both. See the price guide and Understanding your treatment.

‘What is the plan if it chips or debonds?’

All ceramic can fracture, and the answer should cover three things: whether a chip can be polished or repaired in place, what a remake costs, and how much more tooth goes if it has to be redone.

Worth knowing that the first years are the riskiest for any bonded ceramic restoration, and that grinding is the dominant variable. The forces have been measured: a sleep-laboratory study of sleep bruxism recorded a mean bite-force amplitude of 22.5 kgf (SD 13.0) during bruxism events, with a mean event duration of 7.1 seconds. Grinding shortens the life of any restoration, and a nightguard is often the sensible companion rather than an upsell — TMD and teeth grinding and How can a night guard be used to treat TMD?

One distinction matters if a bite problem is raised as part of the plan. A removable night splint is reversible and low-risk. Permanently reshaping teeth to ‘correct' a bite is neither: a 2023 BMJ clinical practice guideline for chronic temporomandibular disorders issued a strong recommendation against irreversible oral splints, and the US National Academies' 2020 review concluded that "occlusion should not be considered a contributing cause for the common TMDs". Protecting ceramic from grinding is a good reason for a splint. Treating jaw pain by permanently altering teeth is not supported by that evidence.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Directions are on Location; enquiries go through Contact Us.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a media item; third-party content is not reproduced. The material above is general information, not clinical advice. Whether any restoration is appropriate, and whether it can be completed in one visit, can only be determined by examination. Suitability, longevity and outcomes vary between individuals. Tooth-reduction percentages quoted above come from a laboratory study of idealised preparations on artificial anterior teeth and describe what each design requires, not what will be removed from your tooth. Quotations attributed to the European Society of Endodontology, the BMJ, the National Academies, the Australian Dental Association and a Senate inquiry submission are those sources' own, as at the dates of the documents cited.

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