You probably already noticed it is common to have local treatment plans include a CDT code D2950 on the same tooth number as a crown. This is the code for the core buildup. This is a procedure that generally raises several questions as to what it is and why it is always quoted as a separate cost alongside a dental crown.
Sometimes, when a tooth is severely fractured or missing a large portion of its surface due to a large cavity or a failed filling, a crown will be recommended to restore function and appearance. However, there are times when the remaining tooth structure is so little that it is necessary to restore some surface area for adequate crown support.
The core buildup is part of the preparation of a tooth prior to a crown. It is an essential part of the process of getting a successful crown, because it is the procedure in which the tooth structure that will then serve as support to the crown is restored. There are cases in which large decay, fracture, or severe grinding leave the restorative dentist little tooth surface to work with. Due to mechanical factors a successful crown, porcelain or otherwise, requires a certain amount of height, taper, and width of structural integrity for the proper retention of the prosthetic. A large percentage of the success of the crown depends on the core buildup.
Traditionally, the buildup was made up of amalgam or other metal-based materials. However, since these act mechanically, not with adhesion, they require a more invasive preparation of the tooth enamel. In other words, they require large portions of grinding for the retention of the metal. Only more recently, dentists use composites in order to create the core buildup because they act through adhesion and require a less invasive preparation. This helps save tooth structure and results in better crown retention.
The core buildup may or may not require pins. As the buildup composite technology advances, there is every day less use of pins to help keep the buildup in place. Only in the case where the structure is so severely damaged that the nerve is compromised would there be a necessity of a pin or post. These were traditionally made of metal, but modern dentistry uses fiber posts due to a higher flexibility. The post will serve as a backbone to the buildup.
Not all crowns require a core buildup. If the tooth is healthy when prepped or if there has been no significant damage to its structure, then the dentist can prep the tooth with no buildup because he will find all the tooth structure he needs for the crown´s proper retention in the tooth itself. It is only when this structure is compromised that the dentist decides to build up the area.
This depends on the expertise of the dentist. An average core buildup should not take more than 20-30 minutes to complete. If it requires the placement of pins and/or post this may extend the process some minutes more. It should also be free from pain. After the dentist is finished, he will be ready to place a temporary crown while the permanent crown is fabricated.
At the Costa Rica Dental Team, our restorative dentists are experts in the art of crown preparation and core buildups. You will also notice that the core buildups are not quoted separately from the cost of the crown as they are in North America. This is because it is hard to foresee the necessity of the buildup until the actual preparation. For this reason, our practice decided to consider whatever buildup necessary as part of the crown. In other words, in dental practices where the core buildup is charged separately, you must consider the total cost of the crown as the sum of the buildup and the crown. At the Costa Rica Dental Team, we consider the core buildup so important for the success of a crown that all is included into a total cost from the beginning.