Cut out the middleman.

That's the philosophy behind a cool little machine that makes full and partial dental crowns, or tooth-shaped caps, right in the dentist's office.

If you've ever been blessed with crowns, you know the standard operating procedure is to have the dentist make dental impressions, which are sent to a lab to create the final product.

What you're left with while you're waiting is a temporary crown and the knowledge that another visit to the dentist is coming your way.

With the CEREC 3D system, the dentist can save the patient that two-week wait and second visit, says Dr. Donato Napoletano, a dentist of 16 years, at his office, Donato Dental, in Middletown.

"Everybody goes home with a restoration the same day," says Napoletano, who got the machine in October and has done about 25 cases so far.

The actual prep part of the process is similar to other dental work. There's an exam to determine whether a full or partial crown is in order, and any decay is removed from the tooth. And, of course, anesthesia is used.

Then the tooth is coated with an optical powder to aid picture-taking (the same powder used to spell out the "M" on M&M candy), and a powerful camera snaps away.

The CEREC computer converts the digital image to a 3D model.

No dental-impression goop, no biting down.

"The beauty of this is that you have total control to fix any parameter of [the tooth] you need to fix," Napoletano says as he turns, twists and flips the 3D image on the screen, outlining areas that need to be adjusted as he tweaks the model to his liking. Doppler imaging shows that the tooth's sides will squeeze neighboring teeth too hard.

Edward Sheskier Jr. of Scotchtown, a patient whose tooth is the object of such scrutiny, looks on with interest.

When Napoletano is satisfied the crown will fit perfectly, he clicks a button and the information that will be used to create the crown is sent to a separate unit.

A little side room in the office is where that tooth-making magic happens.

Tucked away there, the machine, or milling unit, waits for information that was wirelessly sent from the CEREC computer. Not much bigger than a home computer printer - and sounding much like one - the milling device is equipped with two arms, both with drills attached.

The dentist selects the correct size and color of porcelain, attaches the block in-between the arms and lets it go.

The actual crafting of the tooth is like something out of a futuristic movie. The drill arms determine what they're working with, calibrate themselves and set out on their task, using the information from the model the dentist designed.

One arm grinds the chewing surface, while the other one works on the underside. Specially lubricated water ensures the results are smooth.

About 15 minutes later, you have something that looks like it was plucked right from your mouth. And in Edward's case, the tooth pops perfectly into place.

Though the process may take longer than if it were done in two visits, it's worth it, Napoletano says. His confidence in this technology is evident in the $100,000 he spent on the system.

"Everybody's pressed for time," Napoletano says. "If they have to be here an extra half-hour, they don't care as long as they don't have to come back."

Insurance

Whether it's lab-created or CEREC-created, insurance companies typically don't care, so they'll pay, Dr. Donato Napoletano says.

And speaking of insurance, you can rest assured that if you need a root canal after your permanent crown is placed, it won't be a problem.

"Because I have all this information stored in the computer, I can do a root canal for them and rather than making a hole through the restoration - which is normally done with a lab crown or onlay - I can pull the whole thing out, do a root canal for them, and remake the restoration at no extra charge because I don't have to go through the whole process of making another impression," Napoletano says.