Chairside Economical Restoration of Esthetic Ceramic (CEREC)

Chairside Economical Restoration of Esthetic Ceramic (CEREC)

Whenever a patient needs a restorative procedure involving work done with the laboratory, there is always that requisite time with a provisional restoration. A simple crown requires two visits and often there are interim visits due to the provisional falling out or breaking. Sirona has developed a technology that, with over twenty years of testing, has changed the way traditional crown and bridge is performed. Their CEREC system, in its third generation, allows for chairside fabrication of inlays, onlays, three-quarter crowns, crowns, or veneers and allows for cementation that same visit.

The technology used by the CEREC system is complex but easy to use. The CEREC system uses an infrared camera to take an optical impression of the tooth preparation in real time—just try to do that with the stone model from the lab. Ensuring proper contacts is a breeze.

The CEREC system has two major components—the computer acquisition unit and the milling unit. The acquisition unit is a computer on wheels that includes the infrared camera and 3D software. The computer software directs me through each step in order to design the restoration quickly, and the new software makes it easy and predictable. Essentially, I prepare the tooth and take the optical impression with the camera. Within seconds, I have an image of the prepped tooth on the computer screen. If I want to do quadrant dentistry I can simply capture three or four images, hit one button, and before I know it I have a 3D model on the computer screen. I can rotate, enlarge, and edit the image as needed. Then I design the restoration on the 3D software to meet the specific needs of my patient.

Once the final restoration is designed on the computer, I then select the shade of the restoration based on my patient. There are many shades to choose from. There is a new block out now that is made up of three shades to mimic the shading of a tooth from the incisal or occlusal to the gingival margins. Once I select the shade, I place the block into the milling unit, and within five to twenty minutes I will have a completed restoration. Afterwards, I can characterize the shades to match each individual tooth. The restoration is tried in, polished and cemented with a resin cement.

The latest upgrade boasts of taking away the only real obstacle for me, occlusion. The program can virtually adjust the occlusion before the restoration is milled. The new software also provides for faster milling time and even allows you to capture and copy another tooth in the patients mouth for better anatomical matching. It seems that each upgrade, usually occurring once or twice a year, makes the CEREC that much more efficient and fun.

Many colleagues ask me about the fit and how difficult it is to capture the image. My response has become automatic—if you have basic computer skills, can use an intraoral camera, and are familiar with dental anatomy, you can do CEREC restorations. The camera is so precise it will capture the detail you need. The preparation is easy to get used to with a few pointers from an experienced CEREC trainer and a couple of attempts on the typodonts. I find myself designing preparations knowing that if the camera can see it, the milling unit can mill it, and the result is amazing.

I first tried the system back in 2002 on a 90 day trial from Patterson. I decided that if I did not do ten CERECs in a month that I would make Patterson take it back. I got the system installed, went to training, found some willing family members to try my first restorations and I could not believe the results. I got re-energized about dentistry. In the first three months we had completed forty CEREC restorations. My first year we averaged no less than twenty-five CERECs a month, and we only had one fully equipped restorative operatory in our small office.

I have found that my passion for providing high quality dentistry fits well with the CEREC technology. I believe in the long-term success of these restorations and it shows in my case presentations to my patients. I have been blessed with great patients who can see the benefits of this technology and are thrilled with the results.

Patterson has stood behind this system since day one. The CEREC specialist has helped me every step of the way and he is in my office helping me whenever I need him. At first it was almost daily, now I get to help him train other CEREC dentists. Patterson has made a commitment to their CEREC system and it really shows.

Sirona also has a patient marketing kit for the CEREC machine. The kit includes patient recall cards, a stand up display, collateral brochures, and a patient education flip chart. There is a CD/DVD that includes marketing tools with customizable ad templates, press release tips and press releases, radio scripts, and a flash movie for my web site. The accompanying letter states that Sirona wanted to help me spread the word to my patients and other health care professionals of the benefits of CEREC restorations. It is a good feeling to know that a company not only stands behind their products, but that they also go the extra step to help me make the most of my experience and investment with their product.

It is important to understand that the CEREC system is an investment. The sticker shock is pretty intense, but it is nothing compared the impact it can make on your practice. If the CEREC system is integrated correctly into your practice, it can help you provide a tremendous service to your patients. It can help to rekindle your excitement about dentistry, and it can make a positive financial impact.

After bringing in the CEREC system, my lab fees dropped, I became much more efficient and productive since I converted many two-visit crowns into one visit. I was then able to fill that second visit usually reserved for the crown cementation with another CEREC restoration. My patients appreciate this technology and I am excited about offering CERECs to them. My personal favorite is the emergency patient who presents me with a fractured tooth and the associated fear of possibly losing the tooth. Imagine his relief when we not only save the tooth, but also complete a CEREC crown in less than an hour…with no second visit. Talk about a practice builder. Patients love these restorations—not to mention the savings in time.

I enjoy the technology and I have a renewed passion for dentistry. I strive to provide my patients with the best quality dental care and to enjoy my time at work. The CEREC system allows that to happen for me. The biggest mistake I made was thinking that I could not afford the CEREC system. I now realize that I cannot afford not to practice without it financially, and would not want to practice without it personally.

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