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http://www.instructables.com/id/How-to-CEREC-a-
tooth/?ALLSTEPS
This
instru
ctabl
e is
about
CER
EC, a
powe
rful
CAD/
CAM
techn
ology
desig
ned
to fix
teeth.
This
is important because this technology is
increasingly being used nation wide.
Note:
At the time of writing, the author has no financial connections to Ivoclar, 3M, Patterson,
or Sirona.
Note 2:
Sorry for taking so long!
The community has been doing such a great job, that I couldn't think of anything of
worth contributing until recently.
Feel free to PM me with any ideas you'd like covered.
In the case of the BlueCAM (formerly state of the art), it involves stitching multiple
images together.
For the OptiCAM (released late last year), the scanner creates a 3-D image by
compiling from a video feed in live time.
1. Start one tooth distal (to the back) to the main tooth to one tooth mesial (to the
front of the prepared tooth).
2. Have a steady hand.
3. Capture the smallest area required. For the bluecam, try to have no more than 3
images to the model.
4. Less data-> faster processing.
My observations:
For anterior cases, you *will* need to tweak things by hand. CEREC tends to create an
adequate margin, contacts and occlusion. Heights of contour tend to be oversimplified
and "fake" looking.
Note: There is a very well done CEREC anterior case on Youtube.
However, it doesn't mentiont that a master ceramicist did a final cutback, build up, and
glaze prior to placement.
Of course it should look good!
Step 4: Mill
Choose the shade, material, and size.
Dilithium silicate (e-max) is chosen for crowns and posterior onlays due to it's
great toughness.
Empress is chosen for inlays and anterior onlays due to it's easy machinability
and esthetics.
Translucency
HT- high translucency; for relatively esthetic looking restorations. Tend to mimic
enamel.
LT- low translucency; for teeth that have been heavily stained. Tends to block
out dark spots.
Mill.
This is because the cement film may slightly change the height of the
restoration.
Strangely, occlusion (how teeth come together) is one of the most controversial topics
in dentistry.
Strength:
Convenient.
Immediate results.
No temporaries to break or fall out.
Less gas for patient.
Cheaper
Less visits--less overhead: sterilization, drapes, sleeves, staff time,
A block of Ceramic is far cheaper than a ceramic crown.
Quality control
Many labs are "off-shoring" work to Asia.
While some labs are great, many labs use mystery metals and techniques
with no oversight.
Many domestic labs are also dropping in skill as experienced lab men are
leaving.
Lastly, most domestic labs are making CAD/CAM milled crowns as their
standard restoration
. Cons:
Note: this porcelain-fused-to gold crown will last forever, saves more enamel, and look
great for decades.
However, it takes a lot more time to make, and at least 2 visits from patients:
1. Numbing Shot. Prep. Impress. Make temp crown. Cement temp crown
2. Wax coping. Invest. Bake for 2 hours
3. Cast gold coping. Polish
4. Hand stack porcelain base shade.
5. Bake.
6. Cut back
7. Repeat steps 4-6 until happy. Most good labs will have 1-3 cycles. World class
ceramicists may do up to 20 cycles.
8. Final contour
9. Glaze.
10. Bake
11. Seat patient in chair. Cement. Polish
Sorry harmless matt, I understand that it was a big investment you made, but still, what can
guys like 4sc4n10 do in this case?
I'd see that all the time from people flying to China, India, or Latin America for work.
It's more expensive to fix it (IF it's fixable), than to do it right the first time.
However, I have to add that I've personally been burned helping the poor many times: at my
first practice in Oakland, at a nonprofit (that will remained unnamed), and at various events
like RAMM and MOM that I've served at.
I'd advise against medical tourism, but I don't have first-hand knowledge of what's done
outside the US. I would recommend going to a dental school instead, as it's significantly
cheaper (but slower).
For guys who really have low income and want good solid dentistry, a dental school is
probably the way to go. Free clinics can offer patchwork dentistry, but aren't equipped for
bigger cases usually. Most of the foreign work that I've seen is downright junk--with the
exception of some of the University work from top institutions (there was a patient who's
cousin was the head of the dental program in Argentina).
The blocks of material that are milled into the crown are a consumable cost as are the cutting
tools, I have to pay 3 different employees a fair wage so they can put food on the tables for
their families and I have to pay the power company water company and garbage to make the
office inhabitiable. By the time you add up all of these costs unfortunatly a crown has to cost
6-1000 dollars. There is not much of that cost that I take home at the end of the day.
When you start talking implants think about the risk involved and what we are working on is
not a piece of metal that behaves the same way each time you cut into it. We have to deal
with biology and physiological responses of tissues to invasive procedures. Everybody
responds differently. If everything goes just like it should then an implant is profitable to the
practitioner however one thing goes wrong or not as expected you will usually just be lucky to
break even in costs of materials and time to follow up with that patient. For much less that 4k
an implant it becomes hard to make doing these procedures worth your time.
The real problem in society today is peoples perceived value in their oral health. Most of us
have no problem buying the new iPhone every year it is released or getting the new 50 inch
led side lite 1080p tv.
Again I wish I could give dentistry away at far less than what it costs but that would mean
companies would need to sell the things I need to do the job for far less and my education
would need to be free from the govt and in the world we live in here in the united states that
just is not going to happen. You can thank capitalism for that.
So not to rant but hopefully more so to educate you and anybody else reading this what goes
into what we do and perhaps why costs are what they are. In my opinion we are not
compensated enough for what we sacrifice in school today and the debt taken on as well as
the battle constantly fought with insurance companies.
harmless matt (author) leedawgReply3 years ago
Amen!
CEREC requires a minimum of $170,000 with at least $6000 a year for technical support and
software updates. It is only cheaper with volume...which can influence the owners to prescribe
CEREC for everything.
In terms of the expense of dentistry, I think that we're vastly undercharging for a highly
technical, highly expensive skillset. We have the most expensive education (way more
expensive than MD's), high overhead (staff, supplies, equipment, school fees), and we are
squeezed by insurance companies. Frankly, I'd say to drop the insurance and get a health
savings account. Budget for the dentistry, and realize that it's an investment in quality of life.
Going to a good local dentist is actually the cheapest way to do it. Corporations seem cheap--
until you realize that they make up the difference in volume and "upgrades." Ask your local
dental society.
Normal porcelain crowns take longer, but fit much better and last longer.
I'm finishing implant training under Misch (I don't know if I'll ever really be finished).
I'd like to devote my efforts to really mastering the fundamentals.
There's a lot of interesting things to be developed.
If anyone's near Newport Beach, feel free to let me know if you'd like to hang out.
I'll be here until Sunday.
I believe that we are kindred souls, as I'm looking forward to buying a practice so that I'd be
allowed to do a lot of the labwork and to my standards of quality.
I'm thinking of publishing a series of instructables to demystify dentistry, and hopefully
empower the public to make smarter choices.
Without more information, I can't advise cutting all your teeth to have porcelain crowns made.
It's actually a very involved and technically demanding process that only a handful of dentists
are actually capable of.
Heck, I'm a licensed dentist, and I wouldn't want to do my own dentistry either.
The over the counter stuff is just a temporary cement to fill a hole...it doesn't last.
Personally, I'd recommend that you look for a good dentist regardless of tool they choose.
There are three ways:
1. Yelp: subjective, spotty reviews. Some great dentists have 1 star reviews. Some horrible
ones have 4 star ones.
2. Call your dental society-- These guys know all the dentists personally. They'll send you to
someone who is personable and has a good reputation.
3. Call your nearest periodontist (gum surgeon) or endodontist (root canal guy) -- These guys
see everyone's work, and know who is decent. This will net you the best dentist in your area.