CEREC in D-school??

[cdmOMR]

Advertisement - Members don't see this ad

Well I found this a little hard to believe due to the price, but Ive heard from some CEREC trainers that some schools have CEREC machines and train their students do use them. The preps are a little different due to the limitations of the milling machine combined with the unique characteristics of all porcelain restorations. Any truth to schools having them?? Thanks.

Chris

 

[burton117]

Yes.. and which schools have them? I have heard of this also!

 

[Demeter]

San Antonio has a CEREC. Students that completed an optinal course in the Summer were able to use it in clinic.

 

[burton117]

University of Southern California - I believe..

 

[Floss]

Stony Brook.

 

[cdmOMR]

Hmm very cool. I was thinking that it was just a selling point, but thats awesome that they offer classes on it. Ive been through the basic training course and have been working with it for about 6 months now. Its really revolutionary technology (especially the latest versions). At my (uncles) office we can have a patient anesthetized and prepped, and the restoration milled and cemented (bonded actually) in under an hour. I could go on, but Im sure you guys know about it.

I hope whatever D-school I might get into uses CEREC, unfortunatly im not competetive enough to be selective (im just prayin for an interview)

Any other schools??

 

[BuckeyeDDS]

Believe it or not, Ohio State is in the final stages of getting one. It remains to be seen, however, how much the students will get to use it.

 

[WildcatDMD]

BU has CEREC. If you can get a patient to accept the treatment plan, you can use it.

 

[cdmOMR]

to those who replied, how many units does the school have? Im thinking that the schools probably get some sort of discount.

 

[J2AZ]

to those who replied, how many units does the school have? Im thinking that the schools probably get some sort of discount.

Just like drugs and kids...get them hooked early and have a customer for life.

 

[Sprgrover]

Just like drugs and kids...get them hooked early and have a customer for life.

Yup.... Given the limitations they do sound nice.

 

[Miss Mammelon]

You can do Cerec at Columbia too.
Just have to sign up ahead of time w the professor who does it so that he can help you through it- and actually, they charge less than if you made a regular crown. Not sure why the discount, but its a great opportunity to try it out.

 

[cdmOMR]

You can do Cerec at Columbia too.
Just have to sign up ahead of time w the professor who does it so that he can help you through it- and actually, they charge less than if you made a regular crown. Not sure why the discount, but its a great opportunity to try it out.

Materials. The blocks of porcelain the restorations are milled out of are only $8-15. No impression material needed either (other than possibly bite registration).

I think the benefits far outweigh the down sides. The "worst" part I would say about CEREC is it generally needs more reduction due to being all porcelain (just like any all porcelain restoration I assume). But with the improvement upon porcelains I would say this factor will start to dissapear. Other than that (and the cost of the machine), the restorations end up looking very natural, especailly when stained and glazed. Maybe i can find a way to take some pics next weekend when im at work.

Also if anybody wants some screen shots of the software, I have the software here on my computer at school and I can post em if anybody is interested?

 

[drem2006]

Baylor has one

 

[dheav005]

Tenessee (the real UT) has a unit. we have a whole esthetics dept. even...and being able to offer a nice inlay or onlay over a huge filling is pretty sweet.

 

[esspressive]

NYU has three Cerec 3D machines for use in the clinics.

 

[NewNameForGoogleBot]

I have heard we have one in a closet somewhere

 

[cdmOMR]

I have heard we have one in a closet somewhere

Ill take it if you guys arent using it 🙂

 

[coreyb]

NYU has three Cerec 3D machines for use in the clinics.

No wonder my tuition is so high! Hehe!!

 

[crazy_sherm]

Materials. The blocks of porcelain the restorations are milled out of are only $8-15. No impression material needed either (other than possibly bite registration).

I think the benefits far outweigh the down sides. The "worst" part I would say about CEREC is it generally needs more reduction due to being all porcelain (just like any all porcelain restoration I assume). But with the improvement upon porcelains I would say this factor will start to dissapear. Other than that (and the cost of the machine), the restorations end up looking very natural, especailly when stained and glazed. Maybe i can find a way to take some pics next weekend when im at work.

Also if anybody wants some screen shots of the software, I have the software here on my computer at school and I can post em if anybody is interested?

The bigger drawback that has been explained to me and the reason we don't have CEREC machines at school is that the margin can at best only be closed to 50 microns because of the thickness of the powder you have to lay down for the scan. Then there's also the problem with color matching and glazing, most of us aren't going to be as skilled as a tech. We're taught and allowed to do CEREC inLab crowns if we feel like treatment planning it, but there's a much bigger push to do Lava crowns as an alternative to PFMs in aesthetic areas.

Anyone heard anything good about the Evolution 4D system out there?

 

[cdmOMR]

The bigger drawback that has been explained to me and the reason we don't have CEREC machines at school is that the margin can at best only be closed to 50 microns because of the thickness of the powder you have to lay down for the scan. We're taught and allowed to do CEREC inLab crowns if we feel like treatment planning it, but there's a much bigger push to do Lava crowns as an alternative to PFMs in aesthetic areas.

Hmm, I duno. The software has a lot of parametric settings that allow you to account for the thickness of the powder layer. All of the margins I have seen on the ~200 restorations Ive assisted with have been pefect (aside from any human error in design). Im no expert so I maybe wrong, but I think the margins look just as good if not better than PFM crowns. My uncle (the dentist with the CEREC) believes so to, so its just not my uneducated opinion.

**Depends on the prep, powder job and picture a lot too. A crappy prep, with a crappy powder job, and a crappy picture is going to give crappy results.

Anyone heard anything good about the Evolution 4D system out there?

Is that the new version of software that is coming out??

 

[crazy_sherm]

Hmm, I duno. The software has a lot of parametric settings that allow you to account for the thickness of the powder layer. All of the margins I have seen on the ~200 restorations Ive assisted with have been pefect (aside from any human error in design). Im no expert so I maybe wrong, but I think the margins look just as good if not better than PFM crowns. My uncle (the dentist with the CEREC) believes so to, so its just not my uneducated opinion.

**Depends on the prep, powder job and picture a lot too. A crappy prep, with a crappy powder job, and a crappy picture is going to give crappy results.



Is that the new version of software that is coming out??

The little powder spheres are already 25 microns in diameter. No matter how good you are with powdering (and I'm sure there a lot of people who are awful at it), there's no way to ensure you are going to be able to lay down exactly a 1-bead layer all the way around the margin. Unless the dentist checks with an explorer that has a 25 micron tip, there's no way to tell by the naked eye anyway. As for the computer compensation for the powder, CEREC even admits problems with the software in that aspect. They listed a studying on their website that says setting the margin to 30 microns gets a better fit than trying to set the margin at 10 microns. You still end up with a best case scenario of 56 +/- 18 microns.

Every pro-CEREC person I've talked to says it doesn't matter because you just fill up that tiny margin with luting agent. However, out of the three 1) enamel, 2) porcelain, 3) cement, which one do you think will wear away the fastest leaving an open margin? The ADA did not set 50 microns as the minimun arbitrarily, smaller margin gaps statiscally result in longer lasting restorations. It's the same reason why gold is still king when it comes to longevity of restorations, the ability to burnish the margins tight is superior to any all porcelain restoration.

I'm not saying CEREC is horrible or even bad, but it's not a perfect systerm. The onlays and crowns I've seen look great, but better than most PFMs out there. And it's also a great convenience for the dentist/patient, but I feel that you are giving up some of the longevity on the crown. Sure it might last 10-15 years, but will it hold up to 20-25? If you have a clientel that doesn't mind, then it's fine. It'll can be a real time and money saver.

One more issue I wonder about is when a dentist first buys his CEREC machine, does it force him to put in more all-porcelain crowns than he might if he did not have the machine? He already put down $100k on the system so every time he sends something away to the lab, he's losing money when he could just be milling away at it in-house.

The reason I brought up the Evolution 4D is that it's an alternate system by Sullivan-Schein that doesn't use a powder when scanning so one can theoretically get a more accurate tighter margin. However, I've only heard about it and seen pictures, but yet to meet anyone who uses the system. I also don't find much information on the internet.

 

[cdmOMR]

The little powder spheres are already 25 microns in diameter. No matter how good you are with powdering (and I'm sure there a lot of people who are awful at it), there's no way to ensure you are going to be able to lay down exactly a 1-bead layer all the way around the margin. Unless the dentist checks with an explorer that has a 25 micron tip, there's no way to tell by the naked eye anyway. As for the computer compensation for the powder, CEREC even admits problems with the software in that aspect. They listed a studying on their website that says setting the margin to 30 microns gets a better fit than trying to set the margin at 10 microns. You still end up with a best case scenario of 56 +/- 18 microns.

Every pro-CEREC person I've talked to says it doesn't matter because you just fill up that tiny margin with luting agent. However, out of the three 1) enamel, 2) porcelain, 3) cement, which one do you think will wear away the fastest leaving an open margin? The ADA did not set 50 microns as the minimun arbitrarily, smaller margin gaps statiscally result in longer lasting restorations. It's the same reason why gold is still king when it comes to longevity of restorations, the ability to burnish the margins tight is superior to any all porcelain restoration.

I'm not saying CEREC is horrible or even bad, but it's not a perfect systerm. The onlays and crowns I've seen look great, but better than most PFMs out there. And it's also a great convenience for the dentist/patient, but I feel that you are giving up some of the longevity on the crown. Sure it might last 10-15 years, but will it hold up to 20-25? If you have a clientel that doesn't mind, then it's fine. It'll can be a real time and money saver.

One more issue I wonder about is when a dentist first buys his CEREC machine, does it force him to put in more all-porcelain crowns than he might if he did not have the machine? He already put down $100k on the system so every time he sends something away to the lab, he's losing money when he could just be milling away at it in-house.

The reason I brought up the Evolution 4D is that it's an alternate system by Sullivan-Schein that doesn't use a powder when scanning so one can theoretically get a more accurate tighter margin. However, I've only heard about it and seen pictures, but yet to meet anyone who uses the system. I also don't find much information on the internet.

Ya i can completely see where you are coming from with powder layer being 25 Microns thick (in a absolute perfect layer) and having the crown with at least a 5X micron gap . But all I was told and can see on the program is that there is a parameter to compensate for the powder layer; how accurate it is or if the company admits to problems with that, I dont know about, but I dont doubt it. And definatly agree its not a perfect system. I think a more prevelant problem along those lines would be chipping in the milling process if your worried about integrity of the margins.

**its funny how the trainer I had for the basic course said exactly what you said, the luting material fills any small imperfections in the margin...but failed to bring up the fact that the luting material will wear away faster than the porcelain


On the other hand, in a real practice, the practicallity of it far outweighs a 50 micron gap. What my uncle does, is he garantees the crowns for life granted they keep up with regular hygine visits. With a crown from the lab you cant take that risk becaue its another $150+ dollars to get another crown made, with cerec not the case.

And acutally I have heard something about a powderless system being worked on. Dont have any details on it, but it probably uses a different wavelength camera or something.

 

[JavadiCavity]

One more issue I wonder about is when a dentist first buys his CEREC machine, does it force him to put in more all-porcelain crowns than he might if he did not have the machine? He already put down $100k on the system so every time he sends something away to the lab, he's losing money when he could just be milling away at it in-house.

The reason I brought up the Evolution 4D is that it's an alternate system by Sullivan-Schein that doesn't use a powder when scanning so one can theoretically get a more accurate tighter margin. However, I've only heard about it and seen pictures, but yet to meet anyone who uses the system. I also don't find much information on the internet.

When I visited the Patterson booth at the CDA convention, one of the doctors there said that his payment on the cerac machine was around $2000/month. So, he estimated that he needed to be doing around 20 crowns a month (assuming the lab cost of making the crown was $100) before he broke even on the machine. I didn't have the time to get into a discussion with him, but I would have liked to discuss the opportunity costs associated with having to use two appointments to seat one crown vs. using only one appt to seat a cerac Inoffice crown. It seems that a dentist would be able to do twice as many crowns by freeing up one extra appointment (assuming he had enough patients who needed crown work). But to answer your question in part Sherm, yes, I do think dentists who have a cerac machine are more likely to recommend a porcelain crown that can be done in office instead of an alternative from the lab.

I talked with Sullivan-Schein about their machine as well. Seems like they are still working out the bugs. I asked about the possibility of milling gold with their machine, and they were wishy-washy on the topic. Patterson said it didn't make any sense financially to mill a crown out of gold becuase of cost. Apparently, it's not feasible to collect the gold dust that is left over and use it. And, honestly, I think Patterson is right. But, Sullivan-Schein claims their 4D system won't use powder to obtain a scan of the tooth. That would eliminate the problems with getting a good seal at the margin.

Certainly, an exciting bit of technology related to these CAD-CAM machines. Can't wait to get more involved with them.

 

[cdmOMR]

When I visited the Patterson booth at the CDA convention, one of the doctors there said that his payment on the cerac machine was around $2000/month. So, he estimated that he needed to be doing around 20 crowns a month (assuming the lab cost of making the crown was $100) before he broke even on the machine. I didn't have the time to get into a discussion with him, but I would have liked to discuss the opportunity costs associated with having to use two appointments to seat one crown vs. using only one appt to seat a cerac Inoffice crown. It seems that a dentist would be able to do twice as many crowns by freeing up one extra appointment (assuming he had enough patients who needed crown work). But to answer your question in part Sherm, yes, I do think dentists who have a cerac machine are more likely to recommend a porcelain crown that can be done in office instead of an alternative from the lab.

While I dont know all the numbers completely, I can tell you that my uncle has made money on top of what he would have made sending the crowns to the lab. He will generally do more than 20 crowns a month though. After the machine has been paid off (a few years down the line), its all profit. Plus as I said a few times I think there is something to be said about saving money in materials like impression material, temp. crowns, temp. cement...it all adds up.

As for chair time...initially before you get it down pat your not going to be saving any chair time overall. But once you get effecient with the time then yes the patient is definatly in the less chair time over all. For a crown we will generally have a 45 min appointment for prep picture and design....then a 30 minute gap where we bring in another patient for a bonding or whatever while the crown is being milled...then another 30 minute appointment where we bring in the crown patient to cement the crown. If everything goes smoothly and people show up on time then it can be done around an hour. Patient has crown in 1 day, not 3 weeks later.

 

[JavadiCavity]

Just found an interesting bit about CEREC systems in the latest edition of JADA. In summary, it says that by tweaking the settings within the software to adjust for convergence, cement spacing, and scanning powder, the clinician can achieve average margin gap of 50um. But, what is more interesting is that the study claims that "These openings are . . . less than gaps found in a study of metal-ceramic restorations processed at dental laboratories."

The article is titled "Materials for chairside CAD/CAM-produced restorations," and the author is Russell Giordano, DMD.

 

[cdmOMR]

Just found an interesting bit about CEREC systems in the latest edition of JADA. In summary, it says that by tweaking the settings within the software to adjust for convergence, cement spacing, and scanning powder, the clinician can achieve average margin gap of 50um. But, what is more interesting is that the study claims that "These openings are . . . less than gaps found in a study of metal-ceramic restorations processed at dental laboratories."

The article is titled "Materials for chairside CAD/CAM-produced restorations," and the author is Russell Giordano, DMD.

How current is this info. I wonder if it wasnt in the last software upgrade a couple months ago. They had a lot of changes for the better, including a finer detail model constructed from the optical impression, but I dont know if what your taking about was included.

**sorry if im sounding like a CEREC *****, its just opened a lot of doors for me when it comes to learning about restorations. Before I would just prep stone models and thats it, now I can prep a model and mill up a restoration, and adjust the occlusion/contacts, etc.

 

[JavadiCavity]

How current is this info. I wonder if it wasnt in the last software upgrade a couple months ago. They had a lot of changes for the better, including a finer detail model constructed from the optical impression, but I dont know if what your taking about was included.

**sorry if im sounding like a CEREC *****, its just opened a lot of doors for me when it comes to learning about restorations. Before I would just prep stone models and thats it, now I can prep a model and mill up a restoration, and adjust the occlusion/contacts, etc.

Well, now that you made me look, I took a gander at the references cited for the passage I quoted. There were three references. Two of the references dated as recently as 2003 and 2005 related to the claim that CERAC could get between 25um to 50um. However, the claim that CERAC can do better than many laboratories is dated to a study that was completed nearly 15 years ago in 1992. The journal article containing both of the references I made earlier is in the latest edition of JADA dated Sept. 2006.

 

[KY2007]

UK has one.

 

[cdmOMR]

Well, now that you made me look, I took a gander at the references cited for the passage I quoted. There were three references. Two of the references dated as recently as 2003 and 2005 related to the claim that CERAC could get between 25um to 50um. However, the claim that CERAC can do better than many laboratories is dated to a study that was completed nearly 15 years ago in 1992. The journal article containing both of the references I made earlier is in the latest edition of JADA dated Sept. 2006.

Hmm, interesting. I didnt even know cerec was a twinkle in its daddys eye in 1992, but I guess its 20 years old now. But now im hearing conflicting info. The 2003/2005 article you said claims 25-50 microns, while crazy sherm says 56 microns +-.

** I went on the website and they claim they meet or exceed the ADA recommendations of 50um. How official that is I dont know.

 

[JavadiCavity]

And, according to the ADA, a gap less than 100um can't be clinically detected. Although, our prosthodontic faculty will tell you that the tip of the explorer is approximately 25um. From what I've read, CERAC is able to come between 25um to 50um in an ideal situation. And, based on studies, it seems like clinicians get pretty close. Regardless, according to the studies, after 10 years, over 95% of CERAC restorations are still working well in a patient's mouth, which is very, very similar to the success rate of other restorations.

 

[cdmOMR]

And, according to the ADA, a gap less than 100um can't be clinically detected. Although, our prosthodontic faculty will tell you that the tip of the explorer is approximately 25um. From what I've read, CERAC is able to come between 25um to 50um in an ideal situation. And, based on studies, it seems like clinicians get pretty close. Regardless, according to the studies, after 10 years, over 95% of CERAC restorations are still working well in a patient's mouth, which is very, very similar to the success rate of other restorations.

^^^good enough for me

 

[Cathy Ramdial]

The little powder spheres are already 25 microns in diameter. No matter how good you are with powdering (and I'm sure there a lot of people who are awful at it), there's no way to ensure you are going to be able to lay down exactly a 1-bead layer all the way around the margin. Unless the dentist checks with an explorer that has a 25 micron tip, there's no way to tell by the naked eye anyway. As for the computer compensation for the powder, CEREC even admits problems with the software in that aspect. They listed a studying on their website that says setting the margin to 30 microns gets a better fit than trying to set the margin at 10 microns. You still end up with a best case scenario of 56 +/- 18 microns.

Every pro-CEREC person I've talked to says it doesn't matter because you just fill up that tiny margin with luting agent. However, out of the three 1) enamel, 2) porcelain, 3) cement, which one do you think will wear away the fastest leaving an open margin? The ADA did not set 50 microns as the minimun arbitrarily, smaller margin gaps statiscally result in longer lasting restorations. It's the same reason why gold is still king when it comes to longevity of restorations, the ability to burnish the margins tight is superior to any all porcelain restoration.

I'm not saying CEREC is horrible or even bad, but it's not a perfect systerm. The onlays and crowns I've seen look great, but better than most PFMs out there. And it's also a great convenience for the dentist/patient, but I feel that you are giving up some of the longevity on the crown. Sure it might last 10-15 years, but will it hold up to 20-25? If you have a clientel that doesn't mind, then it's fine. It'll can be a real time and money saver.

One more issue I wonder about is when a dentist first buys his CEREC machine, does it force him to put in more all-porcelain crowns than he might if he did not have the machine? He already put down $100k on the system so every time he sends something away to the lab, he's losing money when he could just be milling away at it in-house.

The reason I brought up the Evolution 4D is that it's an alternate system by Sullivan-Schein that doesn't use a powder when scanning so one can theoretically get a more accurate tighter margin. However, I've only heard about it and seen pictures, but yet to meet anyone who uses the system. I also don't find much information on the internet.

I'm a CEREC technician and I'm aware that imaging in the mouth has its challenges. Just think, trying to get a dry uniform surface in a super wet environment is not easy. I work for a mobile CEREC service that uses the same impression you send to a lab to provide the optical imaging. We use a CAD/CAM stone to pour the cast and then we're able to image perfectly (no manual correlation needed). Since we have the cast on hand, we can check fit before we return it to the Dentist. Usually it just drops in the with very little or no adjustment. We use Vita and Empress cad ingots. We polish and/ or stain and glaze. They are absolutly stunning!!! Dentist who have used this service love it!

Hopefully E4D will make its debut by the end of this year. We are hoping to use both technologies.

 

[mg777]

UF has one. Seniors use it and juniors get credits for assiting the Cerec.

 

[g3k]

University of Minnesota has one too.

 

[Dr.Millisevert]

Sydney has one, but not many of the students are using it at the moment.

 

[shabu2]

I did two in D-school, but I would only do it for certain types of cases. Never have to do another though.

 

[sugarsweetDDS]

yup a few at NYU. they teach you how to use it 2nd year and expect you to use it in clinic.

 

[cdmOMR]

Dang this thread came back from the crypts. But cool to see it up top. I think if competition comes out with similar technology and prices drop for these units this type of technology will become very common in dental practices. Dentists love it, patients love it (less visits, no temporaries, from what weve seen less sensitivity, etc), and the thing can pay for itself if you use it properly. The only real downside I see is sometimes since we bond the restoration in while the patient is still numb, if the bite is slightly off the patient cant feel it until the numbness wears off. But even then, the patient comes back and you touch up the bite and its done. Although I agree I wish we could have long term studies on these restorations, but thats what you get when new(er) procedures are tried. Its not perfect and its not for every restoration, but overall I think its where dentistry is heading.

I just took an anterior proficiency CEREC course and its amazing on what you can do with that machine. 8 unit veneer case, stained and glazed in 3 hours and looks great IMHO....but ive mentioned before that this is coming from an untrained eye (still a predent 🙁 ).

 

[Cathy Ramdial]

Dang this thread came back from the crypts. But cool to see it up top. I think if competition comes out with similar technology and prices drop for these units this type of technology will become very common in dental practices. Dentists love it, patients love it (less visits, no temporaries, from what weve seen less sensitivity, etc), and the thing can pay for itself if you use it properly. The only real downside I see is sometimes since we bond the restoration in while the patient is still numb, if the bite is slightly off the patient cant feel it until the numbness wears off. But even then, the patient comes back and you touch up the bite and its done. Although I agree I wish we could have long term studies on these restorations, but thats what you get when new(er) procedures are tried. Its not perfect and its not for every restoration, but overall I think its where dentistry is heading.

I just took an anterior proficiency CEREC course and its amazing on what you can do with that machine. 8 unit veneer case, stained and glazed in 3 hours and looks great IMHO....but ive mentioned before that this is coming from an untrained eye (still a predent 🙁 ).

You are absolutlely correct is your assessment of where restorative dentistry is headed. CAD/CAM is the wave of the future and the future is now! Eight percent of the dentist in the USA own CEREC and E4D is on the horizon. When critical mass is reached, (which is only 10 percent) there will be no looking back!!!!!!!

 

[cotinara]

marquette has one. a classmate (junior) just did a cerac crown. i havent asked him ,but i imagine like me, he has only done max 0-2 crowns so far!👍

 

[cdmOMR]

marquette has one. a classmate (junior) just did a cerac crown. i havent asked him ,but i imagine like me, he has only done max 0-2 crowns so far!👍

cool... now only if Marquette would show me some love and invite me to an interview 🙁 . I'd like to see the school at least.