CEREC mills are routinely better
Coming from a technician background I was always interested in CEREC®. The early days were a disaster really and it was not until 2001 when CEREC 3D was launched and 2008 when 3.85 biogeneric software came out that the system really came of age. Prior to that, the learning curve was so steep that many dentists fell be the wayside and many machines were sitting in corners doing nothing.
By that time I had personally sold around 600 machines and trained well over 1000 dentists and prided myself that my dentists were getting the best from the system and many had paid back their original investment in just a year or two well before their 5 year lease was up.
Used properly the software and milling machines were always able to mill restorations that were routinely better than you could get from a lab. Unfortunately not all the machines sold had the training required to get great results, which prompted me to set up my own dedicated training company – CEREC Training Solutions. I subsequently also started Ceramic Reconstructions Ltd and my first task was to find these unused machines and offer training to get them going again.
This kept me busy for quite some time and now many of these dentists are achieving great predictable results even with machines that are up to ten years old.
If you are not a CEREC® dentist it will be a surprise to know that a very large percentage of CEREC® dentists only use their machine for posterior inlays and crowns! Many never use it for anteriors at all.
Even so most make considerable profits compared to a conventional situation because there is no lab bill and around 30 minutes surgery time is saved on a typical crown appointment. Clinically it’s a win win for patients because there are no impressions or temps and many crown preps turn into inlays because of the fantastic accuracy and smaller lute gap.
The answer to why few use CEREC® for anteriors is all down to aesthetics.
Most machines that have been sold over the last 10 years or so are supplied as a package including a vacuum furnace. Vita and Ivoclar both produce blocks with 3 or 4 shades within the same block but it is not really possible to accurately match existing teeth without staining and glazing the CEREC® restoration in a furnace!
We are big fans of the Vita Tri-lux forte 4 colour blocks, which look fantastic in the back of the mouth. They are based on the Vita MK 11 blocks produced originally for Siemens and are still producing 1st class results. Most patients would not thank you for brown fissure staining so millions of Vita MK11 restorations have been polished without using a furnace at all.
Since 2011 we have been buying used CEREC® machines to recondition and sell on and some of these come with a furnace that has never been used.
Earlier I stated that used properly, it is possible to mill a fantastic posterior restoration that fits perfectly has great occlusion and contacts even with a 10 year old machine. That is hardly good news for the manufacturer though who want to sell new machines and software. They are therefore constantly looking for more things for the system to do including implants, ortho and many more. Each new development comes with its own version of software and that is where the real money is for them.
On my training days I sometimes find a dentist who uses the machine for all of the above and who loves the creativeness of staining and glazing, as do I. This is very rare though and still most of them only use it for back teeth.
I am often asked to train associates because, even after several years, only the owner has used it. That initial learning curve for the principal is often the reason associates are not keen and the idea of getting them to use a furnace is just not practical or realistic in most cases.
The old adage about woods and trees is so obvious here! Nothing has changed from the original reason to buy a CEREC®.
- No impressions
- No temporaries
- No second appointment
The plan is to keep it simple and take things a step at a time. We deal with CEREC® dentists every day so we know what they expect from their CEREC®! Initially I recommend getting one to produce well fitting reliable posterior restorations. Even an old Redcam can do that. However parts are now beginning to be a problem so a CEREC AC with an MCL or MCXL milling unit is perfect.
Later on we can supply a glazing furnace should you feel the need to get creative.
The testimonial from Dr Mel Moody is what she had to say about the CEREC AC and MCXL we supplied to the practice in 2012. They are still going strong using 3.85 software and use it virtually every day.
Powdering Since the start of the CEREC® process it has been necessary to coat the patients tooth with titanium oxide powder before taking optical impressions! It is only recently that Sirona have developed the Omnicam, which is supposed to be a powder, less process. I make a comparison with manual and automatic car transmission! This is the only difference between a CEREC AC Bluecam and an Omnicam®. You still get to precisely the same destination. The software is identical and the milling unit end result is also the same. In fact it is impossible to tell the difference between an inlay I would have produced in 2008 and the same restoration milled today. Powdering can be a problem for the first few restorations but my own feedback has shown dentists soon get used to it and there is no difference in accuracy or time taken.
Mill perfectly fitting posteriors in an appointment time of less than 90 minutes
In conclusion with the right training any CEREC® system supplied during the last 10 years is quite capable of milling perfectly fitting posterior restorations in an appointment time of less than 90 minutes. Most of the long term studies available on line show brilliant results from systems far older than 10 years. If you want to do anteriors a furnace is required. That will obviously extend the appointment time to around two hours. Bridges are possible with the MCXL only. Vita and Ivoclar produce temporary composite blocks for up to 4 units with a mill time of around 30 minutes. However these are only temporaries! If you want to make permanent bridges with e-Max for instance you will need the lab software and make sub structures and super structures and join them up. Its far better to send this work off to the lab. Implants are possible and for that you will need the latest software and lots of training together with a very expensive digital x-ray.
The choice is simple. If all you need is a predictable system for lovely well fitting posterior restorations then a reconditioned CEREC® is perfect and send the rest to the lab. For anything else you will need deep pockets….