Benefits of using CEREC

[paulg100]

Plus sironas ****ty underhanded business practices like time limiting features (stack milling) which expired and were then only available again if you upgraded to a new camera, or restricting the system to a few of their chosen zironcia brands which were totally over priced.

Honestly if felt like they did everything they could to stop you getting ROI on your investment. worst company ever, let alone if the system was actually any good.

God after all the years this still gets me going must be something to do with the $100k that went down the toilet.... yep that'll do it!

 

[Davethedentist]

"If your Cerec is well calibrated with correct parameter settings for your use, appropriate tooth preps and correct choice of material for the occlusion and location in the mouth then it can produce a restoration of equal quality to your average lab."

great if you have control over those factors, the biggest problem with cerec from the lab end is they tried to sell it to labs!!!

secondly, you were a cnc engineer for 13 years and you feel a machine with a specced +_50um and a scanner that they wont publish spec on (or didn't used to last time I looked) is acceptable.... really surprised you think that. Id have thought as an ex CNC engineer you would of been more inclined to have your work milled on a proper industrial mill that's more like sub 5um than anyone.

Yes, I agree however that's just not the reality of cutting a tooth in the mouth, attempting to gain an impression with materials that undergo polymerisation shrinkage , then pouring up a model that's also undergoing change on setting.
Scanning accuracy varies, and there's always a spacer material or clearance value used so the super fine tolerance sounds great on a spec sheet but is not what you find seating crowns and inlays in the mouth.
This issue really is apparent with longer spam implant pros as you no doubt know. Clearances are way bigger than any accuracy quoted by mill manufacturers.

And yeah, I've noted the accuracy in dentistry issue well. It is just a different game here.

 

[Davethedentist]

davethedentist, (davedadentist has more of a ring to it) Why do you charge a pt $1600 for a lab crown, and $850 for a cerec crown? Certainly the patient would want the faster cheaper crown... but why is it half the cost? Ive never heard of anyone ever charging $1600 for a crown prep btw.

Hi.
In Australia that is pretty much the national average for our item number 613. I'm actually priced lower than most of the dentists I know.
I tell my patients that a Cerec may be faster but not as good as lab. In my experience, faster is generally not better.

I charge less for a Cerec as I don't see it as equal to a lab PFZ or PFM on precious coping.

 

[Davethedentist]

And were those models from triple tray quads or full arch..

Triple trays are for bite registration at best.
Im talking about full arches sent to the lab already mounted on articulators. I have 10 fully adjustable non arcon articulators I cycle through my labs. Otherwise I would not comment on a job where I have provided insufficient models or impressions.
I'm not going to pretend every case is sent like this but on 2 or more crowns and it's the standard.

Us (hopefully most) dentist types are realistic, I certainly appreciate the magic that happens when I put some impressions in a box with a lab form and this box returns and a work of art (and engineering) is presented to me.
My blood pressure does go up a bit when I do all that prep and it's off and you have to adjust. Not blaming the lab entirely but if I mill it myself and fit to model and it drops in nice ..? Maybe the labs too accurate on the prep sometimes.

 

[Davethedentist]

Plus sironas ****ty underhanded business practices like time limiting features (stack milling) which expired and were then only available again if you upgraded to a new camera, or restricting the system to a few of their chosen zironcia brands which were totally over priced.

Honestly if felt like they did everything they could to stop you getting ROI on your investment. worst company ever, let alone if the system was actually any good.

God after all the years this still gets me going must be something to do with the $100k that went down the toilet.... yep that'll do it!

Yeah, sounds like the whole sirona set up was pretty poor for the labs. Starting to see why I read so many comments about the top to bottom problems with it.

Oh well, got you to a better place in the end. We get similar crap on the patient treatment side of things from dental companies. Not quite a 100k in one move but all up it would sting a bit

 

[Davethedentist]

Thanks for posting, great insight and I agree Cerec has come a long ways. I think why you find so much angst from Lab techs isn't so much about the loss of work as it is how patterson and sirona rolled this cerec out in the early days. You had cerec sales people going to Dentists saying, "this will replace your lab". Granted, those red cams were a mechanical migraine, the blue a lot better, and omni has improved on that but when you're a lab owner and your Docs call you saying, "Hey Rob, just so you know, I bought a cerec to replace you"...then they find out they just bought a 80k coat hanger, it tends to leave some of us shaking our head moving forward. As others have asked though, why do you charge such a considerable difference between your lab crowns and cerec crowns? Also, I'm really curious what you state is 'correct balanced occlusion'...please share some pictures if you have a second, I think a lot would learn a lot from that. Thanks

Hey thelabguy, I appreciate the comments.
To answer about the fee structure I use, it's because I look at the crown service based on the issued prosthetic, not the time taken to provide it. I do save a second appointment when issuing a Cerec however the chair time is probably more while I program/mill/polish etc.
My lab fee would usually range from $175 to $300 for a crown (pending material) and I guess it's just an accepted thing here that a crown fee is $1500-$1600 (welcome to Australia!)
A Cerec block costs about $40 from Henry Schein and then it's just time to complete. I am entitled to charge the same $1600 but I just can't do it. You know as well as I that a Cerasmar t has its place, but it's simply not as good (I'm talking long term life , aesthetics and strength) as a porcelain or mono Zirconia crown and I think the fee should reflect that. It's an option between direct composite and lab pros to me.

Going back a few years now but I was taught occlusion by THE MAN, a great American. Dr William McHorris (Memphis Tn) We were very lucky to have him visit and teach a 9 day course on occlusion for dentists....genius.

I'm away from the office as it's holidays here but here's a couple of pics that I'm attempting to describe. You guys have probably seen all this before and will roll your eyes at me but here goes.

First pic- trying to show bucco-lingual on occlusion. Basically the plunging cusp (lingual/palatal) on upper drops in fissure of lower with no contact at the tip, contact is on the buccal incline of the lingual cusp with its balancing contact on the lingual incline on the buccal cusp.
The reverse is true for the plunging cusp on the lower molar raising into the upper mid fissure with opposing , balancing contacts on the palatal incline of the upper buccal cusp and the buccal incline of the upper palatal cusp..
This theory balances the vertical occlusal load stabilizing the teeth in the buccal-lingual direction.

To add the mesial-distal axis,
The next picture shows black dots in triangular pattern on the mid fissure, again no point contact but triangulated load on the cusp inclines centres the load. This is bacically showing cusp only contacts through midline. It also introduces the mesial and distal marginal ridge contacts that further aim to balance load.


The last picture is the ideal situation, teeth #3 #4 in your charting system.
If you look at the red contact points they really start to mean something to balance load on a tooth. I may have achieved this occlusion only once or twice because there is the problem that the opposing teeth have the anatomy to actually do this. Also the average dentition is way too worn to have this type of anatomy dropped in a quadrant cause the text book said so..
McHorris teaches this for the theory value and when he describes full mouth rehabilitation he can actually create these contacts, too good for me,,, but it is the goal.

My lab forms here have boxes where you tick either of 2 options:

Occlusal contacts open or closed.. er what?

Sorry but I think I just hijacked a thread?

 

[SiKBOY]

Hey thelabguy, I appreciate the comments.
To answer about the fee structure I use, it's because I look at the crown service based on the issued prosthetic, not the time taken to provide it. I do save a second appointment when issuing a Cerec however the chair time is probably more while I program/mill/polish etc.
My lab fee would usually range from $175 to $300 for a crown (pending material) and I guess it's just an accepted thing here that a crown fee is $1500-$1600 (welcome to Australia!)
A Cerec block costs about $40 from Henry Schein and then it's just time to complete. I am entitled to charge the same $1600 but I just can't do it. You know as well as I that a Cerasmar t has its place, but it's simply not as good (I'm talking long term life , aesthetics and strength) as a porcelain or mono Zirconia crown and I think the fee should reflect that. It's an option between direct composite and lab pros to me.

Going back a few years now but I was taught occlusion by THE MAN, a great American. Dr William McHorris (Memphis Tn) We were very lucky to have him visit and teach a 9 day course on occlusion for dentists....genius.

I'm away from the office as it's holidays here but here's a couple of pics that I'm attempting to describe. You guys have probably seen all this before and will roll your eyes at me but here goes.

First pic- trying to show bucco-lingual on occlusion. Basically the plunging cusp (lingual/palatal) on upper drops in fissure of lower with no contact at the tip, contact is on the buccal incline of the lingual cusp with its balancing contact on the lingual incline on the buccal cusp.
The reverse is true for the plunging cusp on the lower molar raising into the upper mid fissure with opposing , balancing contacts on the palatal incline of the upper buccal cusp and the buccal incline of the upper palatal cusp..
This theory balances the vertical occlusal load stabilizing the teeth in the buccal-lingual direction.
View attachment 27727
To add the mesial-distal axis,
The next picture shows black dots in triangular pattern on the mid fissure, again no point contact but triangulated load on the cusp inclines centres the load. This is bacically showing cusp only contacts through midline. It also introduces the mesial and distal marginal ridge contacts that further aim to balance load.
View attachment 27728

The last picture is the ideal situation, teeth #3 #4 in your charting system.
If you look at the red contact points they really start to mean something to balance load on a tooth. I may have achieved this occlusion only once or twice because there is the problem that the opposing teeth have the anatomy to actually do this. Also the average dentition is way too worn to have this type of anatomy dropped in a quadrant cause the text book said so..
McHorris teaches this for the theory value and when he describes full mouth rehabilitation he can actually create these contacts, too good for me,,, but it is the goal.

My lab forms here have boxes where you tick either of 2 options:

Occlusal contacts open or closed.. er what?

Sorry but I think I just hijacked a thread?
View attachment 27729

Dave the dentist. Being a realist, Good luck trying to get that kind of accuracy and detail from a lab charging $300 a crown. I know of ceramists charging close to $1k for a crown in Sydney and don't work to that kind of accuracy. It's pretty.much impossible as we work with rigid stone models not natural dentition with perio ligaments with some play that you will never get with stone models. Not taking into consideration to give the lab half a chance, that your temps have to be bang on perfect with the example given above red point contact points on your temps.

I just see the above examples are excellent in theory but we don't live in Disneyland.

 

[zero_zero]

My lab forms here have boxes where you tick either of 2 options:

Occlusal contacts open or closed.. er what?

What do you expect for $175...

 

[Davethedentist]

Dave the dentist. Being a realist, Good luck trying to get that kind of accuracy and detail from a lab charging $300 a crown. I know of ceramists charging close to $1k for a crown in Sydney and don't work to that kind of accuracy. It's pretty.much impossible as we work with rigid stone models not natural dentition with perio ligaments with some play that you will never get with stone models. Not taking into consideration to give the lab half a chance, that your temps have to be bang on perfect with the example given above red point contact points on your temps.

I just see the above examples are excellent in theory but we don't live in Disneyland.

I couldn't agree more. But it is the goal