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Productive CAD/CAM Dentistry by Bruce B. Baird, DDS

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CAD/CAM technology was first introduced in Europe in the 1970s. The advances from CEREC 1 to today’s digital optical readers have been transformative. If you’ve been sitting on the sidelines waiting until CAD/CAM becomes mainstream, the time has come.

I have the privilege of lecturing on productivity throughout the country, and typically I see that dentists spend most of their time focusing on diagnosis using risk factors, patient relationships and personal communication skills rather than efficiency. Without the ability to treatment plan the entire need, and communicate it in a way that makes sense to the patient, you’ll never realize your full clinical potential.

I’d like to share some of the fundamental clinical techniques and scheduling tips that help me to provide outstanding care and produce more than $2,500 per hour. The cornerstones are technology and a highly trained team. I use lasers, digital radiography, cone beam imaging, sleep apnea technology and a paperless charting system. But, by far CAD/ CAM has had the biggest impact on my productivity.


To be productive with this technology, I think we first have to take a look at some of the common myths and misconceptions. As I lecture, doctors who don’t use CAD/CAM share fears and beliefs like:
  • The materials are not as durable as lab milled restorations.
  • I am more efficient with current techniques.
  • I can’t figure out how to schedule it properly — I’m always running late.
  • I just can’t afford it. I use a lab that is very reasonable.

Here is the startling truth: These technologies become cost prohibitive unless you have a system in place to diagnose, enroll and schedule patients for care. Let me ask you this: If you needed five or six crowns, would you rather do them one at a time over the course of five years, or take care of them all at once? The reality is that most of us, if money were no problem, would prefer to have the treatment completed in one or two visits. Our patients are no different. We’ve simply conditioned them to take care of one tooth at a time.

I was shocked to hear Gordon Christiansen last year state that single-tooth dentistry has risen from 70 percent to 90 percent over the past decade. We are actually providing less care than in 2004.

Practitioners who’ve embraced CAD/CAM know that new materials such as e.max, Enamic and Lava Ultimate, and the ability to make our own custom abutments for implants produce high quality results in fewer visits. That is a patient wow factor — and a great thing to be known for in your community.

I believe in this technology so much, I recently had my entire mouth rebuilt from the ground up in one day using the techniques I’m about to teach you. I have a combination of inlays, onlays, full crowns and veneers using e.max materials. My good friend, Eddie Coralles, flew in from San Diego to be the ceramist.

So how do we do this? How do we overcome the obstacles of scheduling and materials handling to make this procedure productive and profitable? Here is what I do in my office.

Technique and efficiency

Begin by knowing you are not leaving the room from the time you give the injection until your smile designers take over to mill the restoration. With new software like 4.2 software from Sirona, it literally takes minutes to design a beautiful restoration. With the MCXL milling machine using e.max blocks it’s possible to make a crown in less than an hour with doctors’ time being less than 20 minutes.

With the advent of onset anesthesia buffering, which allows the patient to be pulpally anesthetized in 90 seconds, I can walk in the room, give the anesthetic, wait 90 seconds, and then begin the preparation. I prep dry using electric handpieces and spend about 10 to 15 minutes prepping. For years I did my own design on all of my CAD/CAM restorations. Today I have trained two team members (smile designers) to do all of that work for me.

When I’m complete with prep, I walk out of the room, go see other patients while one of my smile designers scans, designs, mills, tries in, bakes, polishes, isolates, takes a pre-cementation radiograph, steams, treats and then comes and gets me 45 minutes to an hour later. I am currently using Scotchbond Universal Adhesive from 3M ESPE to treat the inside of the restoration and the tooth. Next, I apply RelyX Unicem 2 Automix self-adhesive resin cement to seat the restoration. Clean up is quick and easy. I then recheck the bite and finish my margins. This entire process takes less than 10 minutes.

Is this productive? You bet. Average production per hour nationally is $400 per hour. I’ve spent 30 minutes working on a crown and produced $1,000 worth of dentistry — that’s equivalent to $2,000 per hour! The best part is that patients thank me for not wasting their time and creating such a great result.

Scheduling and team work

Although the prep visit is longer with CAD/CAM restoration, you are eliminating an entire non-productive second visit. In designing your office, I recommend adding a couple of treatment rooms with the intent to utilize these as holding treatment rooms while the design, milling, polishing and final preparation of the restoration can be accomplished by your smile designer.

Over the last 10 years my productivity has steadily risen from $700 per hour to $1,250. Today we average over $2,500 per hour. As I said earlier, I was doing most of the CAD/ CAM design myself because I loved doing it and seemed to have plenty of time to do so. Now I think a little differently and it’s bumped my productivity another $500 per hour! It’s amazing to grow 20 percent when you think you’ve topped out.

We still schedule to productivity in my primary two ops. The difference is that I’ve now added two additional ops for my smile designer. Her goal is $500 per hour and she has two chairs to work out of. Same principles of time management apply:




Advanced cases

Now that we’ve covered the basics, let’s think about the fun stuff — multiple units using CAD/CAM. For the last 17 years while using CEREC, my preference for anterior restoration has been to send out to the laboratory. I use Root Laboratory in Kansas City. They still do a significant amount of my dentistry, especially anything where there are multiple units with teeth missing and I’m doing crowns and bridges, and extensive fullmouth rehabilitations.

With the new 4.2 software from Sirona, I have been venturing out on veneer cases, and smile design cases up to 12 single units. I am using a ceramist, Eddie Corrales, who flies in from San Diego once a month for three or four days and we will do three or four smile design cases start to finish in a single day. Eddie’s company is CAD Smiles. With these cases Eddie does cutbacks and adds porcelain for custom incisal edges and characterization. He also is a teaching expert in all aspects of CEREC 3 software and technology.

Yeah … but

This all sounds good for you, Bruce, but you don’t understand my patients, you might say. They would never go for something like this; they barely do one tooth at a time! I understand, I used to think that way too. Today, when I do a comprehensive examination on a patient, I diagnose everything in the mouth that needs to be done. I don’t look at one tooth at a time, and I don’t look at one quadrant at a time.

My preference is to gain permission from the patient to ask them the question, “ Is it okay if I look around your mouth to get an idea of what’s going on?” I then give them a treatment plan with 70-80 percent of the posterior restorations utiliz ing CAD/CAM technology. The other posterior restorations in non-loadbearing areas are usually done with composite resins. I take the pressure off the patient by saying, “It doesn’t matter if it takes us four months or four years to do this work, we can do it at whatever pace you would like. Does that make sense?”

Learning the verbal skills to help patients connect the dots is step one. Step two is making sure they are able to afford the care they need. I’m a fee-for-service practice in the very small town of Granbury, Texas. Trust me, I know people struggle. But we found a way to overcome that. We offer traditional third-party options for the 50 percent of our patients that may qualify, and use Comprehensive Finance for those whose credit score may have been impacted by the rough economy but are still very payment worthy. Comprehensive Finance provides us with online tools to quickly approve patients, generate truth in lending statements and set up payment arrangements.

The future of dentistry is brighter than ever, and I’m so thankful for the cool technology we have to make this easier!

Dr. Bruce B. Baird has long been known as one of the most productive dentists in the country. He has lectured internationally for over 25 years on technology, dental implants, cosmetic dentistry and full mouth reconstruction. He is the founder of the Productive Dentist Academy and Comprehensive Finance.
Dentaltown Magazine
September 2025
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