CEREC Dentists Are Happy Dentists Jeffrey Mader, DDS
ISCD Certified Cerec Trainer

If you ask, you’ll find some of the most content dentists are Cerec dentists. They place CAD/CAM restorations every day in their practices. The archives of Dentaltown.com contain thousands of examples of happy patients and dentists involved in CAD/CAM dental art. Cerec dentistry is now main-stream dentistry. If you’re on the fence about buying into CAD/CAM, read on and learn a little more about dentistry’s most powerful tool.

The power of Cerec is in the ease of its use, the single visit appointment, and the shear joy dentists experience in exceeding their patient’s expectations. Its highly refined software is now truly user-friendly. The complaints of its users are heard and the software updates continue to address the ideas brought forth by its users.

Too often patients receive fillings with traditional materials only because their dentist did not present better restorative options. Single-unit crowns prevail as the common choice to restore a broken tooth, with not enough regard given to the remaining healthy tooth structure or the adjacent teeth. Are you a proactive dentist or a reactive dentist? Is your alternative to placing large amalgam or resin fillings porcelain-fused-to-metal crowns? Cerec dentistry allows for the conservative restoration of teeth, quadrant by quadrant, meeting the demands and desires of our highly educated patients. Most of our patients expect to keep their teeth for their lifetime. I purpose that Cerec dentistry provides the best avenue to meet our patients’ high expectations, one quadrant at a time.

Picture 1 displays a commonly seen scenario. The large existing amalgams show margination with recurrent decay. Conservative Cerec restorations strengthen these teeth without the need for removal of healthy tooth structure. A Cerec restoration also restores the premolar to health, replacing the large resin. Picture 2 shows the final restorarions. Cerec shines in this typical example. If I fail to convince my patients to proceed with quadrant dentistry, then I am practicing reactive care; the premolar in this situation will eventually succumb to recurrent decay or fracture. Why not treat this tooth with the ultimate restoration, making the most of the patient’s time and healthcare desires. A single-visit appointment restoring the entire quadrant with CAD/CAM restorations serves this patient well.

Can CAD/CAM ever be overkill? Picture 3 shows the prepared tooth after caries removal of a small occlusal lesion. The DIAGNOdent confirmed the presence of caries at a routine hygiene exam. I used a one-quarter round caries removal bur without anesthetic and placed a flowable composite filling.

Picture 4 shows a shallow preparation after removal of caries. Here I placed a hybrid composite. These two cases do not warrant anything beyond simple fillings. For virtually all other posterior restorative dentistry, consider Cerec as the ultimate technique. Give your patients the following options and review the advantages and disadvantages of each: 1. Amalgam 2. Resin 3. Gold 4. Porcelain

Few patients will accept amalgam as an option, unless finances prevent a better choice. Resin is not a long-term solution. Few will accept gold regardless of their financial situations. Cerec dentistry becomes the restorative option of choice.

The following illustrates a very typical case.

Picture 5 shows obvious caries around the margin of #19. Radiographs show the presence of decay on the mesial surface of #18.

Picture 6 shows the interproximal lesion as well as the gross caries under the old amalgam on #19. Intraoral photography displays to the patient visually what only you could see radiographically. This photo adds much credibility to the dentist and strengthens the doctor-patient relationship, especially with new patients. It also helps the patient understand the decay process.

Conventional dentistry would dictate a full coverage crown on #19. However, too much healthy tooth structure would needlessly be removed to accommodate a traditional crown. Picture 7 shows the completed preparations after caries removal and conservative shaping of the proximal and occlusal surfaces. Note the effort taken to preserve as much tooth structure as possible, with heavy reliance on the bond strength to ensure longevity, rather than conventional retentive form. I used electrosurgery to create a trough in any sub-gingival areas, rather than placing cord or Expa-syl. The margins are readily visualized.

Picture 8 shows the optical impression obtained after powdering. Next, the patient closed into bite registration material to obtain an “antagonist” image. The dental assistant trimmed the material, re-inserted it onto the tooth, powdered the bite-material and adjacent teeth and obtained the “antagonist” picture.

Picture 9 shows the completed design of the three-quarter crown. The “dental database” generated the proposed design, which was refined using the various design tools. The use of the antagonist helped generate a crown with a highly-predictable occlusion. The green dots are the occlusal stops created with the help of the “antagonist” image.

Picture 10 shows the “virtually seated” three-quarter crown and subsequent design of the restoration on #18, using #19 as a guide. The virtually seated #19 allows for the formation of a perfect proximal contact between numbers 18 and 19.

Picture 11 illustrates placement of the matrix bands. Size 0.0015 mm bands provided an excellent seal at the cervical areas, keeping the tooth structure free from salivary contamination during the cementing process. They also prevented the cement from oozing sub-gingivally, making clean-up easier. I filled each band with Unicem cement and firmly seated each restoration.

I quickly waved the curing light over the occlusal surfaces and picked away the cement around the matrix bands with a scaler. Next, I removed the matrix bands one contact at a time, gently flossing the contact with a knotted section of floss and subsequently light-curing each contact area.

I routinely cement two or three restorations simultaneously. If doing two restorations, place the larger restoration first. When placing three restorations at once, always place the middle one first, followed by the two on either side. This ensures solid seating of the middle restoration with subsequent success with the remaining two. If the two more distal restorations are placed first, the first two may slide mesially, leaving a challenging job to seat the third.

Picture 12 shows the finished restorations. Medium and fine diamonds provided a highly polished surface. A bristle brush and diamond paste created the final gloss.

My dental assistant designed both of the restorations shown here. She also adjusted the contacts and occlusion prior to cementation and did the final polish. Her skill in providing aspects of Cerec dentistry allows me more time to spend in other areas of patient care.

The patient received two long-lasting restorations in a single, two-hour appointment. Conservative preparations diminished the chance for endodontic therapy. The porcelain blended well with her surrounding tooth structure. The overall experience exceeded her expectations.

I, the dentist, derive great satisfaction in providing this type of care. I believe a Cerec restoration is the best restoration in dentistry. My Cerec machine has added new joy to me personally, creating an excitement I have not previously experienced in dentistry. I frequently encounter dentists who share the same enthusiasm for dentistry that was lacking in their lives only a short while ago.

Cerec dentistry provides a better alternative to conventional fillings and crowns. If you are thinking of becoming a Cerec dentist, remember the power of the one-visit appointment. Consider the value of your and your patients’ time when you schedule their additional visits to seat the finished crowns. Evaluate the cost-effectiveness of Cerec when you open your next laboratory bill.

Become a Cerec dentist and discover dentistry’s most powerful tool.

Dr. Mader is a well-known CEREC trainer, certified by the International Society of Computerized Dentistry. He currently has over 5,000 CEREC restorations in service. He teaches dentists and staff members how to fully incorporate CEREC dentistry into their practices through his CEREC integration courses and educational DVD, “CEREC Made Simple.” His private practice is in South Bend, Indiana. See www.cerecmadesimple.com for more information, or contact him at: drmader@cerecmadesimple.com.