CEREC vs Dental Lab Crowns: Is Chairside Milling Worth It?
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- เผยแพร่เมื่อ 16 ส.ค. 2020
- CAD CAM is a really cool technology, and a lot of dentists love doing chair-side milling. I actually had a CEREC, but sold it a couple of years ago.
I have seen some great in-office crowns, and some...let's say...not so great work that was done in-office. If you know what you are doing, CAD CAM can give you some great results and really wow your patients if you are able to integrate it into your office successfully. But sometimes the CEREC workflow can actually be a headache, depending on your office, and how you like to run your schedule.
CEREC is a great technology, but it doesn't necessarily make you a better dentist. In my opinion, there is still a place for lab-fabricated crowns.
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Exactly the same story here. I've done thousands of CEREC restorations from the CEREC 2, 3, etc. and the dirty little secret I discovered was that eMax restorations on posterior molars and endo teeth break after around ten years in function. The CEREC is a fantastic marketing tool and wonderfully convenient meaning no temp, no second visit and all of the sequelae that accompany temporizing a tooth. Until I can spit out zirconia restorations chairside in twenty minutes, it's not something I'm going back to as it's not what I'd do in my own mouth. Gold isn't acceptable by most of my patients and I wouldn't have it in my mouth either, though one could argue it's almost as biocompatible as zirconia and kinder to the opposing tooth structure. If you highly train your staff, CAD CAM can be a lot of fun and great marketing but eMax is unacceptable on posterior teeth (my opinion) due to longevity issues. Do yourself a favor a get a scanner or two. I got a 3 Shape and an iTero and they are both great for various reasons. iTero is essential for Invisalign and the scanning is so simple, anyone can do it. The 3 Shape has no equal for edentulous spans that the iTero won't capture and most labs will tell you about 3Shape's superiority and I tend to agree. Zirconia has changed dentistry permanently and continues to do so as the opacity gets better and better each year. The anterior pucks with high translucency don't match up to old school, layered feldspathic but are now quite esthetic if stump shades are uniform. It's all give and take..... my take away from the experience with eMax on anterior teeth only as it is quite strong and is the only material I've seen rival feldspathic. Nice video and I could have traded seats with you. ;)
You can spit out a zirconia crown in 5 minutes with the prime mill, but needs about 20 minutes to sinter
There are porcelain fused to gold crowns.
@@nickentros You can predictably mill and sinter molars for under 30 mins?
Kudos for you doc. But even the evil insurance give you 7 years average to replace a crown. Your 10 years run for the patient is more than enough. Beside, it is very technique sensitive because design of prep, isolation of preps during cementation etc...need to be right on.
It's funny, because I've been using CEREC for over 15 years and the amount of fractured lateral crowns, onlays or overlays is negligible compared to the amount of restorations done. And I'm not just talking about eMax material. In fact, I can't remember a time when any of my eMax restorations fractured. I do most of my restorations with Empress material and if all parameters of ceramic thickness are met, I am honestly surprised if a fracture occurs, because they are so rare. If a fracture occurs after 10 years due to a work error and non-observance of the given parameters of work with a specific material, 10 years is quite acceptable and in accordance with the replacement time standards of even the stingiest insurers in Europe. What is not clear to me is with what technology did you replace the eMax crowns and CEREC and expect all dental requirements to be met after 10 years in the mouth? I'm not asking for a friend, but for myself, because if such technology exists, I'd like to know about it. I am sure that you should have looked for the reason for the fractures in your actions and not in the material error.
I’ve been a lab tech for 25 years. I can understand offering a same day crown, but to provide the best care to your patients you need to have an experienced lab tech to partner with you. Unfortunately, finding a lab that actually cares is difficult. I have transitioned my lab to focus on esthetic anterior cases and implants exclusively. My prices have gone up and volume down. Now I am doing work that I enjoy and changes patient’s lives. Things are changing.
I like your attitude and I am a one man lab owner (myself) who cares for example! I lived and worked in Switzerland and I share same values as yourself. What you do now is just complete common sense.
I applaud you on your decision. Definitely don’t go thinking that I am trying to sell you anything but , I live and work in Canada now so if you want to get in touch I can help you find what you need when it comes to high end aesthetic front cases.
Im becoming a dental technician, but i am working with deskstop things inhouse 3d printing and milling zirconia crowns, but like he said sometimes dr doesnt prep enough and leaves me with minimal thickness problems from the milling software
Refreshing to see a doctor honestly not recommend single visit crowns. He's right. In a perfect situation, we can all do a crown start to finish (prep, scan, mill, fire, cement) in an hour. But those situations are few and far between.
Thanks Anthony!
I am a Dental Lab. (SK Dental Lab) Mi. I talk to many doctors each day. I would suggest for the dentist to do what they do best & the Lab to do what we do best..... Lots of hidden cost for the doctor to have a milling machine in his office.....
As a PATIENT who just had a Cerec crown done, it was the BEST crown experience I have ever had! No blue goop. No temporary crown. No having to make another appointment and come back for a permanent crown. And no issues at all with having to fit the crown, grind part of it off, or grind parts of my surrounding teeth down. It was placed in my mouth and was a perfect fit. I was there for an hour and a half total. I think some dentists just don’t have the necessary skills.
#Teamcerec !!
The issues with treatment is not always subject to experience of a doctor but many patient variables , you might just be a good or ideal candidate..
Dentists really miss this point. The patient experience is huge.
I just had a CEREC and it was a great experience . It is so nice looking too.
Dentistry is very expensive and $1200 for a crown is ludicrous. Veneers are soo expensive. I have a little chip on one and every dentist wants to sell me a new veneer instead of just fixing the chip with white bonding.
@@reefturkey and so expensive . Price of a crown is highway robbery
I'm not even in the dental field, but my dad was a dental technician when I was growing up, and I've always found this stuff so fascinating!
Thanks Jim!
Wow! Great video! I own my lab. Dentistry has some amazing technology. Love your attitude and your honesty. I'm one of the few technician (I know there are still some of us out there) that hand stack porcelain on cosmetic cases. Using different types of zirconia for the understructures, depending on the situation, and zirconia linguals. This allows for strength with beautiful cosmetics. Making patients cry because they are so happy, that's an amazing feeling!!!! I am chairside with all of the cosmetic cases. Doesn't matter if it is a single anterior or 10 units. Having my oven and supplies with me allows for us to be able to make any adjustments chairside. Patients are so appreciative and happy. Best advertising in the world is word of mouth, to family and friends.
Your honesty in how this affected your office flow and time is priceless.
Thank You,
Have a Blessed Day.
T B Thanks so much, that really means a lot!!
Your dentists are lucky to have you as a ceramist. I wish I had opportunity to do more anterior cosmetic cases. Most of my crowns are single units at PPO fees, but working with a good lab tech has been such a game-changer for me and really one of the reasons I sold my CEREC. Sometimes I do wish I had kept the oven for staining and adding contacts if needed.
Thanks again for the comment!!
I have dental offices that are mainly PPO practices as well. This limits what they can do cosmetically. But, when a cosmetic patient comes in with a single anterior or 6 anteriors. The doctors give their patients options. You can get the PPO version which may not match perfectly. The other option is to pay added fees (my fees) and use their cosmetic lab which will guarantee match and great cosmetics. When patients are given options, they love it. They feel in control and end up very happy. Most choose the cosmetic option.
Oh have you tried the MiYO staining system for zirconia?
This was a really cool video especially since we just learned how to prep pfm's and fmc's. We only worked with provisionals tho but it's so neat to hear about it all from you having practiced for so long. We also learned with cadcam and the cerec machines. So glad you're making such informative videos that go hand in hand with what we are doing in class right now! Keep it going!
Thanks so much, that really means a lot! Good luck this next year!!
Thanks for the great content. Very helpful stuff for a new dentist like myself!
Thanks so much Ryan! That’s really what I want to do with this channel, sort of talk about the stuff I wish I had known my first year or two out.
You keep things extremely real!
Thanks so much!! That's really what I was hoping to do with this channel!
Hi all. Ceramist here for 25 years. Yes, as I see it, the central considering is what a chairside cad cam setup can do, and can not do, or any system for that matter. I've been making Zirconia crowns for over ten years. The machine is always limited to your skills as a ceramist/technician. In particular, this skill translates into your design ability. For us, as Ceramists, this comes from our decades experience in making physical crowns. A Cad Cam system, in particular the rapid prototyping systems we use in Dentistry, cannot make crowns. It is not a Ceramist. It can only perform the input you give it. I can design a perfect crown in under 3 minutes, but not a Dentist, or chair-assistant. For the same reason, I cannot perform a root canal. This is a great video and I hope more will learn from it. Tech is the future, but we can guide and help each other to save money and time. Some mistakes are very expensive.
I appreciate you for sharing your experiences. Your video has been really helpful in guiding me.
having access to both, CEREC definitely impresses the patient even if it becomes routine for you, very positive for practICE image
As a dentist for over 30 years and having taught cosmetics since the mid 90's you are spot on. I have used in-office CAD CAM for over 15 years (multiple systems and scanners). It is not as simple as it sounds to produce a quality restoration. When I do one-day restorations we schedule enough time and that is key. No rushing, and the patient knows that and appreciates that they will wait a little longer for quality. The other key, like you mention is insertion protocol, meaning how are you going to insert it, adhesively or more conventionally. Today's dentist is redoing a lot of older dentistry and that means removing old fillings left under crowns, rebuilding and often dealing with subgingival issues, sometimes requiring some type of periodontal surgery. The rule is if you can't clean the margin properly than conventional insertion, not adhesion, is indicated. And, if conventional insertion is what will be required, then normally some type of buildup will be necessary for retention of the restoration.
In-office machines are generally sold with over-promise and under-deliver. Sure there are some practitioners who deliver lab-like results but it takes time and the ones who brag about speed are generally the ones whose clinical results are less than ideal.
Labs today have changed and are mostly digital. The problem I have seen, as well as some of my friends, who like me have being doing cosmetics before it was a "thing" in dentistry, is that digital is getting in the way of artistic quality and material choice. Digital can provide too many tempting shortcuts for both the lab technician and dentist. Also, the rise of zirconia is not because it's the best material, but because it provides the greatest profit margin for labs. Zirconia is touted as this super strong material, but why is that a good thing? If it is stronger than normal teeth is can provide detrimental effects to the weaker normal teeth it will function against. The physical properties of gold are still the most ideal. Zirconia is also not "unbreakable" like many tout. I have had several break and when I talk to other practitioners with similar experience, they have had the same problem. We as dentists have to stay educated and not always believe the hype. We owe that to our patients.
Thank you so much for the insight, that really means a lot coming from someone with so much experience!!
Like you said, my wakeup call was when I would pack cord for the second time, in order to try to bond a deep subgingival margin.
Thanks for the insight on zirconia, too. True story, I was recently delivering a zirconia on #18, and it fractured during delivery. I just sent everything back to the lab and had them remake it in gold. And I have seen enough zirconia bridges to know that "unbreakable" is not an accurate description of the material.
You are absolutely correct! I own my own lab as I stated above in one of the comments. Call me "old school" but stacked porcelain is always prettier. The cosmetic quality is superior with hand stacked porcelain. My dental lab friends think I am crazy because I don't just stain and glaze a full contoured milled crown. Honestly it has to do with the question I ask myself. What type of cosmetic restoration would I want in my mouth? A milled crown or a hand stacked and layered crown. The most cosmetic is of course the layered porcelain. Most technicians now do not even know how to layer porcelain. It is becoming a dying art. The artistry of it has slowly been lost. Which is sad. Considering all of the new products and the new materials. There's not a milled product that can look as natural as layered porcelain. Our teeth are not opacious like the milled products. A milled understructer that is chosen according to the circumstances. Then the porcelain is layered over that understructer using a custom shade and photos. It is a beautiful thing. Patients really stress about their anterior teeth matching. But here's part of the issue as well. The practioner tends to want the crowns for $89-$125 per unit. If dentists want cheap units the the labs will make units that require less labor. Layering porcelain is not a fast process. It is labor intensive. So if cosmetics are truly wanted. Please be willing to pay for the labor and artistry to accomplish beautiful aesthetics. Believe me, your cosmetic patients will be very grateful to you for caring that their new smile is beautiful. One of the most common reasons zirconia breaks? Sharp Points of
Sorry I hit send in the middle of my sentence.
Occlusion and lack of space. But that happens with any restoration. Removing the sharp points in centric and excursive movements helps reduce breaking of zirconia crowns. I usually will point out these areas to my accounts on the working model. This way they know ahead of time before the patient arrives. Communication between the lab and the doctor makes each day much easier for all of us. Working together as a team rather than the lab being totally invisible. This makes your work flow better and our work flow better. Also, loving what we do everyday. Wow!!!! We are lucky because we help patients learn to SMILE AGAIN!!!! What a beautiful thing and a blessing. 😁
Are you saying that gold is better than zirconia?
@@marylai5504 Basically yes except it is not tooth colored. Zirconia is over-rated in my opinion (and many others) and it is not my first choice in most cases (excluding some implant restorations).
Perfect timing for this vid! We learned that feldspathic porcelain is not an ideal restoration in areas with high masticatory forces due to its low flexural strength. That totally makes sense as to why those restorations failed in the long run even though the doctors essentially did everything right on their end to prep, mill, and place the restoration.
Simran, thanks so much bro! I will admit I did my share of Vita II on back teeth when I had my CEREC... Fingers crossed, I don't think I have had to replace one yet, but I didn't do that many.
The worst CAD CAM material I ever used was 3M Lava Ultimate. I did not do that many, but every single one failed.
Excellent discussion, thank you
Great video, learned a lot in a short period of time
Thank you Sean, that means a lot!
I currently have a Cerec AC with an MCXL milling unit. I have had them since 2016. Prior to that, I had the Bluecam with the MCXL (2010). I find that most of the crowns that I currently do are full contour zirconia that I send out via Cerec Connect. I occasionally send out for e.Max. If I use the milling feature of the system, it is for in office onlays or inlays with a material like CERASMART that I do not have to fire. This streamlines the work flow. The Cerec Connect feature gets used almost every day, sometimes several times per day. I have a great lab that fabricates the indirect restorations at a very reasonable cost. I also like to lute the zirconia restorations with glass ionomer cement for the fluoride release and the ease of clean-up.
Hey thanks for you videos, I work with my father in Florida, we own PFD Digital Lab. Your videos have been awesome at gaining perspective from the providers P.O.V. I really appreciate it. We work with CEREC docs every day, and the technology is exactly as you say, valuable if you have the time and dedication to being a "CEREC Doc". For some it's a lifestyle, but definitely not for everyone. I would definitely recommend you to purchase a standalone scanner unit, and I would recommend CEREC Primescam because of the quality of the scans and the speed, or for a more economical option Medit offers a great unit. Thanks again for the vids!
Thank you so much Nicholas! I was actually just in Tampa, very jealous of your weather! I will definitely check out the Primescan. Do you have any thoughts on 3shape?
Cerec . I’ve had about 15 of them. Done here in Spain by a German dentist. He’s the only one around where I live who has the machine. I asked him why. He says .having the machine. thing. But knowing how to use it is another. He’s in his late 50s. He’s actually taught classes on using the machine at universities. I think it has something to do with experience more than just owning the machine.
I work with VA now and we just got Primescan Cerec. I have been practicing 42 years (37 years in private practice) and came here thinking I would be able to give back to Vets. Yes it has been interesting to say the least. But recently they invested in this primescan and it has really made me focus on better preps. It is still a learning curve but soooo much better than previous Cerecs. I too was at a point in private practice to move up to scanner...but decided to come to VA. I too was and still am a believer in if something is better it needs to be faster, and easier on me and the patient, and less expensive..or a combo of all of the above...and up until I saw this Primescan, I hated Cerec. In private practice I ended up replacing more crowns done on Cerec than I wanted to admit..open and leaky margins, fracture porcelain...and just bulky crowns...but I will tell you, if you get a chance to try the newer version of the Cerec..think it is the Primescan..try it...and agree..need multi doctor practice to justify the cost. I think you video was correct all the way around... stay true to quality. Rich French
I used both cerec and lab crowns, lab crowns are way more consistent. I can’t remember the last time I sent a crown back. Impressions are so much faster and less headache. Not that you can’t get great results with cerec, there are just way more steps involved and when there are more steps one thing can go wrong and have to rescan, which I hate more than anything. My favorite thing with cerec is when I did root canal core crown cases. Prep the tooth build up, scan and fabricate crown, do the root canal during the milling and deliver after. Cool experience for the patient.
Sounds like my experience exactly. I do know the new scanners are way more user-friendly (or so I have heard).
Great, hang on to the good relationship with the good Lab and Technicians. I've remaked countless chair-side crowns over the years. Not because the materials are inferior, but mostly bad designing. Yes, if the new intra -oral scanners can perform consistently, new possibilities opens up for us. If the scan data can be remotely accessed by a Ceramist, he can design it for you and it can be milled in lab, or at the Practice. Thanks for a great video.
great content, and videos.
Thanks Rodrigo!
I have trios scanner from dandy lab so happy with them
Thank you so much for the video! Im just finishing my dental school and when I learned about in office milling I asked myself why not everyone is doing it. Like you I was all in for the geek technology stuff, making everything by yourself etc, good thing to also hear the practical side from you. Do you have any experience with intra oral scanners yet? I want to save my future patients from conventional impressions whenever possible. Started reading some articles about the different techniques like confocal laser , triangulation technique etc.. but apart from the theoretical pros and cons it would be nice to hear about the workflow and practical results, like you did in ths video about CAD/CAM.
Thanks again for your inside knowledge !
Thanks for checking out the video!!
I love the idea of intraoral scanning. There are some big names on the market (3M, Sirona and iTero), but Medit 500 is really competitively priced has been getting a lot of good reviews as well. If you want a scanner for Invisalign, the options unfortunately limited.
If you are in dental school, check out Dentaltown.com. People talk about scanners all the time, and you can ask questions yourself.
A scanner is definitely on my list of "wants" as soon as I pay down some more debt. Looking back I would have saved up and bought a scanner instead of trying to get the whole system right away.
I love the cerec system❤
Hi .Thanks for the video. It was very useful and now I am much more sure about not to use rsincement for zirconium.
Men I love your channel I'm a dentist in Florida, what I got recently is an inta oral scanner the Heron IOS, I scanned and send it to the lab and the lab will return that crown in 3 days, I agree with you the milling process in the office is really time consuming
Thank you so much! That seriously means a lot! I started checking out the Heron IOS, it looks really cool.
He is a very honest and sincere dentist. I prefer two appointments when I make a crown as well. Remember we are working on human being who deserve a great respect in our dental office.
For me, I bought a scanner and send STL file to the lab and lab makes a crown. The lab makes in 5 days. The temp I put on the prep tooth I use with liquid desensitizer and IRM to make sure no sensitivity reported by my patient. If they are not complaining, then I try in permanent crown and start checking margin occlusion and contact. Esthetics check is a must too. I only spend less than $100 for a crown cost, my assistant quickly learn how to scan properly the prep tooth. 1000% worth your money. Milling machine is a bit tricky to use and $$$ to buy it. + you need to spend your time. Not worth if you dont do 30+ crowns per month.
Great video, thanks! What opensource projects did you mentioned? I've a hefty estimation on 24 crowns I have to install and I would like to contribute to whatever project that would drive prices down for everyone.
Thank you for this most informative video. For the average dentist, such a purchase is not really worth it. The best thing (at least the first step into CAD/CAM technology) is, to invest in a scanner to streamline the workflow with the dental lab. Cheers from Vienna/Austria BioImplant
Thank you for the comment! Your implant system is absolutely fascinating!
I like that you speak so freely and you inspire others to do the same. I am a CEREC fun and user for more than 15 years and I admit that all the things that we are doing each day is very possible to do it better second time if you want to...perfect technic , perfect material is like everything on this planet, we must continue to search them. For now I still believe in feldspathic ceramic because a full contour zirconia crown, which I never do, is much too strong to adapt in occlusion that continue changes with the years. Isrestorationstechnician)teethrestorationeverythingpatientsbusiness
restorationsdeveloped
Wish you all the best.
Thanks for the info! I have read that zirconia can prematurely wear opposing teeth. I do make sure to polish it thoroughly after adjusting it, but I get where you are coming from 100%
Truly amazing quality! I am confident your channel will blow up by the end of the year! You should definitely post on Instagram if you don't already do so!
Daniel thanks so much!! Seriously that really means a lot!!
Good honest review about the other side of Cad/Cam! Are you using e.Max or esthetic Zirconia(BruxZir) for front teeth?
Thanks Alexa1995ns! I get the best esthetics with eMax, but I can get zirconia to work as long as the nearby teeth don’t have a ton of translucency or character I’m trying to match. EMax is definitely more esthetic and easier to match, for me anyway.
In my patient base, I replace some anterior pfms, so I usually just replace with another pfm in those cases. If you have really tight occlusal clearance, pfm with metal lingual can be a good tool to have; I do a fair amount of those.
Great video! I went down the same road as you and decided one day waiting on the process to complete that it just wasn’t for me. I have no problem with dentists that scan, mill and fire in their office. Guess I’m just too impatient
As a patient my cerec molar crown lasted less than 4 years. It cracked in two spots. I did end up getting a root canal in the same tooth about 1.5 years later. Now I'm on the hook for another crown.
what kind of crown did you get after?
A regular one they make in the lab. Not a same day. Porcelain I guess.
@@MrMike300x thanks. How did the crown break?
Do you have a root canal on the tooth underneath ?
As a patient, I prefer staying more over visiting more. So this is what I like about cerec. You only should go to the right dentist who knows how to use cam cad correctly.
As a lab owner this video makes sense. Ive seen the morphology and quality of a in chair system and i dont think its fair to sell a patient final crown that looks like a temp. Also emax isnt as strong as zirconia and more or same price to produce iv had issues with emax chipping and discolouration on rct teeth. Layered zirconia crowns is the way fir me and i have 100percent succes rate even with darkest of cores. I do still do an occassional pfm criwn. Looking to get a full cadcam system for both removable denture prosthtics as well as crown and bridge however turover and client base is a huge factor to consider.
I agree with all the extra time you need to design the Crown, but you'd have to pry the camera out of my cold, dead hand. Even with gold and pfms I send to the lab, the fit is unbelievable, and it cuts the wait time down when you don't have to mail the impressions.
I’m not a dentist rather a patient and I just learned something here, interesting video.
I’m curious about replacing my gold crown with zirconia for aesthetic reasons someday.
Thanks for checking out the video! You can definitely replace your gold crown with zirconia someday if you want to. Zirconia has a great track record, and is really becoming a go-to material in dentistry. Most people I talk to are using zirconia primarily, and most of the thought leaders in dentistry use it a lot too. The only downside is that if you are looking for PERFECT esthetics, you still have to use a less durable porcelain, but zirconia is continuing to get better.
@@KevinFisch Gold crowns are pretty easy to get off actually and nobody is bonding crowns to bone. That being said I still believe gold is great for posterior teeth, especially second molars.
Just finished watching all your videos!! I’m actually a 3rd year dental student in Chicago currently, but from Michigan as well! My girlfriend is born and raised in frankenmuth so we are in the area a ton! I’d love to get in touch with you next time I’m around and shadow you!
That’s wild, I actually grew up in Frankenmuth!
Yeah for sure, if you’re ever in the area definitely hit me up!
Hi Adam,
great video! I agree with you. the staining, designing, and firing for emax can easily take two hours. then its a struggle to rubber dam, or isolite/optragate to bond them in with deeper margins. two questions for ya:
1. what do you use to cement in your temps so that they stay on without coming off?
2. can you share a little about your technique for final impressions for crowns? I always seem to get a bubble on my margins :/
My favorite part of CEREC is not having to use make temps or impressions. but maybe if I just get better at them it won't be as much of an issue :)
Thanks Umer!
I use Centrix Access Crown as a temporary material, and cement with ETC from Parkell. ETC seems to hold well, and it is easy to clean off of the tooth when you take the temp off. It is pretty strong, so I end up cutting off about 1 in 5 temps.
For the impression, I use Kerr Extrude in a triple tray (wash on the tooth, and heavy in the tray). The wash is super runny, but I don't get as many bubbles at the margin. I used to see more bubbles when I was using a slightly thicker wash. I know cord is the standard, but I have been using 3M retraction paste with really good results. Sometimes, I have to go over the sulcus with some viscostat clear if it is really deep.
I need to do a video on my crown technique. Thanks again for the comment!!
As a 15 year plus CEREC user, I think you make some valid points. CEREC has an extremely steep learning curve and I don’t think it is for everyone. Over the years with zirconia coming into play, the economic advantage from a lab savings standpoint is not as significant. Ultimately with where the technology is now in Primescan, most dentist have to be honest with themselves. If technically it is not returning the results you expect, you have to evaluate what you are doing because you control the whole process so the fault is likely your own. If you want to just take an impression and not deal with it the labs will fix and correct the short comings in your prep, but you are not really getting feedback as to what you are doing right or wrong. Any staff member can leave at any time, so you have to be the expert if you are going to invest in the system. Just my opinion.
Greg, thank you for the kind words. I actually just started using a 3Shape last month, and I love having a scanner again. Being able to use it for not only crowns, but also bitesplints and partials is fantastic. I have heard great things about Primescan as well.
Which scanner would you recommend and would it be possible to get a used one out of ebay for example and still get good results? Or it has to be new with warranty etc. I was offered Trios for 29,000. Would highly appreciate any advice. Thanks
I completely agree to you sir. Everything you said was the truth not fake
Just a patient, but very interesting to hear what's going on on the other end.
Another question, who does the dentist go see to get their tooth done?
Thank you Kenji!
Dentists just go to another dentist, but we are usually pretty selective of who we go to (we see other dentists' work). I have had the honor and privilege of treating a couple of retired dentists myself.
I would suggest for the dentist to do what they do best & the Lab to do what they do professionally much better.....
I’ve got Cerec Primescan with no mill. Send all crowns to lab. My assistants pack cord and scan. They do great but you have to set a high standard for their scans. Pretend your an instructor in dental school. They re-scan on enough worn out patients and they get better quick. Scanning is harder than traditional impressions (but more accurate IMO). Send great scans of great preps to a great digital lab and margins are perfect. And by the way, my labs get single unit crowns back to us in 3-4 business days. We rarely have to re-seat temps because if one comes off we have the permanent crown back already most of the time. That turns an annoyance for the patient into a pleasant surprise.
Being in a family dental lab that has been going for nearly 50 years (20+ for me) we are now at a point where a lot of doctors are coming back to labs. I have to turn them down due to too much work.
Chair side crowns are what put most of our local labs out of business- labs used to make around 50% of the restoration… now it’s closer to 10%
when it comes to custom shade anteriors, upper/lower full arch cases, difficult esthetic/functional cases is it worth it? When it gets to the point where doctors are only sending the most difficult cases I’ll get a job at UPS-
My lab made Zirconia Bridge was cemented with Harvard Cement. 5 years ago. What’s ur opinion on Harvard Cement? You use glasionomer cement?
Harvard cement is old school zinc phsophate. It's a good cement. Your bridge shouldn't have any issues related to the type of cement used!
I got a cerec omnicam; just because it was there b4 From the old guy… one thing i really love is Partial crowns. I had a patient with zero Space 27 huge cavity and After caries removal i realized Its gonna be such a mess doin a Corebuild up. Tooth was still vital tho cavity had the negative shape of a golf Ball..so i just pulled out the cam and just tried to make an easy Quick Scan… so That worked out Great and celtra duo is very cool Material… i just Composite and Syntac
Classic. Works like a Charme. So over all if u have a huge cavity and u can properly Scan in my opinion cad cam for Partial crowns is brillant. And you Know what i agree 100prrcent on what u Said about the Full crown issue. I ve been there 2 Hours Start to finish… Worst case langer. Its all down to the frequency… and the Situation. If u have high Standards u Want a solid Design. No matter How good u r… starting From a Messy situstion Its obviously Not gonna be fun… however, Scanners get better and better…
That is exactly what I mess about the Cerec. The workflow I have now is a very "cookie cutter" approach (ideal crown prep), and I really miss being able to do these onlays and partial crowns. I still do gold onlays occasionally if I can talk the patient into it.
I have my blue cam from Cerec but its time to give a ride with the MCXL ( zirconia milling machine too), am thinking to buy the new one from Cerec chair side, Primescan and Primemill, and the old one are goin to the new lab with the MP7 from Ivoclar plus lab scanner too ...........
I love bonding find it relaxing 😂
Hey we all have our things, I find dentures relaxing lol
My dentist just milled a crown in the local departmental lab using only x-ray images and no impression was made. I am surprised by the simplicity, jet there is a large gap between the crown and the tooth beside it. I wonder whether he did the right thing.
What kind of camera do you use for your videos? Great channel.
Thanks J.C.! I use an M40, the earlier videos are with the kit lens, then some of the later videos are with the sigma 14mm/1.4. I do a little bit of color grading in Premiere
@@BeyondDentistry Cool man. Yeah, great channel. I practice in Illinois. I agree with most of the things you say and you’ve brought some cool things to my attention as well. Quality channel. Going to keep watching.
agree 100%
You got a CEREC for 12k on eBay?! Haha awesome. Did it come with a manual and tech-support/training? I think I would have kept it and just learned to be faster and/or train staff so that you could still work while it does its thing in the background ya know? Nice video though good to think about for sure.
I'd be really interested to hear what the responsibilities of your assistants are and how you are able to increase efficiency with them. I'm starting dental school this summer, and I currently work as a dental assistant, but as assistants we don't make the temporaries, or cement them, we don't clean the cement when seating a crown, and I would be interested to hear what other responsibilities you delegate to your assistants that help you to work more efficiently as the doctor.
Great idea for a video!!
Agreed if you don't have the volume there isn't any point, my wife can do enamic crown in little as 45mins though, for us the primary reason we use it is patient demand 1 hour and the fit is amazing. Also our labs may not be as good as yours.
Agree totally! Patient demand is such a huge factor.
45 minutes, that’s impressive! I was pretty slow with my compact mill, I know the MCXL would’ve been a lot faster.
@@BeyondDentistry Please, just know about PrimeMill and You will be surprised!
What scanner are you considering
I'm open to suggestions lol! I like the idea of something more open like Medit. Seriously, is there a specific scanner you might recommend?
@@BeyondDentistry it’s tough! Part of me wants to get the prime scan because of the possibility of incorporating a mill in the future and getting integrated with cerec technology but everything you said in this video is so on point... I want to start with digital scans and maybe buy a printer (sprint ray) to allow me to print models and make orthotic appliances in house. The prime scan is currently 40k :(
@@SmileInfluencers I agree 100%! I'm just not a big enough office to justify the cost right now - but it would be amazing to be able to 3d print bite splints.
Where is this dentist located?
Ivoclar viviadent they have millbale alloys for disc mils if i am not wrong so CAD cam metal fused too porcelain is posibe just not with cerec again if i am not wrong
Reading the comments, I see a lot about why it is not as convenient for the dentist. Did someone forget about the patient?
Do you use zirconia crowns over implants for the lower front teeth (implants)? Thank you.
It depends on the case, but I do almost always use zirconia in those cases. Sometimes PFM is actually a great option, because if the material is too translucent (like an esthetic porcelain), the titanium abutment underneath can alter the shade of the crown. You can have the lab put opaquer over the abutment if you want to use something more esthetic like emax.
Dear Adam, which color is your teeths following 3D VITAMASTER? Is it B1 ?
I just checked, it's between A1 and A2 . Probably looks brighter because of the bright lights I record with!
I am too not like adhesive crowns. Thank you from Russia ! I am useing bluecan. I like cerec
Thank you for reaching out!! Very cool to hear from you all the way in Russia!
Hi Dr White, how do you remove excess temporary cement when you don't numb the patient up?
Hey Ben! I use something called ETC from Parkell . It usually all sticks to the temporary, so there really isn’t anything to clean off of the tooth, just some inter-proximal sometimes.
I always warn the patient that it is going to be a little bit sensitive, and I can numb it up if they like; most people request that we try without numbing first. Once in a while, I do have to numb the patient, especially if I need to cut off the temporary.
@@BeyondDentistry Thanks Dr White, amazing videos! Been watching all of your older videos as well. I'll definitely check out that product. How do you usually clean the tooth prior to cementation?
@@ExodusLoui Thanks Ben! I just rinse the tooth with water. With endo teeth, it doesn't really matter, but sometimes it can be sensitive if the tooth is vital, in that case you would have to numb the patient.
I have been thinking about doing a more thorough protocol, using plain pumice in a prophy cup, but sometimes if you do too much cleaning or scrubbing much and have a deep margin you can induce bleeding, then you definitely have to numb it and even pack cord sometimes.
Some dentists pack cord for every cement, but I do not.
Hi Adam, i really like your videos. I'm dental nurse, I want study dentistry, do you think would that be easier for me, because of my background experience?
Thanks so much!! You would definitely be ahead in terms of all the dental terminology, and how procedures work.
School would still be hard because of all the sciences like biochemistry and physiology. But in order to get into dental school, you will take some of that in undergrad anyway. Good luck!
@@BeyondDentistry thank you replying back. Are you in USA?
Thanks! I am in the US, I went to dental school in Detroit.
I am doing same bathing now but studying in the Philippines. I am a Dental Lab Technician
@@blackdady365 good luck!
Just hire dental assistants from Pacific Dental Services. They should be skilled with Cerec. Lol.
my dentist is rammed with customers but they still use molds and 3 week waitd for crowns my temp has fallen of 3 times in 3 days pmsl
Helo form Argentina; I Think like you doc. I buy a omnicam 4.6 scanner, and 2 visit is optimus.
My first couple crowns I did in two visits, and I found it a little bit less stressful. I have heard great things about the Omni cam, but never tried it. You guys are making me want to get back into scanning!
you can mill gold. Strategy milling
I used to work as an associate for a dentist who used to fabricate Cerec crowns. We eventually went back to lab fabricated crowns due to poor esthetics of Cercec crowns and poor margins.
Thanks for the feedback! I have seen great cerec crowns and also some pretty bad ones. The worst is relying on resin cement to "fill in" marginal gaps. Those seem to be the ones that fail the most.
Totally agree!
Why does a crown cost $1200 if it only costs $25-150 this is so unfair!!!! There needs to be a regulation on how much you can mark up and this is the reason even with insurance people can’t get all there dental work done!!!
Because the dentist has to Pay for staff. Has to Buy a chair for roughly 50grand or more. Because there is fix costs associated to the process That have to be Paid for. Its Not just the Block. U ever ask a car guy why u dont just Pay for the rubber used for making the tires…v? Now pay us properly
Go to Costa Rica. Cerec crowns are $450.
The CEREC machine itself has an average monthly payment note of ~$2,000 and eventually totals ~$100,000. Remember, this is JUST the milling machine, scanner, and software. You have to spend time prepping it to go into the furnace/paying someone's wage to prep it. Furnaces cost ~$5,000-$20,000, depending on what you need done. Then spending time prepping/paying someone to prep/polish the finished product. Then, you have to make sure it even fits the patient, feels comfortable, and is functional. Adjusting the crown takes ~30 minutes for a more seasoned dentist. This takes time that you must be paid for/time you have to pay an assistant/tech to do. There is a lot that goes into the cost of a crown in-office.
Gosh. No way we put the patient first? Gotta make them go back? Gotta make them deal with a lousy temporary? I feel your pain.
> bites lower lip
I’m a 60year old and 40 year dental tech and I send my zirconia crowns to a milling center,they don’t match the shade and have problems to sit,and here comes the staining and glaze,2 o 3 hrs 😭😭😭
What lab do you use? Thanks!
King Dental Arts in Bristol TN for almost all posterior bread and butter zirconia. The owner’s name is Dennis. They have never let me down, and saved me a couple times on some really difficult cases.
I do a fair amount of anterior PFM, and for that use a good local lab. I have an older patient population, so often a single anterior crown has to match a bunch of other PFM’s. And for that stuff, I like that they are close and I can even send the patient to the lab if there is any doubt about a shade.
I started working at an office that uses cerec...to me is a nightmare. I personally wouldn't get a crown made by it. I'm not trained on it, but the other assistant is. I can't really get trained bc she's too busy with that pt, while I'm with another pt.
why would you not get a CEREC crown?
Silly question but what is CEREC?? Is it a brand of mill?
Hey Bryce! Cerec was (I think) the first cad cam system. It was typically sold as a scanner/mill combo. Today you can mix-and-match different scanners and mills, but when a dentist said they “had a cerec” they typically meant they had the scanner and mill so they can do same-day indirect dentistry.
@@BeyondDentistry thank you 😊
I have been doing Cerec crowns in office for 3 years now. Not a single one has failed yet, the Dr is very skillful and every time we have a deep inter-proximal decay(even bone level) and is bleeding a lot, we use Hemodent or Laser to control bleeding. I’m the only assistant in the office that knows how to scan and do margins properly, even the design of the crown and making sure the contacts are optimal. I’m sure if the prep is well done and the assistant is well trained you can finish a crown in 1 hour and 45 min. From my experience patients prefer to wait 2 hours than have to get a temporary and then wait 2 weeks to get a final crown. I have been and RDA for 6 years now and started doing temps, got pretty good at it, but I will always hate make temporaries. Cerec Chairside is an amazing product that makes everything faster in the office.
this is what you get from a doc. who wants to operate his practice as if it was McDonalds........put in the work sir, cerec is better for patients
Do you think zirconia is better than emax for front teeth?
emax is a better looking and more translucent material, but that being said zirconia can look very nice for front teeth.
I usually use zirconia only if we are restoring all front teeth at once. Emax looks nicer if you are matching an existing, natural tooth and if it's bonded its pretty strong.
Dude you cannot compare Bluecam with a Primescan. I bond everything and it works very well. Letting make your assistants the provisionalnisxavresl risk.
I get it. My experience was unique to me. I have heard great thing about prime scan but I do maybe one crown a day on average. If I could get into same day zirconia for under 50 K, I would seriously consider it.
Young doctor need to wake up. guys you’re losing laboratories left and right and technicians you need to be concerned and start supporting your laboratories and your technicians and give them advanced technology and teaching good luck.
agree, chair side milling is nonsense for smaller practice , time consuming and you will get better results with scan and use lab to do the work for you. do not waste money on cerec buy Itero and scan for all restorative options. labs love it.however some charge for printed models and some crowns needs models too for manufacturing process. not all can be done only digitally . if only digital done you might need adjustment before fit as lab can't check it .
I forgot to tell you, the headaches that have arisen from an ill-fitting bridge to constant migraines. Please people stay away from this quick fix and live happy with a dentist, (if you can find an honorable one) to address your concerns and well-being and follows thru with sound advice, protocol and the decency not to snow you. God Bless.
Haha man I hate Bonding as well. Its such a huzzle
HELLO, My biggest concern with Cerec Restorations, is that I was convinced to have a bridge for one missing tooth, I was interested in a one tooth denture. He was adamant not to do that, because he said it would not work. I have had nothing but pain from the bridge since Feb/27th, 2023. My dentist has adjusted with no success since the bridge was installed in my mouth every week. He keeps telling me, I need to let it relax in my mouth. My concerns with Cerec that the calibration process is faulty. I told him it felt bulky and uncomfortable. He again giving excuses. This fiasco has gone on since Feb23, 2023 and cost me a whopping 3200.00 dollars thus far. Why do dentists depend on speed of a crown or bridge, instead of patient care. I am in the middle of making inquiries on dental malpractice. This is a travesty, for a senior to spend money for uncomfortable dental work and feeling that I am constantly biting my cheek because of the bulkiness. Get rid of CEREC, it is not safe for a dentists convenience. What a Sham!
Would you rather buy a really cool well-made shirt at a cool store or just buy the patterns, the sewing machine and the bolt of fabric and spend hours making it yourself? Same thing here. Labs are better at making crowns than you will ever be.
I think this discussion is 3 years old ...3 year old argument.
I disagree that milling machine could give you a quality restoration. I already have 2 inside my mouth, plus the matching colors for delivering to my patients are never accurate or look natural. I recommend everyone to stay with dental lab technicians and look for the best ones. Milling machines still not ready to give you a natural look.
I’m from the future (2023). I came back to tell you that sirona will make something called MTL and kuraray will make Katana one. Zirconia can be strong and look amazing when chairside. Oh and stock up on toilet paper and buy stock in hand sanitizer because a pandemics is coming your way
You failed to integrate the technology correctly because you purchased a transformational technology on the cheap with no support in place to properly integrate. If you had made a true investment in this technology through a reputable and authorized dealer, the integration would have been complete and workflow properly delegated to your great staff. This technology is about patient experience and will be standard of care very soon.
Hi Arron, thanks so much for the comment! I know a lot of dentists who bought used and loved it, it just wasn’t for me. We did have training and support with Patterson, and I studied the workflow pretty extensively. I also had a membership with cadstar which is absolutely phenomenal for anybody looking to get into cad cam. The CERECs I did five years ago are still looking beautiful and I credit that success to learning the technology and materials, and cadstar was a big part of that. I could jump back in with both feet tomorrow if I wanted to or my patients start to expect it, but for now working with a great lab has given me and my patients a better experience overall. Honestly, I think there’s a time in the future where I will end up doing chair side milling again, but I will probably do scanning only first.
@@BeyondDentistry wow, you appear to be the exception to the rule. My apologies for my tone, as it sounds like you’re someone who’s not afraid to invest themselves into this technology. You really should see what it can do for your workflow today. Properly delegated, it does positively impact your practice through increased assistant ownership in your “mission” as well as deliver an experience that patients deserve. I can tell from your video that patients would like you, but time is the most valuable thing any of us have or could ever offer. Sorry, stepping off of my pulpit. Keep caring, like it’s obvious that you do, and remember, it’s never too early to get back into cadcam! DI is just another way to take an impression. Better yes, but...........it’s beneath you at this point.
@@arronbradford6858 No worries at all, genuinely thank you for the dialogue!! I think one of the most valuable things about his channel is the comments, I think it is important for newer dentists and students to get a bunch of different perspectives. Keep doing the great work you are doing in cadcam, your doctors are lucky to have your passion and enthusiasm!!
CG
Of course you didn't like Cerec, you had old technology. Try the Prime Scan and Mill and it will change your mind. PFM's? Yuck
Cerec crowns are some of the worst emax restorations I've ever seen. I don't know if it is a lack of training or the entire system, but based off of what I have seen, I wouldn't feel right putting that in patients mouths.
I think you’d find that you’re opinion on Cerec might change if you assistants were trained on it. I’m a dental assistant and the dentist I work for has had a cerec for 10 years now. I’ve only been an assistant for 9 months but in that time i have been trained and have gotten it down pretty well. His assistant of 10 years trained me however most of it was hands on training and teachable moments. My dentist uses a rubber dam to isolate when prepping for the crown and he will have the assistant scan, design, mill and adjust, then fire the crown, then we seat. This allows us to mill out multiple crowns a day and raises the level of production. We do still use the lab for anterior teeth, but at times if we are confident in our abilities we will mill out an anterior tooth. I personally think it is amazingly efficient tool to have in an office.
Thanks Mandi, I bet you are right! Having good assistants makes a world of difference. Thanks for the feedback!