Who Says CEREC Doesn’t Fit?

I love my CEREC!  And nothing irritates me more than when a fellow clinician makes the assumption that CEREC is substandard dentistry when it comes to marginal integrity.

I actually argue that CEREC gives you the ability to produce the absolute best margins.

  • You are able to control and evaluate your impression immediately.
  • You are able to magnify your impression and really take a close look.
  • You are able to self mark your margins.  Who better to determine the margins than the person prepping the tooth while it is fresh in their mind?

With the OmniCam it has gotten even better.  Now you are able to better distinguish in color your margins.

This lovely patient came in for a limited exam with pain in the upper left.  She recently had two large resin restorations that were quite deep and in close proximity to the pulp.  It was pretty straight forward that both tooth #12 and #13 needed endodontic treatment with full coverage protection.

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She ended up in our office because we offer dental sedation.  She was fearful of the procedure and ‘had a tough visit for the fillings’.  She wanted to remember nothing!

I believe the greatest adjunct to CEREC is dental sedation.  You can complete treatment in a single visit and avoid having to sedate again for delivery or worse, making your fearful patient be non sedated for delivery.

The teeth were prepared for full coverage restorations prior to making access for efficiency.  Below is a screen shot of the preparations captured with OmniCam.  Please note how the preps are quite sub gingival, but yet we were able to clearly capture the restorative margin.

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Endodontic treatment was completed and the final restorations bonded into place.  Below is a PA and BWX of the completed restorations.  Please note that following this radiograph the excess cement between #12 and #13 was removed.

 

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So again I ask the original question.  How can one say that CEREC restorations lack marginal integrity?  I would argue that it represents the finest in restoration integrity and patient efficiency.

2016-01-17T01:42:39+00:00

About the Author:

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists practice. His common sense approach to business, dedication to clinical excellence, integration of technology and down to earth demeanor has made him a recognized educator.

10 Comments

  1. Dennis Frazee December 9, 2014 at 9:43 am - Reply

    We recently had a prosthodontist start in our office a couple half days a week and the first thing he said was that he would never use the machine because the margins were milled and the would never for as well as a cast crown. His first day, on his first patient he tried it and I helped walk him through it and his exact words were, “I’m incredibly impressed!” As he wore his 6x loupes! CEREC for us has been the biggest practice builder…even in the instance that a crown comes out a doesn’t fit you have the immediate ability to go back in and make the necessary changes and in 7-10 minutes have a new well fitting crown for the patient. The work flow is incredible, the results are incredible, and to the neigh sayers I say, try it!

    • Tarun Agarwal December 9, 2014 at 10:10 am - Reply

      many of these types of ‘assumptions’ are based on the original CEREC restorations done nearly 30 years ago. the technology and milling and materials have come a long long way!

      • Karl Leinfelder April 12, 2015 at 6:33 pm - Reply

        I haven’t talked top you for a very long time. Hopefully everything is going according to plan. I’m still in North Carolina. Karl

      • Karl Leinfelder April 12, 2015 at 6:37 pm - Reply

        You are very accurate in your statement. the original Cerec produced margins that were I the order of 100 microns at the interfacial regions. The new systems are much, much better.

      • Karl Leinfelder April 13, 2015 at 6:25 pm - Reply

        This whole thing is quite interesting. I still remember traveling to the University of Zurich to take a course on the use of the CAD/CAM system. I was so impressed that I spent many years investigating the system and publish several papers dealing with the new instrumentation. What an exciting technology. I wish that I could remember the name of the professor that I worked with. We did a lot of investigatory research at the University of Alabama.

      • Karl Leinfelder April 21, 2015 at 2:33 pm - Reply

        Tarun, It has been awhile since we last communicated. What projects are you involved in at the present time?

    • Karl Leinfelder April 12, 2015 at 6:35 pm - Reply

      We published plenty of data that demonstrated that the most recent systems are excellent in terms of marginal adaptation.

  2. Karl Leinfelder April 21, 2015 at 2:32 pm - Reply

    Are you available for discussion on the Cerec?

  3. Mac January 28, 2016 at 1:12 pm - Reply

    T-Bone, how do you evaluate the occlusion on a sedated patient? After they wake up? If so, how do they tolerate adjustments?

    • T-Bone January 28, 2016 at 9:19 pm - Reply

      we are utilizing conscious sedation in our office. so we are able to get patients to bite down. certainly it is not as easy or predictable as a non-sedated patient.

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