Friday, February 29, 2008

I have been thinking a lot about this. I have come to a conclusion... it is not CERAC I have a problem with.

Okay let me tell you about this meeting. It was a presentation that was going to demonstrate CERAC.

Let me back track to about 3 years ago. I went to an all day meeting put on by Patterson to introduce the CERAC. The dude spent the whole day (8 hours) talking about how great the machine was and how much money you can make with this machine. He answered every one's questions about money. What perplexed me is there was almost NO clinical photos. An all day lecture about dentistry and no teeth pictures. There wasn't any talk about how this benefits his patients. There was a lot of talk about how it is only one appointment, (which, don't get me wrong, I think is a HUGE benefit) but time is not something that moves me to make any decision. But that paled in comparison to the money talk.
So I left there with a bit of a bad taste in my mouth.
Since then I have dabbled on Dentaltown. I was a voyeur in the CERAC threads and my opinion really changed. There are some guys that are masters of CERAC. My faith in my fellow man was restored.
I didn't care what they were charging, they were spending time and working to make a product better for their patients. Their was no talk about how much money they were raking in. Only talk about improving their care. There was a lot of pride in their work.
Am I babbling here? Am I making sense? I work hard everyday to improve my product and be fair to my patients. I feel like if I do this well, I will make money. And it really turns me off to hear people talk about my profession as JUST a means to an end. Not a career of treating people and helping them with their dental needs.
Now back to the meeting.
They talk about how doing CERAC was the best decision they ever made. Then they started to show some of the before and afters. I was not impressed.

I was sitting next to a guy that I know that has a CERAC machine (This guy is my friend, I openly talk to him about this). As the dentist is presenting I asked him how is the insurance accepting these. He says that the insurance is only paying on 3/4 crowns and crowns, so you have to charge out everything as one of those. Hmmm?
I asked him how much to do a restoration. He says that everything is the same price regardless of the procedure, $800. Hmmm?
He also says he doesn't do many fillings anymore? Hmmm?
The dentist was doing MOD fillings with CERAC. The dentist was doing OL fillings with CERAC.
I was thinking to myself, "What is wrong with just doing a filling?" and I had some visions of an $800 charge and a little insurance fraud to go with that.
I don't have any problem with doing fillings with CERAC. But are people charging filling prices for fillings?
A different friend was telling me he worked for a dentist that would do CERAC fillings and charge $300 for them. I think this is fair. You are doing a filling that is indirect. You have overhead. A price a bit more than my price for a filling, I have no problem with this.
My problem is everyone thinking this is standard of care. If you are removing a old small DO amalgam, a FILLING is the standard of care. Have we gone away from this and no one has told me?
Now I have showed you some of my work. I can count on two hands how many of my filling I have replaced. I have been doing fillings at this office for 13 years. I have done over 10,000 fillings and have replaced just a few (I understand other people might be replacing them, but...). That is a pretty good clinical study.
I can tell you from a bunch of conversations I have had with other dentists, and the anti CERAC world, the sediment is there is a lot of over treatment going on.
The dentist is told in order to pay for the machine they have to do 13-20 restorations a month. Now don't you think there is a lot of counting going on in some offices?
I may be different, in fact I know I am different, but I don't know how many crowns I do in a month. I have never counted. But I can tell you sometimes I do 15 in a day but I can also tell you I have done 1 in a week. I am a general family dentist so my schedule can look very different day to day. Somedays I will do 3 New Patient exams, a couple of fillings on a child. The next day I could do 3 root canals. The next day I could see an elderly lady that has all sorts of root caries and then see her daughter to do 4 fillings on. I do what comes in. Somedays my production will be $15000 (pretty rare) somedays it will be $1500. I don't really count.
I try to make it so my overhead is not so high so I don't look at the schedule and say, "Damn! only 2 crowns today." (Don't get me wrong, I have some days that the schedule gets me down but it usually isn't about money).
Now, some of the users of CERAC misuese it and ruin it for the good guys. And I know the guys that are doing it right are cringing when people have this opinion about something they love and are passionate about.
They also realize that some dentists are using it for financial gain first and then patient second.
Then at the end of the lecture some guys around me are talking to each other, "Are you going to get one?", "I don't know. Are you going to get one?"
What!!? Did you guys just see the same presentation I did?
I find myself doing a lot more all porcelain onlays and 3/4 crowns qutie frankly, I love doing them. So I start thinking to myself, if I am doing 15 crowns a month by myself or if me and my partner are is are doing 15 together then we would definitely be thinking about a CERAC machine.

I am excited about maybe having a CERAC machine someday. But I can assure you it will not change the way I see teeth. They will still be white not green.

Have a great weekend,
Rest on Sunday,


Anonymous said...

Hi John,

From my experience in the dental industry, it appears to me that more and more focus is being placed on the Almighty Dollar than on giving patients the care they need.

While I believe there is great benefit to be derived from advanced technology, these new-fangled gadgets should not mean patients are routinely getting high priced dental care that they really don't need.

Whatever happened to the "old school" dentists, who provided quality dental care as needed, rather than deciding on doing a crown on a tooth that can be fixed by a replaced filling?

That is one of the biggest reasons why I have so much respect for my boss, as he continues to provide patients with necessary treatment, but doesn't conjure up dollar signs in his mind and tell patients they "need" something they really don't.

Anonymous said...


I'd better start using my CEREC more. Apparently I am not using like most others are!

Anonymous said...


Actually, you need to get the acronym correct; it’s CEREC, not CERAC. As Cerec users in our office, we have NEVER used Cerec to do any 2 surface restoration (or other small restorations) that could have been adequately restored with composite. We have separate fees for onlays and crowns. Our primary objective is to preserve as much tooth structure as possible, and that’s what Cerec allows us to do. As you know, fabricating an onlay with a lab is not always a preferred choice due to the difficulty of temporization. I’m not sure where your comment about insurance fraud fits in, but in our office EVERY large restoration (Cerec or lab crown, and onlays) is pre-authorized with the insurance company before we start the restoration. We send them a current x-ray, intraoral picture, and a narrative explaining our diagnosis. We have NEVER had any claim rejected. So your insinuation of insurance fraud is not credible. If Cerec isn’t for you, that’s no reason to make baseless comments about those of us who use it. I believe that you are making inaccurate comments based on unsubstantiated “research.”

gatordmd said...

You comments are well taken. I looked over my blog again and see where I was a bit hard. I am sorry for that.
I am just not sold on the machine yet.
And yes you are right about it not being for me and that I shouldn't bash those who do it.
Again I am sorry for making it sound like I don't believe in this kind of dentistry.

Anonymous said...

I have been watching the Cerec machine for years and found it a great idea but the cost was a deterrant for me. In all the 20 years I have practiced high quality dentistry that is not only pretty but sound, I have never (after my first year ) placed an amalgam filling. I have also not placed direct composite restorations in any of the proximal surfaces because they just don't work. I have a rule if you can't see it take an impresdion and make a lab processed restoration that can be bonded in and fits properly and will last so long as the patient takes care of it. Having said that, what the Cerec system allows the paractitioner to do is provide a faster service for the patient less sensitivity with a temporary, less time for the dr to deliver the final restoration and also a much better fit. Having a lab and techincian in my office has always been my dream for may reasons such as shading, remakes, etc. I do a lot of out of town work and I can deliver final restorations the same day. This is amazing for people in our busy society.
Another thing that always amazes me is the shortsightedness of dentists in general. Cerec has amazing potential for the dr and the patient not to mention not needing an oven with all those fumes to make a crown, no acrylic funes etc. I even make my implant crowns with the Cerec system and they are beautiful.

gatordmd said...

Dear anonymous,
Thank you for your comment. It was very well said.
You took a tone that was your opinion and informative but not offensive (I could learn from you).
I appreciate your passion and desire to be the best dentist you can be for your patients.
I hope you like the blog and keep reading.
Thanks again,


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