Wednesday, November 12, 2008

I finally did a Cerec Crown

Hey.
I know what you were thinking?
Where the heck have you been?
Well here is my excuse....Friday I was writing a blog, I was going pretty good.
I went to see a couple of patients and I came back and it was gone. I was so ticked.
This website use to save the blog as I was writing but for some reason not any more and it was gone.
Now, remember I am coaching football again and the practice is at 3:15 and I don't have time after work to write.
So I couldn't write again, so I said forget it.
Monday came along and it was just a busy day. I take the kids to school in the morning at 8:15 and pick them up at 3:15 (I pick Noah up at 1pm) and it seems that this 7 hours goes like lightning.
I lost track of time and next thing I knew I skipped another day.
Oh, by the by, there was practice after school on Monday too.
I am an assistant coach. It is so much easier. I don't know if I told you about my head coaching days. It is really tough on me. I wouldn't sleep because I was so into it.
(I know I have problems, you don't have to remind me. )
We had our first game yesterday and we got creamed. It is a lot of fun.

I am reading this book called Beautiful Boy right now and I am almost done. I am going to write a whole blog on it...maybe Friday. It a true story about a man who has a son. Basically at 18 the kid was addicted to Meth.
So it starts from this kids birth and how this kid grew up. It talks about how the dad found pot in his backpack at the age of ELEVEN. It talks about the rehab and how the fathers love for this kid saves him. But it talks about how a family was destroyed because of it.
Amazing stuff. I have to tell you about it.

I have seen some movies...Rendition...pretty good. And I have just started Expelled.
But with TV going strong, movies are on the back burner. I am behind on my TV and haven't watched in a couple of days. Most of my Saturday is all about college football.
Speaking of...Noah turns five on Saturday and I am taking him and Luke to a "real" Gator game.
It is going to be great.

Okay, I have to tell you about my CEREC experience.
The local Patterson CEREC rep has been trying to get into my office. She came one week with my Patterson supply rep.
My supply rep has told her not to talk to me about money. I have told them in the past that I think leading with, "this thing can make you so much money" is a turn off for me. Talk to me about how good it is for my patient's oral health. Talk to me about how it is good for them and then we can talk about money.
So she leads with, "I know I am not suppose to talk to you about how much money this can make you..."
But she came in and told me anytime I wanted I could have a patient come in and she will bring the CEREC and the milling machine to the office and we will do one together.
That very day I saw this 20 year old with two of those Stainless Steel crowns on her permanent molars. (I think when a tooth comes in all mottled and a dentist didn't know what to do, they would just cut it down and slap one of those on there, Maybe it was a pediatric dentist. It is not a bad restoration, just not a permanent one).
I told her everything about the CEREC machine and if she lets me do this she can save $300 off the cost of the new onlay.
She said okay.

We set up a date and I removed the stainless steel crown and prepped this tooth for an onlay.
Simple prep because there wasn't any decay.
The rep was there the whole time. I was prepping and she was making phone calls. When I was ready for her she kind of took over.
She did the spray and I took the picture (impression).
Now she spent the next 5-10 minutes with the CEREC computer telling it what to do. So she would say out loud but not necessarily to me, "...that is too much contact..." click, click, click.
Then say, "...lets take this out..." and "...lets move this..." click, click, click. "...we can just do this.." click, click, click.
Every once and a while she would say to me, "You see what I am doing here? I am reducing the height of contact.....blah, blah, blah"
Now as a dentist without the CEREC I take all the laboratory does for granted. I haven't thought of this stuff, dimensions of a crown, since school.
I usually take an impression or five and send it off to the lab and expect it to come back perfect.
She asks me, "where do you want the height of contact?"
Duh, I don't know.
"Where do you want this cusp tip?"
Duh, I don't know.
"Do you see here, that the thickness of the crown is going to be a little on the thin side, what do you want to do?"
Duh, I don't know.
She continued talking, but not necessarily to me "Lets move the height of contact up to the occlusal one third but you see then it is going to make this cusp look to bulbous. So lets do this..." click, click, click.
It was amazing to watch. My head was spinning.
Now I have heard from users that there is a learning curve. Now I can see why. I can see why someone would call up Patterson and say, "take this back." Now because of the product but because of the intenseness (is that a word) of the machine.
It is a lot of stuff.

But for me, she did it all.
This did take a lot of pressure off of me and it was nice to just sit and watch her work. Don't forget that she has been doing nothing but CEREC restorations for 3 straight years. She is good at it. I don't even want to think about learning the stuff that she has already forgotten.
And I imagine the only way to get good at it is to start working on it in someones mouth and I think this is were it might suck real bad.
Okay...back to the crown...
I told her I wanted the Lee Culp anatomy in this crown. She said no problem and 400 clicks later she was done.
Then it started to mill and 7 minutes later...Viola.
I put the thing on and man was it good. REAL NICE.
The margins were so good.
(I forgot to tell you a part of the story. She had 3 of these SS crowns on her molars. A couple weeks before I prepped one of them and on the day we were going to do the CEREC one, we were going to cement the regular porcelain onlay that I have already made.
So this was good because I got to compare the CEREC crown with the porcelain crown I was doing on another tooth.)
I have to say the margins on both were exceptional. The CEREC crown got the edge though because it was like glass, I kid you not. I was impressed.
Here is where the porcelain crown won. The color.
This particular block that the CEREC crown was made was not very translucent.
Although the margins were great and the occlusion was great and it looked good. The final look was surpassed by the regular, I can adjust the translucency, crown.
Now there could be more blocks of porcelain that are more translucent that the rep and I didn't talk about.
That was the only thing.
The kid and her mom were thrilled. I was thrilled.

Now I don't think I could justify this machine right now, considering I am doing 1 onlay every two weeks or so but it was cool.
I can see what people love about it. Now if I did 5 a day I might really consider getting one.
But because of where I am at, I think I will continue to stay a interested observer.
It was fun, a great experience.

I will talk to you on Friday.
Hope everyone is having a good week.
john

9 comments:

patti said...

Shut up! We totally are reading the same stuff. We must discuss it!(Beautiful Boy)PS. HATED Expelled...snoozingggggggggggggggg

Anonymous said...

I have a Cerec filling done by my dentist 3 weeks ago and my tooth became very sensitive, I can not chew on it, is this normal?

gatordmd said...

I wouldn't say sensitivity is "normal" but it is not out of the range of possibilities.
Usually sensitivity is an occlusion problem.
That is, if the tooth is a tad high on the bite (sometimes you don't feel it when you bite) or if the tooth hits when you move from side to side.
Call your dentist and ask if he could check the bite...up and down and side to side.
That usually takes care of about 95% of all my sensitivity issues.

Good luck
john

Anonymous said...

The sensitivity is unfortunately a common problem with these restorations( not 50/50 but enough to be a concern). The software eliminates undercuts by artificially blocking them out and this space is filled by the cement. However that can result in voids and or internal stresses that have an adverse affect on the pulp. With excellent technique and some luck it can be minimized but many dentists are trying to get a way around paying their lab bill and hurry up and bill the insurance, not perfect their dentistry. If they really did they would buy a porcelain oven and do the stain and glaze to make their restorations comparable to what the lab provides. But wait! That would take too much time away from the drill fill and bill. . .

Anonymous said...

The Cerec restorations have so many advantages vs. a, let's say, MODB composite filling, not to mention the strength and beauty. Definitely worth the investment for your patient. (and yes, you.)
Sensitivity can occur by just an occlusal filling that is too high, not necessarily a problem patients experience with a Cerec restoration.
We have two Cerec computers in our office, and everyone loves the result.

Anonymous said...

Well I see your blog was from 2008 but, I feel I have to respond before I continue leaving comments to CEREC. I have had very bad experiences with CEREC. It started in 2005 with a dentist in downtown Houston. He started the process of replacing all of my back molers that had amalgam MODs. (I am just a patient.) By the time I finished having them all replaced it was by a dentist in Austin, selling CEREC. This is when I realized I had made a huge mistake. The previous crowns (by the houston dr), were already chipping. Almost immediately after my last CEREC was placed, I had to totally replace an older CEREC (by older I mean 4 years). I choose to replace it with a traditional crown and have had no problems with it. My CERECs however have been coming off like popcorn. They are definitely not worth the money.
Also, the CEREC company will not stand behind their product because, "It was most likely the Dr.'s fault." Ms. Morgan a represenative of the CEREC company, claims that there have been no complaints to the same issues I brought forth.
However, the dentists I have seen to repair my cerecs have commented EXTENSIVELY on the horrible issues they have seen from Cerec crowns. Even the dentist I just had repair my crown this past Thursday. She said she has had to repair many Cerec (porcelain crowns)…that they just don’t hold up! I know I am not an exception. You just don’t hear from many people b/c i.e.: The dentist repairs it themselves, or the patients themselves just have them repaired. These individuals usually are in a higher income bracket anyway since insurance does not cover it.
Also, NO THANK YOU; I do not need to see the clinical performance of CEREC…I have seen its performance PERSONALLY!
And, if it is the judgment of the dentist, shouldn’t you screen your dentists more thoroughly. It is definitely my experience that the dentists that have purchased the CEREC equipment made the WRONG decision in my case. But, CEREC's name was plastered throughout the clinic.
BTW: 20 years in business does not say much to me. My sister owns a college that offers Dental Assisting…she knows and is friends with a lot of dentists in her area. I have had a bridge for 20 years, went through her dental school (just for the knowledge and fun). I have seen dentists for 38 years. I have 3 close friends that are hygienists. My knowledge of dentistry is extensive as well. The only thing CEREC guys are good at is marketing. But sometimes, that’s all it takes, right?
All the best to the CEREC business,
Tasha

Lawrence said...

Tasha, I agree 100%. Sadly I have 3 of these things in my mouth, and 2 were previously replaced under a year's time due cracking/breaking, and now, just this morning, the 3rd one cracks on the side of the crown. For what I paid, i definently did not get my money's worth. Never again. Traditional is much better and cheaper too. Sadly it is all about marketing hype. Clinical trils do nothing for real world experiences.

Anonymous said...

I am a dental assistant, and I think traditional crowns are much better esthetically and functionally. First time I was trained using cerec, I didn't agree with it. The porcialn looked like a temporary crown, and it didn't look strong

gatordmd said...

Well, I have to agree that I have seen a bunch and they did not look that good.
I was not impressed.

But after doing a couple in my office as a demo and the ones I have seen online (DT) are pretty dog gone nice.
I think it has a lot to do with the operator. Do they want to spend the time to make it nice. Do they want to spend the time to stain it and put in anatomy.

But as far as them being strong, all the studies say the porcelain is very strong and the bond is very solid as well.

Disclaimer

PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.


The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.