Not enjoying my Cerec 3D.  Actuall hating it right now
 
Posted:  7/3/2004 10:46:59 PM      

ELSEWHERE!

Total Posts: 24
Last Post: 7/3/2004
Member Since: 5/28/2003

I just read the thread on "tell me this gets easier!"

I have been using the Cerec 3D now for about 10 months, and for me it
has just been getting more frustrating.  As soon as I got the machine,
I practiced every opportunity I could on ivorine models.  In between
patients, during lunch, after work.  I installed the software on my
home computer to practice.  I took the local basic course within 3
weeks of getting the machine.  I was very enthusiastic about learning
how to do this.  I was convinced after listening to Dr. Morin's intro
lecture that this would be a career enhancing opportunity, and it
would be fun too.  Admittedly, I have not taken the advanced course in
Detroit.  Every Cerec user says this is a must and will make me see
the light.

Like most beginnners, I did crowns in the correlation mode.  I would
do a good wax up on the diagostic model and copy it.  Problem is that
it never seemed to copy that well.  Now it copied the basic outlines
and cusp relations, but never the detailed anatomy.  Well, I'm a
beginner, so I figure there are ways to correct this on the computer,
but I don't know so I decide to make nicer anatomy with my burs.  Too
time consuming but, I'm new at this.

I get better at correlation crowns, but still not satisfied with the
occlusal anatomy.  I read Dental Town message boards and hear great
things about Ray Becker's DVD.  Costs around $400, but it is very very
informative.  He uses dental data base, but you still can use a lot of
the tricks to put the anatomy I wanted.  So now my crowns are starting
to look better.  He also shows how to make nice large interproximal
contacts.  For some reason the software automatically gives low
marginal ridges and open embrasures.  But now I know how to correct
this.

Well now the software has upgraded and there is Lee Culp anatomy.  So
I practice using dental data base.  I'm getting a little faster, but I
still prefer correlation since it is easier.  Lee Culp anatomy looks
great on the computer, but the deep occlusal grooves are always a
problem for me unless doing an endocrown.  Trying to shape and modify
the occlusal table gets too frustrating for me.  Especially when doing
this in front of the patient who is just patiently watching me while I
sweat to make that one appointment crown in front of her.

I have several problems with the Cerec.  One factor is time.  Cerec
claims how you save time with one appointment.  With my traditional
build up and porcelain to metal crown, my patient is in the chair for
60 minutes. Prep/Impression/Temp. Seat crown appointment in one month
usually 10 to 30 minutes.  All this is really stress free to me.

Cerec crown for me is 2 stressful hours.  Initial alginate impression
for correlate.  Pour up in quick set.  Prep tooth.  Bite registration.
Trim Bite registration.  Isolate with cotton roll holders.  Spray
powder.  Take image.  Pray that I take a good image.  Take image of
mesial tooth and half of prepped tooth.  Take image of distal tooth
and half of the prepped tooth.  Pray that I take a good image.  Spray
the bite registration. Image the bite registration.  Hope that I
trimmed enough bite registration so the damn computer will correlate
the bite registration and the prep.  Image the correlate.  Make sure
the correlate is the same angle as my initial prepped image.  Wait and
pray that all the images I took correlate with each other and none of
the images have a big red X on them so you can discard it and start
over and wait again.  You see the more images you take, the more
accurate the virtual model will be.  However,  it also takes for you
to find out one of your images doesn't work.  (After all this, I am
ready to take an impression and send it to the lab) Now designing in
correlation is pretty easy.  Basically, outline the correlate.  Just
need to work on the damn proximal contacts.  Mill and adjust.  Always
high contacts for me.  I set the occlusal offset on -200 and its still
too high.  Etch, bond, and clean up.  Damn long appointment, I have to
reanesthetize to etch the tooth. Finally started to use some Marcaine.
Clean up is frustating because I am no longer mentally fresh for this
patient.  Feels like she's been here all day.  I am not blaming Cerec
for this, but at this point I am not checking occlusion as well. They
say to trust the machine, so I try to check it on the virtual bite.
However, my patients are coming back to adjust occlusion.  So much for
the one appointment crown.

Another problem, I like to make beautiful restorations.  I do this
with laboratory crowns and direct composites.  Cerec gives me only
"clinically acceptable" restorations.  How many times do you get a
case back from the lab and say, "Wow, this is beautiful."  Alot if you
use a good lab. My Cerec restorations, "It'll work." or "This won't
work.  Let me take an impression."  I know alot of you will say
"garbage in - garbage out".  And I'll accept that.  However, Patterson
and Sirona claim how simple Cerecs are.  I can wax well.  I can glaze
well.  I think I have excellent lab skills.  However, at this point in
my career I would rather not do any lab work.  Lab work does not
simplify my dentistry.  If you really enjoy it, that is fine.  But I
don't enjoy it nor do I have the time.

Another problem, sensitivity.  For some reason, all of mine are coming
back sensitive. Once again, most likely my fault for leaving a high
spot or not using Unicem correctly.  But that does not make Cerecs any
simpler for me.  For examle, I did Cerec crowns on #19 and # 20 on a
lady.  She suffered from sensitivity to pressures and cold for a
month.  Kept bringing her back to check occlusion.  Finally, decided
to remove the crowns and made lab porcelain to metal crowns.  Crowns
were probably high and leaking.  Immediately felt better next day with
the plastic temps.  Felt perfect with the porcelain to metal crowns.
No more stress for me

Another problem, Patterson representation. My Patterson Cerec rep is a
slick sleazy salesman only intersted in the sale.  Could care less
once he makes the sale. And I told that to him to his face.  Patterson
needs to do everything it can when the say the Cerec does everything
it can.  I had a problem with him returning my calls until I tore a
new one into him.  I actually left six or seven messages before I told
the receptionist that I was pissed that I was having problems with my
$100K machine.  He waits until I am mad and calls within 2 minutes.  I
have 2 new assistants who want to learn how to use it.  I want to send
them to basic training.  However, Sirona won't let them unless I
attend.  I said I took the course already and don't want to take a day
off to take it again.  We go back and forth.  My argument with Sirona
was that everytime I have a new employee, I don't want to take the
same course with them.  They can go alone.  Finally my sleazy rep says
he can come to the office any time and train them.  What the hell. Why
didn't he offer that to begin with.  He says he did.  I say I would
have taken the offer in a second if it were ever offered to me.  I
tell my Cerec rep, Patterson has only everything to gain with Cerec
users.  We can only buy blocks, diamonds, powder, and oil from them
and they need to keep us happy and make sure Cerecs will be successful
in our offices.

Cerec really shine on inlays/onlays not crowns.  If you really enjoy
inlays, then the Cerec is for you.  No questions.  Very easy to do.
Only hard part is handling an inlay whether it is a Cerec inlay or a
lab inlay.  The handling of an inlay is so delicate, that I would have
to charge more for Cerec inlay than a crown.  A trusted lab inlay
would probably just go in place.  Cerec inlay, you have to check
interproximal contact and cut off the sprue.  Not fun.

Cerec onlays.  Cerec wants us to call an inlay into an onlay and code
it as an onlay if it is has a certain bucco-lingual width.  But lets
face it.  If you still have the buccal and lingual cusp tips, its an
inlay.  Once again, inlays are very easy to design.  Lose one cusp,
and thats an onlay as I was taught. Lose at least one cusp, and now
you have to start messing with the program's anatomy.  Not as hard as
doing a data base crown, but actually it can be harder at times.  Try
designing an MODL onlay on an upper premolar.  For some reason, this
can be harder than a full crown.  Sometimes the program will just give
you a funky restoration, and it's harder to modify than a complete
crown.

I had my Cerec rep come over and show me how quickly he could design
an onlay.  I timed myself in front of a patient.  On this particular
tooth I had a hard time.  Once the images were accepted it took me 13
minutes.  Doesn't sound like much but this really does seem like an
eternity.  Under a no stress situation, my rep did it in 11 minutes
and I was not impressed with what he came up with.  He even took
Morin's advanced course.  He was telling me ways to speed up, like not
taking an antagonist image and just adjusting occlusion intraorally
because it just takes as long to get the image.  I did not like that.

I remember at a meeting how the Cerec rep was telling some dentists
that they can return it after 3 months if it wasn't working out for
them.  I was never told that.  Even so, 3 months is not enough.  I am
getting close to a year and am having doubts as I see patients on
recalls.

Well, I have not done a Cerec in 1 month.  Maybe I just don't get it.
I will take Morin's course in a couple of months.  I'll keep on
trying.  I have 100,000 reasons to do so.