Wanna trade Ahnold and his pro-business, anti-college stance for
Granholm ? Please take him I beg of you :)

You could always come out here Amatus and hang with us West Coasters :-)

TD

We could go through a cost analysis if you like, but, I don't want to be
annoying about it.

I think it works out to doing 8 single units per month.  If you do not think
you can do that many, and you cannot convert that many large cores to these,
then, it becomes difficult to justify.  If you are doing 2 core build-ups a
week, and convert these to CEREC (assuming they are not FPD abutments), then
the technology would pay for itself.

Like anything done in dentistry, if enough are done, there will be failures.
I have milled about 1500 of these, so I see the occasional failure.  For my
patients who never miss their recall appointments, I tell them I will re-do
any fractures in the porcelain for free--so long as they continue to make
all their recall appointments. A lot of de-bonding failures occurred over a
6 week period, a couple of years ago.  I went back and looked at the seating
date, and reasoned that I had a bad bottle of Silane.  I tossed out the
bottle, and never saw the problem again.  The only failures are really chips
to a marginal ridge when I did not find an excursive contact, and the
patient clenches.  Failure never chips any more tooth, or renders the tooth
non-restorable.  As you know, patients who clench tend to tighten up their
muscles during a procedure.  Even though, during a CEREC appt, I only have
the patient leaning back in the chair for 15 minute intervals, they will
sometimes spasm a muscle and not know it.  There is no way you can adjust
the occlusion perfectly on these people the same day you treat them.  We
give very specific directions about returning for occlusal adjustments if
they notice particular signs or symptoms.  However, not every patient will
listen to us.  So, every now and then, we will replace one (always free of
charge).  The impact on the office overhead replacing the occasional
restoration like this is minimal.  Material costs are about $20.

I have to hunt for it, but there is a well done 15 year study (independent
of any manufacturer, salesman, or instructor of the technology).  A very
large number of restorations were compared.  It was a study comparing
various restorative materials including: amalgam, composite, gold inlay,
PFM, FGC, lab. porcelain onlays, and machine milled ceramic.  CEREC was
added into the study.  It was not a study on what a CEREC would do.  Failure
rates at 15 years was slightly less than FGC.

NTI,,,,,,,,,,,,,,,  Well, if I find vertical fractures in posterior teeth,
or cusp broken off, and more horizontal fractures under the existing cusps,
I will put the patient on an NTI.  The average CEREC patient has no idea
what an NTI is.  I always check large preparations at about 14X to look for
fractures.  Vertical fractures in the floor of the prep get me excited.
Horizontal fractures with stain inside the fracture line get me excited.
Crazing lines and fracture lines with no discoloration are virtually
ignored.

Personally, I think a restoration on a posterior tooth that lasts less than
5 years is a failure, period.  Sometimes "Hero-dontics" requires that we do
things which last less than 5 years, but for routine restoration, I think
all posterior teeth need to be restored with the anticipation of getting at
least 10 years out of the restoration without further treatment.  I, also,
consider any resin restoration which needs to be patched or have its margins
re-sealed to have been a failure.  I am out to 7 years on CEREC's and they
still come back with margins that look just like they did five minutes after
insertion.

I know one guy who only does CEREC restorations.  If the restoration is
small, he mills from a block of 3M   Z-100 material and only bills as if it
was a routine direct resin  (same fee).  These are easy to do in 45 minutes
or less.  Multiple teeth in the same quadrant take 5-10 minutes more time
per additional tooth.