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I want to thank Don Bell, the Director of Marketing CAD/CAM for Ivoclar Vivadent for his strong presence on the boards at cerecdoctors.com.  I was reading the site today and he posted some great information about Multilink.  He touched on the fact that people in general are not big fans of reading directions.  We generally feel that we'll figure it out.  I hate to admit it, but I've done this from time to time too.  This can be a huge mistake, especially when dealing with adhesive dentistry.  I find that the adhesive part of the CEREC process is that part that most people have questions on from the start.  It is so much easier to just cement a crown, we all know that.  It is imperative to know your bonding agent and how to properly use it.  Today Don talked about some studies they did on Multilink.  They had some questions about how long was long enough to scrub the dentin and enamel with the A & B mixture.  The correct amount of time to scrub the dentin with the mix of A & B is 20 seconds.  Look at what happens to bond strengths when you don't follow directions:

It is so important to follow manufacturers instructions.  The adhesive step is probably the most important step in the long term success of the restorations that we place.  Please take the time to learn how to use them correctly!

I'm sitting in the auditorium of Scottsdale Center for Dentistry and I'm just very energized. Those who know me are thinking, "what else is new!"  

The reason that I'm so energized is the fantastic meeting being given by Sameer Puri, Armen Mirzayan and Mike Skramstad. They are doing a weekend of lectures for our esteemed cerecdoctors.com Mentor Group on how to properly document cases and create beautiful presentations. I'm sitting toward the back of the room and decided to take a photo of the meeting in action.

This is just such a great lecture given to the mentors to teach them the tools to go out and put on presentations like the guys teaching it. We learned Camtasia, Dropbox, iMovie and Handbrake. They show how to record CEREC procedures off the CEREC machine and produce them with audio. They show how to edit videos and photos in iMovie. They not only showed everyone how to use these different programs but sent everyone away with the presentation so everyone has a tutorial to allow them to practice and create these presentations in both Keynote and PowerPoint.

I remember a few years back when Sam told me about his plans for the mentors and all the content he wanted to provide to them. This year he has gone above and beyond all he discussed with me. I'm sure that this course will be given again. If you are a mentor and didn't make the course this time, don't miss the next one. If you are not a mentor, contact Shayna Phipps at Scottsdale Center and get some info about it. The only thing better than the meeting is being with 100 friends here at the center taking the class with me.

I want to relate a similar tale of two dental companies that are in no way related but seem to have traveled a similar path. We are all obviously big fans of Sirona and the CEREC technology and most are aware of the arduous road that has been traveled by most, especially when dealing with our peers and their thoughts on the technology.

We have all heard it: The margins are no good, they are not esthetic, I don't want to be a lab tech, it can't be profitable. I've heard it all in my nine years. The company has been hearing that for 27.5 years, but continues to forge forward and change the landscape that we know today with an incredible and innovative product. You need to be willing to think outside the box to accept it, but once you believe, you can never go back to what we were initially taught.

I was a part of an amazing weekend these last few days. I went to Boston with four other cerecdoctors.com faculty and about 15 mentors to visit the implant facility and operation of Bicon. I will say that 10 years ago, I was trained by Bicon and started my implant path using their implant system.

Bicon was started by Dr. Vincent Morgan in 1985. Dr. Morgan is a very forward-thinking man who does not care what the masses think. He has created an innovative implant system that works, but goes against the conventional thinking that has been taught in implant dentistry.

This trip was just incredible. Their facility is a functioning dental practice, AV center where they can record everything that they do, a teaching facility where they have a state of the art building to share their info with people looking to learn to place implants, and their company headquarters. It is a family- run business and those who work there feel like family, too.

We were welcomed with open arms, but I have to say that many on this trip have a ton of implant placement experience and were a bit leery before hearing what Vince and the other speakers had to say. We were shown many examples of beautiful, everyday, simple cases, and then just things that I would just never imagine being able to be done. Because their clinic is part of the facility and they basically document every case,  they have so much data it is just mind-blowing.

Not only were we able to learn how to properly use their system to place and restore implants, but we watched a live surgery and also live restorations with their system. I could go on for a long time about all the things that are not conventional, but basically here are the main differences I got:

- They have a sloping shoulder on their implant. We saw case after case where bone grows up that shoulder. I placed them for many years, and I can say I saw the same thing.

- They use a shorter implant but showed lots of info as to why you can do basically any type of restoration with the size of implants they use because of the design and amount to surface area their implant accounts for.

- They also have no screws. They use a Morse Taper in their internal well that allows for a cold weld and bacteriostatic connection.

- They restore implants using something called an integrated abutment crown (IAC) where there is no cement interface, so they don't get the cement sepsis that occurs from many cemented crowns over implants.

- They also showed how the design of their implant can allow the doctor to cultivate beautiful papilla where there was none. They are placed subcrestal and for those who place implants like I do now, we place at the bone level and just expect to lose a bit of bone at the top of the implant. This system seems to buck that trend. I think with the creation of things like Lava Ultimate and their stock stealth abutment, we can do amazing restorations in our practice that will allow us to cement outside the mouth and get the healthiest tissue response possible.

- They are also doing large cases with an amazing new material called Trinium. It is a fiber-reinforced framework that is milled and not fired or sintered. It is made of the same technology that they make the bodies of new airplanes with. It is very strong and so light – I could not believe the weight of some of the full-mouth rehab cases they were placing. They were light as a feather.

This system is something that you need to see to believe and I would highly recommend coming out to their facility to learn about this product. After two long days of info, they fed us with world-class food from their on-staff chef. We had amazing food and drink and just talked about the amazing ideas we had from all the info we gathered.

I can't speak highly enough about the quality of the course that was given and the people who gave it. They emailed me the next day telling me how great our group was and that they have never had such an energetic group of people who were so open-minded with as much experience as many of the people in the room had.

A huge thank Vince Morgan and everyone at Bicon for making us feel so welcome, opening our eyes and allowing us to think outside the box – as we have learned to do as CEREC users!

For those who may be unaware, there is a new update for CEREC Connect.

Here is the link: http://www.cerec-connect.com/ecomaXL/index.php?site=CERECCONNECT_COM_downloads

There are some cool updates in here. I really like being able to take pre-op pics to make Correlation bridges. This will be nice when we have a wax-up and made temps to open a bite and would like to recreate exactly what the patient is functioning with in the mouth.

You will notice that there is a new name: Sirona Connect. New name, but still the same great product.

The thing I would like to tell everyone is that milling a temp from the Sirona Connect file is a bit different. One thing everyone must understand is that if you want to send a case via Sirona Connect, you must image it in the Sirona Connect software and not the chairside.

Once you image the case and draw the margin, go ahead and save the case. You used to be able to open chairside at this point and just find the patient you are working on, open up that case and design the bridge.

The new Sirona Connect is a .con file. The 4.0.2 software will not recognize this file. If you want to mill out your temp from the file in the Sirona Connect, go to the top of the screen and click on the Export File icon. Export the file to your desktop and make sure you save it as a .DXD file. Once you do this, you will see the icon for the case on your desktop and you can just drag it onto the 4.0.2 icon and the case will open. You can now design the temporary and mill it chairside.

Enjoy all the new connect functions!

When we go through basic training, we learn within the first few minutes of the class about the importance of the 3 Ps – Prep, Powder and Picture.

The success we have with CEREC generally comes down to these three important factors. The better each is, the less work we'll be doing with the software. When I started my CEREC journey, I had a lot of work to do in the prep category. CEREC made me improve that pretty quickly. As every CEREC user knows, when you see what your prep looks like blown up on a screen, it can be very humbling. The beauty is that we can fix it right away and know exactly where the prep needs to be improved.

When I started CEREC, I worked in an office that had electric hand pieces. I loved them. The ability to prep without chatter and to be able to slow down the hand piece to be able to polish it to a smooth finish with sharp margins was amazing. I was able to obtain very smooth preps that imaged so easily that I improved my success with CEREC right off the bat.

I purchased my own practice five years ago. I spent my extra capital on things like a CEREC machine, new computers for the office and intra-oral cameras for the operatories. I was using air-driven handpieces that we had in the office. I really missed the ability to slow down the handpieces and get that nice smooth finish on my preps. I've had Kavo air-driven handpieces since I bought this practice and about four years ago was introduced to a slow-speed head that accepts friction grip heads.

It made me feel like I was closer to having electric handpieces again. I'm not familiar with every brand of handpiece out there, but I would recommend finding out if there is this type of option with the brand of slow speed that you are using. For me, it has made all the difference in the world.

Here is a prep done with that slow speed friction grip:

There can be lots of reasons. The first reason that I tell all users that they don't have to do crowns in one visit is when they first get their CEREC unit. It can be very frustrating when you are adapting to a new technology and having to learn how to schedule appointments in a different way. It definitely takes some getting used to, and I recommend prepping and imaging the case and getting a temp on there. This way you can design the case on some down time and not turn your schedule upside-down that day.

Today in my office was a second reason that I would not seat a case on the same visit. This was a case where the patient had some interesting dentistry done. Many years ago she must have had a large carious lesion on tooth #30. The doctor used pins and composite to do the build-up, but it seems as if the pins were not going down the long axis of the tooth. See the attached PA and bitewing. She was having sensitivity to cold and a bit to hot, and I was not sure if those pins were going into the pulp or not. The 2-D films made the situation look worse than the actual case. (This is where cone beam would have been great!) Once I finished prepping, the margin was relatively deep on the lingual. I don't believe that crown lengthening is necessary, but if it does need to happen it will make it easier to access the area if the crown is temporarily cemented. I mainly use e.max in the posterior, and trying to cut them off once they are bonded on is just not fun!

I decided on this specific case to do use e.max and have her wear it temporarily and see if the symptoms disappear and the tissue responds positively. The pins were not going toward the pulp, but toward the CEJ, so I'm hoping we will be ok. If in about 4-6 weeks her symptoms are gone, then I will remove it and bond it permanently.

I don't believe there is a right or wrong way to do this, but it is generally how I would handle a case of this nature. What would you do?

Here is a quick tip (or two) when doing multiple teeth in the 4.0 software.

When you are doing a quadrant, make sure that you first have your options properly set up. Go to the configurations (at top of your CEREC screen with the gear icon) and click on Options. There will be an icon that says Restoration Calculation. When you click on that, make sure that the option that says “Calculate Multiple Restorations” is activated.

This will give you the opportunity of having the machine propose your restorations simultaneously.

In the Administration phase, choose the teeth you are going to prepare in your quadrant. With the new 4.0 software, you can choose teeth in the same quadrant, opposing quadrants or any quadrant/arch. You must take the appropriate images of both arches and the bite (if doing Biogeneric).

When you get to the Model phase, you will need to begin marking your margins. The first thing you must do it make sure that you are marginating the appropriate tooth. At the bottom of the screen, there will be icons for each tooth you are working on. The tooth that you are marginating must be the tooth that is highlighted.

Complete your margin and then choose the proper insertion axis. At this point, do not hit the arrow to move to the next screen!

Click on the next tooth icon that you need to marginate and it will activate that tooth.

The margin that you completed on the previous tooth will become a silver color and you will not be able to adjust it.

You may now complete the margin for the next tooth and then set the insertion axis. Continue this for each tooth you have imaged for until all margins have been drawn and all insertion axes have been set.

You can then hit the arrow to calculate after the last insertion axis has been set.

You will notice that all the teeth will be proposed at the same time.

Once you get the proposals, pick one tooth to design to completion. At the end of the day, most of us are limited to one milling unit, so finish the design of one restoration as quickly as possible. Get that proposal into the milling unit. Once you hit Mill, click on the next tooth icon to be designed and it will take you back to that next proposal. Design the next tooth while the first tooth is being milled to maximize your efficiency.

I have found that for me, this is the most efficient way to design a simple quadrant.

The most important step for a long-lasting ceramic restoration is the bonding step. There have been many discussions on the site of what we like to use for cement or what our favorite bonding agent is. There are many that work very well and I’m not a bondodontist so I could not tell you what the best one is.

In a recent discussion someone said that bonding agents and cements are like religion. People will go to the ends of the earth to defend and praise their bonding agent and cement. I don't blame them. If you have something that gives you that kind of success in your practice, why wouldn't you? 

This blog is not so much about the importance of your bonding agent or your cement, but the importance of a great light. Most dentists have no idea if their light is working properly or if it cures the bonding agent that they are using. Different types of bonding agents need different wavelengths to cure. Make sure you are aware of what you need.

You also want to make sure that the output of your light is doing what it says it does. I strongly recommend having a light meter in your office and checking the output of your light to make sure it is doing what you think it is supposed to be doing. Using a light with inadequate power can cause de-bonds, sensitivity and other issues that we just don't want happening after our procedure is completed.

I have a Demetron light meter.

They could not be easier to use. You place the curing tip of the light onto the light meter and activate it. The light meter will give you a reading that should be in the range of power that the instructions of your light say it is.

I have to say that I just got myself a new light. It is the Blue Phase style from Ivoclar. I saw it at the midwinter meeting and it was so light and ergonomic. The reason I wanted it was that it has a polywave technology. I had no idea what that meant, but it was explained to me that it has multiple LED lights in it and they vary in power so it can adequately cure all bonding agents on the market. All I know is that the first time my assistant picked it up she loved how light it was and how natural it felt in her hand.

The bottom line is that you need to find yourself a light that will cure the bonding agent that you are using in your practice and make sure that the light is firing at its capacity and not at a reduced power. It seems so simple but it is amazing how many people never check it.

One of the hardest things that we have to do in dentistry is color match, especially as we move closer to the anterior. The single central makes us cringe.

I think a lot of people are nervous doing anterior teeth for fear of esthetics. One thing that I have used to help lower that pressure a bit is the Vita Easyshade. I started using it when I was an associate and now have one in my own practice. VITA has released new software that helps choose the appropriate VITA block for the case that you are working on.

- You can get a single value for the tooth you are working on

- You can map multiple areas and use that to help dial-in the shade on difficult-to-match situations

- You can check the shade of porcelain on a tooth by telling the Easyshade what color you think the porcelain is and it will tell you if you are close or way off

- You can also determine the accuracy of your existing shade tabs 

I don't use this only for CEREC. I use it when doing composite restorations or when trying to get a shade pre-bleaching. I also use it when sending cases to the lab to give them an idea of the value of the adjacent teeth to help them give me the best possible result. It has made trying to match restorations I'm creating to the existing teeth so much easier and with much less stress.

I have read that 10 percent of men are color blind. I'm not sure if I fall into that category, but this device sure helps keep me out of it!

Every once in a blue moon, computers rear their ugly heads at us. We all know that feeling.

Well, I had a situation in my office today where I was milling an e.max crown. My Bluecam would just not recognize my milling unit. I tried everything I knew and nothing was working.

I did what any smart CEREC user does at that point ... cried! OK, maybe I didn't cry but I did do something very smart. I called the Patterson Technology Center, or PTC as they are known.

Many times people come to our site for answers to questions, especially hardware questions. Even though we have close to 80 years combined experience in the faculty alone – plus way over 100 of years of combined experience with of the mentors, from time to time we come across things that we just don't have a good answer for.   

I'm writing this to remind everyone of what a great resource the PTC is. They have a beautiful new facility in Effingham, Ill. and a staff of people there to deal with CEREC questions and issues. I spoke to an amazing gal named Kerri (I apologize if I spelled her name wrong). She was not only very sweet and patient with me on the phone, but she soon had me up and running and I was able to finish up my procedure.

The techs at the Patterson Technology Center are a fantastic resource for us when we need that helping hand. It doesn’t happen often, but it is nice to know that they are there for us when we need them.

Keep this number handy just in case. 800-475-5036. You may not know their names but they are a great bunch, and I for one would like to thank them: Thanks for your hard work and allowing me to continue to do mine!!