CEREC Doctors - Blog

The importance of following directions when bonding

Richard Rosenblatt (Faculty) — Thu, 17 May 2012 16:52:58 -0700

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:

[image:Bond_Strength.jpg]

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!

Staging Comprehensive Care

Sameer Puri (cerecdoctors.com co-founder) — Wed, 16 May 2012 16:48:01 -0700

*Here is a great blog from one of our Mentors Dr. Darin O'Bryan. He posted this on the Spear Education site and we thought it would be a great blog for the CEREC guys as well.

If you asked most of your patients if money was no object would they fix their teeth, the vast majority of them would say yes. We all have patients in our practice that need our services and want to have the best that dentistry can do for them. How many times have you talked to a patient and they realize they have needs that should be addressed but financially they just can not afford the multitude of crown and bridge that are necessary? With the current economic trend more people are being frugal with their discretionary income. I don't know about you but I don't have a ton of patients with a bunch of cash set aside to fix their teeth. How can we make it possible for them to have the quality care they want and make it feasible financially?

For the patient that wants the best but can not afford complete restorative care at this time it is necessary stage their therapy over time. Long term provisionals with composite are an ideal way to accomplish this objective.

Once the patients restorative needs are determined an ideal wax up is created. The wax up is then duplicated in stone and a vacuform matrix is created. The matrix is trimmed to the gingival margin to make easier clean up. Caries removal is done on teeth with disease. Restorations can either be left or removed depending on their condition. For metal crowns retention grooves can be cut into their surface. Crowns with a porcelain surface can be abraded and then conditioned to bond to the resin.

Once this is done the patient is isolated and the proper bonding protocol followed for the underlying structure. The matrix is then filled with composite and seated on the arch. The gross excess is trimmed away and the whole thing is cured. The teeth are then sectioned if so desired with fine finishing burs, cera-saws and finishing strips. The same is then done for the opposing arch if needed.

There are a number of benefits to staging a patients therapy in this way. It allows the patient to have the crown and bridge work done over the course of years if necessary. If they are an insurance mind set patient now their insurance will cover the crowns one or two a year. It is also a great way for the patient to test drive their new occlusion and pathways of function. If the patient has GERD's or acid reflux it is also a way to verify control of the condition before moving on to more costly procedures.

Now biocopy is your friend. One, two or the entire thing can be duplicated with biocopy. If this is a patient that can only afford or wants to only do 1-2 crowns a year then you can leave the others until such time as their insurance rolls or the patient decides to do a few more crowns.

The combination of the composite mock up and CEREC is a powerful tool that allows the delivery of ideal dentistry over time with amazing results.

[image:S1.jpg]

[image:S2.jpg]

[image:S3.jpg]

Visual Co Diagnosis

Jeffrey Caso (Faculty) — Tue, 15 May 2012 17:04:47 -0700

Providing your patient visual access to their dental problems is so helpful in getting them to realize just what the problem is and the steps that need to be taken to correct it. Many problems arise slowly over a long period of time. In the absence of pain, many patients may not even realize that a problem exists in the first place. We need to walk a fine line between being perceived as over diagnosing and suggesting unnecessary treatment. This problem can many times be solved by showing the patient the problem so they can be a part of the diagnostic process.

Intra oral camera’s served this purpose for many years. The quality of the image was poor but the point was made. Once we realized the power of this tool it was obvious that this type of diagnosis helped us in many ways. Next came the digital camera. With proper training we are able to get superb intraoral photos. Showing them enlarged on a monitor or Ipad is a great way to get your point across and open up a discussion.

There is another way to approach this subject as well. It is one which is simple, in direct view of the patient and needed for the current treatment. I am referring to the virtual models. I will commonly extend my models to capture any broken teeth, open contacts or poorly adapted fillings. When the patient is watching me design, it is simple to show them these areas. Either on the working model or the counter and begin a discussion. It’s all about education. Showing a patient what their problem is and allowing them to understand it will leads to greater patient acceptance. Since you already have the model on the screen, Why not use it to its fullest? If a picture is worth a thousand words, a virtual model must be worth a lot more.

In this screen shot, this patient was advised to treat the problem on 19 at the same time as the treatment was rendered on 18. She refused until I pointed it out to her on the screen. We sent 18 to the mill and went ahead and prepped 19. Not so efficient but it got done. Use you CEREC to its fullest!

[image:caso.jpg]

Getting the Perfect Sprue location

Jeffrey Caso (Faculty) — Thu, 10 May 2012 16:44:06 -0700

I find myself spending a few extra seconds at the Mill Preview screen these days. Setting yourself up here will save time later, and being more accurate with your sprue placement will make your perfect contacts remain that way. It is really simple, using good magnification, to remove the sprue completely and accurately from the contact area, but why even have to do that if you can be more precise in its position in the first place.

At the Mill Preview screen, it helps to go to Display Objects and turn on the model of the arch where the restoration is located. This will show you exactly where the contact is located. You can then position the sprue where it will not interfere. Just a little tip to make your CEREC life a bit easier.

[image:sprue.jpg]

The Advantages of REALLY Getting into the Game

Imtiaz Manji — Wed, 09 May 2012 07:48:08 -0700

[image:IM.jpg]

A couple of years ago my sons, who are big basketball fans, tried to talk me into buying season tickets. I was reluctant at first—I had always enjoyed going to the occasional game or watching with the boys when there was a game on TV, but I wasn’t sure I wanted to make a commitment like that. Then they pointed out that it would mean us spending more quality time together on a regular basis, and I was sold. That’s how I ended up occupying a near-courtside seat. And that’s how my level of engagement with the sport of basketball changed dramatically.

It’s incredible how different the game seems when you are practically right in the action, witnessing the size and speed of the players just inches from your nose. And then there is the feeling of being at the forefront of a group of rabid screaming fans. You can feel the waves of emotion behind and all around you, and you can’t help being caught up in it all. It’s a level of intensity that just can’t be matched by watching on TV, or even from farther back in the building. Just by being there, up close and personal, I have become so much more emotionally invested in the game.

I think the same phenomenon applies to CEREC owners. Anyone who buys a CEREC is by definition, well-invested in it. We are talking about a significant purchase, after all. But there are CEREC dentists who make the purchase and who do the “due diligence” training—an introductory course or two—and then they just take it from there themselves. They’re fans, but their level of engagement is still somewhat removed.

And then there are the ones who really get in the game. They want to get up close and in the action. They attend advanced courses where they can see firsthand how the masters do it and get hands-on experience duplicating their techniques. They stay on top of new developments through online video education. And perhaps most importantly, they get together with other CEREC raving fans at events like CEREC 27 & a half.

As a CEREC owner, you owe it to yourself to be there among the “season ticket holders”—up front, courtside, and in the game. Trust me, just the experience of being there will transform your level of engagement.

Imtiaz Manji
CEO, Spear and Scottsdale Center for Dentistry

In his current role as CEO of Spear and Scottsdale Center for Dentistry, Imtiaz reaches thousands of dentists each year with his speaking engagements, online CE, published articles and popular blog, all the while providing the strategic vision and corporate leadership behind the industry’s premiere destination education center. In addition, Imtiaz lends his skills and passion to the Open Wide Foundation, whose mission is to bring quality dental care to impoverished communities around the world.

Imtiaz will be a keynote speaker at CEREC 27 & a half discussing “The True Value of Dentistry.”

Mentor Field Trip at Scottsdale Center

Richard Rosenblatt (Faculty) — Mon, 07 May 2012 16:31:53 -0700

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.

[image:MG1.jpg]

Lessons from Townie

Peter Gardell (Faculty) — Fri, 04 May 2012 10:09:15 -0700

I’m sitting in the airport on my way home thinking about what has happened over the past few days in Las Vegas at the Townie meeting. A few things stand out.

The presentations I went to were really good, great quality across the board, great responses from the audiences. Many of the GALILEOS and CEREC-based presentations were given by individuals who will be presenting at CEREC 27 & a Half, August 16-18 in Las Vegas. This material is inspiring and thought-provoking; I can’t wait to see what these presenters bring to the big event. There are a lot of developments with the software and the materials that will make the life of the CEREC dentist easier, and the treatment we deliver to our patients better. These people are pushing the CEREC boundaries, and this August they will share much of what they have figured out.

The other thing that stands out is the people of the cerecdoctors.com Mentor Group. These are individuals who are truly special – always willing to answer questions, spend the time spreading the advantages of CEREC and cerecdoctors.com even when they didn’t have, they were in Vegas after all, vacation time. Many I already knew, many I met for the first time, but it was like we were longtime friends. I guess it shouldn’t have surprised me since I have interacted with many of them on a regular basis through the website. The mentors are a fantastic group of individuals, always there to support their fellow dentist, to help them advance and improve their dentistry.

The Settling Effect

Jeffrey Caso (Faculty) — Thu, 03 May 2012 17:20:25 -0700

Remember back to the last time you had a tire replaced on your car. The mechanic used a torque wrench to tighten down the lug nuts to the proper specifications. Then he gave you specific instructions to return after driving 25 miles to have the lug nuts re-torqued. Did you ever wonder why? Well, there is a real reason behind this and it is called “The Settling Effect.”

As CEREC dentists we have honed our skills to such a high level that the placement visit has been shortened considerably. I find that when placing my favorite restoration (the screw-retained e.max crown), I have minimal adjustments and minimal chair time. Well, that might be something that needs to be reconsidered. In an article published in The Journal of Oral Implantology by Sheldon Winkler, D.D.S. et al. The Settling Effect is discussed and offers a compelling reason for implant screws loosening. It is something we all need to know about and take steps to counter.

So, we all know that we need to torque our implant screws to the manufacturer’s recommendation. That is called pre-loading the screw. Torquing actually elongates the screw and pulls the abutment and implant together, and essentially acts like a clamp. Fighting this pre-load is occlusal forces or joint separating forces. So we have this fight going on between the implant and abutment at all times. The pre-load generally wins this battle and the restoration is a success.

There is a phenomenon which can tip the tides against us. As finely machined as implants and their components are, on a microscopic level there is a roughness. As the components mate and the screw elongates to pull them together. This roughness prevents full seating of the abutment to the implant on a microscopic level. Soon after torquing of the screw, the rough areas can collapse, making the fit between the implant and the abutment more intimate. This is a huge concept to understand. If the implant and abutment slide together more over time, the torqued screw is no longer torqued to the proper specifications. This article found that the torquing or pre-load can be decreased by 2 percent to 10 percent. This is The Settling Effect.

Add to that the other main reasons for implant screw loosening like excessive or misplaced occlusal forces or inadequate design of the restoration, and you are providing a force which will further increase the micro-seating of the abutment and thus a further loss of the pre-load. Now you have a screw which is functioning without the proper torque, and it loosens. Leave that screw in function for a while before the patient is aware of it and you can have a failure of the screw itself. I will also add my own thought, and that is while e.max is a wonderful material, it is unforgiving to the bite and marks poorly with articulating paper. This can further affect the preload and lead to a loose or failed screw.

Well, what is the answer? It's really simple. The article found that much of the pre-load is lost in the first 10 minutes after the initial torquing. So, just wait 10 minutes and re-torque the screw. It really is that easy. Also, check and recheck your occlusion and relieve any interferences. Design your restoration with the proper anatomy and do not over-build the occlusal table in a buccal lingual direction. That should solve the majority of loose screw problems.

This phenomenon proved itself to me on a larger scale a few years ago. I had a tire replaced before a vacation and the mechanic told me to come back after driving 25 miles to re-torque the lug nuts. I told him that I was traveling and that wasn't possible. He said that I must retighten the lugs, and was insistent. I stopped after about 75 miles and grabbed my lug wrench. I was amazed. Every lug nut was loose and not just a little. The Settling Effect is real; it's dangerous on a large scale and inconvenient on a small scale. Slow down, do a hygiene check, talk more or grab a coffee, but re-torque that screw in 10 minutes.

The article can be read here.

"Save aS" Options

Darren Greenhalgh (Faculty) — Wed, 02 May 2012 17:01:56 -0700

Here’s another way to help organize and keep track of multiple files of the same tooth on the same patient.

[video:File_Manipulation_1.mp4]

Uncle Bill

Peter Gardell (Faculty) — Tue, 01 May 2012 17:10:04 -0700

I recently had the privilege to be part of the cerecdoctors.com mentor field trip to Bicon Implants. The trip included an implant surgical and prosthetic course held at their headquarters, a facility second to none.

The first thing that caught my attention was the person in the front of the room. Why was my Uncle Bill standing in front of the class? The same mannerisms and that Irish smile jumped out at me. But it was not Uncle Bill, or as his nephews and nieces referred to him, “Sweet, lovable, Old, Bill - SLOB.” A nickname that he cherished; it always brought a smile to his face. And as we got older a quick and witty sarcastic response would just as quickly be returned that made the room erupt in laughter. If you dish it out, you’ve got to take it was how he lived. He was a man stuck in his ways and had the experience to prove his point.

After shaking my head I realized it wasn’t my Uncle Bill, but Dr. Vin Morgan, the head of Bicon. He started by telling us the story of Bicon, how they have met opposition in the past and still face it from companies with larger marketing budgets. These companies unwilling to accept the position and products of Bicon – a company that hasn’t changed the basic design of its implant since it started in 1985 – while these other companies make a normal practice of switching this and changing that on a regular basis.

The hard facts of implant dentistry are not hard facts any more, and Vin Morgan helped to open the eyes of the mentors in the room. He said that they say what they say and you can accept it and bring it into your office, or you can stay set in your ways and at least have a good dinner at the end of the day and go home.

As the day went on I started to see how the advantages of their system worked. The advantages of their surgical protocol definitely raised eyebrows all around me. Case after case of fantastic soft tissue. Case after case of bone growth around the implants, even those that have significant discrepancy with the crown-to-root ratio. In fact, as they have matured as a company, they have gotten away from implant lengths that we would consider the norm. All of their long implants have been discontinued since the shorter implants have a better response from the host. There were implants placed in sites I would never had attempted to try and these implants did more than just stay, they grew bone.

As Rich Rosenblatt said in his blog, there are a lot of similarities with the journey of Bicon and CEREC. Just as I find Sirona a great company to work with as a partner in my practice, I see Bicon being another great partner.

As I finished my dinner at the close of the course, surrounded by some great CEREC friends, we asked Dr. Morgan, “So how was the dinner?” I tried to stir the pot and say, “The first course was good, but I expected some good Irish food!”

He said, “Well if that was the case, then you pick up the tab.”

Uncle Bill, are you in there?

We all left with smiles after a great weekend and Dr. Morgan shared some words that mean a lot to me:

“The doors to this house are always open for you; we are here to help you however we can.”

Minimal Thickness

Peter Gardell (Faculty) — Wed, 25 Apr 2012 11:31:48 -0700

In order for the tools to work correctly, turn the Minimal Thickness option OFF when doing thin restorations.

This video demonstrates this when doing single and linked restorations.[video:MinimalThickness.mp4]

Bicon

Richard Rosenblatt (Faculty) — Tue, 24 Apr 2012 08:04:53 -0700

[image:Rosenblatt_4_25_1.jpg]

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!

[image:Rosenblatt_4_25_2.jpg]

Grid Mode: A smile design aid

Mike Skramstad (Faculty) — Tue, 24 Apr 2012 07:16:53 -0700

One of the new features of the inLab 4.0 software is an analyzing tool called Grid Mode. This design aid will help verify certain design principles:

Making sure your midline and incisal edges are perpendicular
Allow you to visualize length-to-width ratios along the grid lines
Allow you to use the Distance tool along straight lines to measure symmetry of line angles, anatomy, and overall dimensions

The Grid Mode analyzing tool is a simple, yet effective way to verify design... and hopefully a great first step to better things in the future.

[image:skrammy_4_24.jpg]

CEREC Connect update

Richard Rosenblatt (Faculty) — Mon, 23 Apr 2012 07:39:00 -0700

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!

You’ve Got to Move it Move it … Like Fred Astaire, not like Ricky Martin

Jeffrey Caso (Faculty) — Thu, 19 Apr 2012 14:43:35 -0700

I was having a conversation the other day with a longtime CEREC user who was in the throes of adjusting to 4.0. He was commenting that he missed some of the old tools, specifically the wire frame to do gross positioning and size changes in his proposals. I thought to myself, wow I don’t even remember how to use the old Pre-Position tool and only missed it for about a day. Then I thought, why does he have to make such great movements in the first place? Proposals in 4.0 have never been better.

So, here is my synopsis of the problem. It’s the basics that he is faltering on. Prep, Powder and Picture.

He is a longtime user, so I think he knows how to prep for CEREC; powdering should be simple at this point and imaging should be a slam dunk. I bet though, that he is missing something here. Maybe a lack of education, maybe he just got lax. Images in 4.0 are super-critical to great proposals, so maybe the problem lies there. It’s tough to say. Possibly he was getting bad proposals for a long time and was just used to fixing them. Now it’s tougher for him because he lost his old friend the Pre-Position tool.

In any event, we strive for perfection but we live in an imperfect world and work in a difficult venue. Sometimes our proposals need help. We are well-versed in the use of the super-powerful Shape tool, but users tend to shy away from one of my favorite tools, the Move tool. Its two components are Position and Rotate.

Now, using this tool requires grace and eloquence. It is much different than, say, the Smooth tool, where you engage it and run it all over the restoration. Doing that will get you this for position:

[image:Caso_4_19_1.jpg]

Using Rotate aggressively will get you this:

[image:Caso_4_19_2.jpg]

Both situations are not something to be proud of. By being careful and using slow movements of the track ball we can effect small but powerful movements to give us a great proposal very fast.

My two favorite uses of this tool are, first, when correcting an open contact on one side, I like to split the difference by using position, giving an equal space on both sides and the closing the gaps with the Shape tool. Many times when a contact is proposed open, you will also see a symmetry problem with the proposal. This will correct that very simply. Second, I like to look at the position of the cusp tips down the buccal corridor. This is something that we often overlook and it results in our final restorations looking very CERECY.

[image:Caso_4_19_3.jpg]

By using slight movements with the Rotate tool, a great result can be obtained.

[image:Caso_4_19_4.jpg]

The Position and Rotate tools under the heading of the Move tool can be a bit intimidating. Just go slow, using small, l incremental changes and you can have dramatic results. The effectiveness of this duo is something to explore on your own and use when necessary. If you find that you are having to make huge changes to your proposals, go back and evaluate your technique – specifically the three P’s – and see if you need to make some corrections there. Give your machine the best information for the best result.

smoother preps when using air-driven hand pieces

Richard Rosenblatt (Faculty) — Wed, 18 Apr 2012 12:09:01 -0700

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.

[image:Rich_4_18_1.jpg]

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:

[image:Rich_4_18_2.jpg]

Easing Our Workload

Jeffrey Caso (Faculty) — Mon, 16 Apr 2012 14:41:03 -0700

Many opponents of the CEREC technology and way of life say that they just do not want to get involved doing their own lab work. Now I could understand that if I actually had to sit down and stack porcelain from scratch. That is just not the case. Sure, you will have to spend a bit more time at the lab bench than before, especially if you get involved with larger cases, but there is not a ton of work involved.

Yesterday was a prime example for me. I sat town to prep 22-27 at 9:00 a.m. By 10:15 I was dismissing the patient. She was fully prepped, scanned, impressed for a contacts check model on the working arch only, and temped. The temps were the funnest part. I did a wax-up and made temps all at once with a putty matrix.

Between patients, I designed the six units and milled. I love to hear the MCXL humming along in the background. It was a group effort. Whoever walked past the mill as it was stopping put in a new block an milled the next crown. By 5:00 p.m., we were complete. The best part of the process was taking each unit from the mill and placing it on the model. Every one fit without adjustment.

[image:Caso_4_16_1.jpg]

So, in terms of lab work, I will remove the sprues and lightly contour each one. This will take 1-2 minutes max for each unit. Then light glaze and some oven time. The case will be ready to place in a total of two days. That’s not staying late or working through lunch, just a relaxing, stress-free experience that all of the staff feels proud to have helped with.

The key to having no adjustments is a great wax up, transferred to the mouth adjusted and polished. Scan it well, capturing perfect data right down to the gingiva. Know your machine and set up your contact colors just right. For the greatest accuracy, take the buccal bite images and the opposing in the mouth, not off of models. Mill and enjoy the fruits of your labor. Don’t forget the fast turnaround, total control, huge cost savings and personal satisfaction.

[image:Caso_4_16_2.jpg]

Big cases shouldn’t worry you. You can do them same day with the patient present or in a few days off of a model. Control the variable through knowing your equipment and ongoing education and soar through them.

stabilization during stain and glaze

Darren Greenhalgh (Faculty) — Fri, 13 Apr 2012 14:55:59 -0700

Give this instrument a try while staining and glazing. You will not have any issues with stabilizing the restoration.

[video:vita_clamp_blog.mp4]

Selective Etching

Sameer Puri (cerecdoctors.com co-founder) — Wed, 11 Apr 2012 15:32:21 -0700

One of the things that I am a firm believer in is the ability to bond porcelain to teeth. Lets face it, it works. It works well and it's proven.

With so many bonding agents out there and companies working on ways to make the process easier and easier, what we are finding is that we have the ability to really have great bond strengths with our materials. So as I've moved more toward self-etching bonding agents such as the 3M Scotchbond Ultimate or the Kerr XTR bonding agents -- I still like to selectively etch the enamel. If there is a lot of enamel remaining, I feel that you still get the best bond strengths to enamel by etching it. Keep the etch on the enamel and not on the dentin. Even if I use one of my favorite cements such as Multilink, I still like to etch the enamel.

This may change in the future but for now- enamel etching is where its at.

[image:Puri_4_11.jpg]

When should you not cement your final restoration in one visit?

Richard Rosenblatt (Faculty) — Tue, 10 Apr 2012 14:20:56 -0700

[image:Rosentlatt_4_10_A.jpg][image:Rosenblatt_4_10_B.jpg]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?

Stain and Glaze Evolution

Jeffrey Caso (Faculty) — Mon, 09 Apr 2012 11:13:25 -0700

I was committed, right from the start, to running just about every porcelain CEREC that I have made through the furnace to custom stain and glaze. I began my CEREC adventure before e.max required us to use the oven. I thought I was hot stuff right from the get-go as I had a Ney Miniglaze oven in the office and used it a great deal in the begining. It was a manual oven which required me to sit with a stopwatch and run the restoration through the cycle myself. I will say that they came out really well.

I bought a Vita oven within two years of CERECing and then, when e.max came out, I bought an Ivoclar oven with all the bells and whistles, plus dual-ramp capability and vacuum. I still use both ovens and like them very much.

In the beginning, for me it was all about the shine. The shinier the better. I have gone through a true evolution in terms of staining and now see things a whole lot differently. When doing multiple units in the anterior and not having to match the existing dentition, I like to use no stain or minimal stain. I think block shade is the most important criterion for success. Get that right and you have a happy patient. I also try hard not to go super-shiny. After firing, I will lightly polish the glaze down with a rubber wheel. This gives a more natural look. Teeth are just not that shiny.

When conforming to the patient’s natural dentition, proper block shade still reigns supreme. I was fond of going lighter and staining to match. It works, but eventually you will lose some stain and end up with a hopelessly mismatched restoration. For these anterior cases, I like to slightly over-stain the restoration, fire and then polish back some of the stain and dull out the glaze at the same time. That seems to work best in my hands and gives me a surface that is textured and wears nicely.

Part of the staining evolution that I was referring to is using bolder colors. I now use both black and white stains more than ever before. They can be mixed with other colors to easily give you what you need. Keep in mind that a little black goes a long way. In fact, I rarely use a stain right out of the package. Almost always I mix them to get a true custom color.

Posteriorly, I have had a shift as well. I was always accentuating the grooves with brown. Now, I rarely do that. A deep yellow, similar to a cervical stain and white on every cusp tip and incline really makes the occlusion pop. Blue mixed with a touch of black and blended in well gives a really nice translucent look both in the front and back of the mouth.

So, examine the adjacent teeth at some point and take note of how they look. Then, after the tough prep and design work is over, sit back and let your left brain take over. Don't be afraid to over-stain. You can remove it so well and in a controlled way. Enjoy this part of the process. Your patient can't tell if you have fantastic margins. What influences them most is how it looks. Make it look tooth like and it's a home run.

The Restoration Trifecta

Peter Gardell (Faculty) — Thu, 05 Apr 2012 10:24:58 -0700

I have to admit that when I heard the name Scotchbond I immediately thought of the old bonding agent I used for years and years. It worked well in my office but I moved on to newer – and what I thought was better – technology for bonding. I was wrong, and am glad I looked further into what Scotchbond Universal has to offer. I also learned how a new family of products has been developed to work in synergy to create a fantastic union.

Scotchbond Universal can simplify bonding for directs and indirects. Its chemistry may be complicated, but it has been created to be precise in what it does while offering the flexibility to deal with the variable environment that is the oral cavity.

Scotchbond Universal is a single-bottle system that can work equally well with whatever bonding protocol you favor – total etch, selective etch, and self-etch. Many of the pitfalls associated with the different generations of bonding agents can be avoided due to the unique composition. The sensitivity issues of fifth generation bonding agents have been removed since it can rehydrate the collagen if you have over-dried the preparation after etching. A Vitrabond co-polymer is included in the mixture that allows superior bonding to dentin, both dried and moist, to the same extent as we get with glass iomomer materials. It also contains heme which also helps in this area. As a self-etcher, it does a great job of etching enamel, creating a perfect surface for bonding. Since it is a self-etching adhesive, it is more tolerant if there is a bit of moisture present.

For bonding of indirect restorations it has even more attractive features. Silane is incorporated into the material so it can be used to prepare the intaglio of our ceramic restorations after the application of HF. Another component is MPD, which has the ability to bond with metal oxides, opening the door to bonding metal and zirconia to the tooth structure without any special pre-treatment. Or the bonding of our CEREC restorations to stock or custom abutments.

Seventy percent of dentists use more than one bonding agent, complicating the daily operations of their offices. Scotchbond Universal gives the dentist one solution for their bonding needs for all the different situations that arise: directs, indirects, ceramic, metal and fiber, simplifying one of the most widely done procedures in the office for you and your staff.

Doing Multiple Teeth in 4.0

Richard Rosenblatt (Faculty) — Wed, 04 Apr 2012 07:56:50 -0700

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.

[image:Rosenblatt_4_4_1.jpg]

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.

[image:Rosenblatt_4_4_2.jpg]

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

[image:Rosenblatt_4_4_3.jpg]

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.

[image:Rosenblatt_4_4_4.jpg]

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.

[image:Rosenblatt_4_4_5.jpg]

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

[image:Rosenblatt_4_4_6.jpg]

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.

Save As … With a Twist

Jeffrey Caso (Faculty) — Tue, 03 Apr 2012 09:00:14 -0700

Computers are computers and can act up on us at the most inopportune times. Using basic principles to safeguard our information and our progress through a case is critical to success. Hitting SAVE along the way is great and will allow us to return to that point if a problem arises midway through the design of a case, but using SAVE AS is much more powerful.

SAVE AS not only saves that progression of our case but also keeps an entire copy of the images, models and design to the point we are at that moment in time. It is great for big cases with multiple proposals and designs going on at the same time. It is possible for the computer to crash and corrupt the data we have, making it impossible to reopen a case. Using SAVE AS gives us the ability to re-access the case at a point not too far behind when the problem struck.

One issue with using SAVE AS in the 4.0 software is that the case is saved under the same patient’s name and when we go back to find the latest saved case, it can be hard to find. It may require us to open several cases until we find the correct one. Keep in mind that this generally happens when our stress level is through the roof. There is a way to organize our saved cases in a way that makes finding the latest one a breeze. So, when we are moving through a case and we get to a point where we say, a great deal of work has been put into this, let’s slow down and save our information.

[image:Caso_4_3_1.jpg]

We open the Service Menu by clicking the down arrow at the top left of the screen. Then we click Save Case As. This brings us to the patient list with the current patient’s name highlighted. Usually we click that patient and the case is saved under their name. This is where we can become confused when we need to access that information.

Instead, if we re-enter the patient’s name by choosing Add New Patient at the bottom, only enter it a bit differently. I like to change their name to something that will remind me that this case is the newly saved case.

[image:Caso_4_3_2.jpg]

Once done, move ahead by clicking the chevron and the case will reopen, fully saved in total under this new patient. You can then go back to the original case and continue, knowing that you have an exact duplicate case waiting for you if disaster strikes.

The best part of doing it this way is to prevent confusion when looking for the case when you need it in a pinch. It’s not a tip that you will use every day, but one that will make life easier if you need it.

[image:Caso_4_3_3.jpg]

Mentors

Peter Gardell (Faculty) — Tue, 27 Mar 2012 11:35:15 -0700

Being a mentor is not just being happy where you are with your knowledge and thinking you can teach others.

It is a path you take when you realize you can never really know everything and want to learn more. Dentistry is a never-ending journey; there is always something to learn. The naive or lazy dentist can get to a point where they think they now enough to do well, but that can create a static practice that can quickly fall behind and wither and die.

CEREC Dentistry is no different. You want to be comfortable and efficient, but it is such a dynamic field that very quickly you can fall behind. Mentoring with cerecdoctors.com online, in Scottsdale and on the Mentor field trips can really shock you with reality. There is always more to learn (there is always “more than one way to skin a cat,” as my grandfather use to say. Still not sure what he really meant. But he grew to be old and was successful so I guess he knew what he was talking about.)

[image:gardell_3_27.jpg]

I just had an opportunity to join some of the cerecdoctors.com Mentors in Minneapolis to have a rare look behind the curtain at 3M. This company that has turned out to be a great materials partner with CEREC. They are constantly pushing the envelope to make the life of the CEREC dentist better, to make the dentistry we render to our patients better. They don’t sit back and think they have done everything and are happy with where they are right now.

We took a tour of the Innovation Center, where we were introduced to the past, present and future of this remarkable company. They say you are never farther than 15 feet from a 3M product or something built with the help of 3M. After this trip, I believe them.

We learned about the philosophy of the company, how it refuses to be locked into a linear train of thought. It encouraged cooperation among the six platforms that shared the 46 building blocks. Fifteen percent of time at work is to be devoted on personal projects. Employees are free to think, be creative, to team up with other individuals from all different parts of the company. These teams are encouraged to be creative, not be afraid of taking chances – and not be afraid of failing.

This is a company that has decided that it wants to be a bigger player in the dental materials market. And they have a budget of $1.6 billion to make sure it happens.

The Mentor program came to mind as the discussions went along. The cerecdoctors.com family is also a very dynamic community, with many doctors from all over the world sharing their viewpoints and advice, that enriches those who participate in the discussion.

The Importance of a Great Light

Richard Rosenblatt (Faculty) — Mon, 26 Mar 2012 09:05:59 -0700

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.

[image:Rosenblatt_3_26_1.jpg]

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.

[image:Rosenblatt_3_26_2.jpg]

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.

You’ve got to know when to hold them and when to re-propose them.

Jeffrey Caso (Faculty) — Fri, 23 Mar 2012 09:27:01 -0700

With the 4.0 software, proposals have never been better. There are times however when the software can become confused. We can send it a mixed message when we violate the basics – Prep, Powder and Picture. Generally, when we see a less-than-optimal proposal, with a few exceptions, there is a disconnect between what we are giving the software and what we actually want it to do. We have all experienced that heart sinking moment when we need a good proposal – usually when we are feeling rushed or struggling with a difficult patient – and the software gives us a bad one. We need to make that split second decision whether to keep it and work through the design process or go back and see where we went wrong.

Sometimes it’s a tough call. Many times, staying with the poor proposal and using the tools to correct things is our initial instinct. Going back, especially with a patient watching and asking questions, can be a bitter pill to swallow. Poor proposals can be looked at as a symptom of the underlying problem. The exceptions to that rule are when we are proposing Implant crowns and teeth in severe cross bite or other malocclusions. Those need to be worked out on an individual basis. It’s the ones that we expect a slam dunk and get something different that need our full attention and a hard decision.

So, when you get that bad one, first check to see that you did not accidentally call a full-coverage restoration a partial-coverage one or vice-versa. Correcting that can make all the difference in the world.

Next, go back to your images in all catalogs and look for any that are shaky or have a strong angulation that can create spikes and lines. Look for images with blood or saliva contamination and also look for ones where the margin is obscured or covered. Ignore the bad ones and reimage if necessary. Check the margin line for any little steps or loops. Correcting that is easy, just re-draw. Then look at the super- important insertion axis. In fact, after confirming that I declared the restoration correctly, that is the first fix I look to. Tweak the insertion axis and re-propose. Many times that solves the problem.

In addition, keep your occlusal minimal thickness parameter low and you will enjoy better overall proposals. Equally as important is to prep slowly and carefully. Give enough clearance and smooth the preps well. Get good tissue separation at the margins, powder lightly and take great images.

The software is what we all blame first. Generally, that’s not the case. Look to the information we are feeding it and you may just find the problem. Humbling? Yes. Are we bad dentists? No. Think back to the cases where our proposals were bad. Were we rushing? Was the patient difficult? Were there other things going on at the time to distract us? Those are usually the times we run into problems. Just another day in the life…

COLOR MATCHING ANTERIORS

Richard Rosenblatt (Faculty) — Thu, 22 Mar 2012 07:23:53 -0700

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!

Functional Beauty: part 2

Mike Skramstad (Faculty) — Wed, 21 Mar 2012 10:27:41 -0700

I wrote a BLOG a couple weeks ago explaining how to combine Biogenerics and Biogeneric Copy to create "functional beauty." What I mean by this is you can use Biogeneric Copy to copy a tooth POSITION, while having biogenerics create nice anatomy to replace old restorative material or broken-down teeth.

Here is another perfect example of using this method to copy a tooth position in a difficult scenerio:

Prep: You can see we have a big space between 5 and 6. One where there was a natural space there.

[image:Skrammy_3_21_1.jpg]

Straight Biogeneric Proposal: Will still propose open contact correctly, but difficult proposal to work with.

[image:Skrammy_3_21_2.jpg]

Combination of Biogeneric Copy and Biogenerics:

[image:Skrammy_3_21_3.jpg]

[image:Skrammy_3_21_4.jpg]

[image:Skrammy_3_21_5.jpg]

[image:Skrammy_3_21_6.jpg]

This is a perfect example of the power of this techinque.

Creating Better Contacts

Darren Greenhalgh (Faculty) — Tue, 20 Mar 2012 16:04:20 -0700

In this video I demonstrate how to create contacts using the 4.0 software.

[video:contactsmp4_1.mp4]

Cerec 27 and a half

Peter Gardell (Faculty) — Mon, 19 Mar 2012 11:50:47 -0700

Less than six months to go until a fantastic worldwide CEREC event. Hard to believe it is approaching so quickly.

I look back and reflect on what happened with CEREC 25 and it was more than just sitting in a room listening to some of the sharpest minds in CAD/CAM dentistry. It was so cool listening to a presentation through headphones spoken in Japanese, translated into English by a person with a German accent. Where else could you have the chance to shake the hands of an individual who developed a technology that has changed the ways I d things on a daily basis. Or talk with peoplewho developed materials that look better and are stronger than what I use to get made for my patients.

This picture demonstrates what the event was really about:

[image:Pete_3_19.jpg]

It was an event filled with education, fun and good times – but it was also event that created relationships that are the foundation for the CEREC movement. This was a gathering of thousands of dentists from around the globe that do not accept mediocrity with the dentistry they perform and want to help the profession as a whole develop into something better.

At this event, I did what I tell my kids not to do. I interacted with individuals online on cerecdoctors.com and then went ahead and met them in person. On this hat are the signatures of a number of people who have become great mentors and friends, people who have made me step up and improve the patient care I give.

A group of people so generous with the information that they freely give out, they are great ambassadors for the technology and are fanatics that everyday help improve dentistry.

If you have not thought about going to Cerec 27 and a half, please do. It is a unique event that happens only once and awhile, and it always promises to be something unforgettable. You will return so energized you will not regret it.

mirror, mirror on the wall

Jeffrey Caso (Faculty) — Thu, 15 Mar 2012 12:51:27 -0700

Recently on the cerecdoctors.com message boards, a doctor wanted everyone to critique a professionally made video that he was putting on his website. Many doctors came back with kudos, criticisms and comments. One comment was particularly valuable however. While critiques from doctors are especially useful, it would be better to get opinions from those who would be actually watching the video. That would be actual patients.

Along the same line of thought. We as dentists like to evaluate our own and each other’s work blown up and zoomed in on as big a screen as possible. We dissect our work bit by bit, line angle by line angle. That works out great for us and our OCD. When we have our patients evaluate our work, we need to present things a bit differently.

I know that some dentists take a photo of the patient’s new restorations and put them up on a huge flat screen in front of them. This is not a view that the patient is generally used to. You will sometimes get an odd question like, “The back of my mouth is where?” This generally means that they do not visually comprehend what they have in front of them. Similarly, if you give them a small mirror – or worse, a magnified mirror – they are looking at things that they are not accustomed to seeing. Evaluating their new dental work in this manner is difficult for them and allows them to focus in on things that may be irrelevant.

I have found that using a large hand-held mirror works well. It allows them to see the big picture, the restoration in harmony with both the remaining dentition as well as the lips. That is the way lay people can evaluate a new crown or some veneers. You can tell when they are looking at the overall image when you see them adjust their hair or fix their makeup. I also have a half-mirror on the wall so the patient can stand up and look at themselves from a conversational distance. That distance is what matters most to a patient. It's usually all about what others think of them.

Equally important, before you hand them the mirror is to clean them up a bit. I let my assistant do the bulk of the work, removing powder or wiping their lips a bit. I always make sure that at the last minute I also use a wet piece of gauze to just clean up their lip or chin a little. It shows them that I care about how they look and am a perfectionist. It is subtle, but means something to them.

So, for us and our colleagues, bigger is better. For our patients, show them their work the way they look at themselves at home. That is usually in their bathroom mirror. They need to see the teeth and the frame all clean and neat. No need for them to see that the distal incisal embrasure of the lateral is slightly more rounded than the contra lateral tooth. That's for us to stress over, not them. Give them the right tool to see their money shot and make them happy.

Thank you to the unsung CEREC heroes!

Richard Rosenblatt (Faculty) — Wed, 14 Mar 2012 09:53:52 -0700

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!!

Support Your e.max Restorations

Armen Mirzayan (cerecdoctors.com co-founder) — Tue, 13 Mar 2012 07:54:58 -0700

A frequent mishap with firing lithium disilicate is the loss of contacts. Quite a few people have reported that contacts were perfect at try-in stage, but after crystallization they were light or even open. This phenomenon is caused by a lack of support of the material while it is in the oven. The material distorts enough to render weak contacts.

Adequate support is necessary, but I like to cross the line and go against manufacturers’ recommendations when they advise using the issued pegs when placing the material in the oven – especially for larger crowns like those meant for abutments on implants, as there is a much larger surface area to address.

[image:Armen_3_13.jpg]

This photo shows how I load the internal of the crown with Quick-Peg or object fix-like material and then place the restoration on a bed of the same material, making sure that the contact areas are supported. I then place my glaze and stains on the occlusal and buccal/lingual walls. I am not concerned about the contacts areas, as these will be addressed with a quick polish on a high-speed electric handpiece.

This technique has worked well for me for more than five years, and I no longer have to contend with distorted contacts.

A great resource for dental industry research

Sameer Puri (cerecdoctors.com co-founder) — Mon, 12 Mar 2012 08:41:59 -0700

There are many places where dentists can get education. I’m especially proud of the courses, CEREC and Spear, that my colleagues present at Scottsdale Center for Dentistry. The facility is top-notch, the faculty are some of the best around and the resources available to the attendees are tremendous. However, I want to point you to a website that I use extensively to do research and find the latest information on the trends in dentistry. This website is called pubmed. www.pubmed.com

A compilation of all dental research and dental journals, this site has a tremendous amount of articles and research at the disposal of the user to peruse and read. Everything from anesthesia to cementation. Especially notable are the "Systematic Review" articles, which are a compilation of various research efforts that summarize the different camps of thought and give the user a concise summary of the latest research.

www.cerecdoctors.com is your go-to source for all things CEREC and will continue to remain so; however, for in-depth research analysis, visit www.pubmed.com and you will find some interesting features and articles.

Slice: The forgotten tool

Jeffrey Caso (Faculty) — Thu, 08 Mar 2012 07:27:39 -0700

In version 4.0, Slice replaces the old Cut tool. It is easy to forget about the usefulness of this tool – it’s not in plain view as it was in previous software versions. It is, however, easier to use and can help us in so many ways. I like to use it in the Mill Preview so I can be absolutely certain that the full effects of my parameters are able to be viewed.

I use the Slice tool in three ways:

After designing my restoration, I like to examine the thickness of the restoration by scrolling through it. This helps me to fully evaluate my design and make sure I am thick enough in every area. It is so simple to correct a thin spot at this point.

Secondly, I use this tool from time to time to evaluate my preparations. There is nothing more humbling than seeing your work on the screen, very large. You can see if you are smooth enough and how your margins are prepared.

Finally, I always use this tool if I have a fractured or de-bonded restoration, to learn from my mistakes. That, I feel is the tool’s most powerful use. Use it to learn and get better.

There are some things that you can do to use this tool quickly and efficiently. From the sidebar, choose Analyzing Tools and you will see the option for Slice. The angle of the model is critical for you to get the proper view and therefore the proper information. I select from the Objects View option Either Mesial View or Buccal View. You can play around with this to get the information that you want.

By turning on both the upper and lower models and clicking Slice, you will get a view like this. Keep in mind that this is from the mesial aspect.

[image:Caso_3_8_1.jpg]

Note on the upper left, the visible icons allow you to scroll through the restoration. Here you can see the effect of your spacer and any over-milling you may experience. I will also turn on the cursor details to remind me of just how thin I am. As shown in the next screen shot.

[image:Caso_3_8_2.jpg]

This image shows where some over milling, combined with an already thin restoration, can give us a critically low spot. With the opposing arch in place, we can also see where we can add to create more harmony in the patient’s occlusion.

There is so much information available by using the Slice function. It’s one of those things that is not necessary to use every time, but it’s good to have knowledge of its use. Pull it out of your bag of tricks from time to time; it can help you to do your job even better.

HOW TO PROPERLY CEMENT LAVA ULTIMATE

Richard Rosenblatt (Faculty) — Wed, 07 Mar 2012 07:30:31 -0700

Last week on the message boards, a doc was having an issue with debonds using the new Lava Ultimate material.

Lava Ultimate is a promising new material, but it is not the same as ceramic when bonding them in. It is classified as a nanoceramic and has a slightly different bonding protocol. I'm posting an excerpt of the discussion where I discussed with some of the people at 3M the do's and don’ts when bonding in the Lava Ultimate material. The do's and don'ts are standard but I have included a chart from 3M on how to treat the restoration when specifically using their products. Here is what we posted on the thread:

First and foremost, make sure you are using a bonding agent that is recommended for indirect restorations. Also, make sure that you are using some form of complete isolation like Rubber Dam or Isolite. They also said that they have a long history of successfully using Unicem with older restoratives like MZ 100. Although Ultimate is a different material than MZ 100, the elastic modulus is similar and there should be no link between the "flexing" of the crown and debonding.

PRE-TREATMENT OF THE RESTORATION: DO’S AND DON'TS

DO:

1.) Sandblast or air abrade with alumina. Use material with less than 50 micron particle size. Use low pressure (2 bars/30 psi).

2.) Clean the internal surface of the restoration with alcohol and dry the restoration

3.) Depending on bonding agent and cement you select, apply appropriate primer/bonding agent. (3M's Unicem 2 does not require a primer/bonding agent) If you are using the new Scotchbond Universal bonding agent, the silane is in the material. Just apply the Scotchbond universal to the intaglio and air dry. Do not cure it – it is ready to go.

If you are not using Scotchbond, then you should definitely use silane. Most silanes have a short shelf life, so be sure that the silane is fresh. Using no silane or old, degraded silane will definitely lower bond strength.

Why is this step done? To improve retention/adhesion and ensure the surface is free of contamination from milling debris, milling fluids, saliva during try in and grease.

DON’T:

1.) No acid etch on internal of restoration. No HF or Phosphoric

TOOTH PREPARATION DO'S AND DON'TS:

DO:

1.) Mechanically clean the tooth to remove contamination. This can be achieved with a brush, pumice slurry or bur.

2.) Rinse with water and slightly air dry. Surface should appear glossy. (Most bonding systems do not want you to completely dessicate the tooth. When using a bonding agent like Surpass, you are told to completely dry the tooth.)

DON’T:
1.) Don't use other chemical agents such as hydrogen peroxide, EDTA, bicarbonates, astringents (drying agents), or chlorhexidine

2.) Do not Laser etch.

Desensitizers are not necessary with Scotchbond Universal. They are incorporated into the bonding agent. It would be considered a redundant step. Their testing does show that Gluma is not detrimental and DOES NOT weaken the bond. They said that they can't speak for other manufacturers but they can't imagine that would create that much of a negative effect on bonding.

Here is a snapshot of how to specifically use the different 3M bonding agents and cements with Lava Ultimate:

[image:Rich_3_7.jpg]

If you would like to read more about this topic, or ask any specific questions regarding this material and cementation of it, check out this thread py copying and pastuing this url into your browser:

http://www.cerecdoctors.com/discussion-boards/view/id/9290

4.0: Pin your tools so they don’t disappear

Richard Rosenblatt (Faculty) — Tue, 06 Mar 2012 08:13:01 -0700

Docs have such a hard time with change. 4.0 has been a huge one and lots of long time users have been feeling like new users as they try to unlearn all they know to try and learn 4.0. Trust me when I say how much better it is. This software is unbelievable. Get on the site and watch the intro videos to get you up and running quick.

One thing I hear from people just starting out is that they feel as if they are clicking or searching more for the tools because they disappear as soon as we select them. There is an option to pin them so they do not automatically collapse. Here is what you need to do:

1.) Move the cursor to the top of the screen to get to the configuration icon.

[image:Rich_3_6_1.jpg]

2.) Click on the tools icon.

[image:Rich_3_6_2_2.jpg]

3.) Click on the folder icon that says tool-menu.

[image:Rich_3_6_3.jpg]

4) You are asked if you want to automatically collapse the tool menu. Click no. This will leave the tool that you are working on up on the screen so you don't have to look for it.

[image:Rich_3_6_4.jpg]

See if this helps a bit.

Functional Beauty

Mike Skramstad (Faculty) — Mon, 05 Mar 2012 09:31:14 -0700

Over the years, "Correlation" has been a very popular design mode. It was easy, efficient, and predictable. You could copy the preoperative situation and "functional paths" of the existing tooth. The one disadvantage of this technique was that oftentimes you were copying occlusal morphology that was not ideal and "ugly," for lack of a better term. With V4.0, Correlation has been replaced with Biogeneric Copy." This design mode is more powerful than ever.

By taking the upper/lower arch, buccal bite, and preoperative situation, the software allows you to creatively draw the copy line to duplicate exactly what you want. Everything within the white line will be copied on a 1:1 basis and everything outside it will be generated by Biogenerics. You now can copy wear facets and functional paths and allow the software to create natural beauty in other areas.

Here are a couple of examples...

What I normally do is just copy the buccal surface to record the position of the tooth and also the emergence profile. Here, I moved it a bit to the cuspal wear so you could see the effect.

[image:Skrammy_3_6_1.jpg]

[image:Skrammy3_6_2.jpg]

In this next example, I will capture the buccal and lingual contours while getting Biogeneric occlusal anatomy. This is a bit tricky because the adjacent teeth get in the way of the "lapping" line. So in these cases, you crop the Biocopy model in the edit model stage, and you will be able to draw the line effectively to capture what you want.

[image:Skrammy_3_6_3.jpg]

[image:Skrammy_3_6_4.jpg]

RESTORATION COOL-DOWN

Sameer Puri (cerecdoctors.com co-founder) — Fri, 02 Mar 2012 08:08:33 -0700

What’s the best way to cool down a restoration when it comes out of the oven? Next time, try a coffee mug. Not a paper cup from Starbucks or anything like that –a ceramic coffee mug.

When the restoration comes out of the oven, set the entire tray aside on the metal tray beside the oven. This will allow the tray to cool a bit. Put your tongs in the muffle of the oven to warm them. You never want to touch hot porcelain with cold metal.

Once the tongs get a bit warm, move the restoration from the firing tray to the bottom of a coffee mug. The ceramic acts as a heat sink and helps to suck up some of the excess heat, allowing the restoration to cool a bit faster. What’s great is that the mug acts as a great device to transfer the restoration from your lab to the chair.

By the time you walk over, your restoration has cooled enough where you can handle it with ease. This is a super-cheap and inexpensive way to transfer your restoration and cool it at the same time.

[image:Puri_3_2.jpg]

Fissure Height Versus Thickness

Jeffrey Caso (Faculty) — Thu, 01 Mar 2012 07:01:33 -0700

There has been great confusion and many questions regarding what the numbers really mean when we activate the cursor details. Sure, at first, it’s a bit annoying having the cursor details box attached to our cursor. It follows us around and can be in the way of what we are trying to see. I for one have gotten used to it and like that fact that, when activated, it is where I am looking. No need to move your gaze to the bottom of the screen away from the restoration. It kind of grows on you.

The other issue is, just what do those numbers mean? Well, the height of fissure is just that. It’s a measurement of the thinnest part of our central fissure. That makes sense. It’s the other reading or the thickness number that can throw us off. How can we have a low point in the Height of Fissure measurement as one number, and when we move the cursor through the fissure area we get thickness readings that are sometimes less? Even more confusing is that sometimes we cannot replicate or find the Height of Fissure reading. Where is the low spot?

The answer to this phenomenon is simple. The Height of Fissure is measured in the view that is set by you in the insertion axis step. The Thickness is measured in the view you currently have on the screen. So, for example, in this series of screen shots I have created an artificial low spot.

[image:Caso2_29_1.jpg]

You can see the Height of Fissure and the Thickness are the same in this location. Keep in mind that the orientation of the model on the screen is exactly the insertion axis. I know that because I have selected from the side bar, the View Options tab and clicked on occlusal. This view is the insertion axis view and the reference for the Height of Fissure number.

Now look what happens when we rotate the model little bit.

[image:Caso2_29_2.jpg]

The thickness, in exactly the same location as before, is now less than the Height of Fissure. Let’s look at one more example.

[image:Caso2_29_3.jpg]

Here in the same spot again, the thickness is so much greater. Why? Because the reference has been changed, not for the Height of Fissure because that is fixed, but for the Thickness measurement.

That is the reason for these seemingly conflicting numbers. To reliably evaluate your restoration, always look at it from the insertion axis view. That will set the point of reference exactly the same for both of those readings, and you will be much more accurate in this important part of the design process.

READING BITEWING X-RAYS OF ALL-CERAMIC RESTORATIONS

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 29 Feb 2012 08:54:04 -0700

A common misinterpretation by dentists that do not do all-ceramic restorations – or even CEREC for that matter – is how the restorations look on bitewing X-rays.

The first image shows a white "bar" at the interproximal, which is often times interpreted as a margin that is filled in with the resin cement or an open margin.

[image:Armen_2_29_3.jpg]

But taking the X-ray from varying angles reveals a completely different story.

[image:Armen_2_29_1.jpg]

[image:Armen_2_29_2.jpg]

These images are self-explanatory; however, for those who are used to metal margins, which generally hide a great deal of information due to overlap, the following concise narrative properly depicts the situation.

The ceramic material is radiolucent, while the cement is opaque. When an image is taken that bisects the margin at a 90-degree angle, the overlap of the opaque material gives the illusion that there is an open margin filled with resin material.

Do you really need the inLab MC XL?

Sameer Puri (cerecdoctors.com co-founder) — Tue, 28 Feb 2012 06:40:25 -0700

"Do I need the inLab MC XL?"

This is a question that is constantly asked on the message boards of www.cerecdoctors.com. Many doctors want to get into the inLab system so that they can fabricate their own abutments, create bridge frameworks and really take advantage of the different features of the inLab software.

So if you have the inLab software, this means you need the inLab MC XL, right? Wrong! In reality, there is really no reason for any CEREC owner – inLab software or not – to use anything other than the regular MC XL.

With the regular MC XL, the doctor can take advantage of all of the inLab features except one: model milling. In reality, this is a laboratory need and not really indicated for the chairside doctor. Abutments, bridge frameworks, everything can be done with your regular chairside MC XL, except milling models.

If you get the inLab MC XL, you are tied into the inLab software product cycle and miss out on a lot because now you have dongle incompatibility and other issues.

Stick with the regular chairside milling unit. There is no reason for the average CEREC doctor to go with the inLab unit.

Biogeneric Copy

Richard Rosenblatt (Faculty) — Mon, 27 Feb 2012 08:41:11 -0700

Since some would consider me a CEREC old-schooler since I've been using CEREC for almost nine years, then you should know the mantra by which I was taught in 2003: "Correlation is King." All the instructors would tell us that because the computer-generated tooth library (at the time called Dental Database), was not exactly predictable.

We were taught to copy our pre-op condition, or improve it with composite and then copy it. It was the easiest and most efficient way to finish. With the advent of Biogeneric and Buccal Bite and how amazing it was, I stopped doing so much Correlation – but I still loved doing it. Correlation is now known as Biogeneric Copy. New name, same basic function.

When I started teaching with the Bluecam, I would instruct doctors to take a roll shot on the buccal and lingual to pick up as much good information as possible, and then redraw the copy line close to the margin and get an exact rendering of the preoperative condition. That is still possible, but when we draw our copy line, everything inside the circle copies one-to-one, and everything outside the copy line is rendered via Biogeneric.

[image:rich_2_27_1.jpg]

I have found with the new software, if we draw the copy line too close to the margin we will tend to get a roll near the margin, which we have to try and fill in and then smooth out.

[image:rich_2_27_2.jpg]

What we have determined is that if you don't draw the line so close to the margin on the buccal and lingual, the software has an easier time of blending in that transition from the copy line to the margin.

[image:rich_2_27_3.jpg] [image:rich_2_27_4.jpg]

When trying to copy an abutment crown under a partial, you may need to drop that copy line closer to the gum line to insure the most intimate fit against the clasps. Other than that, keep the copy line a bit higher and away from the margin, and you'll get a nicer blend with less work to do on the proposal with the tools.

Hope this helps.

Dealing With Dark Teeth

Jeffrey Caso (Faculty) — Fri, 24 Feb 2012 06:59:54 -0700

All-ceramic restorations can give us a great esthetic result in most cases. When properly fabricated, the material gives us the best ability to mimic tooth structure. The tooth shade must be matched perfectly and the surface texture needs to be spot-on as well. What really makes or breaks the esthetics is what it is placed on. The stump shade is so critical when dealing with ceramic in the esthetic zone.

Stumps can be dark for many reasons. Usually, we are dealing with teeth that have had root canal therapy. Trapped blood in the pulp chamber can cause pigment, primarily from Iron, to enter the dentinal tubules and stain the tooth. Dealing with these dark teeth before the final restoration is made and cemented will help to avoid disappointment.

We can use opaque composite resin to help hide the color, use a restoration with a core like a PFM, or attempt to bleach out the stain. I recently found a very effective method to remove the stain once and for all.

For a long time a walking bleach technique was available, but it was not without its risks. The potential for root resorption was high and it was a chance that I was unwilling to take. The use of sodium perborate has reduced this risk greatly. The added precaution of placing a composite plug in the root and over the gutta percha gives me more peace of mind. I would mix the sodium perborate with saline and place it in the root canal access and cover it with Cavit. Then change it weekly. Some responded and some didn't.

Recently, I heard that instead of using saline it would work better if you mixed the sodium perborate with hydrogen peroxide. Wow, did this make a huge difference. In the few cases that I have used this new mixture, the results have been spectacular. Not only a better result but in a much faster time. After the first week, you can see the dark pigment work its way out of the tubules.

Give it a try. You can even prep the tooth for its final restoration and place the sodium perborate mixture and then seal it in under a temporary crown. You will see the result through the crown at each visit. You will be thrilled with the results.

What’s the best material to use in the anterior?

Sameer Puri (cerecdoctors.com co-founder) — Thu, 23 Feb 2012 07:50:34 -0700

What’s the best material to use in the anterior? There isn’t a day that goes by that I don’t get asked this question.

My answer is always the same: It depends. In reality, there is no "best material." There are different materials for different situations.

Ideally, we want to use the most translucent material possible when restoring teeth for the optimal esthetics. A translucent material gives us the most depth and esthetics in a restoration. The more opaque the material, the less depth and lack of esthetics it contains.

Increased translucency can be good and bad. It’s good for the reason we already discussed – enhanced esthetics. It’s bad because if the underlying tooth structure is dark, then that dark tooth structure will shine through, leading to a decrease in the esthetics by showing a dark root. This is ok if the patient has a low lip line, but not so good if the patient has a high smile.

So what, then, is the "best" material to use in the anterior? I use the list below as a guideline for when you have normal and dark stumps:

NORMAL SUBSTRUCTURE:

1a Vita TriLuxe

1b Empress Multi

1c e.max HT

2 Vita Real Life (Single tooth only)

3 Vita TriLuxe Forte (older patients with dark cervicals)

4 e.max LT

DARK SUBSTRUCTURE:

1 e.max LT

2 Vita TriLuxe Forte

[image:Puri_2_23.jpg]

Removing Powder from the lens

Richard Rosenblatt (Faculty) — Wed, 22 Feb 2012 09:44:43 -0700

When I teach basic training, one question I often seem to get is what to use to wipe the lens if powder gets on it. I don't like to use paper towels or anything that can be abrasive. I thought about using the soft cloths you can get at a LensCrafters so you would not scratch the lens, but I didn't want to have a ton of them and have to keep washing them after every patient.

I found these disposable lens-cleaning cloths in my local pharmacy. We tear one off when we are ready to do a CEREC. When I'm looking at the monitor and see that I have a spot of powder on my lens, I don't even have to look up. I just remove the camera from the patient's mouth, my assistant quickly removes the powder, and I'm right back to taking pics.

Once we are done with all the images, we just toss the cloth we used. Here is a pic of the brand that I found. I'm sure that there are many different brands out there. I just know that it can be costly to replace a scratched lens, so we make sure to keep these around for every case.

[image:rosenblatt_2_22.jpg]

Welcome to the 21st century

Peter Gardell (Faculty) — Tue, 21 Feb 2012 10:59:30 -0700

I just had the chance to sit in on an implant technique course. It was a course that I originally took 15 years ago, but as we all know, the world of implant dentistry has changed a little. Or I should say that my implant dentistry has changed a lot. It was nice to see how there have been some changes in techniques, but nothing I would describe as revolutionary. Some tweaking of principles and materials from years of experience.

There was a surgeon there who was the sponsor of the event. Very nice guy and knowledgeable, but a not a big believer of guided placement. For routine placement, the additional expense of a guide would make the patient decline treatment and irritate the referring dentist. The surgeon didn’t want to get tied into a specific location because the bone might not be good there.

There was a lab guy there who was also knowledgeable. Gave great insight on the larger cases. When we were diagnosing, he was very familiar with the principles of facially generated treatment planning. He was able to answer every question but one, and that one was from me: “What is an Implant handling fee?” He offered an explanation and I told him it didn’t make any sense. I told him it is a remnant of times past when dentists didn’t know any better. Implant dentistry is not rocket science; there is no reason to be intimidated.

I am not saying that all the tried-and-true methods that have given us success in the past need to be forgotten, but as with most things in life, we need to see how the technological advances of the day can make our lives better.

Calendars with pencils, pegboards and card files, film and diptanks – I can’t imagine going back. Digital imaging and computerized practice management software have allowed us to streamline the practice.

Shouldn’t dentists have the same opinion on technology and implants?

People are going crazy over curing lights that save a few seconds, bulk fill materials that may save a minute or two. Why wouldn’t people be interested in making their implant dentistry easier and more predictable? Know how the bone is before dropping a flap, know where the implant should be placed for an ideal restoration, be able to have the temp prepared prior to the surgery, and be able to produce perfect custom abutments designed for the idea restoration. The advantages are huge; in the words of a popular commercial – PRICELESS.

CREATING AN ESTHETIC SURFACE TEXTURE

Sameer Puri (cerecdoctors.com co-founder) — Mon, 20 Feb 2012 09:24:57 -0700

One of the keys to success with anterior CEREC restorations is the ability to create an esthetic surface texture. Too often, when restorations come out of the milling unit, doctors simply assume that they can just glaze them without any other work and place them in the mouth. This leads to a good restoration but not a great one. To get a great restoration, you must take the time to remove the bur marks from the milling unit prior to stain and glaze.

In the example below, a patient presented to the office with a fractured central incisor. The patient had received porcelain veneers approximately six years earlier in another office. When the restoration fractured, we used Biogeneric Reference to match the adjacent central incisor.

Now, when the images are taken, the clinician must – and this is mandatory – follow the appropriate sequence to ensure that the surface texture and luster of the restoration matches what is on the other restorations.

Typically, when the restoration comes out, I will contour the restoration using a fine diamond. This most often is done in the mouth due to the nature of CEREC one-visit dentistry, but can obviously be done off a model.

Once the restoration is contoured, the convex areas are polished with a rubber wheel. You can typically leave the concave areas a bit dull, but polish anything that is convex. After polishing is when we do our stain and glaze.

Now here is the critical part- after stain and glaze: rubber wheel the glaze off the restoration. You want to remove the shiny look and simply have a dull finish.

It’s not the stain and glaze that gives the restoration its luster, it’s the saliva in the mouth. Prove this to yourself by looking at an extracted tooth. It’s rarely shiny, but the surface is polished. It’s the saliva that gives it the luster.

This is exactly the sequence that was followed on tooth #8 below. You can see the luster and shade matches the adjacent teeth. If I had to rate this restoration, Id rate it an 8/10 because what I should have done was given it a bit more surface texture to match #9. Close, but no cigar. Regardless, I hope you get the concept of treating anteriors with the CEREC.

[image:Puri_2_20.jpg]

Using cerec on multiple patients at the same time

Richard Rosenblatt (Faculty) — Fri, 17 Feb 2012 09:31:46 -0700

There are many times when we have to use our CEREC machine on multiple patients at the same time. I have received questions on what is the easiest way to open a second case. I will also show a problem that can occur when opening a second case, and how to combat it.

The easiest way to open a second patient is to click on the Windows button at the lower left of the keyboard.
[image:IA_rosenblatt_2_16.jpg]

Click the button and the Start menu will open. Click on the icon that says CEREC SW4. This will open a second program, and you can begin to enter the patient info.

[image:1_Rosenblatt_2_16.jpg]

The issue we can run into is locking up the camera on the second patient. If the camera in the first case is in the Acquisition phase, it will not be able to be activated and used in the second case. You will see an error message like this:

[image:2rosenblatt_2_16.jpg]

If you are sharing your AC with another doctor, make sure that you take the images and then go past the Acquisition phase into the Model phase. Once you do that, the camera will be active, and you will be able to image on the second patient.

Digital Planning

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 16 Feb 2012 16:42:21 -0700

I'm too lazy to take impressions, pour them up, take out calipers and measure the proportions coming up for a rehab. A quick scan and I can measure the diastema, split in half, and see if I can remove that much from the distal of the Central Incisor. Then I measure to see if I can get to Width to Length Ratio of 75-80 % for the Central. The only thing left is to click a button and have the virtual wax up fall into place

[video:digitalplanning.mp4]

Simple Bonding Technique for an Onlay

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 15 Feb 2012 18:20:33 -0700

Everyone in the past would use a tofflemeier matrix band to seat partial restorations. I found this difficult to do as the closed loop system would prevent it from seating all the way, hanging on the neck of the band

4 friends of mine, jumped shipped, and advised me to use a sectional band so it would keep me out of trouble.

Do yourself a favor and try this approach instead. Works like a charm

[image:bond_onlay1.jpg]

[image:bond_onlay2.jpg]

It's all in the prep!

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 15 Feb 2012 15:19:12 -0700

The day goes by so much more smoothly when you think like the milling machine. Perfect preps and good imaging leads to restorations dropping in at seat. Here are some pointers for partial restorations with regards to fit:

1. Make sure your exit angles have a slight flare taper so that you can see all point angles in the boxes

2. Make sure the isthmus at the occlusal table is wider than the isthmus at cavosurface when you have a lingual or buccal finger / extension. Otherwise, the bur has to mill back on itself and it can shatter the restoration

3. At the path of draw view, make sure you see an uniterupted blue line like the image below. If you don't. then that means there is an undercut that will be milled and you won't be able to seat the restoration.

4. The yellow shadow is a good warning also if you have undercuts.

[image:onlayjpg.jpg]

RESTORING ANTERIOR TEETH THAT HAVE HAD ROOT CANAL THERAPY

Sameer Puri (cerecdoctors.com co-founder) — Wed, 15 Feb 2012 06:57:26 -0700

In my last blog, I talked about how to go about restoring a posterior tooth after it had been treated endodontically. The consensus in the literature clearly states that when you have a posterior tooth treated by endo, do a full-coverage restoration. No ifs, ands or buts.

However, how should you go about treating an anterior tooth that has had root canal therapy but needs restorative work?

Below is a case that was posted on the forum. It was posted for other reasons; however, what caught my eye was the restoration on #9 with the endo access in the lingual.

[image:Puri2_15.jpg]

So my question is, would you have prepped the same way or would you have done a full-coverage restoration? This comes up quite a bit and the answer may surprise you. As we discussed, in the posterior, we want full coverage. In the anterior, however, do all you can to preserve the cingulum and avoid doing a full coverage.

In fact, I would have treated this tooth exactly the same way, as two separate restorations. An anterior all-ceramic with a separate composite closing off the endo access.

The weakest area in anterior teeth is the lingual fossa, and this is the area that causes the tooth to flex significantly when it is undergoing excursive movements.

What compensates for the flexing is the cingulum. If you cut the cingulum away, you significantly weaken the tooth.

To summarize: Posterior teeth, full coverage. Anterior teeth, partial coverage if a restoration is needed. If this was a virgin tooth, close the access with composite and call it a day.

The ProDrive

Peter Gardell (Faculty) — Tue, 14 Feb 2012 06:25:47 -0700

Sometimes you have something, but you really don’t know how good it is until you force yourself to use it.

I have been interested in improving my handpieces by converting to electric, but have been put off by the cost. Always seems there is something that takes priority. I am also a very cheap person.

So, a few years ago my handpiece service guy comes in and talks to me about a product – ProDrive.

It is a turbine replacement for you existing handpieces, which due to its innovative design, increases the power output of your handpiece. They have kits for many of the handpieces on the market; your Paterson rep can help you out with what models are available. I still use the Star 430s that I started with in dental school. The ProDrive is almost a direct replacement for my Star push-button Autochuck. Maybe a slight increase in height, but not something that has made a clinical difference.

The other part of the equation is that this turbine does require a special bur. The good news is that these burs are manufactured by Meisinger, a premier bur manufacturer, the same company that produces the depth router burs. Not every shape of carbide or diamond is available, but there selection is extensive.

These turbines are well-made, no additional vibration noted during their use. No special maintenance has to be performed on these turbines to keep them in top shape.

More power in the handpiece, great cutting diamonds, throw in an Isolite and liquid reference and you have the recipe for a fast and efficient appointment.

HOW TO IMAGE CONTACTS

Richard Rosenblatt (Faculty) — Mon, 13 Feb 2012 09:32:43 -0700

The other day on the message boards, we had a site member post a question about how to solve an issue he was having. I strongly recommend visiting our message board, as questions are usually answered very quickly and fantastic discussions arise with great information contained in the conversations.

The problem he discussed was how to capture the interproximal data on adjacent teeth to a tooth that you are prepping. I've created a short video to show how to properly angle your camera to accurately image the interproximal areas. Please watch it and leave any comments or questions in the comment section. Enjoy.

[video:how_to_image_interproximal_contact_areas.mp4]

PREP FOR SUCCESS

Jeffrey Caso (Faculty) — Fri, 10 Feb 2012 11:31:38 -0700

As CEREC dentists, we need to be open about changing our preparation style to be more CEREC-friendly. Now, what exactly does that mean?

There are many of us who have been practicing for a long time. We have honed our skills and now suddenly we feel like we have been doing something wrong. That is not the case at all. We need to give the machine a preparation that allows for the mill to fabricate a restoration which will easily fit, and one that has a minimal amount of overmilling.

This means that we need free-flowing, properly reduced, super-smooth preparations free of undercuts and tight corners. That’s basically it. Now, since we are not worrying about the patient wearing a temp for a week or two, we can prep with a minimum of retentive elements to help conserve tooth structure. We now can rely more on the bonding complex to keep the restoration in place. That certainly is something that can take some getting used to when we first do it.

Recently there has been a great discussion on the cerecdoctors.com discussion boards about this topic and how it applies to teeth with visible fractures present. It’s an interesting discussion which seems to have no consensus of opinion. It’s thought-provoking and is highlighted with research on the topic. Read it here http://www.cerecdoctors.com/discussion-boards/view/id/8732.

Restoring endodontically treated teeth

Sameer Puri (cerecdoctors.com co-founder) — Thu, 09 Feb 2012 06:03:39 -0700

One of the big questions that constantly gets asked in our courses is, “How do you restore endodontically treated teeth?” Especially if there is a small access opening on a large molar. Suffice it to say, I’ve heard some speakers espouse the merits of simply doing an occlusal inlay for a molar that has been endodontically treated. If you have heard the same, my advice to you is don’t listen to this and do your patient a disservice.

This one paper summarizes it nicely:

Are full cast crowns mandatory after endodontic treatment in posterior teeth?

Tikku AP, Chandra A, Bharti R.

J Conserv Dent. 2010 Oct;13(4):246-8.

The main take-away from the article is summarized below:

"Root canal treated posterior teeth without crowns are lost at a much higher rate than teeth supported with full cast crowns. The risk involved in losing the endodontically treated posterior teeth to fracture if not supported by full cast crown is too high to take."

Buccal Bite and Data Points

Mark Fleming (Faculty & Magazine Editor) — Wed, 08 Feb 2012 06:46:00 -0700

I loved when the buccal bite was introduced. Because of it, CEREC users can dial-in the occlusion of their restorations. But how can the operator ensure they are getting a good buccal bite? Well, it is all about registering enough good overlapping data points.

I personally like getting the buccal bite for posterior restorations in the bicuspid area. When taking pictures in that area, one tiny movement can ensure success. The roll shot in this area will ensure the successful stitching of the buccal bite to the two models.

First, even as good as CEREC technology is, it cannot violate the physical properties of light. It cannot bend light around a corner. To get a great stitch, get the data points BELOW the height of contour on the teeth. Remember, the buccal bite is taken 90 degrees to the teeth, so the more data points one has to stitch too, the more accurate the buccal bite will be and the better the occlusion will be for the CEREC restorations. On lower teeth, it is important to get below the height of contour because usually the incisal third of the tooth is covered by the opposing tooth. It's even helpful to image part of the gingiva.

So to get an accurate buccal bite and ensure great occlusion for the CEREC restoration, remember the roll shot to grab those important data points.

The WAMkey

Richard Rosenblatt (Faculty) — Tue, 07 Feb 2012 12:53:48 -0700

A few weeks back, I received this product to help me remove crowns more easily from a friend who is a rep with a dental instruments company. It is called the WAMkey. They showed me how to use it at the ADA, but I was a bit skeptical. I’m a bit hesitant to try it on a bonded crown, but decided to try it on a cemented PFM that I was removing last month. It was awesome! No more cutting a trench buccal to lingual on the crown. No more nicking the buccal and lingual tissue and making a big groove from drilling in too deep on the buccal and lingual. I removed a gold crown today. Let me show you how this works.

Here is the kit. There are three WAMkeys; each is slightly larger in size.

[image:1_rich_2_7.jpg]

I had a gold crown that had recurrent decay under it.

[image:2rich_2_7.jpg]

They give you a bur that easily cuts through metal and porcelain. You make a window in the crown and advance the bur into the crown along the cement/crown.

[image:3_rich_2_7.jpg]

The smallest WAMkey is placed into the window and twisted. The cement seal breaks and the crown lifts right up.

[image:4_jeff_2_7.jpg] [image:5_rich2_7.jpg]

Neither the prep nor the tissue had big gouges on them from making a trench cut from buccal to lingual.

[image:6_rich_2_7.jpg]

Here is the crown with just the small window in it.

[image:7_rich_2_7.jpg]

I have just been using this a few months, but I am really enjoying it.

Getting the best possible bond

Darren Greenhalgh (Faculty) — Mon, 06 Feb 2012 09:47:58 -0700

There are so many aspects to a successful CEREC appointment. Scheduling, anesthetic, preparation, powdering, imaging, designing, milling, staining and glazing, staff participation – it can be stressful.

In and effort to always be more efficient in my office, we have really worked on most of these aspects, but I still find after all of these years the only time my blood pressure rises during a CEREC appointment: bonding the restoration. Everything we have do up to this point depends on how successful we are when seating the crown – everything is additive in the CEREC process, so one thing that I always try and check to make sure that I am getting the best bond possible – the intaglio surface of my margin.

If you get any glaze or stain on your intaglio surface you will not get as good of a bond as you could if there were no glaze or stain present. I know that many people stain and glaze differently – I for one use a vice made from Vita to hold my restorations in place while staining and glazing.

[image:1greenhalgh_2_6.jpg]

If you are not very careful, you can introduce stain or glaze onto the intaglio marginal surface.

I use a fine diamond at slow speed to roughen up the glaze or stain that might be present before my assistant applies the silane and bond to the restoration.

[image:2greenhalgh2_6.jpg]

Multiple Restorations

Mark Fleming (Faculty & Magazine Editor) — Fri, 03 Feb 2012 13:25:35 -0700

One of the advantages of the CEREC 4.0 software is the ability to propose restorations at the same time. I personally like the simultaneous proposing function of the software.

However, there are instances that you may want to do proposals one at a time. This thread on cerecdoctors.com Discussion Board has some great videos that are very helpful. Check it out.

2 Crowns Same Quadrant-Suggestions?

Digital ortho and digital restorative. Love the combination

Armen Mirzayan (cerecdoctors.com co-founder) — Fri, 03 Feb 2012 10:06:06 -0700

[cerecvideo:Digital Orthodontics Meets Digital Restoration]

here's a case where Cerec was used to fabricate an invislaign attachment incorporated into crown for closing a diastema. Months later the crown was replaced with a permanent crown using Cerec

Put the sprue on a line angle by default

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 02 Feb 2012 10:22:13 -0700

[image:spruelocation.jpg]

here's a quick tip!

If you place the sprue on the facial of a large crown, generally a size 14 block is required. If you place the sprue for a crown at the interproximal, it generally takes a smaller size block to get the job done and the milling time is shorter as well. But you have to cut the sprue off the contact area and if you are sloppy, you can remove the contact.

By moving the sprue location to the facial line angle by default you get the best of both worlds!

e.max

Sameer Puri (cerecdoctors.com co-founder) — Thu, 02 Feb 2012 08:43:15 -0700

One of the most exciting materials available to CEREC owners is the e.max block. With a compressive strength in the neighborhood of 400 mpa, this porcelain block is two to three times stronger than other available blocks. Clinically it has performed beyond expectations, and recently Ivoclar has published a 10-year retrospective on the studies that have been done on this material. As soon as it’s available from Ivoclar, a digital version will be placed in the download section of this website.

[image:e_max.jpg]

The bottom line on the research is that the material works, and it works well. A summary of the IPS e.max Press system showed a failure rate of 1.6%. (Boning et al., 2006; Etman and Woolford, 2010; Guess et al., 2009; Gehrt et al., 2010; Dental Advisor 2010, and internal Ivoclar study) The studies tracked 499 restorations with a survival rate of 98.6% after a mean observation period of four years. Chipping only occurred in 1.4% of the restorations, and the other failures were due to endodontic failure, caries and fracture. These studies used a combination of adhesive and conventional cementation techniques, which I thought was interesting.

Now us CEREC guys are more interested in milling, so what were the results of the milling studies with e.max CAD? Six clinical studies were reviewed (Richter et al., 2009; Nathanson, 2008; Reich et al., 2010; Fasbinder et al., 2010; Bindl, 2011; Sorensen et al., 2009) with a total of 237 restorations (crowns) that showed that 97.9% of the restorations survived after a mean observation period of 2.5 years. The 2.1% failure rate included chipping, fractures and caries.

So no doubt those of you that have been using e.max in your practices can relate to these results. The material works, and it works well. The blocks have been available in both an HT (high translucency blocks) and an LT block (low translucency). The one shortcoming of the blocks (if there is one) is that esthetically, unless you cut back and layer porcelain, you are dealing with a monolithic material – which means monolithic esthetics. Unlike their Empress Multi counterparts, the blocks are the same shade and translucency throughout.

Until now. At the Midwinter meeting in Chicago next month, Ivoclar is expected to release the e.max Multi blocks graduated shade and graduated translucency from one end of the block to the other. Initially, these blocks will be available for the pressed version only. Once the pressed version is released, we will eventually get our hands on milled versions of these blocks for our milling units. They have not set a release date yet, but I would imagine that it will be after the Chicago meeting for the pressed version, and my hope is that we have milled versions of the e.max Multi blocks by CEREC 27 and a half in the summer.

So all you CEREC owners can salivate at what I expect will become the most popular block for CEREC, giving you the appropriate opacity to block out any dark underlying tooth structure with the appropriate incisal edge translucency for the appropriate esthetics. As more information becomes available on these blocks, we will keep you updated on www.cerecdoctors.com

Enjoying Long Bur Life

Jeffrey Caso (Faculty) — Wed, 01 Feb 2012 12:27:21 -0700

Gone are the days of bur errors and short bur life. A few software versions ago we suffered through bad bur chucks, broken burs and errors after four mills that slowed us down and cost us money. Sure, there are still issues, some materials – specifically the temporary materials – still have their problems, but for the most part, we are seeing huge improvements in this regard.

The 12s cylinder and step burs are the work horses of our milling process. The all-in-one bur (where the chuck and bur are one unit) has been the main reason for this nice change. Make sure that you or your staff knows to never grease the threads when placing them. If you do, removal will be nearly impossible.

This extended bur life leads to a maintenance issue. You now need to keep an eye on your mill count, which you can see in the 4.0 software in the Step Menu located on the bottom of the screen when getting ready to mill. I will not let the burs go past 20 mills. At that point you will see mill times increase. Not the time on the screen, but the actual mill time. So, when you see a mill that is supposed to take six minutes and it actually takes 11, that's because your burs are getting dull. It could be other things like wireless interference, but generally it's the burs.

In addition, if I plan to do a big case or some thin veneers, I usually will use a new set of burs.

So, the take-home lesson is this: Watch the bur count so you will be less likely to get an error, a slow mill time or chipped margins. Make sure your water jets are pointed correctly. They should be hitting the tip of the bur. If not, bur life will be greatly affected. Also, super-smooth, free-flowing preps will help a great deal.

Keep an eye on these things or spend a minute with your staff to let them know that they need to keep an eye on these things for you. The advantage is saving time and money, but also avoiding aggravation. That, to me, as I get older, is the name of the game. Less aggravation. More happiness. Better days.

The Most Critical Part of the Prep

Sameer Puri (cerecdoctors.com co-founder) — Mon, 30 Jan 2012 16:15:07 -0700

[image:alpine1.jpg]

[image:alpen2.jpg]

[image:alpen3.jpg]

One of the keys to a successful CEREC restoration is the prep. There is no doubt in my mind that if your prep is not adequate, you will be disappointed with your final margins.

The difference between a good restoration and a great restoration is the quality of your preparation. Having said that, the most critical part of the prep is finishing your margins. You can leave the internal rough and you will get a bit of overmilling. However if you leave your margins rough, you will have open margins or a restoration that doesn’t seat. My recommendation is to smooth out every single preparation at the end with a finishing diamond. If you want clean, pristine margins, you need to provide the machine with a clean pristine preparation.

There are a lot of great burs out there. Here is what I have been using lately – the 847-016 Fine Grit Modified End Taper from Coltene Whaledent. This is from the Alpen series of diamond instruments. Frankly, you can use any of the available burs out there, just make sure you use something similar in shape so that you don’t create sharp points in the internal of your preparation.

Every margin should be glass smooth – a finishing diamond as the last step in your preparation will help you achieve excellent marginal fit.

How We Eliminate Confusion When Milling Multiple Units

Jeffrey Caso (Faculty) — Fri, 27 Jan 2012 15:42:20 -0700

It always strikes me as funny when people say CEREC is the future of dentistry. Actually, CEREC is the present, the here and now. If you really believe it's the future then you will sit back and watch the technology pass you by. The 4.0 software is spectacular and offers the practitioner so much. Designing multiple restorations at once is a pleasure and greatly speeds up the entire process.

Now more than ever it is necessary to be skilled at various techniques to help avoid a backlog at the slowest phase of the process: Milling. Now, don't get me wrong, milling is fast and efficient. It's just that we are tempted, now more than ever, to throw a great deal at the mill, as usually our designs are all completed at the same time. For that reason, techniques like SArmen help to make the entire process blazingly fast.

The real reason I am writing this is to talk about an issue I had last week, and my low-tech approach to overcome it. I had a patient with a cosmetic emergency. I was able to work her into the day between regularly scheduled patients. She was sound asleep in her bed, when a heavy picture fell from the wall and fractured several of her front teeth. That's a heck of a way to wake up.

We diagnosed, prepped and imaged, and went on to another patient. I used Biogeneric individual, a design technique I generally avoid in the anterior; it worked like a charm on this case. Between patients, I designed her restorations. They were all ready for the mill at the same time. I milled the first and went to do other things. My staff finished the milling one-by-one. At try-in, I realized that we had two right centrals and no left central. No big deal, only a six-minute error. It got me thinking...

My answer to this confusion that can occur when milling multiple units was very simple. It came in the form of a Post-it note. As each unit is milled, the tooth number is written down. When it's completed, we place an X over it and write down the next number. So simple, so silly. Maybe someday we will be able to have some sort of a milling queue. Just set it up and mill one by one. For now, we have a pencil and paper. It feels good and comforting sometimes to take a step back to simpler times.

Long Axis

Mark Fleming (Faculty & Magazine Editor) — Thu, 26 Jan 2012 16:02:51 -0700

I use this term a lot when teaching CEREC users. I believe it is a very important part of a successful CEREC restoration proposal.

First, when prepping, as much as possible, prep along the long axis of the tooth and along the long axis of the arch. This makes it very easy to get successful optical images for a virtual model. If you keep this idea of long axis in mind, you set your camera accordingly and just move it straight posterior to anterior of the arch. Once the camera is set, no worries about pitch, roll and yaw. You are already set.

I have found that when I am ready to set my insertion axis after placing the margin for the restoration, if I set that axis along the long axis of my prep, which is along the long axis of the arch, the subsequent initial proposal hardly has to be modified. Proposals can be quickly ready to be milled.

So, the next time you are getting ready to prep for a CEREC restoration, think long axis!

Documentation

Sameer Puri (cerecdoctors.com co-founder) — Wed, 25 Jan 2012 16:45:49 -0700

Let’s talk about documentation – there are lots of different ways to get to the end result, but the main way we document cases is either through photography or video. Both work, and obviously both will give you great results if you want to share cases. However, the first thing you have to decide is who do you want to share the information with? Patients or doctors?

If you want to document cases to show patients, my suggestion is to stick with photography. Video will be complex and "gross" to most patients because, well, video is gross. You will be documenting cases, procedures, the blood and guts of the procedure, and frankly, most patients don’t want to see it. If you are going to be documenting cases for patients, just stick with before-and-after photos. To do this, you need a camera. GET A GOOD ONE. You have two choices: Canon and Nikon. Both work well. With each camera, you will need a camera body, a macro lens and a flash source.

With regard to the camera body, there are lots of great choices from both Canon and Nikon. Get something in the "prosumer" range. For Canon, the Rebel series is nice. With Nikon, the D7000 is a good, newer-generation camera. The body is where you will take all your photos and where you will store your images.

The newer cameras are easy to use and just give great pictures. No need to go super fancy here – keep it simple, stick to one of the models I recommended, and you will be fine.

[image:photo1.jpg]

Next up: the lens. You need a macro lens – this allows you to get close up to the subject, and also allows you to zoom in on the teeth. With a 100 mm lens, you can zoom into about 2-4 teeth. These lenses are a bit heavier, so for some of your team members, you may want to get a 60 mm lens instead. A bit lighter but you can only go to about 4-6 teeth in the closest range. In the past, this would have been a problem, but with the ability to zoom in and crop digital photos, 60 mm will work well for many offices.

[image:ohoto2.jpg]

The last thing you need is a flash, specifically a ring flash. Without a ring flash, the light will not light up the inside of the mouth. The flash on top of the camera just won’t work. The flash needs to be on the front of the lens so it illuminates the mouth properly. Canon and Nikon both have nice options for this. The Canon is shown below.

[image:ohoto3.jpg]

When you put the whole thing together, you get the following set up:

[image:photo4.jpg]

Yes, these systems are a bit heavy for some, but the pictures are worth it. You also need to get appropriate retractors and mirrors, as everything in the mouth will be imaged through a mirror. For the set-up shown, you can expect to spend about $1,500-$2,500. If you know anything about cameras, buy off the internet – www.amazon.com or www.bhphoto.com are great websites to buy stuff. Great prices; excellent service. I’m partial to BH Photo myself, as I’ve bought a bunch of stuff from them. In my opinion, they are literally the best camera store in the world!

If you have no clue with regard to running a camera, go to www.photomed.net, a dental specialty store with the set-ups ready to go. They will even give you a loaner and set your camera right. You will pay a bit more, but in my opinion the service is worth it.

Now that you have your camera, what settings should you use? Here are the settings I use to get the best photos:

Set the camera on “manual” mode
Flash: Should be set at TTL (through-the-lens metering)
F-stop: 29 – This means you have “deep” depth of field (meaning everything from the front of the mouth to the back of the mouth is in focus)
Shutter speed: 125 – This means the shutter is open for 1/125th of a second

These settings work well to give you the proper exposure and a good photo.

If you want to video tape procedures, my next post will be on video options for the dental practitioner.

Comfort

Mark Fleming (Faculty & Magazine Editor) — Tue, 24 Jan 2012 15:59:49 -0700

One of the things that helped me build a successful practice is a "painless" injection technique. I did not develop it; I learned it from my mentor, Gerry Loewe, when I first started in practice more than 30 years ago.

Most restorative procedures can be stressful for the patient. My thought process is that if we can begin the procedure surpassing the patient's expectations, we definitely have set the patient up for a positive experience. Hopefully, this will lead the patient to telling others how great the office is where they have their dentistry done.

Here is my protocol:

Swab the area that has been dried with air with a good topical anesthetic. Currently, I use Best Topical Ever. I let that sit for 30 seconds. Then I SLOWLY inject a carpule of 4% Citanest. This has a ph close to neutral, which, along with the topical, helps make this injection "painless." I use a 30-gauge needle. Then after waiting two minutes, which is timed, I give a second injection SLOWLY of 4% Septocaine 1/100,000 epi. The area has been numbed by the first injection, and after waiting another two minutes, we are ready to begin.

I have had my fair share of dental treatment. I know I always appreciate extra steps that ensure my comfort. I'm sure your patients will also.

Productivity

Armen Mirzayan (cerecdoctors.com co-founder) — Tue, 24 Jan 2012 12:43:35 -0700

i took time stamps of my first procedure today for the upper right first molar:

9:34 am i captured opposing arch (so anesthesia and isolite about 5 minutes prior to this)

9:46 i captured prep arch

9:51 it was in milling machine

10:08 was in the oven

10:30 i bonded

10:44 the patient left, and that was with double hygiene running. that was a single restoration, but frequently i'm doing something else in the same arch or even the opposing arch like this: this is about the best thing about isolite, it gets you to open your mind that you can treat opposing teeth, where as a rubber dam gives you the mental block that you have to stick to one arch

[image:quads.jpg]

A Tip from one of our mentors on implants

Sameer Puri (cerecdoctors.com co-founder) — Mon, 23 Jan 2012 14:49:20 -0700

Here is a great tip from cerecdoctors.com Mentor, Dr. Darin O'Bryan:

“So here is a little trick I do for soft-tissue modeling when doing an implant on a model in 4.0.

When take your images, take them for upper, lower and buccal bite without your gingival mask. Then place the gingival mask and take a Biocopy image. They will overlay and you can proceed forward to design.

[image:C1.jpg]

Here is the crown on the model:

[image:C2.jpg]

And here is the case of the Biocopy of the gingival mask in place:

[image:C3.jpg]

[image:C4.jpg]

The tissue was just like it showed in the mouth.

Here are images of the crown on the model and in the mouth. As you can see, we had a little bit of the abutment showing, but #30 not big deal and it was a little close to the nerve to bury it any further. The patient was happy with the result.

[image:C5.jpg]

[image:C6.jpg]

So with the added catalog you can make a Biocopy tissue model when working on models in the lab. This helps to get the emergence profile correct without having to over-bulk, and then shape with hand pieces.

[image:C7.jpg]

Thanks Darin – great tip here. I officially name this The O’Bryan Technique for Implants. :)

The Practice Dongle

Sameer Puri (cerecdoctors.com co-founder) — Fri, 20 Jan 2012 10:50:31 -0700

For those of you who have 4.0 software installed and want to run the software away from your acquisition center (maybe on a laptop at home to practice 4.0) you obviously need a practice dongle. This practice dongle will allow you to run the software in trial mode – meaning you can’t mill or can’t save cases. But you can download cases from www.cerecdoctors.com and practice them at home.

The regular dongle that allows you to mill costs $5,000 – yes you heard correctly. No reason to pay that extra fee, and I don't suggest you take your $5,000 dongle from your office and transfer it home. Makes no sense when there is a good chance that you may lose it and have to start over again.

Order a practice dongle from Patterson for $95 (Part # is 0449256). This practice dongle allows you to open any RST file from the 4.0 software, and allows you to run the software. You can’t mill or save cases, but it’s great for practicing and downloading cases from the website.

Happy CERECing.

Patterson Debubblizer

Richard Rosenblatt (Faculty) — Thu, 19 Jan 2012 10:40:32 -0700

Sometimes you have to take an impression and pour a model. Yes, I said it. I did a blog a while back regarding new users taking the stress out of the learning curve and doing a CEREC in two appointments. This way they don't feel so rushed with patients in the chair. They can scan in the mouth or take an impression.

Once in a great while, a patient just does not open enough to get the camera in the back of the mouth. These are the few times I have taken an impression, poured it up and then scanned off of a model. Another time that I will take an impression and scan off of a model is when I'm doing an implant and trying to make a soft-tissue model.

For those who will use a model for these scenarios, I have two suggestions to make your life a bit easier. The first is to use a scan stone from vita. It is a fantastic stone material that does not need to be powdered. I have been using it for my assistant training courses, and it works fantastic.

The only problem that I was noticing was that I would get bubbles in various areas when pouring the model. If those bubbles were on a margin, I was forced to pour another model until I got what I needed.

[image:Debubblizer.jpg]

I found this in a Patterson catalog. You just spray into your models and it eliminates about every possible bubble I get when pouring. The day that I got it, I was pouring models for the class out of a silicone mold I have of the preps. My four-year-old daughter was visiting the office and said she wanted to help. I let her scoop up stone with a spatula and fill the mold that I sprayed with the Debubblizer while vibrating out any potential bubbles. I let it harden and the model was absolutely perfect. So I say get your hands on this stuff. It is so easy, a four-year-old can do it!!

Evaluating Your Work

Jeffrey Caso (Faculty) — Wed, 18 Jan 2012 13:53:34 -0700

Taking full control of your fixed prosthodontics is what CEREC is all about. Making decisions along the way that will affect the final outcome is something that we have been doing all along. Now we have to add to that making decisions in the design and post-milling stage. The twists and turns that we can encounter, in the past were dealt with by the lab tech. Some of the paths they took we agreed with and some disappointed us. Having full control is awesome and powerful, but it requires us to strictly evaluate our work, and at times be tough on ourselves.

It all starts with the prep. We need to do our best in the face of sometimes difficult situations. We all know what will work versus what is great dentistry. Next, we need to be able to read our margins well. Guessing at this stage is setting yourself up for failure. Spending time designing a great restoration is so important. Checking and rechecking our design makes for a restoration that will need minimal adjustments. It goes on and on throughout the process.

We have an advantage over the lab in that we still have the patient present. If we need to go back and reduce more or refine a margin or retake an image or re-mill an off shade, we can do this. Put your ego aside and do what's right for the patient. There is no shame. It's what will give us and the patient the longest-lasting, best-looking and highly functional restoration.

Enjoy your work and strive every day to do your best. Dentistry is hard. Every patient and every case is different and challenging. Rise to the occasion and do your best work every time. Educate yourself to be able to do better and advance. Critically evaluate your work and be hard on yourself. Look at X-rays, feel the margins, see the result and make sure that YOU are happy with what you gave your patient. When practicing CEREC dentistry there is no one to help us through. It's all us and we need to be honest with ourselves to be able to do our best each and every day.

Meet the Safe-Vac

Sameer Puri (cerecdoctors.com co-founder) — Tue, 17 Jan 2012 08:24:59 -0700

Have you guys ever seen a product that was so simple, so ingenious that you want to kick yourself for not thinking of it on your own? I saw this little product and thought it was a great adjunct to the dental practice.

We all have gotten the evil eye from a patient who was not completely numb when the assistant virtually sucks out their tongue with the high-speed evacuation. It’s not that the suction is uncomfortable, as it is the sharp tip of the evacuation.

Next time try the Safe-Vac. These suction tips are coated with a rubber tip so that you don’t hurt your patient. It makes it more comfortable for adults as well as kids, especially when the patient is not numb. I didn’t realize it, but these little guys were invented by a CEREC user and a member of www.cerecdoctors.com – Double bonus!

Anyway, some images are attached, and you can order these through Patterson by clicking here:

http://www.pattersondental.com/Supplies/ProductFamilyDetails/11529

Patterson part # 629-7006

The blue one has a screen that will keep you from sucking up that newly cement crown. The green tip is the standard tip with no screen.

[image:Safe1.jpg]

[image:Safe2.jpg]

Why I love digital impressions (and the laser too)

Armen Mirzayan (cerecdoctors.com co-founder) — Mon, 16 Jan 2012 18:01:27 -0700

One of the biggest advantages of digital impressioning is to know within seconds if you captured your margins, as opposed to waiting 4 to 5 minutes for the traditional impression to set. But one common thing between the two is that you must make sure you have soft tissue retraction and displacement of the tissue to discern where the tooth structure ends and the tissue starts. One big adjunct that accomplishes both those things with relative ease is a soft tissue laser. Here you see the pre-op condition where you can tell the clinician struggled accomplishing an important task and in the immediate post op, you can appreciate how hemostasis and retraction worked to achieve the desired results

[image:short.jpg]

[image:closed.jpg]

Keyboard Shortcuts

Mike Skramstad (Faculty) — Mon, 16 Jan 2012 12:32:34 -0700

Many advanced users enjoy the use of certain keyboard shortcuts with the CEREC software. Most of the older shortcuts do not work with the 4.0 software. I've compiled a list of some of the shortcuts that are in the software at this point. I'm sure there will be more moving forward, but these are the ones that I've found as of now. If I missed some or if you find some others in the 4.0.2 software, please join in the discussion and list them on this www.cerecdoctors.com thread: http://www.cerecdoctors.com/discussion-boards/view/id/8232

GENERAL

CONTROL-N: New Case
CONTROL-S: Save
CONTROL-ALT-S: Save as
CONTROL-I: Import
CONTROL-E: Export
WINDOWS ICON: Open up Start menu when not in Windows mode to start new 4.0 program

F1: Help
CONTROL-F1: Administration phase
CONTROL-F2: Acquisition phase
CONTROL-F3: Model phase
CONTROL-F4: Design phase
CONTROL-F5: Mill phase
CONTROL-F6: Configuration options
ALT-F4: Exit program

ACQUISITION PHASE

1: Lower jaw
2: Upper jaw
3: Buccal
4: BioRef Lower
5: BioRef Upper
6: BioCopy Lower
7: BioCopy Upper
ARROW UP: Goes to the next image catalog to the right
ARROW DOWN: Goes to the next image catalog to the left
SPACEBAR: Camera on and off

DESIGN PHASE
-Space Bar toggles:

Between Remove, Smooth, Add in Form tool
Between Position/Rotate in Move tool
Between Anatomical and Circular shape tool

MILL PHASE
-Space bar toggles:

Between Position/Rotate in Move tool

Milling in 4.0

Jeffrey Caso (Faculty) — Fri, 13 Jan 2012 15:31:15 -0700

One great feature of the 4.0 software is our ability to position the restoration within the block. In previous software versions we only had the ability to change the sprue location. This helped to keep the sprue away from the contact areas, but really that was all.

In the 4.0 software, we have expanded capabilities and the ability to move the sprue by rotating the restoration, as well as moving the entire restoration within the block both up and down and front-to-back as well as side-to-side. If we use these features properly we can soon see the many advantages they provide.

First, the mill tools are accessed through the side bar in the milling phase. Choosing “Sprue,” we can rotate the restoration around an axis – thereby moving the sprue away from the contact and placing it on a thick area, away from the margin which will decrease the likelihood of fracture during milling. This tool also allows for us to reset the sprue to the software’s default location.

Also accessed from this same menu is a “Move” tool. It has two options. Selecting “Position” allows us to move the restoration front-to-back and side-to-side. Selecting “Rotate” allows us to spin the restoration incrementally along a full circle, which rotates around the sprue.

So, what are the applications of these tools? Well, in one instance I was certain that I would need to send a very large implant crown to the lab. In previous software versions there was no way that it would fit in a block. In 4.0, I was able to move and rotate it enough to just get it to fit. This saved me a large lab fee and allowed me to turn this crown around in a very fast timeframe. In another instance, I was able to splint two lower incisors and position them in the block diagonally and avoid sending the case out.

For every case, I find myself moving the sprue to a thick line angle. That seems to be my favorite location and gives me a great mill.

I also was curious about how we could improve mill times by using the tools appropriately. I chose a very standard molar restoration and positioned it right at the end of the block, furthest from the sprue. My mill time was 5:30. I then moved it as close as possible to the sprue and the mill time was 7:06. That's more than a minute and a half longer. That may not seem like much, but factor in extra wear and tear on the mill and burs, and over time it can be significant.

So, spend a few seconds and tweak the mill position. Keep the restoration as far away from the sprue as possible and on a thick, non-contacting surface. Take advantage of all that 4.0 has to offer.

Plumbers Tape??

Richard Rosenblatt (Faculty) — Thu, 12 Jan 2012 15:26:00 -0700

I love doing crowns on implants with my CEREC machine.

One of the annoying aspects of the procedure is what to cover up the screw hole with when imaging the abutment. I have the same issue when I take conventional impressions for larger cases that need to go to the lab. I have used wax, impression material, cavit, IRM, uncured composite. They all had their drawbacks for me.

I was reading the other day about just this thing and got a great tip that I wanted to share on how to deal with this exact issue. The answer? Plumbers tape. You heard me ... plumbers tape.

I have no use for plumber’s tape at home since I can't fix anything. We have a rule in my house: don't ask me to fix anything in the house unless you want the final product to look like a tooth!

I know nothing about fixing things, especially plumbing, but I do use the plumbers tape for anterior composites all the time as a separating medium from the adjacent contact. I tried it out today on a case and it was perfect. Plumbers tape is almost rubbery. You can condense it into the opening of the abutment or the transfer coping and take your impression. When you are done, just take an explorer and pull it right out. No mess, nothing getting stuck in the access opening or over the screw. It’s fantastic. Give it a try.

Removing the Sprue

Sameer Puri (cerecdoctors.com co-founder) — Wed, 11 Jan 2012 15:48:30 -0700

One of the questions I get asked frequently is what’s the best instrument to remove the sprue from the restoration when it comes out of the milling chamber?

Well, there are a lot of good ways, but I thought I’d share something that we started using at the Center recently for the CEREC courses. The Alpen polishers from Coltene Whaledent. I use the coarse wheel on a slow-speed straight hand piece at about medium speed to remove the sprue. These burs handle nicely and I would imagine this wheel would last a long time given that it will remove a sprue in just a few seconds.

Once you remove the sprue, you basically polish up the restoration prior to stain and glaze. I’ve included some product shots for reference. If anyone wants to try them, they’re available through your Patterson rep. Good product. I liked it.

[image:a1.jpg]

[image:a2.jpg]

[image:a3.jpg]

[image:a4.jpg]

The only argument against partial coverage

Armen Mirzayan (cerecdoctors.com co-founder) — Tue, 10 Jan 2012 12:13:38 -0700

[image:onlay.jpg]

I love the idea of partial coverage restorations: Being conservative and less invasive! But I hate seeing some of these restorations where there now is obvious decay in the interproximal area of the wall we did not reduce. Eventhough we made every effort to check for caries at the intial placement, there are times where they go undetected and surface years later. This is one of the few arguments against partial coverage. What adjuncts do you use to make sure the tooth structure you leave behind is not compromised?

Thank You, Mr. Zimmer

Peter Gardell (Faculty) — Tue, 10 Jan 2012 08:18:28 -0700

The year has come to an end, and it was touch and go for awhile. The normal week-before-Christmas cancelations didn’t come, but of course all the emergencies came out of the woodwork. Five long days, from morning to night, it was bananas.

Broken teeth, people in from out of town, and the following week I am to be out of the office. The perfect storm that CEREC can help tremendously.

One particular case that stands out and makes me publicly thank (Sirona’s Manager of CEREC software) Mr. Ingo Zimmer was a broken crown I did a few years ago. The patient was back in town to visit her family. I got her to come in at 6:30 a.m. prior to my other patients, and proceeded to redo it. I proceeded to do the visit as normal. Give a block, apply Liquid Reference, take buccal bite and opposing, and in this case I took a pre-op even though I was planning on utilizing Biogeneric.

I took the pre-op because:

I was trying out a new workflow
I wanted to copy an old PFM with a fractured DB cusp
No real reason

I removed the old PFM and the recurrent decay that extended pretty far sub-G, rebuilt a core and refined prep. Nothing out of the ordinary, and things looked good, just took some time to get this completed. Rendered the proposal and looked from the buccal and saw my marginal ridges were way off. Then I looked at the clock and saw that the appointment time for my next patient was quickly approaching. In my sleep-deprived state, I messed up the buccal bite and didn’t pick it up.

What to do? Re-image buccal bite and possibly the prep and opposing? Guess at the occlusion and grind it in? But this would take time. Then it hit me I had the extra folder! Even though I was doing Biogeneric I have the flexibility in 4.0 to do so many things efficiently. I could edit restoration and turn it to Bio-copy if I wanted. In this case, I just overlaid the Bio-copy folder on the virtual model and used that to establish the occlusion. By taking 30 seconds to take the Bio-copy folder, I save a bunch of time in the long run due to my missing a good buccal bite.

So the answer is C. But I was real lucky that I did do the extra imaging. The extra folders help add flexibility to an already powerful system

Thank You, Mr. Zimmer.

How would you Prep?

Mike Skramstad (Faculty) — Mon, 09 Jan 2012 07:41:50 -0700

One question I get very often from people is, "How do I design my preps for CEREC restorations?” When I hear this question, my mind immediately goes back to dental school – how we are programmed to think a certain way... an onlay looks like this, a crown looks like this, etc...

I completely understand this line of thinking, because I was once there myself. Every full-coverage crown was similar in design. Maybe you prepped a deep chamfer or maybe a shoulder with a bevel. Whatever your design of choice, you most likely went into that procedure with a plan in place on how you were going to prep that tooth.

One of the great pleasures of practicing same day CAD/CAM dentistry is throwing that philosophy completely out the window. CEREC allows me to be creative on how I approach a situation. I never have a set prep in mind.

I now approach a tooth in a much different way. I start by removing the restorative material and any existing decay, and then I just let the prep "come to me." Every prep is different, just like every tooth is different. Not only can this often be better and more conservative for the patient, but this creative mindset is also much more fun for a dentist.

Take a look at this case and visualize how you would prep this case. There are no right or wrong answers, and many dentist would prep it differently. I will show you how I prepped it. How would you prep it? Feel free to join in on our discussion on this topic here: http://www.cerecdoctors.com/discussion-boards/view/id/8179/page/1

[image:MS1.jpg]

[image:MS2.jpg]

Both of my Bridesmaids are CerecDoctors now

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 05 Jan 2012 22:34:17 -0700

My two good buddies from dental school are cerec users now. Dr. Raj Anand was actually the very first office in the US to have Cerec 3D installed the very first day it was released some 8 years ago, and they have been cranking ever since. My other good friend Dr, Joseph Nguyen, aka, a to the k, Sundance Kid, just had their cerec delivered. He has been watching all the videos on this site and I was elated to get this text from him today:

"Did my 1st Cerec Yesterday. Was awesome and your site had me totally prepared me. Restoration flew in there with minical occl adjustments. So much better than traditional lab."

I can't emphasize how excited I am that they are on board. From our class of 1998, there are now a good number of us in the digital realm. Dr, Brad Drosh, Dr. Eric Martin, Dr. Veena Bhat, and Raj's wife Nisha is also using a cerec in her office. Ask me about Nisha when you see me next time in person and I'll tell you how she discourage my wife from dating me :)

Both Raj and Joe played the role of Bridesmaids for me back in a dental school halloween party. I have worn a dress twice in my life, both at halloweem, and I have to admit it was the most comfortable outfit I have ever put on.

[image:photo_3.jpg]

How Thin Can You Go?

Sameer Puri (cerecdoctors.com co-founder) — Thu, 05 Jan 2012 13:12:17 -0700

I had an interesting observation today when milling out some units for an experiment Im doing on Adhesive Gap - you know the paramters for onlays that so many people understand so clearly (Insert sarcasm here). In milling out some restorations out of the LAVA Ultimate material for this test, I noticed something interesting - how thin the material will mill.

Let me explain - when you mill out a CEREC restoration, there are some left over fins on the block itself. sometimes the fins stay, sometimes they break- we really dont give it another thought in that the amount of remaining porcelain is somewhat errratic.

So I milled the first restoration and lo and behold there were some fins left over on the block. It was interesting to see how thin the remaining material was as you can see from the photo below:

[image:Lava_Ultimate003.jpg]

Yes- as a reference I put a dime behind the restoration to give you an idea of size. The material mills very thin:

What wasnt interesting that only one restoration had the left over fins. What was interesting was that all 5 blocks that I milled had the exact same pattern. Even if you are milling the same file, other materials will break off and sometimes you have a fin left over, sometimes you dont. In this case all 5 blocks had the same effect.

[image:Lava_Ultimate001.jpg]

If the long term luster and shine holds up on this LAVA Ultimate material, I think we have a real winner here. Initial impressions are very promising.

How are the margins?

Richard Rosenblatt (Faculty) — Wed, 04 Jan 2012 10:06:39 -0700

I get lots of questions over the years about CEREC. I honestly think that one of the biggest misconceptions that we have had to deal with is that the margins are not good. The margins are what makes me love doing CEREC. 3M has come out with a new material called Lava Ultimate. It is a nanoceramic, and may be the nicest milling material of all the materials we have available to us. I have been really impressed by it.

I can show post-op photos all day of what a restoration looks like, but I think images of a restoration right out of the milling unit with no resin in there speak volumes. Here is a recent MOL onlay I did on a second molar. I'm pretty darn happy with these margins out of the miller.

I have been using this material on what I was using standard resins for before. For me, it beats placing a ring and band and wedge and praying I have a good contact.

If you do a lot of resins in your practice, you know how exhausting a quad of resins can be. One of these days, try doing it with your CEREC and Lava Ultimate. I've been really happy with my results.

[image:margin.jpg]

When Should You Change Your Burs?

Sameer Puri (cerecdoctors.com co-founder) — Tue, 03 Jan 2012 11:24:06 -0700

In the 4.02 software update, one little feature that we now have is the ability to track how many times the burs have been used. In the Mill Preview, in the Restoration step menu, prior to hitting Start to begin the milling, you will see (as indicated by the arrow) the number of mills each bur has. This allows you to keep track of the bur usage and change it out regularly.

[image:Sam 1.jpg]The question that arises is how many times should you use a bur before you swap it out? There has been a lot of research done on this internally by Sirona, and the consensus is that after about 20 mills, you should swap out your burs. There is a tremendous amount of wear after 20 mills, and not only does it affect the time it takes to mill (your indicator says six minutes to mill but it actually takes eight – this is a sign of worn burs) but you can have increased chipping at the margins. Worn-out burs will tend to chip your restorations and leave a slightly rougher surface if you push the limits with them milling. So once you hit 20 mills, change out your burs. If you are at 18 mills and one bur goes bad, change them both out. Keep things consistent and simple.

Avoiding Cement Sepsis

Jeffrey Caso (Faculty) — Fri, 30 Dec 2011 10:20:39 -0700

Cement sepsis is now thought to be a leading cause of peri implantitis. It will lead to bone loss around an implant and ultimately to total implant failure. This iatrogenic problem is easily preventable. Avoiding intraoral cementation is the key. This is simply accomplished by fabricating screw-retained implant crowns wherever possible.

Fabricating cement-retained implant crowns with CEREC is simple and predictable. Fabricating screw-retained implant crowns is also very easy and makes the placement visit fast and enjoyable. This is a procedure I tend to do in two visits, which makes this totally stress-free. It's a total win/win for both the doctor and the patient.

Simply, I take a fixture-level impression and images of the opposing arch and buccal bite, pour up a soft tissue, place the appropriate abutment and adjust it as needed. I image the abutment and design the crown as usual. I make the restoration transparent, and using the Form Minus tool, I make a hole directly over the screw hole in the abutment. I mill the crown, finish the screw hole by hand and complete the crown. Then I cement the crown to the abutment and thoroughly clean up the extruded cement.

At the place visit, I just unscrew the healing cap and screw in the restoration and abutment as one unit. Now, surely there are more nuances to this technique than I have listed. After a few, you will find so many shortcuts to make your life easier. Challenge yourself to do this and you will be totally convinced that this is a fantastic way to do dentistry. Most importantly, you will remove the risk of the dreaded cement sepsis.

There are multiple threads on the cerecdoctors.com discussion boards to help you through the learning process, as well as videos to visually walk you through. CEREC and implants are a match made in heaven. We have the accuracy and the materials to make fantastic restorations. Do it and make dentistry fun.

One more thing to mention: Using the InLab software and fabricating a custom abutment will also help to avoid cement sepsis. The custom abutment will raise the cement margin to be at or just slightly below the gingival level. The crown is then cemented, and the extruded cement is easily cleaned up. Both ways work well. Do what you feel comfortable with.

Should I save or should I throw?

Richard Rosenblatt (Faculty) — Thu, 29 Dec 2011 13:07:19 -0700

I started to hum the song, "Should I Stay or Should I Go" when I was thinking about this blog topic. I blogged last week about being able to salvage a case on a patient who had a broken veneer and came in to my office to fix it. As I was writing the blog I had a patient call that I did a case on about 18 months ago. This is an elderly woman who had a tooth that had a very guarded prognosis. It was #7, it had large decay near the nerve and there was not much tooth structure left to bond to. There was a good amount of bone loss, but her daughter really wanted to save the tooth as long I could. I told them I'd try and do a build-up and crown and see what I could do. I did the case last year and all seemed well. I had seen her for a few recalls and it was holding up fine. They called last week and she broke it. When she came in, it appeared that there was a de-bond. The buildup I did was pristine. I decided that I'd find the old case on my CEREC machine and just mill it and see if the margins were ok. In about 10 minutes, I was able to take the crown out of the milling unit, try it in and have a perfect fit. I was so happy that I saved the case. It was a time-saver for me as well as for my patient. We were able to get her out of the office in less than 30 minutes, start to finish.

This story made me think about the question, "Should I have or should I throw?" Should I save all my old cases on my machine or should I delete them? I have to say that this kind of thing has not happened to me often. When bonding, you normally would not be able to just re-mill. There would likely be some re-prepping to get the old porcelain and resin cement off the tooth.

From time to time, as in this case, you will get an ideal case to re-mill. Another instance of when this has happened to me over the years is with implant cases. I have had about three in the eight-plus years I've been doing CEREC break. This was mainly because I was using conventional porcelain blocks over the metal abutment. There was no choice early on in my CEREC career. The great thing was, when these restorations failed and the patient called me to tell me their crown broke, I was able to mill and characterize a new one by the time they came into the office that day and it fit perfectly over the metal abutment.

I do not feel that my machine is slowed down any by keeping the files. After a few years, I have saved them to an external drive just in case, so if they are removed from my machine, I still have them. If you ask me if you should save all your cases, I say, "If you save you'll avoid trouble, and if you throw there will be double." Terrible Clash parody, I know, but save your cases. In my opinion the pros definitely outweigh any possible cons.

Misconceptions About the Shortened e.max Cycle

Sameer Puri (cerecdoctors.com co-founder) — Wed, 28 Dec 2011 15:14:29 -0700

There are a lot of misconceptions, hyperbole and misunderstandings regarding the shortened cycle for e.max, and because this topic keeps coming up again and again, I thought it appropriate to dedicate another blog post to it.

I want to take this opportunity to review some facts, and let the folks make their own decisions regarding the shortened cycle and whether they want to use it or not in their practice. We as clinicians should always heed manufacturer instructions, however, sometimes it makes sense to read between the lines.

First - here is a blog post that I did a while back on this topic that addresses the strength issue:

I had the opportunity to be the opening keynote at a CEREC conference in Quebec, Canada. The event was amazing and it was absolutely brilliant how the entire Patterson Canada team came together to do this event. I've attached a brief video of Friday evening's festivities to give you a glimpse of how beautifully executed the symposium was.

There were some great speakers at the event, one of them being Dr. Fasbinder who I've had the pleasure of knowing for years now. He is a researcher at the University of Michigan and one of the most knowledgeable people I know when it comes to CEREC materials. We started discussing one of my favorite topics: the shortened e.max cycle.

Dr. Dennis Fasbinder presented some data on the fast fire. According to his data, you have a roughly 20% loss of strength with the fast fire. His data showed that at a 28-minute firing cycle, the strength was 476 mpa. At 19 minutes it was 456. At 12:40 it was 378 and Empress CAD glazed 177.

When Dr. Paul Child originally did the study, he found no loss in strength. So best case scenario you have no change in strength; worst case scenario you lose 20%.

Dr. Fasbinder also stated that in his numerous ongoing clinical studies, the worst success rate with ALL materials is 96%.

He and I were at dinner and we had a great discussion on how strong is strong enough. In other words, if I have a weaker material (VITA, Empress) and the lowest success rate with those materials is 96% in his studies, then isn't a supposedly "weaker" e.max with the shortened cycle at 378 mpa strong enough?

My contention remains that for routine work, the roughly 8-18 minutes saved in the fast fire cycle is well worth the loss of strength (even if its 20%). That 378 is still more than twice as strong as anything else.

I've asked Dennis to come on the site and discuss this as he feels that there are enough users here to collect some real world data to see if the 378 in his data is a big deal or not.

To me, loss of strength is not a reason to not use the shortened cycle at all. The restorations are "strong enough" in most routine applications. Dr. Russell Giordano has done a study similar to Dr. Paul Child’s study, where he found no loss of strength in e.max. so with three independent studies, two found no loss of strength, one found approximately 17 percent loss of strength from the 19 minute to the 12:40 cycle. So if you average the three studies, you have about a 5 percent loss of strength when you go to the shortened cycle.

The next area of contention is the incomplete conversion of lithium metasilicate to lithium disilicate when you fire the restorations. This conversion of the meta to the di is what causes the restorations to change color as well as gain its final strength. One may feel that if there is incomplete conversion in the shortened cycle. This may be interpreted as a problem.

However, let’s look at this conversion and look at the facts:

Yes there is incomplete conversion of the meta silicate in the 12:40 cycle. However, there is incomplete conversion at the 19-minute and 26-minute cycles as well. In all the cycles, some level of meta silicate remains in the restoration.
The only side-effect of the incomplete conversion appears to be a slight color modification on e.max LT blocks – as reported, the restorations look a bit "bright" – there is no effect on color on the e.max HT blocks.
Even with the incomplete conversion, there appears to be virtually no loss of strength (5 percent, as stated above)
Lithium metasilicate causes no damaging effects to the body – meaning it’s not as if your patients are going to develop any abnormal symptoms from metasilicate in their restorations.

So if you look at the facts, other than a slight color issue with LT blocks and a slight loss of strength, using the 12:40 cycle seems to have no ill effects. As a clinician, what you have to decide is when the seven to eight minutes of time savings is enough for you to use the shorter cycle. If time is not an issue, by all means use the 19 minute. But clinically I’ve used the 12:40 for several years with no issue whatsoever.

Does this mean that for the future we are completely safe? Don’t know. Until more data comes out, we have to approach with caution, and as I stated above, we should always follow manufacturer recommendations. But you also have to use your clinical judgment.

I leave you with one thought – Let’s assume for a second that you do lose significant strength at the 12:40 cycle. A weaker restoration seems to be the big worry here, that the crowns will break prematurely. My question then is, why are you still using Empress and Vita? An e.max at 12:40 is still twice as strong as anything else. And as Dr. Fasbinder stated, the worst-performing material in his studies still had a 96 percent success rate.

My two cents: I have used this cycle without fear for several years now, thanks to Dr. Child and Dr. Giordano's research. The time savings to me are significant enough where in a busy practice I would not hesitate to use the 12:40 cycle. I know there are speakers and trainers out there proclaiming the end of the world if you use this shortened cycle. I just wonder if they will be as willing to admit they were wrong as loudly if and when Ivoclar ever does change the times officially.

Treating Holiday Emergencies with CEREC

Richard Rosenblatt (Faculty) — Wed, 21 Dec 2011 15:46:42 -0700

As the end of the year comes, we get all kinds of emergencies. I always find that the broken front tooth or front crown seems so much more prevalent than other times of the year.

Here is a case that is a few years old, where the patient was going out of town for the holidays and broke an existing veneer. He had the broken veneer and brought it in with him.

I was able to bond it lightly back onto the tooth and then take some images of it with my CEREC machine that I used to copy exactly what was in his mouth. I then prepped the tooth a bit to clean it up, and took a new image to make a new veneer. I used a Vita block to match his existing porcelain and with just a bit of glaze I was able to get a great match and send him on his way.

This is the kind of service that is not possible without having the ability to mill in your office.

I took a three-year post-op image of the tooth. The patient could not be happier with the result. He was so amazed by the technology and service provided by our office. A nice way to wish a patient happy holiday!

[image:rich 1.jpg][image:rich 2.jpg][image:rich 3.jpg][image:rich 4.jpg]

Just because you can...doesn't mean you should

Jeffrey Caso (Faculty) — Tue, 20 Dec 2011 13:22:03 -0700

Being able to design multiple units simultaneously is probably the greatest feature of the 4.0 software. Recently there was a discussion regarding ways to approach a case where the doctor was treating both teeth numbers 3 and 14. Basically, there are three ways to approach a case like this. The options are interesting.

- Image the full arch of the pre-operative situation. Image the full opposing arch. Image the full arch after the teeth are prepped. Image the buccal bite. Wow, that's a huge amount of work which will require a great deal of effort for both the doctor and the patient. Additionally, it will tax the resources of the machine. There are many issues that can occur to make doing it this way quite challenging.

- Image the right side pre-operative situation and then skip to the left side and image that. Go to the image catalog and ignore the images of the left side. Do the same for the opposing and ignore the left side. Do the same after both teeth are prepped and once again ignore the images the left side. Finally, take a buccal bite image of both sides and ignore the left side. Sure, you can see where this is going. Design the right side and send to the mill. Reopen the case and re-activate the ignored images and ignore all of the images for the right side. Move forward designing from this point. That's some pretty advanced image manipulation and some trickery. It's good practice for multiple adjacent units, but you can get in trouble very fast. The bottom line here is that you get slowed down at the cementation step because you need to isolate and cement separately.

- Finally, you can treat each tooth as an entirely separate case. In one instance of the program, image the right side completely and in another instance image the left. Once you finish designing one side, send it to the mill and design the opposite side. This is simple, reliable and fast. It's not glamorous and surely doesn't take advantage of the best part of 4.0, but it works well.

I am sure there are some who will use each way and feel that that's the best. There is no right or wrong here. As we all get used to the 4.0 software, just keep the basics in mind. That includes thinking through all of your options ahead of time and choosing the one that you feel most comfortable with. The end result will be the same for all options. It's the means to the end that has the ability to stress us out and change our day negatively.

Proper preplanning is the key to happiness.

Avoiding Microfractures

Sameer Puri (cerecdoctors.com co-founder) — Mon, 19 Dec 2011 16:03:58 -0700

On one of the recent discussion threads, there was a question about sandblasting the internal of e.max restorations and whether or not that may cause the restoration to fail prematurely.

After coming out of the oven, there is sometimes residue left over from the firing process. What’s the best way to remove this residue? Can you sandblast the internal of an e.max to clean out the debris?

Any time you alter the internal of a piece of porcelain, you risk microfractures that can spread.

Microfractures start out small but over time can spread and cause eventual failure of the restoration. If I take a handpiece to the outer surface of an e.max, chances are that the glaze or polishing the surface will remove the defects that I have created, and keep them from spreading.

On the internal however, because we don’t polish or glaze, there is a chance that the defect will spread. Whether that defect is created by a handpiece or by a sandblaster is not important – what is important is that we avoid causing any unnecessary stress to the porcelain itself. With weaker porcelains the stress can spread more quickly. With e.max – because of its strength, it typically takes longer for the stress to appear.

The bottom line: To avoid these microfractures, avoid altering the internal of the restoration at any cost. If you do have debris, try removing it with a tooth brush. If you must use some form of a sandblasting device, limit it to a small microetcher with the 25 microns of powder. Do not under any circumstances use an air abrader that has large particle size or has high pressure.

By minimizing any contact with the internal of the restoration, we minimize the potential for microfractures and the eventual failure of the restoration.

There is a great discussion on this topic happening here:

http://www.cerecdoctors.com/discussion-boards/view/id/8010

My Top 6 “Things I Cannot Practice Without”

Richard Rosenblatt (Faculty) — Fri, 16 Dec 2011 15:14:59 -0700

As the end of the year quickly approaches, I get questions from other doctors about what things they should invest in for themselves and their practices. I have a definitive Top 6 list of things that I cannot practice without. (I made it six because I really couldn't not talk about each of these six items.) I also have 1 BIG THING on my wish list that I hope to get soon.

My Top 6 list of THINGS THAT EVERY DENTIST SHOULD HAVE:

6.) A DIODE LASER

I love my diode. I use it every day when doing CEREC restorations, when doing cosmetic cases were I'm adjusting tissue height, when doing gingival composite restorations and so many other areas. Some use it for perio. I use it to remove the discomfort patients receive from pathos ulcers. The prices on this technology has dropped dramatically over the last few years and now is a great time to pick one up for your practice

5.) CEREC

I had to include this, of course. I'm sure that many would think this would be No. 1 on my list. Don't get me wrong, I love this technology. The reason it is No. 4 is because I don't use it on every patient every day. It has a great ROI, my patients love it, my staff loves it, it makes me a better dentist and it has re- energized my love for this profession.

4.) ISOLITE

I did a recent blog on the importance of this piece of equipment. I cannot stress strongly enough how important isolation is for the majority of the procedures we do. The reason this is higher on my list than CEREC is because I use it way more on a day-to-day basis. If you don't have one in your practice, get one. You will not regret it!

3.) DIGITAL X RAYS

I could not ever imagine going back to film. Getting my info immediately and being able to see it blown up on my chairside mounted monitor is fantastic. I don't miss processors, chemicals, mounting films and the time it took to get the images. So easy to share info with patients and use it as a teaching tool.

2.) INTRA-ORAL CAMERA OR SLR CAMERA

I think getting a digital camera and taking photos of every patient that comes into your practice is of the utmost importance. A picture tells patients 1,000 words. When you can show an image of a situation in your patient’s mouth and ask the question," Do you see that?" and wait for their answer, they will tell you what is going on or at least ask you about it. I use it for insurance reimbursement, before-and-after images, Invisalign cases and just a baseline when new patients come in. I also use it when I see a suspect area that I want to send for a surgeon for evaluation or biopsy. It is an invaluable piece of equipment in our practice.

1.) LOUPES AND A PORTABLE HEAD LIGHT

I will cancel patients if my loupes break. I have actually done it. I cannot imagine ever prepping a tooth without magnification. About five years ago I added a mounted portable light to my loupes and I could not believe how much more I could see. I have not turned on my overhead light in years. You have a flood of light wherever your eyes look. This combination of magnification has taken my dental skills to a much higher level. There are lots of good options for both loupes and lights. Get a 30-day trial and use them. An absolute must have for EVERY dentist, in my humble opinion.

Now for my wish list, I have one item on my brain.....GALILEOS. That will for sure be my next big present to me and my patients. I hope the next time I put out Must-Have list, I can give my feedback on what GALILEOS has done for me, my practice and my patients.

Multiple Restorations with 4.0

Sameer Puri (cerecdoctors.com co-founder) — Fri, 16 Dec 2011 07:10:52 -0700

So, the neat thing in 4.0 is the ability to do multiple restorations. Not only multiple restorations on the same arch, but on opposing arches as well. Beta tester extraordinaire Dr. Bobby Chaggar ran some tests on which order you should propose the restorations.

Which is better?

Doing the mandibular first or the maxillary?

What about when you are doing two restorations in the same arch? Obviously you can propose both together, but sometimes, time-wise, it’s better to do one at a time to take advantage of the time savings.

Regardless – during beta testing, what Bobby found out was that if you are proposing two restorations together, propose the distal before the mesial and propose the mandibular before the maxillary. This will give you nice results and it will result in proposals that require the least amount of work. There are some great videos on this on the site that you can check out that go into the details of what happens when you don’t propose things in the proper order. Review them, and you will learn a ton about how the software functions:

Quadrant Rules in 4.0

Proposing Two Restorations – Mesial or Distal First?

Learning Never Gets Old

Jeffrey Caso (Faculty) — Wed, 14 Dec 2011 14:37:07 -0700

One of the things I really love about CEREC and cerecdoctors.com is that rarely a day passes where I don't learn something new. I think it's great when a topic or process that is unclear to me suddenly just makes total sense. Sometimes it's the repetition of hearing it several times, but usually it's just the way the topic is presented or discussed that just hits a chord.

Recently there was a discussion board thread that did such a thing. Not an earth-shattering subject, maybe not even a topic that will change my technique at all. It is more like a clarity or understanding that just drives a point home. The discussion was about design techniques and when to use them. It was more of a poll with people chiming in with their opinions.

The general consensus was:

BioCopy for special posterior situations, like crowning a tooth that is a partial denture abutment or resides under an orthodontic aligner or night guard. Anteriorly, it is the design method of choice when we want to copy teeth with favorable shape and alignment, mocked-up situations or temporaries made to ideal specifications. That's generally the way it's been for a long time. Nothing really new here.

Biogeneric Individual for most posterior applications not listed above. That, hands down is what most are doing. Using BioCopy posteriorly was the way most did it years ago, but the Biogeneric process has gotten so good that most are now using it almost exclusively. Granted, there are exceptions to every rule, so use your clinical judgment and what you are most comfortable with. Using Biogeneric designs anteriorly can be done, but it can be a crap-shoot at times. For this we have other choices.

Biogeneric Reference is the best reason to avoid Biogeneric Individual in the anterior, and here is the thing that gave me clarity on the subject. Like I said, not-earth shattering, but makes sense for me. Use Biogeneric Reference anteriorly to copy the anatomy of a central or lateral. This will avoid the need for a mock-up to allow for Biocopy or the roll of the dice with Biogeneric Individual. Does NOT use Biogeneric Reference in the posterior to, say, copy a premolar when designing a molar. Sure it will work, but why use it when we have such a strong Biogeneric process? The exception might be when we have a lone molar or a bunch of blown-out adjacent teeth with limited, valuable data to base a proposal off of. Mostly however, I now think of Biogeneric Reference as an anterior design option that works great.

I may change my mind in the future, and that's ok. For now, that's what I took away from that thread and that is why I love what I do. The learning never ends and never gets old as long as you are open to accept it.

Saliva, Tongues, Cheeks and Respiration

Richard Rosenblatt (Faculty) — Mon, 12 Dec 2011 16:02:45 -0700

As I talk to docs all over the country, both CEREC users and non-CEREC users, I get lots of questions about the CEREC process. The two most common are about powdering and bonding. These are probably the two most technique sensitive parts of the CEREC process. This does not mean that either is difficult, but steps must be taken to make sure that both are done well.

The first question that I ask these doctors is, "What are you using for isolation?" Many times, the standard answers are cotton rolls and dry angles, and four-handed or even six-handed dentistry to keep saliva at bay. To me, this is the root of the problem.

When powdering, we have a few arch enemies: saliva, weeping tissue, cheeks and tongues. These things really tend to toss a monkey wrench into what we are doing, just as they do when taking conventional impressions. It is hard to have an assistant try and control that overly active tongue, that cheek and lip that seem to want to purse when we put anything inside the mouth, and the excessive salivation that occurs in many.

These same issues also seem to rear their ugly heads when bonding. Some docs will tell me that they have the best chairside assistant ever and that they have no problem overcoming these barriers. I tell them that is great, but who is stopping that patient from breathing? Every time they exhale, there is moisture and likely a contaminated bond. This is why isolation is so important.

I know that when I mention the words “rubber dam” to doctors, they look at me as if I have spoken in an ancient language that they do not understand. I tend to get that look myself. I like to use the rubber dam on occasion, but also struggle with it for larger cases. I aspire to be like some of the CEREC docs out there who use it on every procedure (Andy and Russell, you know I'm referring to you!).

I have a list of things that I cannot practice without. One of those is the Isolite. This eliminates all the struggle of saliva, tongues, cheeks and respiration that we run into with every patient. I'm always amazed at how many people have not even heard of this device. It has been a practice-changer for me. This product hooks up to your high-speed suction and has disposable mouthpieces that keep away the cheek and tongue, and simultaneously suction the area. It allows you to work on upper and lower arches simultaneously. I use it for CEREC (even with full-arch impressions!), restorative, sealants, hygiene and sometimes even during extractions and implant placement. I cannot recommend this piece of equipment highly enough. You can get more info about it at isolitesystems.com. For those of you out there struggling with powdering and bonding, you can thank me later!

Dental Anatomy

Jeffrey Caso (Faculty) — Thu, 08 Dec 2011 16:31:47 -0700

One of the first classes that we all had in dental school was Dental Anatomy. Granted, we like to forget those days, but as horrible as they were, what we learned was very important. The real problem with learning Dental Anatomy so early in our schooling was that we learned so many things and really didn't know what was truly important to remember and what wasn't.

I remember my first operative procedure. I knew ahead of time that it was a class 1 amalgam on tooth number 14. I studied up on the anatomy and spent probably 30 minutes carving the amalgam. The instructor sat down to check it and asked for the largest spoon excavator that I had and a wet cotton pledget in a college plier. He immediately scooped out all of my painstakingly placed anatomy and smoothed everything down with the cotton pledget. He never explained why, and I soon realized that most amalgams looked the same way. It was a lesson that made no sense and there was no reason for it.

Fast forward 25 years, and we as CEREC dentists now wear an extra hat. We are dentists and also lab technicians. It is up to us to know our dental anatomy cold and be able to place it virtually and manually. Sure, we stare at teeth all day long, but mostly what we see is that terrible-looking scooped-out amalgam. We need to make sure that we are up on our anatomy for each and every tooth.

Recently I began to take a greater interest in placing very accurate primary anatomy. It makes our restorations look better and provides a home or our stains, which then makes them look great. Grab your old anatomy book and take a look. It doesn't matter how old the book is, dental anatomy is unchanged. You might be surprised at some of the things that now, as seasoned dentists you see. You are able to cut to the chase and see what is most important.

I plan to make it even easier for you to brush up on things. I think it is so very important that I am in the process of making a series of videos on dental anatomy. After a review, I will show you my technique to place and refine correct anatomy virtually. It adds less than a minute of design time and really makes our restorations look great.

As soon as I have the first ready, I will post it for you. It's not the most riveting subject, but one that is very important to our daily practice of dentistry.

Perspective

Peter Gardell (Faculty) — Mon, 05 Dec 2011 14:53:24 -0700

A Sunday afternoon drive through central Vermont. The sun was up and it looked like a beautiful day. On the surface it was a beautiful day. But on closer look, you could see that things were different than they were in August. Hurricane Irene has changed the people and the countryside.

Many of the main roads have fresh pavement and new guardrails; a tremendous amount of work has been accomplished in the few short weeks since the storm, but many of the side roads were still roped off.

The normal stops were closed, when you would think they would be open and getting ready for the “busy” season that comes when the ski areas start to open. As you look closely, you can see they are actually more than closed, they are destroyed, having succumbed to the forces of the water.

You look up the hillside where the streams and brooks run down, and they look like lacerations and gashes violating the Green Mountains.

The lakes don’t have that clean, mountain-lake look; they look more like chocolate milk. Large trees sticking out of the water that weren’t there before. At the sides of the rivers you see bare rocks, missing trees and the rough-hewn timber that held up a barn for 150 years. You see remnants of what was, destruction of peoples’ lives and livelihoods.

It’s scary how in today’s world – where we think we can control so many things – we still are at the mercy of nature.

At this time of year it is important to remember what is really important in this world.

Our families, our friends, their safety, health and happiness.

Can’t Say This Enough: Save Early. Save Often

Sameer Puri (cerecdoctors.com co-founder) — Fri, 02 Dec 2011 15:19:29 -0700

In 4.0, if you are doing Biocopy – the new name for Correlation – you might find that the machine is locking up on you, especially with older systems and with larger cases. You might be imaging for a quadrant, and all of a sudden instead of hitting the arrow and going from the acquisition step to the model step, the software locks up and you lose all your images. Not much fun.

By default, the 4.0 software saves once you go from the Acquisition step to the Model step, and the second time, it saves automatically is when you hit Mill. So with Biocopy, you might have spent the last 10 minutes doing your design only to have a hiccup and lose your entire case, design, images and all.

My suggestion is as soon as you are done taking your images – hit Save. Once you marginate – save again. Don’t forget to do this, or you will lose all your information.

As we say in the courses: "Save Early and Save Often."

Scouting Colleges with My Son

Peter Gardell (Faculty) — Thu, 01 Dec 2011 15:36:56 -0700

Fall time with a high school senior in the house means one thing: College road trips. Exciting and daunting at the same time. Your child looks to you for advice because they don’t want to make a “wrong” decision. Or, in reality, what they are looking for is to be told what to do. It’s hard, but now is the time for the parent to transition to the role of a spectator. You have to hope that the foundation that you as parents have laid down is a good one, and allows your child to make a wise and mature decision.

My son Andrew and I set off Columbus Day weekend, leaving early enough to avoid the holiday traffic. Attempts were made at small talk, but the headphones quickly went on and episodes of Family Guy occupied his time. It became apparent that the lack of conversation was not due to rudeness, but to nervousness. He was entering into the unknown, being pushed into the adult world. At the same, time Mom and Dad were being pushed into letting go and hoping for good decisions

Time ticked away and miles turned on the odometer; after a few episodes of Family Guy (well not a few, more like eight), some questions started to come from the passenger seat. (Yes, I was driving, since this was the son who trashed the brand new family car a few weeks ago.)

“What is tomorrow going to be like? What are we going to do?”

I had to answer truthfully: “I don’t know. We have to show up and see.”

Things are much different than I remember when I looked at schools. To be honest, I didn’t actually look at schools. I applied to a few, was accepted at fewer, and when I made my decision I was denied by the parental units. Why, I asked. “Because too many of your friends are there.” That day I learned an important lesson. Pocketbook trumps independence every time. But turns out they were right, and it was a wise move to go where I went.

Walking into the student center was an eye-opening experience. This school wanted to give an experience that you would not forget. The campus was polished; the students attentive to all questions. This was an engineering school, and when I walked into the labs, my jaw dropped. Being a CEREC dentist, I love tech stuff, and the tech stuff they had was tech stuff on steroids.

Indy cars, off-road vehicles, electric cars, radio-controlled drones, robots, concrete canoes and metal bridges – all projects for collegiate completion. Where can I sign up? This isn’t what I remember about college, but then again I studied biology, not engineering. Then to top it off, this school has a ski team and was interested in Andrew’s skiing credentials.

My son was happy, and on the afternoon drive home, there was less Family Guy and more conversation. He asked if I liked the school and I told him, “It doesn’t matter what I think, what did you think? How did walking around the campus feel?” I knew he was excited, but I could also see he was very tired; he didn’t sleep much the night before since he was so wound-up over this.

On the beautiful drive home, we saw points of interest that I remember passing during a summer 30 years ago. It made me think about the passage of time. I have to have faith in Andrew; he was asking the right questions; he is focused on what he wants to study.

Another morning and another open house and Andrew started to take the lead with questions. I started to get the feeling he was ready to start picking his path and determine his future.

Erosion as Applied to CEREC

Sameer Puri (cerecdoctors.com co-founder) — Wed, 30 Nov 2011 16:09:43 -0700

This past week, I had the opportunity to sit through the Treating the Worn Dentition course with Dr. Frank Spear and the rest of the Spear faculty. He showed some amazing examples of systematically restoring severe wear cases. There were many pearls to take away from the seminar, but one in particular is burned in my mind.

If a patient is going to brux and grind – and we decide to restore that patient, chances are they will not stop bruxing no matter what type of porcelain we put on the teeth. I know there is a ton of controversy on bruxing and wear, but suffice it to say that I agree with Dr. Spear: If that patient has worn down their teeth, worn away the linguals or just ground stuff away, chances are that they will do the same to the porcelain that we put on them. Changing their occlusion or putting them in a night guard will cause them to simply grind on the guard, but won’t stop their destructive behavior.

But you have to differentiate patients who have pathologic wear from those patients who have some form of erosion going on – whether it’s from GERD or other some form of acid, such as the soda they are drinking. These patients will need to be treated very differently. How do we determine if a patient has worn their teeth from acid reflux or from simply grinding? Which do you think is going to be safer to treat?

One key that you can look at is the wear facets – are they shiny or are they cupped and dull? Shiny means that the patient has been grinding – and after treatment, they will most likely continue to grind, breaking all that beautiful porcelain that you placed. However, if that wear facet is cupped – not shiny and flat – most likely it’s from some form of erosion or acid damage to the teeth.

The former will be a nightmare for dentists, as you don’t know what the patient will do to your work in the future. The latter is easy – fix the teeth, address the erosive agent and chances are the patient will be just fine.

How does this apply to CEREC? The type of wear and the type of wear facets will play a large role in the material you choose. If my patient has shiny facets, lots of wear – I better use the strongest material with perfect bonding and appropriate reduction. If the patient has wear from erosion, then material strength is not as critical.

A Few Thoughts About Sensitivity

Jeffrey Caso (Faculty) — Tue, 29 Nov 2011 16:23:30 -0700

Post-operative sensitivity plagues us all from time to time. Fortunately, if we understand its causes we can take action to prevent the circumstances leading up to it. In addition, we can use materials developed to stop it cold.

The leading theory of what causes sensitivity in general is the Hydrodynamic Theory. It is simply that movement of fluid within the dentinal tubules deforms the nerve endings in the pulp and elicits pain. This is something we all have learned, and it makes sense. So what do we do about it? Simply, we need to seal the dentinal tubules to stop this movement of fluid.

Let’s start by listing the most common causes of dentinal sensitivity that we as practitioners have some control over. This list came directly from the Heraeus Kulzer website.

Over-etching the dentin
Dehydrating the dentin
Inadequate marginal seal (commonly caused by contamination)
Using expired adhesive
Failure of dentin bonding (not following directions)
Inadequate light cure
Oil contamination from the dental unit
Using cavity liners like Glass ionomer, which can microfracture after placement and separate from the dentin

I will add two more which I feel are important as well:

Incomplete removal of Titanium Dioxide powder
High occlusion

There is so much that can go wrong in dentistry, fortunately we have products designed to help us right our wrongs. Now, don’t misinterpret my remarks. Look at the above list and take every precaution that you can to avoid those errors, but just in case, I use Gluma by Heraeus Kulzer on every vital tooth that I restore. It is 5% gluteraldehyde, 35% HEMA (hydroxyethyl methacrylate) in water. Its main action is to reduce post-operative sensitivity, but it also is a cavity disinfectant and a re-wetting agent or adhesive promoter. Its mechanism to reduce sensitivity is by reducing the permeability of dentin by precipitating plasma proteins to seal dentinal tubules. A study on the Heraeus Kulzer site shows that it actually occludes the tubules up to 200 microns. That’s pretty effective in my opinion.

Well, that’s a great deal of information and a lot to think about in terms of our technique. It was a necessary precursor to understand one thing. As Gluma is compatible with virtually every bonding system out there, the big question is: When in the process do I place it?

Think of it this way: It needs to be placed on dentin that has not yet been affected by the bonding agent. So, if utilizing the total etch technique, apply after rinsing off the etchant. If you are not etching, place it at the start of your bonding process. That’s it! Very simple.

Here is my technique: Isolate perfectly, if using a total-etch technique apply and rinse etchant, apply Gluma, then follow your bonding protocol. If using a self-etch system, then apply Gluma right after isolation. Either way, I lightly dry the dentin, scrub in Gluma for one minute and dry, reapply for one minute and dry and then follow the rest of my bonding steps. I do not rinse the Gluma at all.

You can read more and see the study’s that support this at http://www.heraeus-dental-us.com/.

4.0: Keeping An Open Mind

Peter Gardell (Faculty) — Mon, 28 Nov 2011 15:26:13 -0700

Now that 4.0 is being released and it is different than what we are used to, there are many questions from the members of the CEREC community.

I recently had the chance to work with a few Study Clubs, and have been pleased with the way people are preparing for the future. They are engaged and asking the right questions. You can see that there is some hesitation as they push themselves to go into new territory outsie of their comfort zones. That's a natural reaction.

The 4.0 tools are different - even if they have the same name, they function differently. It is important to keep your mind open. If you are set in your ways it will be frustrating.

If you keep your mind open you will experience faster design times and easier execution of larger multiple-unit cases.

The future is very bright for CEREC dentistry. Invest the time to max out its potential.

Dialing in Occlusion in Biogeneric Copy

Richard Rosenblatt (Faculty) — Wed, 23 Nov 2011 09:08:08 -0700

Biogeneric copy is one of the most powerful tools we have in our software. It allows us to copy a pre existing condition and recreate it both virtually and then via fabrication. This design mode is used for anterior crowns when we have an ideal wax up created and then copy it. We can use it when a patient comes in to our office with decay under an abutment crown. In the past, we would need to tell the patient that not only would a new crown be needed but likely a new partial denture. With biogeneric copy, we can just copy that pre existing crown with its rest seats and guild planes and buccal undercuts and get the restoration to fit under that partial like a glove. A question I get a lot with biogeneric copy is, "how do I dial in the occlusion?" With the new 4.0 software, we have the ability to take buccal bite with biogeneric copy and use that to dial in the occlusion. That is a great option, but the beauty of biogeneric copy is that we only need to take a few images of the pre op condition and then a few images of the prep and we are on our way. I have created a video to demonstrate how to very quickly dial in occlusion in biogeneric copy cases. This video will give you the do's and don'ts on how to create a great occlusion.

Watch the Video

Finding and Correcting Thin Spots

Jeffrey Caso (Faculty) — Mon, 21 Nov 2011 08:48:55 -0700

In transitioning to 4.0 from previous software versions there is a great deal to absorb and to get used to. The basics however are the same and we all find that in a short time we come to realize the genius behind the changes that have been made. Sure things look different and we mourn the loss of some of the tools that we have grown accustomed to. Well, rest assured they all there, just in different more powerful forms and with different names. We all need to accomplish the same result which is a great fitting, great looking and highly functioning restoration. So here is a tip or two to get the job done with speed and efficiency. I initially struggled with restoration thickness and finding my thin spots. The height of fissure line was the tell tale sign of low spots and the scale tool raised that low spot to an acceptable level very fast. That ease and speed came at a price however. By raising the fissure in it's entirety we flattened out the occlusal table and produced an unnatural looking restoration. In 4.0 we can find our low spots very simply. I generally do not rely on the minimal thickness thimble for this. You can, but I find when it is set high, it's poor effect on the proposal slows me down too much. My strategy is to view the restoration from the buccal and then turn the restoration transparent. This will quickly show me where I need to add thickness. Initially, I struggled with the new tool to turn the restoration transparent. By selecting Display Objects from the Side Bar you can then select Restoration. Clicking the tooth inside of the circle can make the restoration disappear and reappear. The circle is what will make the restoration transparent. This is the part that I struggled with. My instinct was to left click and hold the circle and then rotate the mouse around the circle itself. This had some of the desired effect but never seemed to work just right. After experimentation, what I found was by left clicking on the circle and holding the left mouse button down, you had full control of the tool by not rotating but by moving the mouse up and down vertically on the screen. Voila, the tool worked great. Simple, just not so obvious to me in the beginning. Now, viewing the restoration from the buccal and making it fully transparent, I use the tool I probably now use most often as it works so well with just a little practice, the two directional, circular shape tool. It helps to turn on the Cursor Details feature which is accessed from the Analyzing Tools option on the Side Bar and watch the height of fissure measurement while doing this. You can thicken up the thin spots so fast as evidenced by the rising thickness measurement in the box attached to the cursor. In a few seconds you have attained as much thickness as possible and you haven't flattened out the entire occlusal table. This leads to a better looking restoration. As long as you have prepped correctly you can simply bump up any thin spots and rest assured you are providing your patient with the strongest restoration possible. Sure there are many ways to do this but for me this is the simplest and most effective. Give it a try and see what you think.

4.0 at Toronto study club

Armen Mirzayan (cerecdoctors.com co-founder) — Sat, 19 Nov 2011 08:55:41 -0700

Had the pleasure of speaking to about 80 doctors at the Toronto study club yesterday. It is always inspiring to get good feedback and keeps the motivation going. I outlined throughout my presentation the most likely errors someone will make when first using 4.0 with the learning curve so I thought I would outline them here:

Entering the wrong design type by mistake (calling it a crown when it is a partial crown)
Not selecting the correct sized block at the mill phase (placing the wrong block size in the milling machine will delay the process as the machine will kick out an error saying there is something wrong with an instrument / bur when in reality you just put in the wrong block)
Not recognizing that there is no status bar in acquisition phase when models in corelation (biogeneric copy) are being stitched automatically and wondering if they have done something wrong
Spacer at 0 in 3.8 is 100 in 4.0
In quads, placing margins on wrong tooth. Place margin on tooth that is highlighted in gold halo in step menu
Not following protocol and placing model in correct orientation at insertion axis step
Not making sure the patient is biting into maximum intercuspation during buccal bite capture
Control H does nothing for fit. Not in this version or prior versions
Can't have a Cerec discussion without addressing preps. Must prep and visualize how it will mill, getting proper isolation, and proper tissue retraction

Great Partners are Key

Sameer Puri (cerecdoctors.com co-founder) — Thu, 17 Nov 2011 10:42:30 -0700

I just want to make a quick note how important it is to have reliable partners in a business venture. Armen Mirzayan has been that guy for me. We have definitely had ups and downs and have learned more about coding for servers than we ever wanted to know, but if it wasn't for his vision, persistence, and commitment, there is no way we would have taken this hobby to the current platform it is now. We are so excited about the functionality of the new site (our 14th I think) and how it will help foster the growth and implementation of cad cam into dental offices.

So a thank you to Armen, and my question to you: Who is that reliable partner for you?

'Tis the Season

Richard Rosenblatt (Faculty) — Thu, 13 Oct 2011 00:00:00 -0700

It's getting to that time of the year I love. I know, most people love the summer, but I can't wait for fall and winter. I love the change of seasons, the snow and skiing. The other thing that this time of the year means to me is the busy time in my practice. September and October tend to slow down from time to time, but once Thanksgiving comes, my office goes nuts. Everyone seems to want to wait till the end of the year to get everything done that we've been talking about for the last few months. They also want to max out their insurance. This is the time of year that I love to connect with my patients. Sam wrote a blog the other day about the death of Steve Jobs and how apple separated themselves by creating a good product and also customer service. I pride my office on customer service. I love when patients tell me that coming to our office is like visiting family because of the caring personalities of my staff. We make sure to go above and beyond to get to know them and share things about ourselves, too. I make sure that as the end of the year approaches, I send out a letter to all my patients. We pick out a nice fall stationery that people always comment positively on. In this letter, I like to share milestones that staff members achieved during the year. We talk about weddings, births and other great events that happened in our lives so the patients continue to feel connected to our office. I also share things that I personally have done. I talk about the wonderful events that occurred during the year like my daughter's bat mitzvah, my son's graduation from elementary school and the completion of the first year of preschool of my youngest child along with other memorable times. I then go on to highlight courses we have taken to continue to keep our practice on the cutting edge. I talk about new procedures that we have incorporated into the office to improve on patient care over the past 12 months. This is a great time to let your patients know all that you do to continue to bring them the best, most comprehensive dental care possible. I will also remind them of insurance reimbursement ending December 31 and that our practice gets very busy the last two weeks of the year and to not wait because we may not be able to get them in, even if we expand hours some. Use this time of year to stay connected to your patients. Invite them into your world a bit and humanize yourself and your staff. You will be shocked at the response that they give you. It is something that I enjoy very much putting together every year. It is almost cathartic to think about all that positive stuff, especially when we are always reminded of the tough times that we are in. Your patients will enjoy this uplifting read from your practice and I encourage anyone to try it!

Quebec CEREC Symposium (a.k.a. "Fast Fire with Fasbinder")

Sameer Puri (cerecdoctors.com co-founder) — Wed, 12 Oct 2011 00:00:00 -0700

I had the opportunity to be the opening keynote at a CEREC conference in Quebec, Canada. The event was amazing and it was absolutely brilliant how the entire Patterson Canada team came together to do this event. I've attached a brief video of Friday evening's festivities to give you a glimpse of how beautifully executed the symposium was. There were some great speakers at the event, one of them being Dr. Fasbinder who I've had the pleasure of knowing for years now. He is a researcher at the University of Michigan and one of the most knowledgeable people I know when it comes to CEREC materials. We started discussing one of my favorite topics: the shortened e.max cycle. Dr. Dennis Fasbinder presented some data on the fast fire. According to his data, you have a roughly 20% loss of strength with the fast fire. His data showed that at a 28-minute firing cycle, the strength was 476 mpa. At 19 minutes it was 456. At 12:40 it was 378 and Empress CAD glazed 177. When Dr. Paul Child originally did the study, he found no loss in strength. So best case scenario you have no change in strength; worst case scenario you lose 20%. Dr. Fasbinder also stated that in his numerous ongoing clinical studies, the worst success rate with ALL materials is 96%. He and I were at dinner and we had a great discussion on how strong is strong enough. In other words, if I have a weaker material (VITA, Empress) and the lowest success rate with those materials is 96% in his studies, then isn't a supposedly "weaker" e.max with the shortened cycle at 378 mpa strong enough? My contention remains that for routine work, the roughly 8-18 minutes saved in the fast fire cycle is well worth the loss of strength (even if its 20%). That 378 is still more than twice as strong as anything else. I've asked Dennis to come on the site and discuss this as he feels that there are enough users here to collect some real world data to see if the 378 in his data is a big deal or not. But as far as I'm concerned, I have had no clinical issues with the fast fire at all. [CERECQuebec.MOV-v-]

CEREC Assistants Lecture

Richard Rosenblatt (Faculty) — Tue, 11 Oct 2011 00:00:00 -0700

What a great time I had in Minneapolis last weekend. Thursday night, I shared my tips and tricks lecture with a packed house in the beautiful new Patterson branch in Eagan, Minnesota. The crowd was great and I always have fun sharing my CEREC experiences with peers from around the country. Friday was the first of what I hope to be many assistant training lectures. There was a full house of assistants looking to learn all about CEREC 4.0 and how to design, mill and characterize restorations. I have been working so hard with Pete Gardell and Darren Greenhalgh to put together a lecture to help assistants understand CEREC fundamentals. We want to teach them to understand what good versus bad imaging is, what good versus bad powdering is and how to recognize preps that will and won't work with the machine. The day started off with about 90 minutes or so of lecture and then a demo of how to do a restoration from start to finish. The assistants were then on the machines, designing and milling restorations of their own. We discussed partial coverage restorations and then they were right back on the machines designing and milling those. We had them designing and milling crowns using the biogeneric copy function. We tied up the day with tips and tricks on cementation, machine maintenance and changing broken burs before ending with a final Q&A session. It is really fun to teach people who really want to learn. You can tell during classes like this to what extent CE and knowledge really energize and empower people. As an instructor, there is nothing better than witnessing the light bulb switch on for an individual during class. I have to thank Paula Nelson, Don Bell and Ivoclar rep Mike Matzke for providing a great presentation on materials, customizing restorations, and properly preparing the tooth and restoration for bonding. Ivoclar provided blocks and kits to allow all participants to characterize both their empress and e.max crowns. A lot went into this class and I could not have done it without the help of the folks in Scottsdale like Shayna, Stacie and many others, along with the belief and backing from Kaleim Manji and Sameer. It was a memorable day for me and I hope those that attended the course enjoyed participating as much as I enjoyed teaching. I hope those assistants continue their learning journey with CEREC and maybe one day I will see them again at an advanced training course at Scottsdale Center. For me, I can't wait for the next class!

One Bad Apple...

Jeffrey Caso (Faculty) — Mon, 10 Oct 2011 00:00:00 -0700

Today was a day that both I and the entire staff has been dreading for a while. There is this one patient who just isn't very nice. She isn't nice on the phone, she isn't nice when she gets here and she just isn't nice to me. The last part I can handle. It's the way she makes the staff feel that upsets me. They work hard and do a great job. The impact that one negative person has on a person's self-esteem and the morale of the office is huge. Seeing her name in the appointment book has been downright depressing. So, why do we deal with her at all? Why not just send her a dismissal letter and be done? Well, it's more complex than just that. Starting my practice from scratch more than two decades ago has been a wonderful thing for the most part. The down side is that so many patients have referred family and friends that each and every patient is related to or friends with so many others. It's hard to dismiss someone when all of their extended family members are patients and very good patients at that. That is this person's situation. They know she is difficult, but blood is blood. So, for all intents and purposes, I am stuck with her unless I want to lose a group that numbers more than 30. So, like a cowboy breaking a horse we needed to find a way to break this person's personality down and take control of the situation. Today was the beginning of a new attempt to tame the wild beast. The plan was a two-pronged attack. From the moment the front door opened we killed her with kindness. Something that she just wasn't used to at all, she generally got what she gave and that was aggravation; today it was different. Secondly, we just didn't give her an opportunity to complain and degrade anyone. We used a sensory overload technique which kept her engaged in a conversation at all times. Only this conversation was different. It was one-sided and she was barely able to get a word in. It seemed to be working great. I was able to address her dental issue and there was never a lapse in the conversation. At all times we were overly kind. We finished up and off she went, dumbfounded. I think she needed to get away from us. Everyone felt as though we won today's battle. Who knows what tomorrow will bring? For now, all is well and we are all back to our happy selves, working the day away with small smirks on our faces. It is truly amazing how one person can drag an entire office down. Identify these people and find a way to make it better. Sometimes dismissing them is the only option. Most importantly, talk to your staff and let them know that they should not be demeaned by these people and reassure them that you are happy with what they are doing. Good, healthy morale is vitally important to a properly functioning office. Put a value on it and work together in the open to keep things going in a positive direction. Don't let one bad apple spoil everything.

Run With It?

Jeffrey Caso (Faculty) — Fri, 07 Oct 2011 00:00:00 -0700

Bringing the CEREC technology into your office is a big step. Actually, it's a huge step. It's a big financial commitment. It's a commitment of time. It's a commitment to advance yourself through ongoing education. It's a commitment to changing the way things are done in your office. If you have gone through it already then you know full well what I am talking about. If you're on the fence and thinking about the technology, well then, what are you waiting for? Sure it's going to change a great deal of things in your office and your life, but isn't that what practicing dentistry is all about? Staying fresh, staying engaged and staying happy. I am now at the part in my CEREC journey - and yes, it's a journey, closer to a marathon than a sprint but one that you will enjoy immensely - where I want more. Fortunately, there is always something else. Something challenging and exciting. I see it as three paths that for me intersect and cross over and over again. My chairside system is serving me very well. So now it's time to begin the next phase. For me, it's InLab. I want to bring even more of the things I offer my patients in house. I want to mill my own implant abutments, permanent bridges and Zirconium restorations. It's another investment of time to learn something new, but it's exciting as well. The lab end of dentistry has always fascinated me. Why not explore it a bit further? I plan to start tomorrow getting this done. My lab needs some new equipment and getting that before year end will help in other ways. Once I have a good handle on the lab side of CEREC, then it's time to jump on guided implant placement. That's actually work that's ongoing and I am beginning to train for it now. I so look forward to the day I place my first implant. That will be the culmination of a several years long plan. It will be a good feeling. So, my point is this: Getting into the CEREC technology is fantastic. Taking it as far as you can isn't for everyone, but it sure is available to you though. Push yourself just a bit every day. Are you only doing single posterior units? If so, push for that anterior crown in an easy going patient. Push to do two units next to each other then the quad. Challenge yourself to soar with your machine. Then move on to the next big challenge like I am. Educate yourself along the way and be happy practicing dentistry for an entire career. Get out of your comfort zone just a little bit every day, but most of all, enjoy it!

Channeling Our Own Inner Steve Jobs

Sameer Puri (cerecdoctors.com co-founder) — Thu, 06 Oct 2011 00:00:00 -0700

As you may have read, Steve Jobs passed away yesterday. Ironic that you probably read of his death on a device that he designed. Scores of people are hailing Steve as a true visionary - which he obviously was - and a person who will no doubt leave a void in our world today - which he no doubt will.

There is a lot that one can learn from a man like Steve Jobs - vision, passion, dedication. But as far as we are concerned, think of what a person like Steve Jobs would be if he were running a dental practice.

Would he be concerned about finding the lowest cost insurance plans for his office or would he seek to make the patient experience so intense that cost of treatment would not matter?
Would he opt to practice in a 1970s decorated office or would his facility be state-of-the-art and modern?
Would the phrase "The inmates are running the asylum" be applicable to his staff or would his team be a well-oiled machine that would make sure patients received the best care possible?

There is a lot that can be said about Steve Jobs. How are you going to use the examples that Mr. Jobs set to create the most valuable company in the world?

If we all channel our own inner Steve Jobs, what impact can we make on dentistry?

Respect

Mark Fleming (Faculty & Magazine Editor) — Tue, 04 Oct 2011 00:00:00 -0700

I jokingly say sometimes if you had 10 dentists in a room they would give you 15 different opinions! A lot of procedures that dentists perform can be done different ways and have an acceptable clinical result. What works for me may not work for someone else and what works for someone else may not work for me. If someone gets an acceptable result consistently, who am I to tell them they are wrong? It is common courtesy to respect someone who has success by acceptable means. Just because I don't agree with them is NO reason to disrespect them. I know I'm always learning. In fact, life is a learning experience. And I will always respect those who are open to learning and passing their experiences on to others. It is then up to those others to decide whether it works for them.

4.01 Software Update

Sameer Puri (cerecdoctors.com co-founder) — Mon, 03 Oct 2011 00:00:00 -0700

Some of you may have already received your 4.0 disk while others may still be waiting. It's critical that you download the 4.01 update that was recently released. There are some updates in the software that are addressed by this patch and included in the attached document. 4.0 was a massive software release. As the engineers develop the software further, they will release these update patches. Install them ASAP. Make sure that you keep your software current. Enjoy the videos on 4.0. [UpdateDesc_401_EN1.jpg]

What I've Learned this Year

Richard Rosenblatt (Faculty) — Thu, 29 Sep 2011 00:00:00 -0700

Earlier this year, I promised you all that I'd be letting you all know about the CE courses that I have taken and what I thought of them. Here goes... - Sirona Speakers Academy I did this in January with Dr. Paul Homoly. It was a great course and I learned a lot about how to speak in front of a room and also how to communicate to my office and staff. I highly recommend it. - Townie Meeting I love this meeting and have not missed it in seven years. While I was in Las Vegas, I took the Six Month Smiles course. It was the one-day "crash" course with no hands-on. Lots of great info and very happy I took it. I do Invisalign and am looking forward to adding this to my options of treatment. I took many other courses at the Townie meeting, but the one that stood out was Dr. Scott Leune's intro course to the Breakaway Practice Seminars. Great info and something I may pursue in the future. I hope many of you come out to the Townie meeting in April 2012, as it is the 10-year anniversary of the meeting. It is at the new Cosmopolitan Hotel and should be tons of fun. - Facially Generated Treatment Planning The course I want to talk about is Facially Generated Treatment Planning with Dr. Frank Spear. This course was, by far, the most amazing course I have ever taken in dentistry. The instructors were incredible and their presentation of info in this course has me looking at patients, their needs and how to treat them in a completely different mindset. I was telling a friend about this course and he told me he had also taken it. I told him that the amount of info was phenomenal; he said it was like drinking water through a fire hose. It is amazing that you only know what you know in life. This course challenges you throughout the three days. It is not just someone feeding you information; it is hands-on and interactive with other students and mentors who have previously taken the course and are there for guidance. I left there wanting to take the course again right away. I have recommended courses to colleagues of mine throughout the years, and I don't think there is a course out there that is more eye-opening as to how to successfully treat patients who present to your office with challenging cases than this one. Dr. Spear, Dr. Gary DeWood and Dr. Gregg Kinzer were fantastic and present the info in such a concise manner. I will tell anyone reading this to do themselves and their patients a huge favor, and get out to Scottsdale to experience this course. You will thank me!

Back in the Swing

Mark Fleming (Faculty & Magazine Editor) — Wed, 28 Sep 2011 00:00:00 -0700

In just a few days, I'll be heading out to the ADA Annual Session. I'll have the opportunity to work with my good friend and fellow cerecdoctors.com faculty member, Rich Rosenblatt, at the Sirona booth. Rich and I have worked together at several shows and I always enjoy doing these events with him. I also enjoy the opportunity to help others see the ways that one can improve their practice utilizing digital technologies. And hopefully I'll have some time to walk the floor and see what else is happening in dentistry. If you are there, stop by the Sirona booth and say hello. After the ADA Meeting, I get to go down to Scottsdale to help teach the courses, which I ALWAYS look forward to. This will also be the first time we have the opportunity to teach Level 2 with the new 4.0 software. I had to miss the last session in September, so I feel like I'm going through some withdrawal symptoms. It will be great to see everyone at the Center and help CEREC users learn to get the most out of their CEREC experience. Transferring CEREC knowledge...I love it!

Comprehensive Services

Jeffrey Caso (Faculty) — Tue, 27 Sep 2011 00:00:00 -0700

In my last blog, I spoke about a recent trip I took to the Catskill Mountains in upstate New York. It was a great get away and allowed me to reminisce about the past and the great times I had in that area as a teen and young adult. The entire region recently felt the wrath of Hurricane Irene and experienced severe flooding. Much of this already economically depressed area was severely flooded. The rivers crested and spilled their banks and the raging water had in its grips trees, cars, portions of houses, barns and whatever else it found in its path. Entire towns were destroyed and many bridges were washed out, further blocking access to these areas. Rebuilding, if it ever happens, will take years. I traveled through these areas with a heavy heart as I just couldn't fathom where the money to rebuild would come from. This area was hit hard in the recession and this was likely the death blow. A glimmer of hope arose when I approached one of my favorite stores. It was a convenience type store that gave you the feel of an old time General Store. It stood alone on the outskirts of town, nestled into the side of the mountain. It was old but had a very inviting porch and the necessary creaking wood floor. On any morning a group of aging local men would meet for coffee and pass the day away. The first thing I noticed which concerned me was the lack of people congregating. As I entered, I could immediately see that this business was struggling. The shelves were all but empty. In fact the only stock was beer and cigarettes. The old coffee urns were filthy and in disrepair. I was confused until I started to remember back to my last trip through the area. It was getting to this point then, just not as bad as today. The owner had lost interest. He let the place go. Products were not restocked or were allowed to expire on the shelves. The coffee machine broke and was never repaired. There was no longer fresh produce. The feel of the country store was all but gone. This business was not a victim of the storm; it was a victim of the owner. As the shelves grew bare the customers moved on. Don't let the struggle of the act of doing business on a daily basis get in the way of the basics. Keep your office neat and clean. Repair all of those annoying issues that patients will notice like the squeaky front door. Most of all, however, keep your services fresh and up-to-date. Offer a new service or two per year and buff up on new techniques for older services. Do this through a good deal of continuing education. People sense this and respond well to it. Sit in each of your patient chairs and see your office through the eyes of the patient. Is that shelf dusty? Are the hand piece hoses clean? Heck, sit in the waiting room chairs and see what needs to be done there. These are high-impact items that cost little or nothing to rectify. Don't let patients just fade away because of a small issue with the infrastructure. In addition, keep your shelves stocked with services. You will do better if you supply almost all of your patients' needs in-house. We endure so many storms in business. Some we weather easily and others give us more trouble. Those things are out of our control. We just learn to deal with them as best as possible. The things that we can control, like keeping our offices orderly and well-run, need to be dealt with immediately. Don't let the shelves go bare. Keep it fresh and friendly. Patients will respond to those subtle things and the rewards are a happy, healthy business which you look forward to every day.

Lava Ultimate

Sameer Puri (cerecdoctors.com co-founder) — Mon, 26 Sep 2011 00:00:00 -0700

There is a new composite block coming out from 3M called Lava Ultimate. Our mentor group should be receiving samples of the blocks. These are the newer versions of their long-popular Z100 blocks. As you know, I've been using these a ton for my indirect composite restorations instead of placing direct composites. Better margins, better contours, better wear over direct composite. What's not to like? The Lava Ultimate blocks, which will be released in the coming months, are supposedly even better. Lots of work has been done by 3M to improve these blocks and I'm told that their indications are not just inlays and onlays but also full-coverage crowns. I'll be looking forward to the feedback from the Mentor group. Stay tuned for these blocks and hopefully you will find a new tool in your CEREC restorative arsenal.

A Rite of Passage

Peter Gardell (Faculty) — Fri, 23 Sep 2011 00:00:00 -0700

Ahh, summer time. The weather is great, the kids are off from school, things are good. I was working in the office when my cell phone rang and it was my oldest son Andrew, "How you doing?" I asked. His response was, "You need to talk to someone." That someone was an EMS person who said that there was a little accident and Andrew was fine, but due to his age they needed someone to come and release him. As I was on the phone, my father-in-law happened to drive by, saw what was happening and stopped. Andrew was released to him and I told him I would pick him up later. So Andrew had his first accident: traumatic for him, traumatic for his parents, but luckily no one was injured. A momentary lapse in judgment for this 17-year-old. He took mom's car out...Mom's 3-week-old car...with only 1,100 miles on it...while she was out of town...and planted it into the back of a utility truck. Ouch. In the back of my mind, I immediately saw how this incident could morph from Andrew being a poor driver to Dad being a bad father. I was not looking forward to that phone call or to when my wife came home later in the week. I cancelled my day's plans so I could get all the loose ends tied up so that when I called Maria I could tell her everything was fine, no one was hurt, and there was no need to come home early. During the dreaded call, Maria asked all the questions expected and I guess she heard the answers she was looking for. Then she asked if Andrew felt bad. I responded in a way a father should, "I hope he feels bad. He just totaled the damn car!" Seriously, this whole incident was a sensitive situation. I couldn't overreact without the risk of having Andrew and my other kids not feel comfortable calling when a time came that they really needed to - an accident, out at a party, or any situation that can arise in a teenager's life. I sat them down and made it clear that they can call whenever they need, at whatever time. No if, ands or buts; no questions, comments or interrogation. So this episode was not only a minor hiccup in the road for Andrew, it was a learning experience for Dad.

Cash or Good Checks Only

Jeffrey Caso (Faculty) — Thu, 22 Sep 2011 00:00:00 -0700

This past weekend I did something wonderful. I took my 87-year-old father to his summer home in the Catskill Mountains in upstate New York. This was something special to both him and my family because we have had so many great times there. He hasn't been able to get there in recent years due to his advancing age and his inability to drive. He expressed an interest to go a short while ago and I jumped at the chance. This was not just a house to him; it was his place to escape a very stressful profession and relax. Nestled in the woods atop a mountain it was a refuge from the storm. I have never met someone who worked as much as he. Up at 5:00 am and many nights still working at 9:30pm. He loved his job as a physician and was available to his patients around the clock. Later in life, he just needed a place to escape once in a while and relax. This was the place and it means so much to him to be able to see it again. That, however, is not the point of this blog. The house is in the hills above a very small, very rustic town. The one major attraction is the auction house that draws crowds the equivalent of the Christmas tree lighting in Rockefeller Center every Saturday night. High-end cars from Manhattan start arriving early in the day and people examine every piece of merchandise in the place. Watching the auction is a great experience. The things you think will never sell fetch huge amounts and some cool items get put back on the shelf. My wife and I have an old joke. More than 20 years ago at that very auction house, we bid on and won a great hutch which is still in our dining room today. We placed a $100 limit on ourselves and bought it for a very close $95. I tell everyone who asks that we actually should have gotten it for $85 but my wife got so excited bidding that she bid against herself twice. Of course that's not true, but it alludes to the excitement that occurs at an auction. So, once again, my point. For the past several decades whenever I have entered this auction house, so many things have remained unchanged: the unique smell, the 100 chairs with masking tape on them bearing the names of the auction's best customers and in essence saving their seats. But one thing has always caught my eye. It is an ancient handwritten sign by the register on yellow, cracking paper which says, "Cash or Good Checks Only." This time, after so many years, the timing was just right. A friendly-looking older woman was standing beside the register and I just had to know. I said, 'Does that really work?' gesturing toward the sign by the register. She smiled and said, "Not one returned check in more than 50 years.' I smiled and said, 'I thought so.' Sometimes in business it's luck and sometimes it's simpler than that. Just tell people what to do; they need to be guided a bit. This business set the rules up years ago and now by virtue of that aging sign, they drew a line in the sand and nobody wants to be that terrible individual who will break a multi-decade streak. That's what I do in my office. My front desk staff tells people in no uncertain terms what is expected of them and what they need to do to keep up their end of the bargain. No guesswork. Here's what you do and here's how you do it. Now, that's a good lesson in business, any business really. As far as my take on that aging sign that I have been looking at for so many years. It's not good business, it's luck. I just prefer to think of it differently. Why? Because it makes me feel good. Like the planets are aligned and the world can really be a good place.

Field Testing XTR from Kerr

Sameer Puri (cerecdoctors.com co-founder) — Wed, 21 Sep 2011 00:00:00 -0700

So I tried a new bonding agent last week. One of the Scottsdale Center employees broke a 12-year-old porcelain onlay. What better place to use the CEREC! We numbed him up and prepped the remaining tooth structure away for a conservative onlay prep. Once I imaged with the CEREC and designed with the 4.0 software, we milled out the molar only with e.max, my go-to material for all molars. Once it came time to bond, we decided to use XTR from Kerr; in fact the cerecdoctors.com mentors all got a sample of XTR and NX3 and are involved in a little internal study to test it out. Here is what Kerr says about XTR: It's a self-etching bonding agent with bond strengths in the 30-50 mpa range (depending on what study you look at). The interesting thing is that Kerr claims that XTR does not lead to sensitivity. Being an avid fan of Gluma, I decided to see if this was, in fact, the case. XTR seals the tubules (similar to Gluma) and helps combat post-operative sensitivity. So we followed the protocol: Brush the primer, air dry, brush the adhesive, air dry, apply cement and seat restoration. Cleanup with the NX3 cement was easy and the restoration was bonded in place. The true test came a few days later when I saw the patient for follow up. How was the sensitivity? None, he stated. None whatsoever. It's one patient but I think it was a good indication that XTR might work as advertised. I'll have to use it more and see what the result is with other patients but so far it's performed nicely in the cementation of an onlay.

Getting out of 'The Box'

Mike Skramstad (Faculty) — Tue, 20 Sep 2011 00:00:00 -0700

I feel compelled to write something on Facially Generated Treatment Planning... This course is shockingly good. Actually, it's far and away the very best course I've ever been to. I'm writing this not to ask, but to TELL all you CEREC owners that this is a course that you must take. I've learned more in two days about dentistry and treatment planning that I have in 11 years of practice. Ours is a rare group, cerecdoctors, because we all thrive on technology and constantly improving ourselves. We are different than the majority of dentists (trust me) because we constantly take time away from our office and families to be better dentists. But sometimes we have to get outside of our beloved CEREC boxes. As someone who spends time teaching rather than attending courses, I will freely admit that I have gotten stuck in a box the last several years. My entire professional life has revolved around CEREC. Whether it's teaching, testing, treating patients or just plain learning the intricacies of the software, I have neglected other areas of dentistry that I feel will make me a better dentist. Facially Generated Treatment Planning has opened up my eyes quite a bit. I feel like a lot of you do after attending one of our advanced courses...rejuvenated! I'm excited like I haven't been in awhile and cannot wait to finish the Spear Curriculum and become a more well-rounded dentist. For some of you this isn't anything new... Others have been stuck in a box for many years like me. I encourage you all to expand your horizons and look past your CEREC from time to time. There is a lot out there to learn.

Adapt

Mark Fleming (Faculty & Magazine Editor) — Mon, 19 Sep 2011 00:00:00 -0700

I gave a presentation last Friday for a Study Club. Because of a last-minute situation, there was some confusion; ok, a lot of confusion on how my laptop would connect to the venue's AV setup. We had among us about seven different adapters, none of which solved the problem of getting my presentation to the projector. After nearly giving up, the local CEREC Specialist, Bryan Blasingim, figured out what would work. As you can see in the photo, with the help of about three or four of the adapters, we were able to run the presentation from my Mac through the CEREC AC to the projector. In this case, the CEREC AC was TRULY the hub of the venue, an incredibly versatile piece of technology! Bryan, you absolutely saved the day. Thanks! [laptop_AC.JPG]

Lessons from a College Search

Peter Gardell (Faculty) — Fri, 16 Sep 2011 00:00:00 -0700

Summer break between junior and senior year in high school is a busy time. Different than I remember, much different. Tons of junk mail from all the learning institutions, all constructed really well. I feel sorry for the mailman because this stuff has to weigh a ton. Much worse than Christmas cards and the delivery of these things spans a much longer period of time. Glossy pictures, high-quality printing - these things must cost a fortune to produce not to mention the mailing charges. It would be interesting to see what the budgets are for this operation. Why would colleges and universities spend so much on something like this? Is it needed? The good schools always seem to be full; you always see they had thousands of applicants for each spot in the incoming class, so why would they spend this money? To set themselves apart from the competition, make themselves stand out in a competitive market. They spend a lot to make their message a little different than the others. They identify a niche and gear their advertising to fit that niche. Not saying we should all go out and send high-end printed materials to everyone, but identifying a niche and getting the word out to the public, social media, print, radio, word-of-mouth (most cost-effective way, IMHO) in today's competitive market is a huge necessity. For me, single-visit esthetic dentistry and a willingness to have flexible hours have allowed my office to grow and prosper in today's world. And it has enabled me to save for a personal financial crisis in the making - three kids in college at one time in the next four years.

Stop Looking for It

Jeffrey Caso (Faculty) — Wed, 14 Sep 2011 00:00:00 -0700

A wise man once told me that if your main purpose is the pursuit of money, sadly you will never find it. I believe that statement to be so simple, yet so true. In essence, it means that if your goal is solely to become wealthy, you will have a long, uphill battle that will usually end in failure. Last week was a reflective one for all of us as we neared the tenth anniversary of 9/11. I personally am slowly healing, though never fully, and not in a way that allows me to forget or become less angry. Just in a way that finally is allowing me to turn the grief around in a positive manner. I recently decided to make a real effort to step up my personal charitable contributions and to develop a program in the office to do the same, getting the staff and patients on board so we can really make a difference. When you give back, good things will happen in your life. It's really funny how things happen sometimes. All of these thoughts of wanting to help out a cause and the approach of 9/11 and not pursuing money can be confusing. Clarity on this complex subject can be elusive until that one event, sometimes seemingly insignificant, occurs and the entire cluster of ideas just comes into focus. For me it came in the form of a high school classmate suffering a rapid decline from the effects of Multiple Sclerosis. He arrived for his appointment and immediately I saw through the window that his condition was very serious. I went out to greet him and helped him into the office. We spoke more than treated as his condition would not allow much in the way of dentistry. I helped him out and said a heartfelt goodbye. I rushed back into the office and sat at my computer. I Googled the local MS society and BAM, everything cleared up in an instant. The next charitable event was set to take place on 9/11 in Southampton on Long island. I picked up the phone and sponsored a rider. I was invited to watch the riders arrive at the finish and enjoy the day and barbeque. So, I loaded up the car, took the hour drive and had a great day. Each group of riders was escorted by a member of the Blue Knights motorcycle club along the 150-mile, 2-day course. The final mile there was a police escort to the finish to the cheers of many well wishers. So now the stage is set. The real money that these organizations need is from the participants and their sponsors. So with the huge impact of social media, it should be simple to turn a dental office into a hub for getting the word out, getting sponsorship and getting the job done. I will keep you posted. I want to create a model that can be used by offices to generate charitable contributions, have fun, increase morale and make a difference. Stop looking for it and start doing it. Hey, that may just become my motto. I am starting by suggesting to all of the offices that send Christmas gifts to use that money to contribute to a good cause instead. We have to start somewhere.

Do Unto Others

Richard Rosenblatt (Faculty) — Mon, 12 Sep 2011 00:00:00 -0700

I try to live my life by the "do unto others" philosophy of. I try to put myself in the place of other people and think, how would I want something done if I was that person. Well an interesting thing happened to me this past weekend. I have a very close friend who lives across the street. I live on a great block and have made some very close friends in the few years I have been in this home. I consider them family and try to treat them as if they are my own. I'm not always saying that is a blessing! Anyhow, my good friend lost his mother last week to a long-term illness. Her funeral was Friday morning. I went over the house to help out with anything they needed and to provide some emotional support to my friend. His sister and brother-in-law were in town from Canada for the funeral and were staying for a few days. It was about 5:30 at night and I heard someone talking about the brother-in-law having a bad tooth ache. What would I want done if I were in his shoes? I'd want to be out of pain ASAP. I also was thinking of my friend and his sister and that the weekend was tough enough as it was and now the brother-in-law was going to have to be in pain the entire time also. I did not know the gentleman, but I went outside and introduced myself. I could see he was in terrible pain and asked about his symptoms. Turns out #14 was necrotic and needed a root canal. I told him I was taking him to my office right then and was going to do the root canal. I think I caught everyone off guard, because no one asked me to do it. I just knew it was the right thing to do. It would be what I would want done for my own family. We ran to the office and I did a molar root canal on him. I have to say, you really appreciate your dental assistant when you don't have one! We completed the root canal (and yes, I found the MB2, all you dental geeks!) and sent him home with pain meds. I saw him the next day and he looked great. He was feeling almost no pain and I felt blessed to have helped in their time of need. He, his wife and the family could not have expressed more appreciation to me for what I had done. It will now be a story that will be told many times over I'm sure by the family, but I just was honored to be able to help out. I always have tried to live by this motto and this past weekend, I'm really glad I did!

Web Marketing: Fad or Fab?

Armen Mirzayan (cerecdoctors.com co-founder) — Fri, 09 Sep 2011 00:00:00 -0700

I had just landed in Phoenix for this weekend's course and my office manager texted me the following: "I'm going to reschedule Tuesday's meeting. Received an e-mail for an appointment for a new patient requesting two CEREC crowns, filling and a bleaching.' This is literally the fifth person in a week who has found us on the Internet, seeking us for specific treatment that we make sure distinguishes us from others. Everything we have done in the last decade has been done to ensure that people realize what we have to offer and how it categorizes us differently than the public's perception of the dental field. These are the exact measures we have put in place so that our profession is not reduced to a commodity like our colleagues in the medical field. Sure, we still have many patients who are price shoppers or who are looking for discounted care, but our focus has been on people who appreciate the difference and place value on our profession.

The Art of the Performance

Jeffrey Caso (Faculty) — Thu, 08 Sep 2011 00:00:00 -0700

Last weekend I had the pleasure of seeing country music star Blake Shelton in concert. The venue was in the center of a horse racing track in Maryland. It was a beautiful night and a fantastic concert. The warm-up band was Chris Young, an accomplished artist in his own right. What I found really interesting was the way each of these seasoned singers presented themselves to the audience. To me, Chris Young seemed slightly nervous, had an imperfect use of the English language and cursed more than many in the audience were comfortable with. This singer, with several number one songs, chose to present himself this way probably to feel like he could connect with his audience. In my opinion, it did the opposite and turned off many people. Headliner Blake Shelton proved to be different right from the start. He was refined and took command of the audience immediately. He had a presence that exuded confidence and the audience reacted to this immediately. After the first five minutes he could have done a terrible job, but no one would have cared because he had already won the crowd over. These two singers were polar opposites in the way they worked the crowd. One was successful and one failed. In our practices, we need to win our patients over in the first minute or we will fight an uphill battle from that point onward. We need to be polite, speak properly, be courteous and be truly interested in our patient. Most importantly, we cannot be distracted or distant. We need to make that person feel like they are the most important person in our life at that time. This takes some concentration and work on our part but it will win over a patient, garnering trust in us and reinforcing the feeling that we are truly concerned about them. Add to that presence that you bring with you, a clean, neat, well-dressed appearance and you will become the only person that your patient wants to work on them. They do not want someone who uses slang or acts cool to impress them. They want you, the professional who makes them feel comfortable because you are confident in your abilities and you let them know it in a subdued yet sure way. I learned something from these two performers. I learned what I like and what I do not like. This experience will make me a better performer in my own office. Striving to connect in this manner, one person at a time. Doing this effectively will build a loyal patient base that will stay with you for your entire career. Just like a country music star performing on stage we need to be the star in our own offices. Give it a try.

Alix in Wonderland

Richard Rosenblatt (Faculty) — Wed, 07 Sep 2011 00:00:00 -0700

Life could not be busier for me right now. Office has been bustling, finishing up the assistant training course, basic training and other events booked until next year. All that pales in comparison to what my family is preparing for this upcoming week. This week is something that we have been looking forward to since the birth of my oldest daughter Alix. This Saturday will be her Bat Mitzvah. Some may ask what a Bat Mitzvah is. In Hebrew, Bat Mitzvah means 'daughter of commandment.' This is the year that she is recognized by Jewish tradition as an adult and is morally and ethically responsible for her decisions and actions. She has been studying for this event for years, including learning prayers in Hebrew. It is a long process that involves a lot of dedication from a soon to be 13-year-old. It is considered one of the most - if not the most - important events in their Hebrew lives. This is a weekend of celebration for my family. We have family coming in from both coasts to share in the event. My daughter takes part in services on Friday night and Saturday morning. We have planned a huge party for her, her friends, our immediate family and some of our local friends. We have been planning this event for years. A Bat Mitzvah (or Bar Mitzvah if the event is for a male) can be on the scale of a wedding for some, but we have kept this to more of a party for my daughter and her friends. My wife Aimee has been just amazing. She is a very talented person. There is a very artistic side to dentistry and my wife would have been an amazing dentist because artistically she is unbelievable. She made all the centerpieces for this event. I'll show some pics next week of the event and her unreal talents. These parties each have a general theme to them. We decided to make this a bit more whimsical of an event and created a theme called 'Alix in Wonderland.' Wait till I show some pics next week of how my wife ran with this theme! While I've been working like a mad man, she has been organizing this day and doing such an outstanding job. I can't believe that this day is less than a week away. I can't believe my baby is no longer a baby. I can't wait for this weekend. I can't wait to get together with some of my family and friends and celebrate the day. I'll post a follow-up blog next week and let you know about the emotions that I'm sure will have run through me. All I know is I could not be more proud of how hard Alix has worked for this day. She has studied and is prepared. This will be a memorable event for Alix and my family. I remember what it was like to have mine as if it were yesterday, and that was 28 years ago! I know my daughter will have a great day and I can't wait to enjoy the experience as a parent. Best of luck, Alix, I could not be more proud!

Coming Soon to a Theater (Really, Really) Near Us

Sameer Puri (cerecdoctors.com co-founder) — Tue, 06 Sep 2011 00:00:00 -0700

One of the things that I greatly cherish is the time spent with my two girls, and one of our favorite pastimes is going to the local movie theater. Granted, I rarely get to watch the movie that I want (ok, let's face it, I NEVER get to watch the movie that I want), but I do enjoy making a trip with my two girls, even if it's to see a kids' flick like "Bolt." Since our move to Arizona, we have not yet had the opportunity to go out often to the movies as we have been busy getting settled into our new home. With the kids' school starting and them getting integrated with our new surroundings, it's been all work and very little play. Looking out into the horizon, I see lots of things planned but very little time for our movies. So what is a man supposed to do in a desperate time such as this? Simple - instead of going out to the movies, just bring the movies home. Our new home has a media room that had a spot for a big screen TV. After doing some research, I found that the cost to do a full-blown movie theater is quite reasonable. Since our home already was pre-wired and had the speakers, receivers and all the other goodies that are needed, it was simply a matter of getting a projector and screen. A few phone calls later we ordered a 126-inch Stewart screen with a Sony HD/3D projector. Install date is next week and although I can tell you that my wife thinks I'm crazy for putting in such a big screen, the kids and I are utterly giddy over the prospect of watching "Avatar" in 3D at home! Stay tuned and I will post some photos of the new theater.

Make Lemonade

Jeffrey Caso (Faculty) — Mon, 05 Sep 2011 00:00:00 -0700

Today I am doing something very different. It's a travel day for me and in the wake of Hurricane Irene, transportation proved to be a challenge. I need to get to Wilmington, Delaware, about 120 miles from home. This being Labor Day weekend, driving off Long Island was uncertain. The traffic is extreme and many of the areas I would need to go through are suffering from flooding, damaged bridges and destroyed roadways. Usually, this trip for me would be an easy flight into Philly and a car ride from there but with thousands of cancelled flights the airports are a mess. I had one other option and I took it. So, I am writing this from the Amtrak Acela, cruising through New Jersey's farmland at 90 miles an hour. If I didn't look out the window I would think I was on an airplane. Comfortable and ample seating, access to the Club Car for food and beverages. Free Wi-Fi is an added bonus. I will arrive in Delaware in just under two hours. Sure I had to get to New York's Penn Station, but that's simple. Just a short walk from home and a 45-minute ride to 'The City.' Just being in Manhattan is exciting. I happened to be early so I made a quick trip to my favorite spot - Little Italy Pizza on 5th and 35th - for the best deal in all of Manhattan. Two slices and a soda for five bucks. It also happens to be the best pizza in the world. As I sit contemplating the events of the day as well as the past week, I realize that being dynamic and able to shift gears to accomplish something that works in light of the prevailing conditions is the key to success. Not just in life but in the business of dentistry as well. I was further inspired by some recent dialogue on the cerecdoctors.com message board regarding different people's views of the same situation. A huge diversity of treatment options was presented by various doctors all having the same goal. Everyone wanted the same thing - the best, longest lasting treatment for the patient. The thing that was missing to everyone except the original poster, however, was knowledge of the patient's desires. It is so easy to diagnose when the patient is unknown. We diagnose DENTISTRY in that situation when in reality we need to diagnose the PATIENT. So, just like considering various forms of transportation to get the best end result, we need to evaluate different treatment options and make a mutual decision based upon our expertise as dentists and the patient's desires and abilities. I rarely present a treatment plan that is not altered somewhat to better accommodate the patient's ideas of what he or she wants. We need to offer guidance when the patient's thoughts can lead to compromised treatment and we even need to step back and not treat when the patient's desires are not in line with what we are willing to do. It is the ability to be dynamic, hear the patient, educate and arrive at a mutually acceptable treatment plan that is so important. It is a skill that requires compassion and understanding. So, make lemonade from those lemons that we get from life. Work to find an acceptable plan and then enact it. Be dynamic and make changes along the way as situations change. Most of all be comfortable with what you are doing. That makes everyone happy, including yourself. Just arriving in Wilmington a few minutes early. Ha. I love it when a plan comes together!

Surround Yourself with Winners

Mark Fleming (Faculty & Magazine Editor) — Fri, 02 Sep 2011 00:00:00 -0700

I have heard Imtiaz Manji say many times to be careful with whom you share your sandbox. Basically, watch who you surround yourself with. If you want to be successful, surround yourself with not only successful people but also people who are invested in your success. I just had the opportunity to spend several days at a conference put together by 3M. They have some incredible people at the company. They have a great culture that allows people to spend time on projects that may not be directly related to what they are working on now. They don't have to worry about making mistakes but they get to let their creative juices flow. Many of their products have been developed this way. Creative people are surrounded by other creative people and success ensues. How about you? Are you surrounding yourself with winners? Are you allowing your staff to be creative without worrying whether they are 'wrong'? Who is in your sandbox? It may be beneficial for you to explore these questions. Have fun and enjoy!

Creating Value

Sameer Puri (cerecdoctors.com co-founder) — Thu, 01 Sep 2011 00:00:00 -0700

There was a recent thread on www.cerecdoctors.com where the doctor was asking about setting fees for his restorations. It got me thinking - does it really matter what the fees are if you create the right value for the treatment? As some of you may know, I'm a fan of watches and enjoy reading about and following the trends in high-end watches. My favorites happen to be Audemars Piguet and Patek Philippe, both highly respected watch brands based out of Switzerland that have been in business for more than 100 years. The least expensive watches from these companies start in the $15,000 range with some models routinely running into the hundreds of thousands of dollars spectrum. The average cost of a 'run of the mill' watch is around $30,000. Now, you would wonder how any company can stay in business and survive in this economy charging these kinds of fees when you can buy a digital watch for about $50 that does the same thing as well, if not better. You probably are not surprised to hear that not only are these companies surviving, they are thriving. Both Patek and AP, in fact, raised their prices (AP for the second time this year) about 10% on September 1, which means that a $30,000 watch just went up in price $3,000. Yet despite the price increase, these companies cannot keep their watches in stock; even the most loyal customers find it difficult to find the exact models they want without being put on a waiting list. How then do we apply this knowledge and gain the same loyalty in dentistry? What if we could create the same customer excitement in our own practices where price was not the big barrier to treatment that it typically is? How do we create a practice where patients value what we offer enough to not worry about cost and are only concerned with getting the best treatment possible? It all boils down to setting yourself apart and giving patients what they want instead of giving them what you want them to have. Think about this statement and let it sink in. Set yourself apart by giving the patients what they want, not what you want them to have. My suggestion - do a survey. Ask your patients. What is it that you want from our practice? If they want convenient hours, why do you close your doors for 90 minutes every day at lunch? If they want evening appointments, why do you see your last patient at 4:00? If they want better looking teeth, why have you not invested in the education and technology to offer them the best care? Think of the value that you provide your patients; think of how to make them raving fans for your services. Find out what patients want and do it to the best of your ability and you, too, can thrive like the Pateks and APs of the world.

Blue Camp

Darren Greenhalgh (Faculty) — Wed, 31 Aug 2011 00:00:00 -0700

A video update from Patterson Blue Camp [bluecamp.wmv-v-]

Patterson Blue Camp

Richard Rosenblatt (Faculty) — Tue, 30 Aug 2011 00:00:00 -0700

What a fun weekend. I've been in Minneapolis for the last two days with the basic and in-office trainers from around the country. Many that attended I know from doing this the last few years and meeting them at other gatherings. Others I met for the first time and really enjoyed getting to know them. We all flew in to learn about 4.0 software, CEREC connect 4.0 software, club CEREC, the GALILEOS and other things. Brian Connolly and Rich Lake did an awesome job with the launch. Kudos to Sue Running and Sue Schwantes for doing a phenomenal job organizing things. Patterson is really fantastic with these large events. The speakers were excellent and it was especially great to have Chris Goodson, the global product manager for CEREC, coming over from Germany to demo the software to all of us. I have been using this software for about eight months now and I still learned some new stuff from the great demonstration that Chris put on. My favorite part of the weekend was getting to spend time with a bunch of the cerecdoctors.com family. We had some faculty members out here. Darren Greenhalgh, Pete Gardell and myself were all in attendance. Poor Pete had to change his flight three times to get a flight out early enough to beat Hurricane Irene up to the NYC area. There were also a bunch of cerecdoctors.com mentors out here also. It was a ton of fun getting to spend a couple of days with the guys and catch up. It is like seeing family every time we all get together. We even got together for a group photo. Sorry for the blurry image taken with a cell phone. Also sorry that we missed Darin O'Bryan in the pic as he was in attendance. The energy at the Hilton was fantastic with most in attendance getting their hands on the software for the first time. Attendees were pretty impressed by all of the changes and the ability to see the future potential as to what this new software platform will be able to do. I really can't wait for this software release! [cdocsfamilyatbluecamp.jpg]

The Aftermath

Jeffrey Caso (Faculty) — Mon, 29 Aug 2011 00:00:00 -0700

Before I can write about the aftermath of Hurricane Irene, I need to write a little bit about the time leading up to the actual hurricane. While I live no more than 10 miles from where this giant storm made landfall, the storm itself was the easy part of this past week. I should be used to the weather causing chaos in my life. Just like it was yesterday, I can remember the hurricane that hit on my wedding day 23 years ago. These two storms had a great deal in common. Most notably the fact that we knew they were coming for at least a week in advance and that the National Weather Service predicted their track correctly. This time, however, the storm was conflicting with taking my son to college for the first time. Sure, many people have done it and it's no big deal. Well, when it affects your child it is a big deal. I spent the first part of last week in denial. Once that passed I was in military mode. Designing a plan to get us in and out quickly but not in a way that would make my son feel badly. I also needed to get home to deal with my house, office and elderly father. The timing was tight. Drop off Friday at 6:00 p.m. Forget that we were supposed to stay until Sunday for the new students' convocation which is supposed to be an awesome event. Help him set up a bit, meet his roommate and his parents, and bid him farewell. That was and still is the hardest part. Leave Washington, D.C. at 9:00 p.m. Drive two hours. Sleep. Wake up at 5:00 a.m. and get back to Long Island by 9:00 a.m. Prepare for the storm and wait. That may not seem like much, but it definitely was. As I said, the storm was the easy part. We all were fortunate; no injuries, just a short power outage and some damage to my boat. The house, office and my Dad all made out just fine. Someone was definitely looking out for us all. Now just one thing left ... I need to plot my revenge. I was robbed of all of the parents' events at college - no campus tour, no tour of the town, no lunch in the dining hall, no parents' dance on Saturday night, no convocation and most importantly, no slow, comfortable goodbye to my son. But no need to get mad. I have an ace in the hole. In six short weeks my wife and I will be heading back for parents' weekend. The weather better be perfect. The itinerary of events better be great. The dance better be fantastic. I plan to have a perfect visit and make up for what I missed out on. Really though, I am kidding. I am just so happy that the storm is over and everyone is safe. For now, our job is done and it's time to relax.

Endless Summer

Jeffrey Caso (Faculty) — Fri, 26 Aug 2011 00:00:00 -0700

WOW, what a great summer this has been! Here in the northeast we have been enjoying spectacular weather. I for one have been cramming so much into each and every day. Work has been super busy with the usual run of back to school checkups and those reassurance visits that patients need before they take off for vacation. Ten-hour work days have been the norm as well as an unusually high volume of after-hours calls. I haven't let the daily work grind slow me down in the least. Post-work picnics on the beach and twilight swims have been a common occurrence, as have fishing trips, relaxing in the yard and good old-fashioned family time. While the signs of a waning summer are becoming more and more apparent, there is still a great deal of time left to indulge some more. Cooler nights, earlier sunsets and the appearance of late summer green flies signal both an end and a new beginning. Early in the summer I blogged about this being the last summer for us before my oldest son heads off to college. I vowed to make this a great family summer and it has lived up to all of our expectations. Next week we will be packing up the car and heading out to drop him off. My sadness early on has turned into excitement for him. He is ready and so are we. Now, that's me talking right now. Maybe I will change my tune when the moment arrives but so far so good. I am happy that work is busy because that helps to keep the mind on the straight and narrow. Not only is work demanding but very shortly the release of the 4.0 software will require that more time be spent on the cerecdoctors.com message boards assisting people with the transition. This is a good thing. So, next week I will blog about the actual drop off at school and how it has affected me. If you see me posting on the boards at 3 am you can make your own determination. As for now, we still have a few more days to spend together. See you in September.

Back to School

Sameer Puri (cerecdoctors.com co-founder) — Thu, 25 Aug 2011 00:00:00 -0700

One of the unwritten perks about my new job and relocation to Scottsdale is the ability to be a student again. For years I've presented about 600-800 hours of lectures. I've had the opportunity to go around the country and meet lots of amazing doctors and share with them the benefits of CAD CAM dentistry. The downside of all this travel, however, was rarely having the time to sit through a course myself. Monday morning, however, I came to work, took care of a few things, grabbed my laptop and sat in on Gregg Kinzer's composite class. What a fantastic experience to sit through the class as a student once again. I soaked in the knowledge of hybrid and microhybrid classes of composite and I saw some amazing direct composite bonding that Gregg showed. Today, I get to sit through the worn dentition program by Dr. Frank Spear. I am so enjoying being a student again and soaking up all the information at the seminars and workshops at Scottsdale Center for Dentistry. There is no doubt that this will have a positive impact on our teachings of the CEREC courses at the Center. With regards to our courses, I'm pleased with the positive responses we have had. With the introduction of 4.0 so many people have been jumping on the website and registering for the courses to learn about the new software. Just a few notes about 4.0. I've stated this before but it bears repeating: You will need Windows 7, 64-bit to run the 4.0 software on the Bluecam. This disk will be sent to you by Patterson. Do not attempt to upgrade Windows on your own as there are drivers for the camera that are not on regular Windows. The Bluecam does not need a hardware upgrade so all Bluecams in the field are ready to run 4.0. The Redcam will need a hardware upgrade and will not be available until early 2012. All you Redcam owners will have to wait just a bit for the 4.0 software to arrive. I'm looking forward to hosting you all at the next course at the Center. We hope that you will join our CEREC family here online and in our courses.

Are You Asking Your Patients How You're Doing?

Richard Rosenblatt (Faculty) — Wed, 24 Aug 2011 00:00:00 -0700

For the first time in a few years, I'm starting to see some growth in my practice. I always thought that if I just did the things I do well, my practice would grow. The strengths of my practice are my staff and their amazing personalities, my ability to talk to my patients as people and not as patients, and my hunger to always be better at my job by taking lots of CE every year. All that being said, my practice has been a bit stagnant and maybe even dipped at times. I decided at the end of 2010 to use a service to communicate better to my patients for their appointments, post op call reminders, events we have going on in our office, future recall appointments, birthday wishes and other great things that brought our office even closer with our patients. I personally use Lighthouse 360 and love them. Here is a link if you'd like more info: http://www.LPMG360.com/rr. There are many excellent options out there and I would recommend checking out which one rings best for your practice. I have seen consistent growth during this past quarter for the first time in a few years and the only thing that I'm really doing very differently has been the addition of this service to my practice. What I enjoy the most about this service is the electronic patient surveys that are automatically e-mailed to patients as their appointments are completed. Asking your patients how you are doing as an office is a pretty powerful tool. They are asked a series of questions such as: - Were you seen on time? - Were you greeted in a friendly and timely manner? - Did you wait long? - Was the office was clean and up to date? - When the appointment was over, did you have a good understanding of your dental situation? - Was the staff was friendly and courteous? - Would you gladly refer others to the practice? And so on. The patient can answer from strongly agree to strongly disagree. They can also leave a personal comment at the end if they choose to. There are separate surveys for doctor visits, hygiene visits and new patient visits so the questions vary depending on the type of appointment the patient had. I have to say that getting anything less than a strongly agree feels like a failure to me. The one thing that it does do is to keep our office on our toes. Since each facet of the office gets reviewed, you know the areas that are constantly strong and the areas that need work. We, as a staff, look at these. We take pride when we get a great survey back and discuss what we can do as a team to improve if we get a survey that we feel is substandard for us. I have to say that I'm very happy with what I usually read, but every day is not a perfect survey, and sometimes our profession throws us a curve on a day and things just don't go our way. The survey will show that. It's okay. Just understand that you did and do your best to not let it happen again. If you consistently see remarks that do no suit your liking, maybe it is time to step out of yourself and look at you practice from entrance to exit and see what you like and don't like. These surveys will tell us a lot about how we are doing. It is either a nice pat on the back or a swift kick in the pants. One thing is for sure, it will keep everyone more focused on a daily basis to strive to always give their best effort. I highly recommend a service like Lighthouse 360 or similar services. It has done a great job for both our practice numbers and office self esteem!

It's a Dry Heat

Sameer Puri (cerecdoctors.com co-founder) — Tue, 23 Aug 2011 00:00:00 -0700

So after a few weeks in Scottsdale, I have to say that I'm really enjoying my time at the Center. It's been great to be able to go in and really have a fun day at the office. Not that I didn't enjoy my days in private practice at my office in Los Angeles - I did. I had a fantastic staff and had a great time seeing patients. But coming into Scottsdale Center - the home of cerecdoctors.com is different. The place is amazing; my office has all the bells and whistles a techie dentist could ask for. We have 30 CERECs on site, all of which are going to be updated to 4.0 in the next week or so. It's a dream come true for any dentist. Despite all the great things about the new job, the new office, the new work colleagues I get to see every day, there is one thing that I am not quite used to - the HEAT! Holy cow! When they say "It's a dry heat," it's true; it's dry but it's still HOT! Being a California resident for the past 30-some-odd years, I have to say that after leaving the Golden State I really do appreciate how great the weather was back home. I'm sure in due time the weather here will just be a part of life and I, along with my entire family, will be used to it. But in the meanwhile, it's just flippin' hot here! :)

Paddleboarding

Jeffrey Caso (Faculty) — Mon, 22 Aug 2011 00:00:00 -0700

In a previous blog, I talked about the calming effects of my newest hobby - paddleboarding. Here's a short clip of me on the water, paddling my cares away. [HDPaddleboardingblog1.wmv-v-]

Retrograde?!?

Mark Fleming (Faculty & Magazine Editor) — Thu, 18 Aug 2011 00:00:00 -0700

Most who read these blogs are techno geeks. Go ahead, admit it! When things go right with technology, life can be a breeze. But, when things don't go so well... Ever heard the saying "Mercury is in Retrograde"? What I know about it is mechanical things begin to break down during this time. I really don't believe in this. HOWEVER, my receptionists told me last week it had started. No big deal, right? Well, warning light comes on in my car. iPod starts going crazy. Sterilizer breaks down. My server goes down! I'm on the phone today talking to a specialist and my phone goes dead. Will have it fixed by noon tomorrow. And that is not the worst part. When you call the office, you get this message from Verizon: This number is disconnected and no longer in service! Well, this is being written at 35,000 feet. Hope Delta has taken good care of this plane. You'll know they have if I post a blog next week. See you then...I hope!

Three Cheers for the Mentors!

Richard Rosenblatt (Faculty) — Wed, 17 Aug 2011 00:00:00 -0700

I'm on my way out of Scottsdale again. I was just here last weekend to help with the Level 3 and 4 classes. I went home for a few days to work and then back here Wednesday night for the beginning of the cerecdoctors.com 3rd Annual Owners Symposium. Since I'm visiting my daughter at camp this weekend, I'm unable to attend the meeting over the weekend. I still decided to fly down for the day. There was one reason for this - the cerecdoctors.com mentors! I wanted to thank them personally for the amazing effort they put forth on the site. They have allowed the site to rise to another level over the past year. They are professional in their responses on the site, show amazing skills in being able to dissect cases for new users, and I have gained tons of knowledge from the cases they work up. I have not met many of them, so I really wanted to come out here and personally thank as many of them as I could. I'm so proud of the group of skilled dentists that have shared their enthusiasm with the thousands of CEREC users that frequent our site every day. I wish I could have spent the entire weekend to get to know everyone better, but I'm so glad that I came out for the 18 hours that I was able to spend out here at Scottsdale Center. You all make CEREC dentistry better for the masses with the time you have put in on the site and I, as well as the rest of the faculty, are thrilled that you are an integral part of the community. Thanks for all you do!

4.0 Is Out!

Sameer Puri (cerecdoctors.com co-founder) — Mon, 15 Aug 2011 00:00:00 -0700

The final disks will be hitting your offices starting mid- to late September. In an effort to get you ready, here is what you need to know about updating to the 4.0 software. 1. Do not contact your territory rep or CEREC Specialist in an effort to try to get the software faster. They have no control over this and you will get the software once it's shipped. 2. You must update your CEREC Bluecam to Windows 7 64-bit to run 4.0. Don't try to do this yourself. Patterson will have a conversion disk for you which contains all the drivers that are needed. If you attempt to update your computer yourself, your camera and milling unit may not work. 3. Each software comes with a license dongle that will need to be installed in order to run the software. This will be available to all CEREC Club members. 4. Redcam owners will receive the 4.0 software in January. They will require a computer upgrade that will be available from Patterson. These are just a few of the basics. You can find additional information on the www.cerecdoctors.com message boards.

Assistant Training

Richard Rosenblatt (Faculty) — Fri, 12 Aug 2011 00:00:00 -0700

I have been talking to Sam for a while now about what I feel the missing link is with CEREC training. That missing link is training assistants. As speakers, we talk all the time about getting assistants involved in the process to design/mill and finish the restorations so we can be in another room being productive. I always love when doctors bring their assistants out to Scottsdale for advanced training and have them design all day. I know that they will go back to the office and be on their way to greater efficiency and productivity. The problem is that not everyone can get their assistants out to Scottsdale. I have been thinking about this for some time and have decided to come up with a solution. After a great deal of planning, and waiting for the release of the 4.0 software, we are ready to launch an assistant training program around the country. Starting this year, we will be in select locations, to teach an assistants-only class on how to design restorations in multiple modes and finish them by both staining/glazing and polishing them. The course will begin with a review of the important aspects of CEREC dentistry - understanding a proper prep, good powdering and good pictures. We will ensure that all attendees can distinguish between good and bad prepping, powdering and picturing. One of the important things that we teach in Scottsdale is that designing restorations is quick and easy when you give the machine the information that it wants. So after this course, assistants will be able to "think like a machine." This full-day introductory class will be limited in the number of attendees so that they will get the proper attention. We will be in Minneapolis, Chicago, Milwaukee and Baltimore this year and hope to be in many cities across the country in 2012. I look forward to seeing your staff out at the courses and teaching them the basic principles that many of you CEREC doctors have been taught at our classes in Scottsdale. This is a very exciting time for me. We'll keep you posted as to when a course is coming to you and where you can sign up.

Sunday Night Blues

Mike Skramstad (Faculty) — Thu, 11 Aug 2011 00:00:00 -0700

My bet is that a very high majority of the working public has what I call the 'Sunday night blues'.... The feeling that the weekend is over and the dread of going back to work Monday morning to jobs they don't like and care very little about. I certainly love my weekends. Family time is priority number one and I wouldn't trade it for anything. This is especially true in the Minnesota summertime where we actually can enjoy the outdoors without our teeth cracking from the bitter cold. However, my Sunday nights are perhaps a little different from some. I often will review my Monday schedule before I go to bed. I look at the procedures that I have planned for the day and the patients who will be coming into the office. I think about what cases will be documented, filmed, or recorded for www.cerecdoctors.com and presentations. In fact, I just finished doing this five minutes ago. Some may think that I have a problem, some may think that this is odd...to them I say, 'Hey, I just like my job.' It's great to do something you love and be involved with a technology that is constantly challenging you and making you strive for something better.

Celebrating the cerecdoctors.com Family this Week

Richard Rosenblatt (Faculty) — Wed, 10 Aug 2011 00:00:00 -0700

I just want to give a shout out to some of our cerecdoctors.com family: This week, a few of our cerecdoctors.com family have some special dates to celebrate and I wanted to share them with everyone. First, I want to wish Liz Davison a very happy birthday. For those who don't know Liz, she is big part of the glue that holds our fantastic organization together, and one of the best people you will ever meet! Even though she is behind the scenes a bit compared to the faculty, she does a great job here. Happy Birthday, Lizzy! Next I want to congratulate Armen and his wonderful wife Jeannie on 13 years of marriage this past weekend. Many of you know that Armen and I love to make fun of each other at any given second. It is pretty humorous to watch and be a part of. I always say that if I don't make fun of you, I probably don't like you much. Well I guess I really like Armen a lot!! He ran out of class on Saturday to get home to be with his wife for the tail end of their anniversary. I have met very few people in my life who are as dedicated to their spouse and family as that guy is, and vice versa. Happy anniversary, guys. Finally, my last shout out is to our fearless, aging leader! Sam Puri turns 40 years old this week. It has been an honor getting to know and then being able to call Sam one of my closest friends during the last 10 years. I'm always amazed at the vision and the drive that Sam has, between cerecdocs and the townie meeting and such. The more amazing part is that he, like Armen, manages to make his family a priority (and if you've met his wife and two daughters, you certainly know why!). He is a devoted husband and dad and even sold his practice and moved to Scottsdale so he could spend less time on the road and more time with the family. Here's to a very happy 40th birthday, Sam. Looking forward to celebrating many more with you.

The Hardest Word - Goodbye

Sameer Puri (cerecdoctors.com co-founder) — Tue, 09 Aug 2011 00:00:00 -0700

Typically it's my wife or kids that tear up in the face of emotion. Today, however, was one of those days that I got teary-eyed. Today was the day that I said goodbye to my staff at my dental office. As many of you know, I'm relocating to Scottsdale with my family to spend more time working at the Center, manage all the work that goes along with running cerecdoctors.com, and minimize the travel that's associated with all the lectures and courses. I'd known this day was coming, but I guess I didn't really realize how unprepared I was for it. I've been at my office for 14 years. Over the years I've had a tremendous amount of fun growing the practice and taking care of patients. We've had some good team members and we've had some bad team members. I have to say that the team that I've had the chance to work with over the past six years has been second-to-none. So when it came time at lunch to say goodbye, I had a whole speech prepared. I had outlined in my mind all the things I was going to say. I'm a professional speaker for god's sake; how hard could it be? Well, I guess you don't realize how unprepared you are for goodbye until it's time to say goodbye. I mean if I hated these people and simply showed up to work just to get a paycheck, goodbye would have been easy. But my team have been my friends. We've been bowling together. We've been to Vegas together. I've enjoyed beers with them, had margaritas with them. They've watched my girls grow up. They are family and I will miss every single one of them. At lunch, I could barely get words out. Anyone who tried to speak was the same way. No one wanted to speak for fear of losing it in the restaurant. There is nothing worth doing if you don't put your heart and soul into it. I put my heart and soul into my practice and my team. I know they are sad to see me leave as am I to go, but I hope that in some way I have managed to touch their lives and leave a lasting memory. Even though we are moving and the kids will be starting school in another state in a few weeks, I plan on coming back to the office and visiting. I plan on helping out whenever I'm needed. I wish my team - my friends - the best.

Feels Good

Mark Fleming (Faculty & Magazine Editor) — Mon, 08 Aug 2011 00:00:00 -0700

Everyone wants to feel good, at least I hope so. Sometimes, it is about us. But it does not have to be! Haven't you noticed how you feel when you share in others' successes? Feels good, doesn't it? I am happy to say this weekend this happened multiple times for me. First, as it often does, it happened when participants at the courses given this weekend saw how they could be more efficient in using the CEREC technology. That's a GREAT feeling when you are teaching. And this weekend I shared in some successes with friends. Rich Rosenblatt shared his excitement about all the CEREC trainings and speaking engagements he has coming up. His enthusiasm about the CEREC 'religion' is infectious, which makes him a great ambassador of this technology. Pete Gardell hit a home run with live surgery at the Discovery Event on Friday. Pete has been working diligently to become more of a presence in the CEREC world and his hard work is paying off. Sam Puri made the BIG move to Scottsdale this weekend. He is even more committed to taking CEREC training to a higher level. Many will benefit by this dedication. What about you? Who around you are having successes in their endeavors? Share the enthusiasm and celebrate their victories - and watch how you feel. Have a great week!!!

EZ Pass

Jeffrey Caso (Faculty) — Thu, 04 Aug 2011 00:00:00 -0700

Most of the country is headed toward an expedited method of collecting tolls on our roadways. In the Northeast it's the EZ Pass system. From a business perspective it sounds like a perfect plan. Move vehicles through the toll booths in a faster, more efficient manner, collect the tolls through the drivers' credit cards and have fewer employees doing the work. Let's look at how it benefits the roadway authority. You have the funds deposited electronically. No cash to be embezzled or stolen from the workers. The traffic moves through the toll booths faster, which keeps the motorists happy. Fewer employees are needed to collect and process that money. Moving away from cash is better for so many reasons. So, if it's such a good system, why are the non-EZ Pass lanes so crowded that they spill over into the EZ Pass lanes and cause a back log there as well? That's a tough question to answer. A few years ago, they made EZ Pass car tags available just about everywhere. You could get one in any convenience store and it would be linked up to your credit card on the spot. What could be easier? Well, something was hindering people from getting them. I refrain from using the words "buying them" because they were available for free. You just paid as you went. No hassle, no charge, no wait at the toll booth. Yet the program was falling flat on its face. So, next move. Give everyone a credit on their EZ Pass account for $25 just for getting on board with the program. Then to sweeten the deal a little more, just about every toll was reduced for EZ Pass users. People are funny. Even this great deal had very few takers. So, with the EZ Pass authorities scratching their heads, they are left with nowhere to turn. The system is working, just not as well as they would have liked. In our offices we all have issues like this. We go to a new class and get all gung ho on a new procedure only to find that we have very few people accepting treatment. Where does the problem lie? Generally, it's with our inability to show the patient the need and therefore the value in what we are proposing. Sometimes it's that we are so enthusiastic it comes off as the hard sell and people get put off. Or maybe it's our inability to present the situation and treatment in layman's terms and we confuse the patient too much. We need to educate our patients so well that they will end up seeing the need before we even stop talking. That, in a nutshell, is the key to case presentation. Education in terminology which is fully understood, followed by an "aha" moment, and then best thing ever: co-diagnosis. If many patients are avoiding treatment, then we simply failed to educate. Surely, there are some patients who will never commit. Much like those motorists that think the EZ Pass system is put in place to track their movements. We can't make everyone see the need that we see. Perhaps the EZ Pass authorities failed to very simply teach people how the system works. I can think of so many TV commercials featuring the famous rabbit and the turtle, where the turtle wins because he has EZ pass. Educate, educate, educate. That is the answer.

People to People

Peter Gardell (Faculty) — Wed, 03 Aug 2011 00:00:00 -0700

My son David is traveling across the globe with a group called People to People. It is a student ambassador program designed to open the eyes of the young people in our country to cultures and traditions in other parts of the world. The Internet and television can only go so far to make you understand others. You have to walk a mile in someone's shoes to really comprehend why they are who they are. They visit with other students, business people and the politicians of the target country. It is more than a fun vacation; it is a fantastic learning experience and something I am sure will stay with him forever. I hope he realizes that there are many points of view. Even if he doesn't agree with them, I hope he is prepared to have an intelligent conversation - to state his position, back it up with facts and be willing to listen to the other side. And when needed, to even utilize the lost art of compromise. I hope this experience will lead these young citizens down the right path, help them discover their interrelatedness and uphold the common good.

Yep...

Mark Fleming (Faculty & Magazine Editor) — Tue, 02 Aug 2011 00:00:00 -0700

...I did it. I took the weekend off. Lori and I rode our bikes, walked, relaxed at the pool and basically took it easy. It's good to recharge, to get away from the hustle and bustle. I just needed it this weekend. Still had some calls about the cerecdoctors.com magazine, rewrote my Editorial piece, and did go to the office for a short time...but for me, it was an off weekend. Good thing, since for the next six weekends I'm away from home. Oh, well, at least I had this weekend...

Dude's Day Out!

Richard Rosenblatt (Faculty) — Mon, 01 Aug 2011 00:00:00 -0700

I spent five days in northern Wisconsin teaching some new users CEREC in their practice. It is always very rewarding seeing the change in their confidence from the beginning to the end. I don't do this kind of training often. Sometimes the summer can slow down a bit in my practice, and when I was asked by my local CEREC specialist if I could take a few days this summer to help out some docs in their practice, I figured why not? The real reason it was easy to decide to go was that my middle child Jack (my only boy), was supposed to be going to overnight camp. He was on a waiting list, but we were told there was a pretty good chance he'd be going. It was his birthday on the final day of training and since he was supposed to be away, I wouldn't feel so bad. Well, turns out that Jack did not get into camp. I was going to be out of town on his 11th birthday. I felt pretty bad about going now! I talked to him that day and told him I would try to get home as early as I could. I was shooting for dinner. I told him to think of something fun to do the next day, his call. Jack decided on Six Flags Great America. A "dude's day out," as we like to call it. We just had the best time. My son is my best bud. Words cannot describe how much I love the kid. When we get to hang together as we did this day, you would not know that I was his parent. We tell silly jokes and just crack each other up all day. We total have the same sense of humor. For those who know me pretty well, there is no surprise to hear that I act like an 11-year-old! I cherish days like this. He told me it was his best birthday ever. I just love spending time with my little dude. No matter how big he gets, he'll always be that to me. Happy birthday, buddy! [richnjack.jpg]

Scenes from a Wedding

Sameer Puri (cerecdoctors.com co-founder) — Fri, 29 Jul 2011 00:00:00 -0700

I had one of those amazing weekends last week. It was my cousin's wedding. Now, this was no ordinary wedding as my cousin is the baby in her family (the youngest of three kids) and the last to get married. It was a splendid affair where we had family from all over world - London, Singapore, Malaysia, Canada, New York, San Francisco and Chicago - fly in to attend. Indian weddings typically last three to four days depending on how many functions are thrown. All of these parties have a meaning and symbolism based on thousands of years of tradition in the Indian culture. One of the nights is called 'Mehndi,' where the women get their hands painted with henna, a temporary tattoo that lasts a few days and then wears off. Usually the designs are elaborate and decorative, for most but it's customary that the bride's hands and feet are covered. The picture that you see is one of my other cousins with a relatively simple mehndi application. Imagine the entire hand covered - that would be the bride. [henna.jpg] The next day we were off to the wedding. Dress code for Indian weddings is fairly elaborate. The women wear heavy saris (decorative cloths that wrap their bodies). The men usually wear suits or traditional Indian outfits. For this one, dress code for the men was black tie. The Puri family was in full dress-up mode for this party. [puris.jpg] As you can see from this picture of my wife and cousins and other relatives, the colors that are worn are bright and varied. Weddings typically are the events where you go all out, where you wear your best clothes, your favorite jewelry, etc. I mean this is a no-holds-barred event as you can see from the photo of the ladies. [ladies.jpg] This was a special event in that my 92-year-old grandmother made the trip all the way from India to be here. It was great to see her and she looks great! Our nickname for her is 'Bade Mama,' which literally translates to 'Biggest or Eldest Mom." [grandma.jpg] Now with Indian weddings, the groom's side, called the barat, will dance their way to the bride's side. This is symbolic of the old days where one village would dance over to another village, have the marriage ceremony and then take the bride home. Obviously times have changed and there are no villages in Southern California so usually the groom's side will dance from one end of the party to the other end where the bride's side will receive and welcome them. The groom would usually ride in on a horse, or a carriage but every once in a while, the wedding planners go all out and try to do something different. To simulate a royal wedding where the prince would ride in something bigger than a horse, the groom in this case rode in on an elephant. Don't ask me how they arranged to have an elephant in the parking lot of a hotel, but there it was. The procession you see ahead of the elephant is the groom's side wedding party who are all dancing their way to the bride's side. [barat.jpg] This elephant was the real deal. Accompanying the groom is always his 'Sirwala' or groomsman. Just in case of trouble, the groomsman can step in and save the day. [elephant.jpg] Patiently waiting for the 'barat' is the bride's family. The bride is not there. She will come later. But the father, brothers, mom, cousins and close friends wait for the barat to arrive and greet them. The dancing from the barat can last about 10-15 minutes, or in the case of one wedding, the barat took an hour to dance their way to the bride's side, dancing and drinking along the way. Indian weddings are festive occasions so there is usually food and drinks ready for both parties. The ceremony was a typical Indian ceremony. As you can see from the picture below, this was an outside wedding. Traditional Indian ceremonies are actually done at the very end after the reception when the guests have gone home and the only people left are the close families. Today, however, a bit of blending is done where the ceremony happens first and then the party. [crowd.jpg] [outdoors.jpg] While the groom was seated in the 'Mandip' or the altar where they were to be married, the kids started making a bit of fun of him as he was waiting for the bride. I know in the back of his mind was running the thought, "What if she doesn't show up??" [mandip.jpg] In the end, of course, she showed up wearing the traditional red that is worn by brides from the region of Punjab (where my family is from). The couple had a great time, the ceremony was beautiful and I want to wish my cousin and her new husband lots of luck in their life together. Congratulations, Sonia and Deepak! [couple.jpg]

Having Fun

Jeffrey Caso (Faculty) — Thu, 28 Jul 2011 00:00:00 -0700

In a previous blog I eluded to the fact that I have way too many hobbies. The reason for that is that dentistry is a hard job. It's stressful from both a work and a business standpoint. Working in the mouth is just plain difficult. The stress level can be great. Hobbies help to wash away that stress and keep you healthy. For me skimming across the water in a boat is like driving down the highway on a motorcycle without a helmet on. Catching a big fish is a huge stress reliever, but even better is the thrill of the hunt. Using your gear and knowledge to get you to the right spot and present the right bait in the right way at the right time to actually catch the fish is a real high. Fixing a broken car or working in the backyard is of equal value. Hobbies help us in so many ways. Recently, I picked up a new hobby. (Like I really needed another one.) The ones listed above were just the tip of the hobby iceberg. This one, however, is helping me in many ways. I had fallen into a bad habit of arriving home from work and standing in the kitchen talking to my wife while she is finishing dinner preparation. I would eat a little of this and a little of that and then sit down to dinner. No way I needed a pre-dinner snack. So I decided to do something with that 20 or so minutes to keep me out of the kitchen and away from food. My answer was odd, I will admit, but awesome at the same time. I bought a huge 12-foot long by 3-foot wide stand-up paddleboard. For those of you not familiar with paddleboarding, it's like standing on a huge, stable surfboard. While it is big, it only weighs 35 pounds and is easily handled. It all started years ago in Hawaii and is now catching on in my area. So now I come home, kiss my wife hello, put on a bathing suit and drop the paddleboard in the pool. I jump on and for 20 minutes or so, floating around using the paddle to effectively move around the pool without touching the walls. I am instantly transcended into another world. I have to concentrate on what I'm doing and have no way to think about other things. Essentially, I am forced to relax. All the while I am getting a great ab and core workout without thinking about that either. When I am called in for dinner, I am a calm, happy guy who is less stressed and hasn't spent the last 20 minutes eating a before-dinner meal. It's a win in so many ways. Soon, I will hit the beach with it to further challenge myself. As for now, I am happy with my newfound love and intend to take advantage of its Zen-like effect on me for as long as possible. Find your own stress relief and use it to its fullest. Mine may be weird to some but I think it's a pretty cool thing to do.

Give Us a Break!

Richard Rosenblatt (Faculty) — Wed, 27 Jul 2011 00:00:00 -0700

I wish Mother Nature would make up her mind! First, we got 80 mph winds, downed trees, and power outages for up to five days in my area. Then, we had an insane heat wave - felt like I was walking around with a hot, wet comforter on me all darn day. Next, it was a torrential rainstorm - supposedly almost 8' overnight last week. That storm screwed up my car of all things. No, I didn't leave my window open; I just went my local Amoco for gas. Next day, I get this horrible knocking in my car to the point where it was stalling out. The car is six months old! I took it in and found out that my gas tank had 40% water and 60% gas in the tank. Naturally, that was not covered by my warranty, so $500 later, it was running again. Turns out the underground tank at the Amoco station likely got water in it during the deluge. First the Gulf and now my new car! Armen constantly makes fun of the weather in Chicago, mainly the winters. I'll tell you, I did way better in that wild blizzard we had the week before the Super Bowl than I'm doing with this crazy weather. What I wouldn't give for a few weeks of normal weather right now!

A Ride to Remember

Peter Gardell (Faculty) — Tue, 26 Jul 2011 00:00:00 -0700

Flying home from the 3rd Annual CEREC Owners Symposium, I was thinking about how I once again had the chance to be in front of my peers. But this time, the stakes were higher, much higher because this was the cream of the crop of CEREC owners. These guys know their stuff and there was no way I could get anything by them. And there were a lot of them. Again, I had to walk to the edge of the cliff, but this time I had some tools to use and much-needed support from my wife. She saw my determination to make this good and was there to offer encouragement when the frustration was apparent. The symposium is an event like no other. Fantastic individuals from around the world are there with the single purpose of learning from one another and making the CEREC world a better world. (It's funny - I'm doing what I tell my kids not to do - meeting strangers online and then meeting them in person - sounds weird but it is exactly what we do!) It truly is a dynamic community that has been brought together by a vehicle created by my friends Sameer and Armen. Both of these people have had a huge in?uence on my professional life. This event is full of great cutting-edge information, materials that are here now and breaking news on what is coming out in the near future, new software developments and glimpses of the new release due out shortly. All packed into a format where we have a lot of fun both in session and after hours. So I ask myself how I got this great opportunity, this big intimidating opportunity. I asked Sam if he was sure and he responded, "I know you are going to do a great job." I told him I would not disappoint. A lot of preparation went into it, and as I said above my wife was very supportive of the undertaking I had accepted. So I went to stand on the stage, the edge of my comfort zone. I peered over the cliff but stood fast. Time appeared to stand still. I had confidence in the tools and in my ability. The audience appeared engaged and as I went along my fear of not having enough material for the time evaporated. The clock was now moving fast and my time slot quickly came to an end. A roller coaster type of experience, apprehension quickly turned to exhilaration. I thank Sameer and Armen for letting me on the ride, my wife, my friends who are fellow faculty and mentors, and most importantly the audience for their time and support. It was an e-ticket ride that I will always remember fondly.

Rock On

Sameer Puri (cerecdoctors.com co-founder) — Mon, 25 Jul 2011 00:00:00 -0700

Here's a post by one of our mentors, Bob Conte... At some time in our lives most of us have had the opportunity to attend a great music concert. For some it's country, for others classical or jazz music. For me, I love live rock and roll. Some of my greatest memories revolve around live shows by the Grateful Dead, Springsteen, U2, Jimmy Buffett and just about every artist of that genre. There is nothing like the rush, excitement and energy of a live show by a great group of artists. These nights, in the moment, are like nothing we experience in out day-to-day lives. We find ourselves immersed in the moment and feel like it will never end. We leave expecting what we felt at the show to carry over for days, weeks, years. We tell our friends and co-workers how great it was, but are unable to articulate the feeling. Soon our busy lives take over and what we saw, heard and experienced becomes a distant memory. Dental education is very similar for a lot of dentists. We will attend a conference or a weekend seminar and feel excited about our profession. We learn amazing new techniques or valuable practice management skills that will take our practice to a new level. We vow to take what the national speaker has taught us and, on Monday, immediately implement everything we heard. We excitedly share with our staff at the first morning huddle how we are now going to do things differently. Unfortunately, we fail to articulate our excitement and soon the euphoria passes and we settle into our usual routine. The staff dismisses the proposed changes and progress stalls. This past weekend I attended a rock concert of epic proportions with a dynamic lineup of stars. The 3rd Annual Cerec Owners meeting was an action packed weekend of listening to the superstars of our field. We were introduced to the new 4.0 software by the very men who headed the project. We were exposed to new and advanced techniques by all of the amazing faculty of cerecdoctors.com. New materials were unveiled by the very men that invented them. Lastly, we were touched and motivated by the incredible visionary, Imtiaz Manji. These men are leading all of us in the revolution that is digital dentistry. We were rocked out of our socks. No one held up their lighters for an encore, but were we on the edge of our seats the whole weekend and didn't want it to end. You could feel the excitement of everyone in attendance. The challenge for all of us is to keep the momentum moving forward. Don't fall back into the routine. Involve your staff. Excite your patients. Stay engaged at the highest level. Live the message that these rock stars delivered and don't let go of that excitement. The future is amazing. It's going to be a long, strange, trip...

Goals

Jeffrey Caso (Faculty) — Fri, 22 Jul 2011 00:00:00 -0700

I have found myself reflecting a good amount lately on where I am in life and where I really want to be. Thankfully, I am happy with my situation as a whole. I have a great wife, fantastic kids, a rewarding career and too many hobbies to list. Reflection is a good thing. You examine your past and find ways to avoid reliving negative experiences while at the same time maximizing past positive experiences. It's really pretty simple. Learn what makes your body as healthy as it can possibly be. We all want to grow old gracefully. It's important to me to eat right, exercise regularly and have a positive self image. Set some goals and make them happen. It may be an optimal weight or a low-fat diet. It may be simpler than that, maybe you just vow to drink more green tea to help your heart out. Goals don't have to be lofty or hard. It's important to exercise both your body and your brain equally. Yes, work gives us plenty of mental exercise, but find something that interests you outside of work to stimulate your brain in a more relaxing way. Consider what you can do at work to make the everyday grind less stressful. Set up new rules for the staff. They don't have to be harsh like no more cell phone use or personal phone calls. How about a morale building exercise like if you can collect from a delinquent account, resolve a certain insurance problem or save money on a particular high use product, then you buy everyone lunch or a new set of scrubs or let someone leave an hour early one day with pay? Set some goals along those lines and you will get some good old-fashioned competition going to make every day more fun and less stressful Find out what you can do to help out your personal financial situation. This one is easy to figure out just hard to put into effect sometimes. Do you need to make a bigger contribution to your retirement account, pay off a debt or buy that stock you have been thinking about? Set a goal and give it your best shot to achieve it. Discover what you can do to help out your family. Spend time with them and help solve any problems they have to make them happier and more content in life. Most of the time this is simple. Just spending quality time with them is enough. Turn off the computer and cell phone; it will do as much for you as it does for them. Reflect on your past experiences now and then and set some achievable goals to make your life better. That includes your work life, your home life and your personal life. It's all about being content. That in itself is a great goal.

Safe-vac

Richard Rosenblatt (Faculty) — Thu, 21 Jul 2011 00:00:00 -0700

I always like to throw stuff up on the blog that can make things a little easier for us when we practice. While at the Scottsdale Center this weekend, I was introduced to a very cool disposable high-speed suction tip. The tip is called the safe-vac. It has a soft rubber tip on the end to make it very comfortable for the patient. There is also a screen in the inside of the tip to help avoid the 'I just suctioned up my onlay' look on your assistant's face! Contact your Patterson rep about these. They are very cool. For more info, check out their website at www.safe-vac.net. [safevac.jpg]

Learning New Things

Jeffrey Caso (Faculty) — Wed, 20 Jul 2011 00:00:00 -0700

With the upcoming release of the new 4.0 CEREC software some of us are going to have to step out of our self-imposed comfort zones and challenge ourselves. Our current software is working well for us and has been a huge advancement in and of itself. Some may say, "Well, if it's working for me now and it's doing what I want it to do, then why switch?" The answer, my friends, after spending some time testing the new software, is simply because it's the future. That may not be a good enough answer for some of you who look at this release as a hassle, thinking 'Why should we have to relearn the entire software when what we have is just fine?' Well, it's not really going to be that you need to relearn everything. You already know the dentistry involved in giving the machine CEREC friendly preps. You already know how to image. Milling is essentially the same. The element that is different is the design process. The learning curve will not be steep at all and what you will gain is enormous. Dentistry, CEREC dentistry in particular, is moving toward creating a level of convenience for your patients that they have grown used to. They just expect everything to be done in a manner that minimizes their time in the chair. I was always concerned about presenting quadrant dentistry to my patients. Well, after using CEREC for quite some time, I don't have to present it. They present it to me. "Hey doc, while you're working on that side, can you replace the ugly amalgam in the next tooth?" Sure I can. It will only take a few extra minutes to do that. Well, in my opinion, that's what 4.0 helps us with in an extraordinary fashion. The simultaneous design of multiple restorations, anywhere in the mouth. The proposals are dead on and the time it takes to accomplish multiple restorations is lightning fast. In addition, the design of anterior restorations just became simple. Mostly because the proposals are great and the 3D tools are simple, intuitive and super-effective to use. Learning new things can make us nervous, especially when we are learning in front of our patients. My advice is to jump in with both feet. Start by watching videos on cerecdoctors.com and practicing a few times in between patients. Then just go for it. The software is now refined to a level that will make you smile. Challenge yourself if you must; push yourself if you need to. Embrace the change and in just a case or two you will be using it in a fast, efficient manner. Don't make the mistake of looking at it as a hassle; don't let it sit on your desk for weeks. Just do it. It will amaze you, it will tantalize you, it will reinvigorate you and it will make you a better CEREC dentist. Most importantly, don't be afraid of it. Enjoy the next phase of your journey. The future is now. Have fun with it.

Comfort Zones and Milestones

Peter Gardell (Faculty) — Tue, 19 Jul 2011 00:00:00 -0700

This past weekend was a milestone for me. It was a huge step, a major accomplishment that I wouldn't have been able to complete without the support of my family and friends. Neither would let me take the easy way out; they pushed and encouraged, and I trusted that they wouldn't let me fail. I have talked about getting out of my comfort zone on the cerecdoctors.com boards when doing the training at Scottsdale Center and when doing a training session with a new CEREC owner. I like a challenge and when it comes to doing things or solving problems I work my tail off to complete the task successfully. I look inside and see how I can do it, how I will complete it, with the intention it is my responsibility, I will accept the success or the defeat. If it is defeat, I will self-evaluate to see how next time I will succeed. The task this time was getting in front of a group of my peers, my mentors, my esteemed colleagues, to present information that they would find beneficial and hopefully entertaining. I did not want them to leave with a feeling that I had wasted their valuable time. The process started with an invitation to be part of cerecdoctors.com in a faculty position a few years ago. That opened the door to speaking opportunities at smaller events that were easy for me to prepare for and to manage. CEREC 25 approached and then the e-mail to see if I would take the stage. This was upping the ante. The time came and I fought through it. But I was at the limit for my comfort zone and I doubted that I had delivered to the audience the quality of lecture that they deserved. For me to progress I needed to grow, to learn the craft of speaking better. It was at this point that I heard about the Sirona Speakers Academy and that a group of my peers and mentors were going. I wouldn't let a golden chance like this pass me by. Sameer Puri, Armen Mizayan, Mark Fleming, Mike Skramstad, Rich Rosenblatt and Tarun Argwal; the big dogs, my mentors and my friends. They are all well-seasoned veterans of the big stage; I was the newbie, the amateur and glad I made the cut, but at the same time worried I would hold them back from them getting the most out of the class. I was more nervous standing in front of this group trying to present than the day I went to my father-in-law for permission to marry his daughter. I was at my comfort zone threshold, and I felt paralyzed, physically and mentally. I needed to ?nd a solution, I could not allow self-imposed limitations stop me from advancing, and my mentors and friends were there to help me. Gentle prodding, reinforcement, colorful jokes to break the tension, and sharp kicks in the ass all enabled me to move past my comfort zone. Now that I think of it, the jokes were very important because if the tension had not been broken I probably would be sitting in a jail somewhere after being convicted of killing Paul Homoly. Whom I owe a lot to because his surgical-like dissection of my personality, identi?cation of my weaknesses and the proper drill to strengthen them. You cannot have a major breakthrough with being stripped down to the point where your defenses seem useless. If not surrounded by my mentors whom I respect and their constant support, there is no way I would have gotten anything out of the weekend other than the knowledge that I suck as a public speaker. I left with the feeling that I was 0 for 4, with three strikeouts. But I did get the bat on the ball my last at bat, and that's enough to keep me wanting more.

A Long, Inspiring Trip

Mark Fleming (Faculty & Magazine Editor) — Mon, 18 Jul 2011 00:00:00 -0700

Sitting in the Atlanta airport waiting for my last leg home to Sarasota. I am returning from an incredible four days of CEREC. Thursday and Sunday were dedicated to the Mentors and Friday and Saturday were the Annual Owners' Symposium. There was definite excitement about the new software that will be released in September. Talk of new materials and techniques also piqued the interest of the attendees. It was a great four days. But, for me, the highlight was Imtiaz Manji sharing his vision for the Open Wide Foundation. It is the opportunity for dentists to give back from their abundance to help give dental care to those in need. Imtiaz gave a truly inspiring presentation about the Foundation. You can find out more at http://www.speareducation.com/openwide/. Well, it's time to catch another plane. Thanks to all for a GREAT time. Can't wait for the next step. Can you?

Giving Back

Darren Greenhalgh (Faculty) — Fri, 15 Jul 2011 00:00:00 -0700

Everyone gives back to their community in different ways. Volunteering time, money, talents, or possibly some sweat with occasional manual labor. I have the opportunity to give back to my community in the way that I think I am the most helpful - dentistry. [GivingBack3.png] [GivingBack1.png] [GivingBack2.png] Many years ago I signed up for a program that gives back to those who are in need here locally in the Seattle area. This program is called DDS (Donated Dental Service) and is run by a charitable organization called the Dental Lifeline network (formerly the National Foundation of Dentistry for the Handicapped (NFDH)). Their focus is to help disabled, elderly, or medically at-risk individuals who don't normally have the opportunity to receive quality dental care. The great thing about this program - they do everything. They assess the situation and the patient's needs, arrange for transportation if needed, and make the appointment. We have all been burned in the past - where charitably appointed patients just don't value the treatment you are offering and fail to show up. It can certainly be very frustrating or it can be very rewarding depending on the outcome. Since I've been volunteering with DDS, I have never had a problem with a patient not showing up - or missing an appointment. Another new and exciting way to give back to those less fortunate is through Spear Education's Open Wide Foundation. What a wonderful opportunity to help in such an ambitious project - to break the cycle of poverty. I can't do the massive project justice in a few sentences, so I encourage you to visit the Open Wide Foundation website at www.speareducation.com/openwide/. There are so many ways to contribute and so many opportunities to help. If you already do charitable work for those less fortunate then I don't need to tell you how happy it can make one feel - we have so many talented individuals on cerecdoctors.com - I hope giving back becomes contagious with all of us here!

It Is a Small World After All

Peter Gardell (Faculty) — Thu, 14 Jul 2011 00:00:00 -0700

As I travel today to Scottsdale for the CEREC Owner's Symposium, I think of my son David who is on hour 27 of his travel time to Australia. Amazing how small this world has become. Different languages, different dialects all adding to the spice of life, all offering different perspectives. Great dialog can be created and we can learn so much from one another. All too often we sit in our little piece of the world thinking, "This is it, this is right, everyone is out of touch because they don't agree with me." When we expand our own worldviews, we open ourselves up to some truly incredible learning - and life - experiences.

Are You Struggling? Submit a Case!

Richard Rosenblatt (Faculty) — Wed, 13 Jul 2011 00:00:00 -0700

All of us were new users at one point in time or another. We all remember a frustrating case or two along the way. I personally remember my CEREC journey that began eight years ago. There was nowhere near the amount of help that there is for users today. You could visit Dentaltown, which was pretty much the only site for questions. But back then, you were a renegade as a CEREC user and asking questions could be intimidating. Most of the learning users at that time did was to just figure it out on our own or take one of the few advanced courses offered around the country. Thankfully, this has certainly changed today. One of the most powerful tools that the cerecdoctors.com site offers is the ability for a user to submit a CEREC CDT file that they are struggling with. For those of you who are new to CEREC and cerecdoctors.com, a CDT is a CEREC file. At cerecdoctors.com, we have eight faculty and more than 50 mentors who eagerly await the submission of these files. How does it work? It's simple: Once a file it submitted (go to Boards - CDT Upload), it is reviewed by a faculty member and advice is given on how to improve the case or how to make some changes so the next case is more successful. This can be accomplished through message board comments, taking screen shots to point out a correction or making a video of the design process to demonstrate how to improve the case. I was always amazed at how fast eight guys (the faculty) could make time in their busy schedules to give feedback for the submitting doctor. With the addition of 50+ mentors, now the response time is incredible. It almost seems real-time. What I have found over the years is that not only does the submitting doctor improve from getting their questions answered, but the cerecdoctors.com community advances. Most members discover that they have also made that same mistake and have now learned to correct it. I know it may seem intimidating to submit a case, but I can say without reservation that the critique is nothing but positive and constructive. The outpouring of support from other users is amazing and I applaud the faculty, mentors and members for this incredible gathering of professionalism! If you are struggling with cases, I strongly recommend utilizing this fantastic service on the site. Sam and Armen changed the CEREC landscape forever in February of 2006 with the introduction of cerecdoctors.com. If you are looking for a little direction and guidance, go ahead and submit a case. You will not be sorry!

Why?

Mark Fleming (Faculty & Magazine Editor) — Tue, 12 Jul 2011 00:00:00 -0700

I get asked that question a lot when I'm in Scottsdale, especially in relation to my travel. In case you don't know, I'm in Scottsdale once or twice a month traveling from Sarasota, Fla. And it's worth it. Allow me to explain. First, I get the opportunity to be with close friends. Through CEREC, I've made friendships not just in the U.S., but across the world as well. Second, I get to help others use the CEREC technology better. It's really nice when participants are back for another course and tell us how much more successful they are now utilizing the technology. This has me thinking ... how can I show more gratitude for what others do for me? I know how I feel when others show me gratitude; why not share that same sentiment with others? What about you - why do you do what you do? What opportunities do you have to share gratitude with others? Maybe it's time to explore these questions. Enjoy!

Handling Cash Flow Hiccups

Jeffrey Caso (Faculty) — Mon, 11 Jul 2011 00:00:00 -0700

As our economic situation sputters on and on in a seemingly endless horizontal quagmire, battle weary small business owners need to endure the new normal. I think many of us have had to offer our patients more latitude in payment of their bills than we have ever had to before. This is something that we may not be entirely comfortable with but it is completely necessary in light of our economic situation. I have offered credit to loyal patients who have suffered through the recession. These are people who didn't ask for the problems that were handed to them. I felt that in their time of crisis, I needed to step up and not turn my back on them. I made the necessary treatment for them and their families work out by either lowering my fees, extending credit or in some cases both. Desperate times deserve desperate measures. So, as can be expected, there are times where collections are slower and we need to weather the storm. Having a fixed lab bill every month is fantastic and I have CEREC to thank for that. In addition, we order supplies as needed and try not to carry a great deal of inventory. We also have cut the fat in many places. I just finished shopping for services like infectious waste disposal and recycling of my amalgam separator. The savings were in the thousands. I used my check writing software to assemble a list of the things I have paid for this year and used that as a guide to find things that could be reduced. You will be amazed at what can be done to drop your overhead. So if our economic storm is a huge hurricane, we may very well be in the eye. The big nasty part has passed, but there is still some more to endure. Hopefully, it's shorter and less intense than what we have previously seen. Those patients that you have stood by and helped out will regain their footing and become some of the most intensely loyal patients you will ever have. Practice smart and you will be there smiling when this is all over. You will be bigger and stronger than ever and comfortable with the road that you took to get you there.

Travel I'm Really Looking Forward To!

Richard Rosenblatt (Faculty) — Thu, 07 Jul 2011 00:00:00 -0700

This has been a year for me that I never imagined happening. I've wanted to be a dentist since I was 8 years old. Actually, I wanted to be an orthodontist, but once I got to dental school and realized I could not bend wire for anything, I decided that general dentistry was a better fit for me. The other thing I wanted to do my entire life was teach. Becoming faculty at cerecdoctors.com almost three years ago allowed me to embark on that dream along with becoming a CEREC basic trainer for Patterson. I tend to travel a lot now. I never thought I would be on a plane as much as I am but as my wise friend Sameer once told me a few years back, 'Be careful what you wish for!' A few years ago when I started to travel just a bit, my wife said to me, "I didn't think I was marrying a traveling salesman.' Sometimes it really feels that way. As much as I love it, and I do, I really dislike one aspect - leaving my family. It gives me some guilty feelings when I'm gone frequently. I'm a family guy first and foremost. When I'm not working or teaching, I'm with my wife and kids. It is something that I try and prioritize, sometimes better than others! Well, I finally have some guilt-free travel coming next week that I'm really looking forward to. My oldest child Alix is spending eight weeks in overnight camp in beautiful Eagle River, Wisc. She just loves it there. At the four-week mark, parents and family are allowed to come up and spend the weekend. I can't wait to wrap my arms around that kid and give her a big hug! I also can't wait to get up there and have a great family weekend. The camp opens up its facilities. We spend the day water skiing, kayaking, sailing, and enjoying other great activities. It is just a fantastic time and we look forward to it every year. There is nothing better for me than spending time with my family. I read Jeff Caso's blog about the summer he is spending with his family before his oldest son goes to college. It really hit home for me at how fast kids grow up. The more I travel for work, the faster my kids seem to grow up. It is weekends like the one I have coming up that seem to slow that aging process down just a bit, at least for that weekend. This is some travel I truly look forward to!

Moments

Mark Fleming (Faculty & Magazine Editor) — Wed, 06 Jul 2011 00:00:00 -0700

Somestimes when doing a procedure that involves CEREC, I forget how incredible it may appear to a patient. I had a patient yesterday who we were replacing a crown for. What was potentially complicated about it was that the crown was a retainer for her partial. After trying in the crown and making sure it fit the tooth and the partial, the patient remarked, 'I sure am lucky you can make this crown here in one appointment and have it fit my tooth and partial.' To tell you the truth, I had forgotten how incredible this procedure was in the eyes of the patient. I followed up with her on how this technology can be a definite benefit to my patients as she had observed. I consider this exchange a behavioral moment, an exchange that really can't be scheduled. When these happen, I find that they are powerful times in our interactions with patients. To take advantage, you must be aware that they are happening. Are you and your staff aware? You may find that these moments can be very instrumental to the success of your practice.

E.max Cycle Times

Sameer Puri (cerecdoctors.com co-founder) — Tue, 05 Jul 2011 00:00:00 -0700

In our courses and on the message boards of www.cerecdoctors.com, there seems to be a lot of discussion on the shortened cycle to crystallize e.max. Many of you might be thinking that I'm referring to the 19-minute cycle that is officially approved by Ivoclar. I'm not. I'm referring to the roughly 12 1/2-minute cycle as described by noted researchers, which showed that there is really no loss of strength at this shortened firing time. I get asked all the time whether this shortened cycle is a safe cycle to use for e.max restoration. My answer to the question is really the same as my answer to anything in dentistry - there is no right or wrong and there is no one size fits all. What the user has to do is look at the clinical situation and determine what route they want to take to get the job done. Those of you who are contemplating the cycle that's been discussed on the message boards need to realize that this cycle is not approved by Ivoclar. Their internal testing has been done on the 19-minute cycle and Ivoclar for various reasons doesn't feel that going shorter on the cycle is worth it. Having said that, I think with anything one must look at not only manufacturer studies but make an independent and educated assessment as to the best way to use the products and materials in their practices. Fact of the matter is that six to seven minutes of savings may not be a big deal for many practices. If it is not, then stick with the regular cycle. However, if your practice is like mine and you are doing four to five CEREC restorations a day, seven minutes per restoration can be a significant amount of savings. One common argument is that the lithium metasilicate in e.max does not fully convert to lithium disilicate in the shortened cycle. The effect of this seems to be a slight difference in color which is only evident in the LT blocks and not HT blocks. Other than that, there does not appear to be any adverse affect of the incomplete conversion. Even in the 19-minute cycle, there is incomplete conversion of the lithium metasilicate. I have yet to have someone who talks about this incomplete conversion explain to me what it really means. Another argument is that the restorations are weaker when not fully crystallized. While independent studies by Child and Giardano refute this, let's assume for a bit that there is a 20% loss of strength and the restorations are 300 MPa in strength instead of 360 MPa. At this number, the restorations are still twice as strong as any other porcelain block made for the CEREC. In fact, if this is such a huge problem, Ivoclar should remove Empress from their product offering because it's roughly 150 MPa in strength. Bottom line is that the debate about the shortened cycle is not about to end anytime soon. I've used the shortened cycle many times over the years with no adverse affects as have hundreds of other clinicians. While more formal testing needs to be completed (and is underway), clinicians must use their own judgment as to the materials that are offered and how best to use them. Manufacturers are a good guide to help us get started but often it's the ingenuity of the individual clinicians that leads to great strides in clinical science and technique.

Family Time

Jeffrey Caso (Faculty) — Mon, 04 Jul 2011 00:00:00 -0700

For me July 4 marks the beginning of a special summer. At the summer's terminus my oldest son will be leaving for college. It's exactly what he wants and it's totally what my wife and I want for him. He has worked so hard and accomplished so much and deserves to have a rewarding college experience. So, if it's really what we all want, then why will it be so hard for all of us to see him go? Well, the answer is easy. He has been a remarkable son. Respectful, compassionate, trustworthy and a pleasure to be around. He has been a fantastic brother as well. The change in the house will be enormous. The fact of the matter is that just because he will be attending a college five hours from home, he will never stop being all of the things that I mentioned and more. It's his time to experience all that life has to offer and he deserves the best. I plan to do everything in my power to help him fulfill his hopes and dreams. I look at this time as an opportunity to be able to spend a little more time with my two other sons. They will feel the difference in the house as well and I hopefully can help them get through the transition by doing some special things with each of them. They are in the formative years and every little bit of quality time is a benefit. Come September, to help myself handle the situation, I plan to immerse myself in my work. The InLab software is one of my ideas. Beta testing will be winding down, but work on cerecdoctors.com will be ramping up as the 4.0 software nears release. So, bring on the work - it's good therapy. Feeling fulfilled at work makes everything better. As for now, the final summer before college has a special meaning. It's all about spending time together as a family. Not just hanging out, but really enjoying each other. We have some great plans and they begin right now. I plan to cherish each and every day and look forward to the future with excitement. It's not the end. It's a new beginning. Find your own balance between work and play. Work hard for fulfillment and play hard for yourself and your family. Do it now! Each day needs to be maximized, whatever you are doing. Most of all live, love, laugh. Time passes by quickly.

Everything is marketing. Part 8976987634

Armen Mirzayan (cerecdoctors.com co-founder) — Sat, 02 Jul 2011 00:00:00 -0700

In the spirit of Fred Joyal's book, Everything is Marketing, and figuring I have nothing to lose, I created a short video, placed in on the server, created a QR code, and made a very simple flyer that went up on the community board next door at Starbucks. QR codes are still on the rise and have not been abused so I figure people will scan just for the sake of scanning. It's best to put the content you want up on your own server so you can track the hits and views. The format can be any content: video, pdf file as a coupon, picture, etc... this one is a video Here's how it looks at Starbucks [photo17.JPG] The QR Code and the flyer [Screenshot20110702at2.14.56PM.png] (GO AHEAD AND SCAN THIS WITH YOUR SMART PHONE!!!!) [Screenshot20110702at1.29.09PM.png] Here's what they would download and see! This is hi def version but too big. the smart phone version is only 2 MB so its an easy download [estheticdentistryoffer.mov-v-]

Third Annual CEREC Owners Symposium

Sameer Puri (cerecdoctors.com co-founder) — Fri, 01 Jul 2011 00:00:00 -0700

So the Third Annual CEREC Owners Symposium is just two weeks away and I have to say that I'm getting very excited. And I've been given word that there will be some major announcements by some of the manufacturers on the product end of things. I'm not at liberty to say what will be shown but I can say that it will be a huge step forward in the field of CAD/CAM dentistry. Looking forward to catching up with all the great friends that will be attending in July!

McDonald's and Perceived Value

Peter Gardell (Faculty) — Thu, 30 Jun 2011 00:00:00 -0700

McDonald's has done well through this latest bump on the economic road. The reason is that they have the systems as discussed in an earlier post that allowed them to expand a dollar menu but still make profit by increasing volume. Now that Washington reports that our economy is doing better (I for one, am leery about the positive reports; I still haven't heard patients saying they are doing that much better), it will be interesting to see what happens. McDonald's has not felt confident enough that they can move away for their successful move of the past few years. It remains to be seen if they will be able to transition out of the Dollar Menu model without a negative reaction from the public. People are very wary of what their money will by. For some, $.99 cent cheeseburgers and $.99 cent quarts of iced tea are worth it for the perceived value and the convenience. I think that the whole thing boils down to the perception of value. Not just the dollar and cents amount. Fast food - exactly what is on the menu. Nowhere does it say gourmet, epicurean, fine or even good. People are there for filler and the least amount of time spent getting it the better. You don't even have to get out of your car and walk into the location if you want to save even more time. We need to give the patient a feeling that the experience they receive in the office is like no other. Respect our patients' time and save them visits. If we succeed we will have taken a big step in creating a raving fan.

Sanctuary

Jeffrey Caso (Faculty) — Wed, 29 Jun 2011 00:00:00 -0700

In a past blog I wrote about my ongoing office renovation and how I was attempting to design my waiting room after Starbucks. I was looking for that inviting, comfortable, homey yet high-tech feel. I am still in the process of achieving that goal and so far so good. The rest of the patient care areas are in place and almost ready, but there is still some plumbing, electric and lots of computer work to accomplish. That part gets dull. Coordinating this work so there is no disruption in patient care can be a challenge. After a couple of weeks of that, I decided to work on a part of the project that I have really been looking forward to. That part is my private office or what I have been calling my Sanctuary. I tried to give it a cool SoHo kind of feel with a stone tile floor and old-fashioned tin ceiling. Each part of it has some special significance to me and will give me a nice, comforting feeling when I go there to take a break from a hectic day. I plan to decorate the walls with photos printed on canvas and antique items that my wife and I have collected over the years. The stone tile floor is the same type of floor that was in a farmhouse my family vacationed in when I was young and the tin ceiling is very similar to an old pub where my wife and I met and spent time in while we were dating years ago. The pictures will be of my children from vacations we have taken. An accent chair by the window makes for a great place to read the paper and write in charts. Behind the scenes in my Sanctuary is an office that is moving rapidly towards being paperless, has access via the Internet to a series of security cameras and has computer control of every aspect of the office's functioning. This includes scheduling, digital X-rays, electronic perio charting, practice management software, banking and everything else that makes the office run smoothly. I love the "sleeper" effect. The high-tech world all rolled up into a vintage surround. That is what makes me feel better when I just need a break from the rigors of the day. It's been the most fun part of the renovation. One that still needs some work but is heading in a great direction. Find your place of sanctuary in your own office and make it special.

Perception

Mark Fleming (Faculty & Magazine Editor) — Tue, 28 Jun 2011 00:00:00 -0700

Took the family to a baseball game last night. My hometown team, the Reds, were in town; well in Tampa Bay area. It had been awhile since I had been in Tropicana Field, the home of the Tampa Bay Rays. It is an interesting place. It is a dome stadium with catwalks that are in play. Not too many baseball stadiums have ground rules for a ball that hits a catwalk or supporting wires. In fact, a Red hit a support and it was ruled a home run. I thought what a strange happening. This began to shape how I saw the field, how I viewed the home team, etc. It was not the most positive perception. This got me thinking. How do patients see my home field, my office? What do they see and experience? How do these perceptions affect how they see the services we render? Maybe it is time to take a look at your own home field. Is it presenting or representing the best services your practice can offer?

CEREC Justification

Sameer Puri (cerecdoctors.com co-founder) — Mon, 27 Jun 2011 00:00:00 -0700

Here is an implant abutment and final restoration that was designed and fabricated with the CEREC. This case was done by Dr. Mike Scoles, a dentist who has dedicated himself to the CEREC process. Because of the volume of dentistry and the number of patients his two offices treat, having the ability to make abutments and final restorations with the CEREC saves his practice a ton of money. [implantabutment.bmp] Anyone who looks at the ROI of CEREC needs to look at it with all of the things that the machine can do. If all you are going to be doing is small inlays and onlays, then you need to do a lot of restorations to justify the cost of the machine. However, if you can get the proper training and add anteriors, posteriors, implant crowns and bridges, the cost of the technology almost seems laughable - especially if you have two offices like Dr. Scoles. I want to thank Mike for sharing this case and the fantastic use of the technology.

Blocking Out Endo Teeth in the Anterior

Mike Skramstad (Faculty) — Fri, 24 Jun 2011 00:00:00 -0700

Sometimes you have some very dark stumps that you cannot block out with even e.max LT. Here is a great solution for you inlab users so you don't have to send these cases out. You can block the dark teeth out with an e.max MO coping and use a more beautiful ceramic with more translucency over the top. Best of both worlds. This is just a sample case on #7. You want to avoid using multilayer mode in this instance because it produces too big of a collar and a sprue on the margin. The best practice for this is to do the following: Step 1: #7, framework mode. Draw the margins short of the actual margin. Mill this out of e.max MO, use finishers to thin out margin and remove undercuts if needed. [step13.jpg] Step 2: Place frame on model and reimage. Do a crown drawing margin on actual margins and mill the crown. I would increase the margin thickness parameter to protect the margin and manually polish this back later. In this instance I milled Triluxe 1M2 block [step2.jpg] [step2_2.jpg] Step 3: Crystallize the frame and stain and glaze the crown, bond them together and you are done. [step3.jpg] [step3_2.jpg] Great way to help block those endo teeth in the anterior.

Systems: Keep It Balanced

Peter Gardell (Faculty) — Thu, 23 Jun 2011 00:00:00 -0700

I have talked about the Apple store many times over the last few months and how their "presence " is refreshing and innovative. I was intrigued by the way they found their own path in attacking the retail world. And wouldn't you know it, they go and re-invent their retail model? Makes one wonder, but looking at initial response they have another Charlie Sheen move. Why a company with what appeared to be a very successful business model, would take a chance like that, I don't understand. Why shake things up when they had systems in place that allowed for smooth work flow? As dentists, we have been preached to that to be a successful office we need systems in place. Systems lead to efficiency and allow the staff to follow a decision tree to act with some autonomy. The need for the practice owner to micro-manage is removed. Staff can do their job and dentists can treat their patients. How many smiling employees do you see at McDonalds who haven't had an attitude adjustment in one way or another? Not many. Just as you get same quality of food worldwide, you get the same blank, bored look on the employee serving you. It doesn't matter how many "Smile at the customer" signs they have hanging in the back. McDonald's has a made systems a science; they have spent more on developing and perfecting systems to make their operations more efficient than they have on developing new menu items. But beware: Systems can lead to monotony. We have to remember that dentistry is a service industry. We have to make the patient feel welcome, make them feel special. Our patients need to be raving fans and spread the word about us. Monotony does not create an environment that produces raving fans.

Quality of Life

Jeffrey Caso (Faculty) — Wed, 22 Jun 2011 00:00:00 -0700

There are certain things that occur as we get older that we just need to accept. Then there are others that are so important that they deserve the good fight. Since turning 40 more than eight years ago there has been a steady decline in my eyesight. Not something that is uncommon. I, however, fought its effects very hard. I used reading glasses for a while, ignoring the fact that my distance vision was suffering as well. I would hang them on my shirt when I didn't need them and soon noticed all of my shirts were droopy and ripping. Still I fought on. One night, my wife and I went out to dinner on one of our "date nights" and I sat in a dark restaurant and soon realized that I couldn't read the menu at all. My glasses were not helping and I was embarrassed. When the waiter came to take our order, my wife ordered first and I said, "that sounds great, I'll have the same". She looked at me funny, fully aware that I had never done that before and she knew that I really didn't love what she ordered. I 'fessed up and promised a resolution. Off to the eye doctor for an exam and I ended up with progressive lenses for both reading and distance. I lived with this type of lens for many years. Unhappy but resolved to the fact that this is what was necessary. In the last several months, however, I became aware that I hate wearing glasses. I had to move my head in an exaggerated way to read the paper, going down a flight of stairs was treacherous and seeing the food on my dinner plate was impossible. I begged my eye doctor for a better answer and he offered me only more of the same. Frustrated, I did something I hate to do. I tried another doctor. I sat in her chair and immediately she began to listen to my story. I explained my plight and added that I wear loupes all day and am unable to see things on the bracket table. Looking up, I couldn't see the CEREC screen. My prescription changed so fast I never had it put into my loupes. It was so expensive and needed to be changed every six months. She saw my frustration and offered me a solution. The answer was bifocal contact lenses. She put a pair in and immediately I felt like I had a new lease on life. I got back my peripheral vision, I could see steps and curbs again, I could see the food on my plate, I could see intermediate distances so well. The computer screen was clear, so were street signs. I could go into a store and not have to wear my prescription sunglasses inside because I never remembered to bring my regular glasses. I can see through my loupes and see things on my bracket table. So many things happened that I felt like I was walking on air. Sure there were issues. Extra time in the morning to put them in and at night to take them out. The learning curve was steep but fast. I was motivated though and nothing was going to stop me. So, this major change in my life took place because someone was willing to listen to me and help me to resolve my issues. She asked the right question. What can I help you with today? That's a question I now ask every patient in my practice. Just tell me what you want and I will see if I can oblige. If I can't, I will tell you why. You may just change somebody's life by listening to what's bothering them and trying to make it better.

Time

Mark Fleming (Faculty & Magazine Editor) — Tue, 21 Jun 2011 00:00:00 -0700

Well, made it through another year. Hit the big 60 over the weekend. Another decade added to my life. Can't wait to see what happens in the next one. The last decade brought about a lot of change in my professional career: bought a CEREC, moved into a new office (wondering how I could afford it), met Drs. Puri and Mirzayan, became involved with cerecdoctors.com, met Imtiaz Manji and became affiliated with the Center, met Dr. Spear and ALL the fine people at Spear Education. I've been pretty fortunate. Right now, looking at potentially more changes in my life, some I would rather not deal with, some I'm really excited about. One thing is consistent with these, I'll have the opportunity to choose how I spend my time dealing with them. Sometimes easy, sometimes a bit more challenging. What about you? Bet there are a few things happening in your life. How are you spending your time dealing with them? Because you can choose how you use that time. Hopefully, as the Stones said, you will see time being on your side. Use it wisely!

Optimizing the CEREC Practice

John Roark — Mon, 20 Jun 2011 00:00:00 -0700

Sameer Puri blogs from his new Scottsdale Center digs about the upcoming CEREC practice event. [BlogIntrotoOCPandOffice.mp4-v-] Visit http://www.scottsdalecenter.com/cerec/ocp.php for course details.

Are Systems Bad for Your Office?

Peter Gardell (Faculty) — Fri, 17 Jun 2011 00:00:00 -0700

No way. They are needed. But the problem is, if they are used without thought, you can turn your employees into robots. That could turn off your patients. Systems need to be evaluated occasionally so you can maintain a healthy environment in your office. To keep your employees - the faces of the practice - happy and motivated, you can't make their days boring. Systems put in place and not re-evaluated can lead to boredom. Patients can pick up on the vibe of the office, and your patients are your ambassadors. Patients like seeing smiling, happy faces when they come in. Efficiency is important, and we should never lose sight of that. There are a lot of areas where we can get caught in a rut, thinking we are doing all right and there is no need for change. A course with the staff can revitalize them AND you. Sure, you might learn something that disrupts some of your established systems, but sometimes you need to shake things up to take yourself to the next level. Imtiaz Manji is a wonderful teacher, and the course that he presents with Sameer Puri, "Optimizing the CEREC Practice," contains so much information it is bound to make you rethink a lot of what you are doing every day in your office. It will make your team members rethink their roles. This one course will open your eyes to the potential that is there. Make a plan to attend and bring your team to Scottsdale, Aug. 12-13.

Have You Seen the New Issue of cerecdoctors.com Magazine?

Sameer Puri (cerecdoctors.com co-founder) — Thu, 16 Jun 2011 00:00:00 -0700

Have you received your Q2 issue of cerecdoctors.com magazine yet? I have to say that the cover is one of the best I've seen. I want to give kudos to the design team for creating it, and more importantly, kudos to the 4.0 software that allows us to do all of the amazing things shown in the magazine. I want to invite all the CEREC owners out there to submit an article. The magazine goes out quarterly, and it's really become a labor of love for some of us that work with it on a regular basis to make sure that we have relevant articles from users who are in the trenches. Submit your article to our clinical editor Dr. Mark Fleming at mjfddsinc@aol.com Hope you guys have an amazing summer.

3M Focus Group

Richard Rosenblatt (Faculty) — Wed, 15 Jun 2011 00:00:00 -0700

I was invited to 3M last weekend to participate in a focus group with some other dentists I know from Dentaltown. It was a great meeting. They wanted our opinions on products, on the dental landscape, on things like buying trends during this down economy and lots of other stuff. They had amazing insight and information on how dentistry has changed so much during the last three years during the economic downturn. We were able to see and use some of their new products coming to market. One thing that I was excited to learn more about was their new composite block. It has a similar technology to their Filtek Supreme Ultra. Very strong and highly polishable. They were talking about using it for crowns on second molars and on implants, and they spoke of how it was a nice material because the margins will mill even more accurately because composite won't chip the way glass can. They also spoke of how you can finish down the margins to a very thin finish. It looked very promising and I can't wait to get my hands on some. All in all, it was an excellent weekend. I learned a ton about the amount of research and testing that goes into every product that they release. We also got to go to the new target field in Minneapolis and watch a Twins game. It was a great time, and I really learned a lot. What I learn from these types of meetings is that the companies that we deal with when it comes to CEREC are first class. Companies like 3M, Ivoclar, Vita and Sirona to name just a few. They work very hard to put out great products for us, and I really appreciate their effort. Their hard work makes the dentistry that we do on our patients that much better and I, for one, very much appreciate that.

Patience

Mark Fleming (Faculty & Magazine Editor) — Tue, 14 Jun 2011 00:00:00 -0700

A lot of you know I get the opportunity to travel quite a bit. My travel happens so often from Phoenix on early Sunday mornings that the lady at Starbucks greets me with ' it's Sunday, you must be on your way home.' Sometimes, especially when tired, my patience tends to drop. This past Sunday, after spending the weekend in L.A. for a speaking engagement and having a great time with Sam Puri and his family, I found myself on an early flight from LAX. Door to the airplane closes five minutes early and I, along with the rest of the passengers, figure we are on our way. More than an hour later, we wonder if we are ever going to leave. Someone plugged in some wrong figures about the cargo weight the plane was carrying, and it took quite awhile to find out what the problem was. That was when I decided to take the time a catch up some reading that I had brought along. Patience, patience. Even though I arrived late in Atlanta, I had an hour between flights. I had only to go from A24 to A27. Not too bad. We boarded and arrived in Sarasota a little early. Now I try to always to carry on my luggage, but the last couple of times that I had checked baggage, because of Delta's Priority Handling, my bag had always come off within the first couple of bags. Well, after waiting until all the bags had gone around, I got the opportunity to file a missing baggage claim! Patience, patience. At least I was home and not on the road. You know, we can't always control what happens to us. We can control how we deal with it. Lord knows, I am/have been dealing with many happenings recently. Patience is something I'm working on to deal with what is happening to me and around me. Sometimes I do well, sometimes I work on doing better. What about you?

There Is No Magic Bullet

Sameer Puri (cerecdoctors.com co-founder) — Mon, 13 Jun 2011 00:00:00 -0700

We have all been there. Broke, hungry, empty chairs. Looking for the magic bullet, the one thing that is going to change our practice -- the one marketing piece that is going to get us 50 new patients a month. That one technique that is going to make all the patients say, 'Wow, I'm gonna send my entire family to this guy because of what he does.' However, I hate to say, there is no magic bullet. I learned that the hard way over the past 14 years in private practice. What there is is commitment and dedication -- to continue to learn, to continue to improve and, over time, something just clicks. What used to be an appointment full of fillings and adjustments is now a schedule of quads and larger cases. You gain confidence and you treatment plan more comprehensively, simply because you know more from the education you have taken. Look at the successful dentist who treatment plans comprehensively -- when a patient walks into his office -- he sees disease, he sees treatment need, he presents treatment that is the cost of a car. Same patient walks into another office and the treatment plan is two buccal composites for the erosion and we will 'watch' the wear and broken teeth and worn fillings. Why the difference? Is one doctor more aggressive, unnecessarily? Is the other doctor not aggressive enough? Bottom line is what we do in dentistry is elective, what we do is not life-or-death. What we provide is a better smile, the ability to eat and chew properly and the ability to give the patients confidence. This confidence for the patient comes from the ability of the treating doctor to treat and diagnose, and the bottom line is that you and your team need to be on the same page. Don't look for magic bullets to magically transform your practice and your life. What you have to do is commit. Commit to a lifetime of education, to make your self better and more knowledgeable. It's the same as someone trying to lose weight -- they buy that magic pill thinking that those extra 30 pounds are just gonna come right off, not realizing that they need to have a lifetime of exercise and eating right -- that's the only way to a better life.

The Power of Social Media

Sameer Puri (cerecdoctors.com co-founder) — Thu, 09 Jun 2011 00:00:00 -0700

Is your practice utilizing social media? What if instead of 1,500 party goers, your practice attracted 1,500 patients for whitening? Or CERECs? Or Invisalign cases? This article below is the perfect example of why your practice needs to be active in social media. BERLIN -- Better check your Facebook settings before posting a party invitation online. A teenage girl in Germany who forgot to mark her birthday invitation as private on Facebook fled her own party when more than 1,500 guests showed up and around 100 police officers, some on horses, were needed to keep the crowd under control. Eleven people were temporarily detained, one police officer was injured, dozens of girls wearing flip-flops cut their feet on broken glass and firefighters had to extinguish two small fires at the 16th birthday party in Hamburg, police spokesman Mirko Streiber said Sunday. The birthday girl, identified only as Thessa, went into hiding, Streiber said, but 'nonetheless the party was a hit.' Thessa had initially only wanted to ask some friends over to her home in Hamburg-Bramfeld when she posted her invitation on Facebook, but mistakenly she published it so that everyone on Facebook could see it. The invitation quickly went viral, and some 15,000 people confirmed online they would come to the party - without even knowing the girl, weekly paper Bild am Sonntag reported. When Thessa's parents found out, they made their daughter cancel the party, informed police and hired a private security service to protect their home on Friday night. Despite public announcements in Hamburg that the party had been canceled, some 1,500 teenagers and young adults showed up on the street in front of Thessa's home, Streiber told The Associated Press. 'We had cordoned off the house, some 100 police were on the ground, four of them on horses - but that did not keep the kids from celebrating,' Streiber said.

Active Octogenarians

Jeffrey Caso (Faculty) — Wed, 08 Jun 2011 00:00:00 -0700

In my practice, I see a fair amount of elderly patients. I enjoy talking to them about their lifetime of personal experiences. I am like a sponge around knowledgeable, articulate older people; I take in what they say and try to learn from their experiences. Many of these people have suffered through the loss of spouses or other loved ones and most have thrived in spite of it. The area that I live and practice in is so fortunate to have senior services offered for free that help to make their lives easier and provide social interaction. The success of the senior citizen centers has a profound effect upon the quality of life of so many people. Mostly from a social perspective but it goes further than that. The desire to get up in the morning, shave, shower and get out of the house is valuable at this point in a person's life. Also, realizing that there are so many people in the same situation and surviving with a great quality of life is a real eye-opener. It is a really good thing. Today in my practice I had the pleasure of seeing two men over 80 years of age. I have been seeing both of them for more than 20 years, and while I am their dentist, I also feel like a friend. Both lost spouses who were also patients of mine and we talk about that often. Both of these men have embraced the Senior Center and go just about every day. What I found interesting was that both men had injured an upper central. One needed a crown which I was able to do right away and the other needed a directly bonded restoration. The interesting thing was that both men were very happy to be finished today so that they could get to The Center and both were very concerned about how they would look with their final restorations. So much so that I was inspired to work hard to make them happy. I found this need to look good well into their 80s such a great sign. To me it signified a sense of self-worth and a healthy mental outlook. I worked hard and pleased them both. I found their high esthetic demands both professionally challenging and personally inspiring. Plan for your future now, keep physically active, exercise your brain through reading and learning, eat healthy, love your spouse or significant other and be happy in all that you do. I recently read a book titled "Chasing Life" by Sanjay Gupta. He travelled the world trying to find the secret to a long life. He interviewed many extremely old individuals and came up with one commonality. They all had a positive relationship with a loved one, essentially, a reason to live. Now that's a lesson to carry with you into the golden years. Be content with your work and life and everything else will fall into place.

Optragate

Richard Rosenblatt (Faculty) — Tue, 07 Jun 2011 00:00:00 -0700

I have to say that I'm becoming addicted to a great product from Ivoclar call the Optragate. It is a soft lip retractor that is non-latex so you can use it on all patients. I love to use it in conjunction with my Isolite when I'm taking images. I find that when I don't use it, saliva or moisture from the cheek can smudge my powder and cause issues when I image. The Optragate does a great job of keeping that tissue away from the teeth when imaging those buccal areas. I use it all the time for anterior composites and also if I take impressions for partials or bleaching trays. It keeps those lips and tissue out of the way while I'm inserting the tray in the mouth. I know, I talked about impressions! I don't do them too often, but sometimes I still have to. It is also great when I'm doing in-office bleaching, or placing attachments for Invisalign. I find myself using this great tool more and more and I highly recommend trying it out. Check out the video section on the site to see how to place and use the Optragate on your patient. [optragate.jpeg]

Low Water Pressure? No Problem!

Sameer Puri (cerecdoctors.com co-founder) — Mon, 06 Jun 2011 00:00:00 -0700

A quick resolution to a 'low water pressure' error [WaterFilter.mp4-v-]

Impact

Mark Fleming (Faculty & Magazine Editor) — Fri, 03 Jun 2011 00:00:00 -0700

I had the opportunity to attend the Spear Visiting Faculty Meeting. Mary Osborne was the featured speaker. If you EVER have the opportunity to hear and work with Mary, please do yourself a huge favor and take advantage of it. We talked about how people impact others' lives. It got me thinking about something that had just happened in my office. A couple had come for their hygiene appointment and informed us they would be leaving the practice. They had been with our practice since I had started in Florida in 1993. They were going to move to the Orlando area, which was going to be over two hours away. The interesting thing was they had been driving between an hour and an hour and a half since 1996. They told me I had been a huge part of their lives but now the distance was just too far. Goodbyes, mixed with tears, were exchanged and the end to an era of the practice had taken place. What type of impact have you had on others? Whether you realize it or not, you are ALWAYS impacting and influencing others. It's up to you how you do it. I have a saying next to my lab bench from a ProSynergy Workshop that I try to live up to. It says: Make your values and purpose so clear that your work is a reminder of what you like best about yourself. What is your purpose in dentistry? Remember, you are ALWAYS impacting others, those you treat and those you work with. Be aware and have your work positively impact others.

Treating a CEREC Colleague

Darren Greenhalgh (Faculty) — Thu, 02 Jun 2011 00:00:00 -0700

[videoblog1.mp4-v-]

Love walking into an office and finding patients intrigued with what we are doing

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 02 Jun 2011 00:00:00 -0700

Very simple blog. It says it all [IMG_13201.JPG]

Good Times Ahead

Sameer Puri (cerecdoctors.com co-founder) — Wed, 01 Jun 2011 00:00:00 -0700

4.0 is amazing. Beta testing is by no means fun because of the trouble that you have to endure. However, beta testing 4.0 is quite a different story. It's far from complete as they still have a ton of work that needs to be done, but man, it's a game-changer. Being able to do biogeneric reference with a buccal bite or correlation with a buccal bite or combine biogeneric and correlation all in one case really makes your restorative options very easy and simple to do. The fact is that 4.0 is a major step forward, and upon its release the CEREC community will be pleasantly pleased with the end result. What I'm even more excited about is that 4.0 is just the first step. Can you imagine what 4.2 will bring? Or 4.4? Or all the other versions that are based on this initial release? It's a good time to be a CEREC owner.

It's Always an E

Jeffrey Caso (Faculty) — Mon, 30 May 2011 00:00:00 -0700

One of my most important roles in life right now is lending a helping hand to my 87-year-old father. He is a physician who practiced until almost 80 years old and still takes care of the family including my three children. In his long career he delivered more than 3,000 babies and then took care of the majority of them through adulthood. He says that he arrives at a diagnosis while watching the patient walk into the room and seldom relies upon diagnostic tests. He is old-school and super-effective. Patients of mine who were also patients of his still ask me if they can speak to him regarding a health or personal crisis. He does so graciously, offering words of advice but mostly just giving them moral support in their time of need. Mostly, that is all they are looking for. Recently, there has been a decided change in him. He seems to be at peace and accepting of the inevitable. I think he feels that this is necessary and helpful for the family's sake. Allowing us to feel accepting of what is to come as well. Hopefully, not too soon. With this change, he has elected to stop driving and is quicker to ask for help. This makes my life easier. He just asks and I am happy to help. So, last week he asked me to take him to an eye doctor's appointment. No problem at all. Sitting in the examination room with him, the doctor begins to test his eyesight. He puts up a line of the eye chart and asks my father to read it. He says that he cannot. The doctor then puts up a larger line. My father once again says he cannot read it. The doctor being a bit impatient says how about we start at the top then. My father looks at it and says "E". The doctor is called from the room and my father looks at me and says, "Do you know how I knew it was an E?" I looked at him suspiciously and said, "How?" He let out a big smile and said, "It's always an E. Now let's get out of here." We were laughing pretty hard when the doctor came back in and was wondering what was going on. We didn't tell him and let him finish the exam and then laughed all the way home. The problem was that the doctor did not spend a few minutes to get to know his patient. Make it a point to have a meaningful conversation with each and every patient. Stop what you're doing and listen to what they are saying. Ask questions to show that you are interested. It makes the patient feel better and more at ease. It makes them open up to you and tell you more about their own situation. That may help you treat them better. By having a meaningful conversation with each patient, you may find work is more interesting and it may make you more fulfilled. It's good for everyone.

Move Over, Bob Vila

Peter Gardell (Faculty) — Thu, 26 May 2011 00:00:00 -0700

The screwdriver: It's an indispensable tool for the person trying to do anything around the house. Putting batteries in toys, fixing toys thrown around because the batteries weren't changed in time, fixing loose things around the house or building something new. The old-fashioned straight screwdriver did its job in a predictable way, but its design had certain limitations that limited its ability to allow us to become more efficient. The invention of the Phillips tip opened the door to automatic screwdriver. These were a big improvement but were still human-powered. It allowed manufacturers to make quantum leaps in efficiency but we were still hindered by the capabilities of the wrists and forearms of the operator; not everyone can be built like Popeye. Air-powered, then battery-powered allowed another huge leap in efficiency that one couldn't have imagined a few short years ago. The weekend warrior now can knock out larger construction projects that previously would have taken large construction teams a lot longer to perform - decks, sheds, dog houses, home renovations, etc. Kind of like the advancement of the CEREC system. Many evolutions have opened the door to great advancements for the CAD/CAM dentist. The imaging advances that came with the Bluecam can now be utilized by the software to really make our days easier. Multiple simultaneous designs, multiple materials, all controlled in one master file by the CEREC dentist. We now have the Mack-daddy 24v hammer drill in our tool belts. So move over, Bob Vila and Norm Abram, and get ready to watch the next episode of "This Old Mouth."

It's Prom Time Again

Jeffrey Caso (Faculty) — Wed, 25 May 2011 00:00:00 -0700

Where did the time go? I am not talking about the year that elapsed between last prom season and this year's prom season, but the bigger picture. How did my little boy who waited for me to come home every night and read him a book before bedtime grow up so fast to be going to his own senior prom? I am so proud of what he has accomplished thus far in his life and look forward to all of the great things that he will continue to do. I wanted him to grow up into a fine, able young man who could identify and follow his dreams. I just didn't want it to happen so fast. Tonight was a mandatory prom meeting at his school. If your child wants to go to the prom you had better be there. No excuses. The principal covered many topics and then said he was going to deviate from his usual discourse about how you really can have fun without alcohol and showed us a video on texting and driving. Wow, what a tear-jerker that was. He was right; it is a piece that every parent of a driving age child should watch. Better yet watch it with your child. http://youtu.be/DebhWD6ljZs I actually got a lot out of the meeting and understand more about where this generation is coming from and some of the unique problems they face. Social media has such a huge impact upon this generation and the end result of this is still playing out. Bullying can be so devastating because of the massive amount of people that hurtful comments can reach so quickly. Holy cow, times are so serious for this generation. I came home and discussed the lessons I learned with the whole family and we all got a lot out of it. Life is certainly hectic these days but it's imperative to take a break and really understand what's going on in your children's lives. The times they are a changing. Listen, learn and change with them. Understand how changes in technology affect your family and adapt to be the guiding force that your kids look for in you. Boy, this job is not easy.

Initial IQ Lustre Paste

Richard Rosenblatt (Faculty) — Tue, 24 May 2011 00:00:00 -0700

One thing that always drove me crazy before CEREC was adjusting contacts and opening one up. Don't tell me that I'm the only one who has ever done that! Since I became a CEREC user eight years ago and we got our oven, I have been able to deal with that with relative ease. One product that has really made that even easier for me is Initial IQ Lustre Paste NF from GC America. The reason that I really like this product is that it is porcelain infused. I find that you can thicken it up a bit and add that to a light or slightly open contact and get that floss snapping once again! I do not add back large open contacts but if it is light or just barely open, this stuff works like a charm! The other thing that is great about this product is that it is a low-fusing porcelain so it can be used with any of the porcelain blocks. I use it with both my Empress and VITA blocks and the stuff looks great. If you are looking for a glaze that will work with either porcelain block, and also does a great job of adding back a contact you may have ground away, give it a try! [luster_paste_NF.jpg]

Out with the Old, in with the New

Mike Skramstad (Faculty) — Mon, 23 May 2011 00:00:00 -0700

One of the most stressful life experiences I've ever had is selling a house and preparing to move. Living in a staged home and trying to sell in this difficult market can strain every aspect of your life. Well the day finally came, and we sold our home. Stress over, right? Not even close... Now comes sifting through 10 years of accumulated things in your house and packing the things you actually 'need' in boxes ready for the big move. An interesting thing happens when you do this. Of course you find things that you forgot you even had, but you also find many things that give you a moment of reflection of where you've been and where you are now. One of the things that I found was a box of all my CEREC installation disks and instructions. And let me tell you, there were a lot. As I was looking through them, the earliest one I found was from 2003. This was version 2.10 R1500. For those of you who have no clue to the exciting possibilities that this software introduced, one of them was...the DROP TOOL. This seems silly now, but back then, it was the best thing ever. There was no form tool, no step bur, and we hadn't even begun to talk about biogenerics! When I think back to this and then look forward to all of you getting your hands on the new 4.0 software, it really outlines the journey that the CEREC software has taken all of us on. From these little, simple tools that got us all excited some eight years ago, to now the Bluecam and the completely new graphical interface of the 4.0 software. It really is quite amazing. So 10 years from now when we find the 4.0 software sitting in the bottom of a box in the basement, we again may chuckle compared to where we are now. The possibilities seem endless.

Doors Opening

Mark Fleming (Faculty & Magazine Editor) — Fri, 20 May 2011 00:00:00 -0700

On my way back from speaking in New York City. It was my first time spending time in the Big Apple. I gave a talk on Digital Restorative Dentistry. As part of my presentation, I relay a story about my father 'forcing' me to stay at a high school. I wanted to transfer but he told me to stay one more year. I truly believe I would not be where I am today if I would have transferred. I owe that to his decision. That decision opened doors for me, even to this day. However, I had to walk through them. As opportunities presented themselves, I had to take advantage of them. I've been very fortunate; I have had some great opportunities because some great friends have opened doors for me. I'm truly thankful for that. At cerecdoctors.com, many doors are opened from the website where many answer questions, to courses like Optimizing the CEREC Practice with Imtiaz Manji, and meetings like the 3rd Annual CEREC Owner's Symposium. What do you plan to do with these opportunities? That choice is up to you. Doors can open; it is up to you whether you walk through them or not. Take advantage of doors opening and the opportunities that come along. They could be life changers!

Vegas Redux

Jeffrey Caso (Faculty) — Thu, 19 May 2011 00:00:00 -0700

Well, as promised, I am writing this blog on the flight home from Las Vegas and the Townie meeting. In my last blog I wrote about being on the way to the meeting and how I was bringing my staff with me. I sit here happy and content in that the meeting was a resounding success for everyone. We arrived safely and attended the Wednesday night wine and cheese reception. It was great to see so many friends and it was even more exhilarating to introduce those people to my wife and staff. They have heard me speak of so many of these people and it's great to put a face with a name. There is so much to say so let me just touch on the highlights. The costume party and our office costume were great. The theme was Cinco de Mayo and we attended as a life-sized six-pack of Corona. It went very well and made us laugh for hours. For me, I think the greatest thing was seeing everyone watch out for each other and work hard to make sure all decisions were good for all and that they stayed together at all times. I really believe that a group of already good friends bonded in a way that developed a mutual respect and strong friendships that will withstand the test of time. Educationally, the biggest take home message for them was insight into cross-coding dental insurance to medical. There is more work to do to get this going in my practice, but it's a trend that can truly help our patients a great deal. I personally need to learn more about this in the days and weeks to come. It seems that many offices are doing this successfully. I will relay more information on this in a future blog post when I understand it fully myself. I attended mostly implant courses and learned quite a bit both in placement techniques and restoratively. I had two other great experiences and need to further investigate both. The first was the value of Perioendoscopy. I went in with a preconceived notion that this was a gimmick and came out seriously considering a purchase. Diagnostically, you can visualize fractured roots, sources of inflammation such as poor crown and restorative margins and early decay. Using it to evaluate periodontal treatment results, especially in those cases that just do not resolve as good as you had hoped, is another huge benefit. The second important experience was watching a video of a patient undergoing a sleep study and having episodes of Apnea time and time again and the violent nature of this problem. In addition, they overlaid a graphic of the airway to visualize just what was happening at each moment. I need to run, not walk to the next sleep course in my area. This is a serious problem and that was unmistakable in this video. So, sadly it's all over. I just need to bring everyone home to their families in time for Mothers Day. I wish I could give them all a few days off to recover, but Monday is just a day away. I think we will hit the ground running and work together in a new, energetic way as co-worker and friends. I thank them for this great opportunity.

Six Month Smiles Course

Richard Rosenblatt (Faculty) — Wed, 18 May 2011 00:00:00 -0700

Well I survived the Townie meeting once again! What a great time. Between taking some great classes, having the honor of teaching a class myself, and seeing some of my best friends in the world, it has once again lived up to its billing for me. What I'd like to relay to everyone is feedback on the Six Month Smiles course I took - it was awesome! I have been an Invisalign user for many years and still do a few cases a year. I wanted to be able to offer something to my patients that was similar but didn't take quite as long, and would be more cost effective for both of us. Taking this course will allow me to do just this. It focuses on the movement of the teeth in the cosmetic zone. Bites are not readily changed. This will help a variety of different people in my practice. It will help those that come in with a minimal cosmetic complaint of some crowding or spacing and I can address it quickly. It will help me when trying to do a case using porcelain; I'll be able to quickly get the teeth in better position to allow me to be more conservative in my preparations. It will also help me to attain a great result on those patients who just know that they won't be compliant wearing the aligners. Dr. Ryan Swain, the founder of Six Month Smiles, was our instructor. He reminds me of a really good CEREC trainer. He is so passionate about the product he is delivering to his patients. He had a vision to create a practice that was limited to this cosmetic orthodontic procedure and people thought he was nuts a few years back! I think of all the people who thought that getting into CAD/CAM was crazy, too. I just know how I felt doing offering the procedure. I know how my patients felt receiving this very different kind of treatment. I was doing something that I loved and it showed. I really enjoyed taking this class; it has added another tool to my ever-growing tool belt, and it was a privilege to learn it from a person who is as passionate for what he teaches as I am about CEREC! I would highly recommend it to any of you looking to offer something new to your patients.

Optimizing the CEREC Practice

Sameer Puri (cerecdoctors.com co-founder) — Fri, 13 May 2011 00:00:00 -0700

I would like to take this opportunity to announce some great news. I've convinced Imtiaz Manji, CEO and Founder of Scottsdale Center for Dentistry, to teach a fantastic new course this summer. Optimizing the CEREC Practice will be held August 12-13, 2011, and I have the good fortune of making a cameo appearance in the program as his sidekick. Imtiaz has decades of experience in dental practice management and has seen more dental financial statements than anyone else I know of in the dental world. What I love about Imtiaz is that he has a way of communicating with staff that I have never been able to do. I can try to implement a program and give instructions 20 different ways, yet Imtiaz needs to only explain it once. It was Imtiaz who taught me the "Manji Walk," and I have to tell you that it works wonderfully. We know that it only takes one person in the office to spread negative energy. What I personally learned from Imtiaz was how to deal with that person, and more importantly to learn the leadership skills so that we are never in that position. Optimizing the CEREC Practice will transform new and experienced CEREC owners alike. The course will help their offices to be all CEREC all the time and increase productivity as much as possible. With everyone on board with the CEREC from hygiene to the front desk to treatment coordinators and assistants, your CEREC practice will be unstoppable. This will be a great event and it only occurs once a year. I hope to see you all at the program. Contact shayna@cerecdoctors.com for more information. For details, visit http://www.scottsdalecenter.com/cerec/ocp.php.

What Do You Focus on?

Darren Greenhalgh (Faculty) — Wed, 11 May 2011 00:00:00 -0700

I don't know if many of you are aware of the biggest issue that dentists are facing in the state of Washington. It's a change that will be effective June 13 of this year, and if successful, will not only affect our net income dramatically, it will sooner or later catch up to you. It's only a matter of time. Let me just share the cliff's notes with you. Washington Dental Service (WDS), a Delta Dental company, sent all dental providers a letter about a month and a half ago stating that in order to be more competitive, they are going to be dropping their reimbursements to dentists by 10 - 15%, effective June 13. They are also discontinuing their premier (non-PPO) service as well. Not only that, they have frozen fee increases for the past two years. WDS is the biggest dental insurance provider in the state; all state employees and all of Boeing have WDS, just to name two monstrously large groups who utilize WDS. I don't want to get into all the anti-trust/collusion issues, legal fights, financial issues, many other repercussions, and overall difficulty many dentists here in Washington will face. I don't know how it will affect you, but I know it will at some point, probably sooner than you think. Don't kid yourself into thinking that your state will be immune - every insurance provider in the country is watching this case very closely. I discussed the situation with many of my colleagues, which didn't really help my state of mind; we were all bitching and moaning about the same thing and how negatively this will affect us! Then I discussed this with my wife, who had some incredibly wise insight into my "woe is me" dilemma. She asked me what I was going to do; I told her I didn't know and then she said, "Well, you will get what you focus on." When change comes, whether it is through our initiative or not, we will always get what we focus on. Focus on CEREC, your CEREC will be more successful. Focus on being healthy, you will be more fit and have more energy. Focus on patient care, you get more thank yous in the mail. Focus on your family, great memories will happen. Life is too short - let's focus on the things that make us happy!

Off to Vegas

Jeffrey Caso (Faculty) — Tue, 10 May 2011 00:00:00 -0700

There have been many blogs posted recently about the Townie meeting and what a great, fun learning experience it is. So, I won't bore you with more of that. This year is my fifth Townie meeting and it will be a very different and special one for me. For the last four, I traveled out from New York to Las Vegas with my dental school roommate and long-time friend Pete Gardell. This year, I am still traveling with Pete and also decided to bring along my entire staff and my wife, who is also my office manager. I wanted to do this for several reasons. First, as a thank you to all of them for their hard work and loyalty to me over the years. My wife has been working with me since I started my practice over 22 years ago; two others have been with me for 12 years and another for six years. Many months ago I presented this idea to them and they all knew of the great times I have had at the Townie Meeting every year. They rearranged their home schedules and agreed to come along (one will even be away for her and her husband's wedding anniversary). Secondly, from a staff development perspective, there is a fantastic speaker lineup. There is a nationally recognized practice management consultant, an insurance guru and some great motivational speakers. So, at this point, so far so good. We are all on the plane and will be landing soon. Tonight is a free night. A nice wine and cheese reception and then dinner and gambling. Tomorrow is a long day, culminating in a Cinco de Mayo costume party. This has been a great thing for everyone. They banded together to come up with a group costume and made it from scratch. We will be a six pack of Corona, complete with foamy tops, limes and a six pack holder made of boxes. We, however, are a group of five so we adopted Pete for the night so that the six-pack will be complete. I promise to write a blog about the overall results of this trip on the flight home. I can't see it as anything but a fantastic experience for everyone. Keep your fingers crossed for me. I may even post a picture of our costumes if they look good. I have made myself one promise going into this. I will never introduce them as "my girls." In my opinion, we all work together toward a common goal and are colleagues. Stay tuned...

The Best of Times, the Worst of Times

Richard Rosenblatt (Faculty) — Mon, 09 May 2011 00:00:00 -0700

I was watching television last Sunday night when the news broke in to tell us that Osama Bin Laden had been killed. It was one of those moments that I will always remember where I was at the time that it happened. Reflecting back, I'm glad that I was home with my daughter, whose birthday is 9/11/98. I will never forget where I was on 9/11/98 and on 9/11/01. In 1998, it was literally the happiest day of my life; the birth of my first child. I didn't think anything could ever put a damper on the joy that Sept. 11 could ever bring to me. On 9/11/2001, I was in my car at the junction of route 90/94 heading into work and sitting in traffic as I did several days per week at that time. My wife called me frantically telling me that a plane had just flown into the World Trade Center. As she was telling me, the second plane hit. I remember getting to work and watching both towers come down. I remember going home that day and watching the news tirelessly, with my 3-year-old daughter asking why the buildings were on fire. I don't tend to wish death on anyone, but May 1, 2011, brought some closure to the events on 9/11/01 for me. It is always weird when someone asks my daughter when her birthday is, she says Sept. 11, and people say to her, 'Sorry.' Who wants to hear that?? I don't think his death will change that response, but at least the person behind it has paid the ultimate price for what he masterminded! Sept. 11, for me, will forever bring extreme joy and sadness. I will always thank God for the gift given to me that day and pray for the lives lost on it. It will always bring tears to my eyes for the extreme joy and pain I felt and will forever feel on that day. I personally am happy to bring some sort of closure to the painful part of those tears.

Gratitude

Mark Fleming (Faculty & Magazine Editor) — Fri, 06 May 2011 00:00:00 -0700

I was in Scottsdale last weekend helping Sam and Armen with Level 3 and 4 courses. Once again, it was fun to help others with their CEREC experiences. I'm grateful to have friends such as Sam and Armen and have the opportunity to get to see them so often. I am heading to the Townie Meeting this week. An excellent meeting and another chance to come together with the faculty of cerecdoctors.com and others. Once again, I'm grateful for this opportunity to get together with great friends. It's a bittersweet time, though. It was during this week several years ago that I lost both parents in successive years. I called a very close friend on my way home Sunday to wish him a happy birthday (there's a group of us who are turning the BIG 60 this year). He relayed to me his father's health is failing fast. His father was a big influence for me when I was in high school and college. The sound of my friend's voice tugged at my heart. Be grateful for the time you have with loved ones. Be grateful for the times you spend time with your friends. Be grateful for the time you interact with your staff and patients. Hey, just be grateful!

And the Winner Is...

Sameer Puri (cerecdoctors.com co-founder) — Thu, 05 May 2011 00:00:00 -0700

I can't believe how many people have been e-mailing me and asking me about the results of the contest. So I'm sure you all are wondering what happened? Well, technically it was a draw but I'll consider it a victory. Let me explain. I lost 22 pounds of weight, most of it in the last six weeks as I upped the intensity of the workouts and really tightened up my diet. My competitor only lost 9 pounds of weight. Victory for me. But weight loss was only part of the bet. We were also tracking fat loss. According to my scale, I dropped 3.5% of body fat and my competitor lost 4%. So he won that. We called it a draw because frankly we didn't trust the measurements on the scale we were using. For example, my body fat fluctuated 4% in a period of eight hours according to the scale. Umm, hello?? Regardless, by the time the weigh in came, both of us were so sick of the diet and brutal workouts we just congratulated each other on the hard work and decided to call it a draw. Both of us made tremendous improvements to our bodies. As I mentioned previously, I'm in the best shape of my life and at my marriage weight from 14 years ago. Here is the kicker: we both had planned a huge celebration meal where we were going to pig out and eat all sorts of dessert, but we both chickened out at the dinner table. Sure we splurged a bit - had an appetizer with carbs, ordered dessert. But it wasn't the gluttonous feast we had planned. I think we both felt guilty. After all the hard work, why throw it all away? I'm happy to report that I will continue my hard workouts (probably not to the same intensity) and clean diet (again-not to the same degree). This whole experience made me realize what is possible when you put your mind to something. I had been stuck at the same weight for the longest time; I had hit a plateau. But with hard work, motivation and some incentive, frankly, I'm proud of what I was able to achieve.

Christmas in May

Peter Gardell (Faculty) — Wed, 04 May 2011 00:00:00 -0700

I know the calendar says May but these past few weeks felt like December. Rumors, innuendo, secret spy photos from IDS, leaked screenshots all indicated something special on the horizon, but we really couldn't get a scope of what was to come. We had to wait; I felt like my 6-year-old marking off the calendar day by day waiting for December 25. We were told "soon," then May 1, then May 3. The waiting was frustrating - aggravating in fact. Well, the wait is over. The moment the clock struck 12:00 a.m., we had Mike Skramstad's video on the Web. I then checked cerecdoctors.com, and hard to believe, but there were more than 20 videos ready to demonstrate the power of the new software. It is fantastic! I am so happy that I have found a partner in Sirona who wants to make my practice and my life better. I am proud to be a member of cerecdoctors.com. There is really no other place for cutting-edge info on the CEREC world.

CE City!

Richard Rosenblatt (Faculty) — Tue, 03 May 2011 00:00:00 -0700

As a faculty member of cerecdoctors.com and a CEREC basic trainer for Patterson dental, I talk all the time about taking CE to improve CEREC skills and knowledge. This hopefully leads to improved efficiency and a nice return on investment financially. Well as we know, dentistry is not just limited to CEREC; there are many facets of dentistry that we try to learn and master. I'm heading to Las Vegas for the Townie meeting. I will be giving my tips and tricks lecture on Friday (hope to see some of you there), but I'll also be taking many different courses that I hope will increase my dental knowledge. The course that I'm most excited about is the Six Month Smiles course on Wednesday. I have been using Invisalign for many years but wanted to learn a bit more about ortho. I'll be writing next week about my observations on the course, and I look forward to sharing that with you.

A Silent Thank You

Jeffrey Caso (Faculty) — Mon, 02 May 2011 00:00:00 -0700

Once a week I take one of my sons for horseback riding lessons at a local ranch. The lesson that takes place before his is an equine therapy session. Equine therapy has been shown to be helpful for a variety of problems, and has been used in rehabilitation of juvenile offenders, recovering substance abusers, as well as those in need of certain forms of physical therapy. This lesson, however, is even more special than that. This particular lesson involves a group of autistic teenagers. After having watched their progress of several weeks it is truly an amazing sight to see. These teens who have considerable deficits and trouble with the spoken word, flourish when dealing non-verbally with horses. Their ability to control these animals and keep them walking and cantering is amazing. In addition, they are also able to run barrels in different patterns and stop, turn and totally command their horses. The thrill and sense of accomplishment must be great for them, though due to the autism it is hard if not impossible to see. Without exchanging any words about it, my son and I have started to leave for his lesson early in order to be a part of this weekly event. We don't do much and probably our presence there is more for us than for them, but we do what we can and what we are asked. We offer words of encouragement, which seem to go unnoticed. That lack of affect is what must be the most difficult thing for the parents of autistic children. I have noticed, however, that these parents are truly special people themselves. Yesterday, after the session, I was holding the gate open for a young girl. Now this girl is so great, she rides well and to the very end. I offer her words of encouragement each time she passes. After she passed through the gate and I closed it, I was standing with my hands in my pocket. She came up to me and started to grab my wrist. I was unsure about what to do but the gesture was not malicious in any way so I let her control my arm. She pulled my hand out of my pocket and gave me a firm, very nice handshake. Then she turned and left. It brought a tear to my eye. Experiences like that need to be revered. Daily, we deal with people who have all kinds of issues, maybe something significant, maybe just fear. Taking a minute to try and figure out where their issue comes from and what we can do about it, can really make a difference in a person's life. Selfishly, the level of personal satisfaction we get from trying to be helpful and encouraging is staggering. Go for it!

Will I Be the Biggest Loser?

Sameer Puri (cerecdoctors.com co-founder) — Thu, 28 Apr 2011 00:00:00 -0700

When I was growing up, I was a fairly skinny kid, a bit athletic but mostly skinny. After getting married, the workouts, the exercise, the fitness pretty much ceased due to a new marriage, a new practice and eventually kids. Lately, I've been on a quest to regain my fitness and get back in good shape. The impetus was a bet with a good friend in the middle of January to see who could lose the most weight and body fat by Cinco de Mayo. Well, I proceeded to kick my workouts into high gear. I had been working out regularly the past three to four years with a trainer (prior to which I had peaked in weight), so my fitness was better, but the weight was still a bit high as I didn't really care about diet. I just enjoy eating and drinking too much. The workouts have been going great but I had some challenges that I knew were going to be a problem. A week-long trip to the IDS in Germany and a Disney cruise with the family after that. I knew if I could survive these trips, I'd have a good chance of winning the bet. Surprisingly, I made it the two weeks and only put on .5 pounds! And trust me, I ate like you have never eaten on both trips. What's the fun of going on these trips if you aren't going to live it up? But I did work out daily during those two weeks, squeezing in a run, pushups, whatever I could, whenever I could. Hence the minimal weight gain. Once I got back I doubled up the workouts. I'd go to the gym in the morning switching between three days of cardio and three days of weights, and I would come home and do a round of Insanity - an intense workout routine. And once the trips were over, diet became strict - very strict. I figured I had primed the pump with lots of food and exercise - now if I continued the exercise and just cut down on the food, I'd see some significant results. So every day since the bet started, I have been weighing myself. I know weight fluctuates but I wanted to see the trends of my hard work, double workouts, and eventual clean eating, etc. Every night I would weigh myself, and weigh again in the morning. The difference was about 2 pounds. Don't know the reason, but that's what happened. It averaged about a 2-pound weight difference between each night and morning. Now during the day, I'd eat and drink, so the weight would come back, but I started to see a consistent trend. I was losing about .25 to .5 pounds daily with my workouts. I'd be 215 one night, drop to 213 in the morning and the next night I'd weigh in around 214.5 or so. This continued and continued and showed me that my hard work was paying off. Well, last night, I was 202.2. This morning - 200 flat! When I started my bet I was 217.9 (using the same scale I'm using today). When I got back into working out four years ago, my weight was in the 230-235 range. Mind you, I've never been fat but I sure as hell have been skinny fat! Skinny arms and legs and big gut. I'm just so happy with the weight loss, and frankly, I'm in probably the best shape of my life. I can do more pushups, more pull ups, bench more, pull down more, curl more, do more triceps dips, and run farther than I ever have been able to. Running 6-8 miles now is no issue at all, whereas in the past, I'd struggle with just a mile or so. When I got married almost 14 years ago, my weight was around 195. I'm 6'4' so that is a lean 195. So today, I'm about 5 pounds away from marriage weight. The great thing is that I don't think the weight loss is stopping anytime soon. I feel as though I could keep this up forever. I'm not starving - in fact, I'm really eating a lot, but eating clean. It's amazing once you get your metabolic engine in place how much energy your body burns. The weigh in for my bet is May 5. Cinco de Mayo. Well, it's May 4 actually - we both agreed to push the date up so that we could have a nice enjoyable cheat meal on May 5. I'll let you know the results. The stakes are high - the loser buys the winner a custom-made suit! But regardless of what happens, I figured I've already won as I've been able to break through a threshold of weight that I had been stuck on for years.

Is ANYTHING for Sure?

Mark Fleming (Faculty & Magazine Editor) — Wed, 27 Apr 2011 00:00:00 -0700

A patient and I were talking the other day. I've been seeing him for about six years now. When I first saw him, he was working a good job, lots of overtime, things were good. You know, he had one of those jobs with a relatively long-standing company in the area. Made a lot of car parts, both mechanical and electrical. And since EVERYONE needs a car, things looked pretty secure. Is ANYTHING for sure? Yep ... CHANGE. That patient, having been out of work for awhile, has just landed a good job again. I told him that back in the early '80s I had several patients who worked for AT&T - not the AT&T of today, but the one that had the long-distance monopoly. I figured they were set. Guess what? That changed. Cincinnati Milacron - long-time employer - gone. I'm sure we all have our own examples. Something we thought would be around forever, changed drastically or gone! Change is a constant. And change can be good. I look at how dentistry has changed while I have been practicing these 33 years. Just a few changes! HA! So what can we do? Be adaptable. Look at how you can improve yourself and your practice. Look to people like Imtiaz Manji to see the future of practices and how to be efficient and effective in your everyday procedures. Learn, learn, learn! So be ready for the ONLY thing that is for sure ... CHANGE!

So Much to Learn

Jeffrey Caso (Faculty) — Tue, 26 Apr 2011 00:00:00 -0700

Not so long ago, the previous generation of dentists had very few materials to work with. Think about it the next time you look in the mouth of an older patient. We call these patients dental museums. We see a great deal of amalgam, cast gold, gold foil and silicate cement. Sometimes we can even see the evolution of esthetic full-coverage restorations. From gold with acrylic facings to three-quarter crowns leaving facial enamel to porcelain fused to metal with large facial collars to Captek to Procera to CEREC and so many more in between. It's really quite interesting. Having so few materials to work with, dentists really became proficient working with say, amalgam, for example. Some of the amalgam fillings are really a work of art save for the color. The power of mechanical retention amazes me when removing these. Then, look at the bases we see underneath. I have used a lot of Zinc Phosphate cement in my day; not the easiest material to work with and highly acidic at that, but it did a great job as an insulator under these massive amalgams. Dentistry was a hard job then and is still a hard job. I think it's the changes that we need to make in our heads that may be the most difficult thing. We throw our heart and soul into the next greatest thing. Go to classes, learn everything, train ourselves and then our staff, educate our patients and then integrate it into our practices, sometimes to be disappointed in a short time. CEREC is not one of those flash-in-the-pan type things. That we don't have to worry about. We do, however, need to keep up with the changes. It can be mind boggling. Think about just the last year. A move toward implant abutments, In Lab software, permanent bridges, GALILEOS integration, new materials. Will I need a sintering oven or will e.max save me from that expense? Holy smokes, it can make your head spin! That's enough of my Andy Rooney rant. Let's figure out how to stay ahead of the curve. I see two types of CERECers. Those that have the Red Cam and love it - it does just enough, works well, and why rock the boat? Then, there are those that need to get everything right away, get training and start doing it. That's what makes the times we are living in so great. Do what you want; do what fits with your practice style. We all choose our path and feel comfortable with our decisions. There is no right or wrong! The comfort to me is belonging to a group like CERECDOCTORS.COM, so that when these advancements occur we can all learn and grow together. We figure out what we are supposed to be doing and what works in real life. Then we graciously share our newfound knowledge with each other in an environment that facilitates learning. Thank you all for this opportunity. I truly am so grateful to be able to learn new things every single day. Life certainly is not boring.

What a Day!

Richard Rosenblatt (Faculty) — Mon, 25 Apr 2011 00:00:00 -0700

What a fun way to start my day today. Went to the garage to get something for my daughter before she went off to school. I accidentally kicked my daughter's bike with my bare foot. I thought I just stubbed my left pinkie toe but when I looked down, it was pointing due left. I'd include a photo (because I had to take one!!), but don't want to make new visitors to the site pass out!! Turns out I fractured it very badly and dislocated it. I'm in a protective boot for a few weeks. Try not to step on it while I'm on the dance floor at the costume party next week while attending the 9th annual Townie Meeting. The show must go on!! I'm really looking forward to the Townie meeting. It is my favorite CE event of the year and one I never miss. I can't wait to see old friends and make new ones. There are going to be tons of great lectures and amazing entertainment. If you are looking for something to do last minute, come to Vegas!! Best bang for the buck out there in dentistry. Even hobbled and less than 100%, there is no chance I'm missing it!!

Inspiration

Peter Gardell (Faculty) — Thu, 21 Apr 2011 00:00:00 -0700

With so many innovative business models out there, we can easily think of ways to improve our day-to-day office operations. I was in the Apple store recently; actually I was in the store many times recently which I am sure Steve Jobs liked. Very cool place, the appearance is striking, clean, uncluttered; nothing there to distract your attention from their products. Even the area for kids was clean, no fingerprints on the computer monitors, no junk on the floor. There was a person walking around who was just cleaning all the monitors and counters. The associate quickly comes up and asks if I need assistance. Very knowledgeable of the hardware and the software that Apple has to offer in the store and online. They have the answers for the various questions, but they also have been empowered to say they don't know. If they do say that, then they immediately find someone who does know. If they needed to demonstrate something, they quickly did it on one of the Macs or iPhones. My experience in Apple made me wonder how I could utilize some of the technology I already have to improve my patients' experience - to make them raving fans. Incorporating the iPad for patient education is a fairly quick and easy practice adaptation, since most of us photograph our cases anyway. Use these photos to show patients what you have done and what you are capable of, and your case acceptance will go through the roof. Checking out is a quick swipe of the credit card, a keying in of an e-mail address and done. No wasted motion. These very efficient systems don't waste the time of the customer or the staff. When you implement technology into your practice with purpose and vision, it is a wonderful addition to your business.

Continuing Education Musings

Mark Fleming (Faculty & Magazine Editor) — Wed, 20 Apr 2011 00:00:00 -0700

As I pointed out last time, I was getting ready for Spear Education's Worn Dentition Workshop. I really enjoyed it. I believe it helped further my skill set in treating my patients better. And it also gave me some other benefits. You see, now I was the student instead of being the instructor. It helped me see how I could be a better instructor. I noticed that maybe at times because of my familiarity of the CEREC software, I may be explaining things too quickly when a participant may be having a difficulty. I'll be more aware of this when I next head out to the Center to help others learn how to benefit from the CEREC technology. My learning experience also got me thinking about transferring information to my patients. I'm very familiar with dentistry but I still needed some questions answered when I was learning at the Worn Dentition Workshop. Most of my patients have minimal understanding of the technical aspect of dentistry. It is even more important to take my time explaining my recommendations or finding others who do that task better than I can. So at your next learning experience, be open to other learning possibilities that are not part of that particular program. You may just find those opportunities as just as important!

Planning for Vacation

Jeffrey Caso (Faculty) — Tue, 19 Apr 2011 00:00:00 -0700

The weeks leading up to a vacation can be very stressful in the office. I like to leave with everything perfect. Part of a restful vacation is not worrying about any unfinished business. This includes not leaving any patients in a vulnerable position and pre-paying any bills that may come due while your gone. I will say that over the years this preparation has gotten easier. Using an online billing service, like the one offered through my bank, makes keeping on top of bills so much more efficient. Just click which bills you want to pay and when and they get sent out automatically. I would struggle sometimes weeks before departure with prosthetic cases. I would never leave with a patient in temporaries. The stress was huge. On the last few days, everything coming back from the lab had to fit perfectly. With CEREC, no more temporaries, no more fit problems and no more worries. I think it's great that as I prepare for my upcoming vacation, my last two patients are scheduled for CEREC crowns. Now, granted they are both on endodontically treated teeth and should be straightforward, but how easy is that to provide this service right up to the end of the day and then leave with a clear head? CEREC has changed my practice in so many positive ways; this is just another way. It really makes life easier and gives me confidence to get some much needed rest without regret. It also provides me with one other advantage. When I return from vacation, I can immediately and definitively offer the patients who experienced problems while I was away the dentistry they need. This helps them to have a permanent resolution of their problem and it surely helps my cash-starved practice to get back on track after being closed. Practicing CEREC dentistry is such a smart thing to do. Enjoy it and be thankful for everything it has to offer!

Teamwork and Problem-Solving

Richard Rosenblatt (Faculty) — Mon, 18 Apr 2011 00:00:00 -0700

I'm a proud Papa today. My oldest child, my daughter Alix, participates in a competition called 'Future Problem Solvers of America.' A group of students in her sixth-grade class, led by a very dedicated teacher, compete in this event. In the competition, each team gets a problem, and they use problem-solving skills to try and find a solution. It has both an oral and written component. In the recent state competition here in Illinois, the 33 teams competing were given the topic of poor water quality and how to fix it. Each student on Alix's team has a specific job in this problem-solving competition and each is judged on it. My daughter's team worked very hard in preparation to do their very best in this competition, lead by their teacher Mrs. Greenwald. At the end of the event, my daughter's team placed second in the contest and qualified for Internationals, which will be held in June with groups from around the globe that won the same event in their respective regions. Why am I talking about this on the blog? Besides beaming with pride, I realized that they are being taught what we try and impart to new users when learning about CEREC technology and integrating it into their practices. If you want to be successful, you need a strong leader (the dentist) and a team that knows their role in the process. Each team member performs crucial tasks on each procedure to try and improve the efficiency and quality of the process. My daughter and her team put in so much effort before the event to be as prepared as they could when the time came to perform. When a practice makes the commitment to use CEREC in their office, they need to do the same. My daughter's team could not have just shown up and performed as well as they did this past weekend. In the same respect, CEREC users need to take the time to practice on the machine. Make sure you, the leader, watch videos regarding upcoming procedures you may have on your schedule to improve your knowledge and be prepared. Strive to take more CE to push the limits of that knowledge. Delegate to your staff things that they can do to improve certain parts of the procedure. When the leader and each team member learns and perfects their role in the CEREC process, success is bound to happen. Just remember that success in anything generally does not come easily, but the preparation and the journey is part of the reward! My daughter and her team are really looking forward to the next step in their journey and will be putting in a lot of personal time perfecting their roles for that big competition and payoff. You and your team should strive to do the same!

Be Safe and Plan for the Unexpected

Sameer Puri (cerecdoctors.com co-founder) — Fri, 15 Apr 2011 00:00:00 -0700

A little while back, I was at the office, having a nice little run-of-the-mill day. I finished up the day and went to my routine of going to the gym and working out. After warming up, I got on the leg press machine and did a couple of sets. On the third set I pushed with my legs and heard a snap. "Oh, no!" I thought, "What just happened?" I got up and immediately felt soreness in the lower back. I walked around a bit and tried to stretch but I could just feel it getting tighter. At that point, I grabbed my back and hobbled out the door to go home and ice my back. Well wouldn't you know it that on the 10-minute drive home, my back went into spasms. Forget stretching, it took me 20 minutes just to wiggle my way out of the car. I laid down in the living room and couldn't move for 45 minutes. I share this because all sorts of thoughts about my career started racing through my mind. "What if I did permanent damage and couldn't do dentistry anymore?" "What if I'm not able to move around and travel to teach courses at Scottsdale Center?" "Who will take care of the practice and my patients?" All far-out thoughts, but ones that went through my mind nonetheless. The good news is that it took a few days but luckily everything is back to normal. Back spasms stopped and I am able to do all the normal things that I usually do. My suggestion is take care of yourself. Make sure you have planned out your future and know what you and your family will do in case of an emergency. You never know when a silly thing like working out could end your career.

A Few Thoughts on the Economy

Jeffrey Caso (Faculty) — Thu, 14 Apr 2011 00:00:00 -0700

Recently Bill Simon, the CEO of Wal-Mart had some grave economic news. In a nutshell, he said that due to an increase of the cost of raw materials used to make goods, the poor performance of the U.S. dollar, the high cost of oil which makes it more expensive to ship goods and a multitude of other factors, the cost of products sold in his stores, which by the way accounts for 10 percent of all retail sales in America, will rise, and rise seriously in the next few months. The Federal Reserve's policy of buying $600 billion of U.S. Treasury Bonds to ease money concerns during this massive recession is further leading to inflationary pressures. The money spent works its way into the economy and further devalues the dollar. Gold, the safe haven and hedge against inflation, is doing crazy things as well and is valued at just under $1,500 an ounce. Silver is just under $40 an ounce. Just 10 years ago, gold was valued at $300 an ounce. That's a wild ride and some are saying that it is headed toward $5,000 an ounce in the future. So, on a personal level, we are already seeing gasoline prices rise. Down the line, expect to see an increase across the board - food, clothing, paper goods, etc. Let's not get crazy, though. This is a long, slow process and we have to have some confidence in our government that they will do what they can to stifle this process. On a business level, let's prepare a little. No need to fill your basement with bibs and cotton rolls, but do alert your person in charge of ordering to keep you apprised of things they might notice like an increase in the cost of supplies. Watch your lab bill for increases and watch everyone you do business with for increases in shipping costs. Make sure you are aware of this in real time and tweak your prices accordingly. As dentists we usually are running a few months behind on things. By the time we notice a slight increase in last month's supply bill and wait to see if it was just an anomaly, it's two months down the road. Now we are losing profit and digging a hole for ourselves. When the same thing happens with our lab bill and electric bill and water bill and so on, it's a problem. Don't stress out too much about this; we can't control it. Just be vigilant. Alert the staff to watch for changes. Adjust what needs adjusting, and do it early. Don't get caught waiting things out for a few months; it's too late then. This is just a cycle and some say it's part of the recovery from poor economic times. Who really knows? Think like a business person and not like a dentist and all will be well.

CEREC Study Clubs

Peter Gardell (Faculty) — Wed, 13 Apr 2011 00:00:00 -0700

I was recently in Saint Louis giving a study club presentation and had a great time. Matt and Steve are great CEREC specialists, and are developing a study club for the benefit of their CEREC owners. They are kicking around some fresh and exciting ideas, and they should be applauded for their enthusiasm for the technology and their desire to learn. Some individuals traveled more than two hours to attend; I felt honored by their efforts. There have been some posts on the boards about starting study clubs and this is such a great idea. Face-to-face interaction can help create a local dynamic community that helps all owners, veterans, newbies and prospects. Study clubs are a fantastic avenue for sharing information with one another and with the various companies that we use in the course of our CEREC procedures. A two-way exchange of information leads to advancement for all. Get involved with a CEREC study club. Raise the bar. Advance dentistry!

Moment of Gratification

Armen Mirzayan (cerecdoctors.com co-founder) — Tue, 12 Apr 2011 00:00:00 -0700

We have trained thousands of dentists both online and at Scottsdale Center over the last few years, and the cerecdoctors website allows us to closely follow our graduates with regards to the progress they make after they leave us. We see doctors come through who were timid and apprehensive with their machines at first, but by the time they go through the curriculum, they have confidence with the toughest and largest of cases. I find it very gratifying when we see a doctor who posts clinical cases that are handled with surgical precision that implement all the important principles we preach. One very important principle is knowing how the software stitches models together. It's accomplished by the 15 percent and the 30 percent rule; the program scans adjacent landmarks, and if they are redundant between the pre-op model and the prep model, the models are accurately related to each other. This is a foundation for everything we do; from single restorations to full mouth rehabilitation cases. It's a topic I directly address for every single presentation I do, whether it's for a novice or master user. Recently, Dr. Michael Alsouss posted a treatment that involved a 12-unit case for a patient who needed the work done on short notice. I was thrilled to see him implement all the techniques we have taught over the years to accomplish the task at hand. Furthermore, he created a video that documented the case very thoroughly, which I can imagine required as much effort as treating that particular case. With the amount of energy our faculty puts into each course, it was rewarding and gratifying to observe the process and see all of our hard work come to fruition as he delivered outstanding care for his patient. Good job Dr. Alsouss. You can see the presentation here http://cerecdoctors.com/ui/ViewForum.aspx?ForumID=5665

Communication and Education

Mark Fleming (Faculty & Magazine Editor) — Mon, 11 Apr 2011 00:00:00 -0700

I was part of a discussion on a dental board the other day that got my juices flowing. It was concerning treatment planning a case. What got me involved was this quote: '...on an 80 year old?' Now, I guess I am more aware about age for two reasons: one, more than 60% of my patient base is 65 years or older; and two, I'm turning the big six-zero this year. My reply was: Why should we not offer our best services to anyone? Ask questions, give options and help the patient decide what is best for them. If this patient lives another 10-15 years, who are we to deny a treatment that may impact their quality of life just based on some chronological tag? Maybe something to think about the next time you communicate with your patients concerning possible treatment. Another dentist in this discussion later said that 'this old dog can't be taught new tricks.' Well, as far as I'm concerned, this old dog is NEVER too old to learn. In fact, I'm in Scottsdale right now taking a Spear Education Workshop on the Worn Dentition. Even after more than 30 years of practice, I know there is ALWAYS more that I can learn to help treat my patients better. Maybe I'll learn something to help an 80 year old today!!!

Words of Wisdom from my Dad

Richard Rosenblatt (Faculty) — Fri, 08 Apr 2011 00:00:00 -0700

I wrote a blog about the importance of technology in our practice to patients. I started thinking about that and wanted to pass on a few words of wisdom that my father, also a dentist, gave to me when I was younger and worked for him as a dental assistant. My dad knew that I wanted to go to dental school. I told everyone I wanted to be an orthodontist since I was about 9 years old. Well obviously that never happened, but I have landed my dream job. My dad was always a pretty progressive dentist, but he told me two things that I should remember in order to be a successful dentist. The first: Talk to patients as if they are friends or family, not as if they are "just patients.' Get to know about them and their families, and have your staff do the same. Find out about their interests and inquire about them when they come in for their future visits. The second tip he taught me was to learn to give a great injection. He made me practice once on a piece of fruit, and when I went too quickly he told me that that patient would be flinching or in tears. He told me to place topical on the tissue for at least five minutes, and to go as slow as I could while injecting. He said when I didn't think I could go any slower, to slow down more. The line that I always remember him saying is that doing these two things well is so important because patients don't know whether or not we do good dentistry; they just know 'was he nice to me and did he hurt me?' When I wrote my previous blog, I started to think about this saying and I realized that even though technology is very important in my practice, patient relationships and comfort are still number one. I practice by those words of wisdom my dad taught me over 20 years ago and maybe I didn't listen to him all the time, but I'm sure glad I did during that conversation....and so are my patients!

Making the Most of Time

Jeffrey Caso (Faculty) — Thu, 07 Apr 2011 00:00:00 -0700

Time is the problem. There just isn't enough of it these days. It seriously is my biggest problem. I find that I never have time to sit down and relax. Certainly not at work and very rarely at home. Looking at this vexing problem from a different angle, life certainly isn't boring - there is just no time to be bored. I have found since adopting CEREC into my practice that it is partially responsible for my lack of time. I am so glad that it is. In the early part of my CEREC experience, time was taken up with learning. Reading everything I could get my hands on, interpreting it and then going to the machine to confirm its usefulness. Later, it was the implementation of what I had learned. It took me a very long time to get through a CEREC appointment. When I worked hard to cut down the time it actually took to complete and deliver a crown suddenly e.max came along. I was so happy to have it available, but it added a 29-minute crystallization process to the appointment. All of my hard won time savings went right out the window. Slowly, we were able to shorten the process down again and now have a very respectable super-fast crystallization process. I was enjoying the extra time I now had when suddenly in-office fabrication of Implant crowns became a reality. Such a great evolution and a great service for the patient. I do most of these restorations during my spare time. Ha, there is no such thing. I fabricate these during lunch, which I never actually schedule, or after hours. I get a great sense of accomplishment when a crown fits without adjustment and it was fabricated solely by my own hand. To do that, however, it takes time. So with time at a premium, I have resorted to making lists. If I don't have time to do something right away, I put it on a list to get to it at some point. The list is growing ever longer. It includes so many cool things that I look forward to getting to, like abutment fabrication, a short term ortho class and spending time to get a better understanding of the InLab software. Like I said, the list is too long to even remember everything on it. Don't get me wrong, I am happy that my time is being taken up with so many rewarding things. It's a great time to practice dentistry. I already have gotten into the habit of waking up earlier in the morning to get things done. Maybe I should stay up later at night. Sleep is a waste of time anyway. Enjoy life while you can and make the most of every moment!

Technology Is Awesome: Part 623

Sameer Puri (cerecdoctors.com co-founder) — Wed, 06 Apr 2011 00:00:00 -0700

I just set up the personal hotspot on the iPhone. It's great. For those of you that are on the road and are sick of paying for Boingo Internet access at airports, this is a must. Most cell phones now have this. It basically allows your iPad or your laptop to set up a personal hotspot, which means that you can use your wireless signal from your phone to check e-mail and surf the net. This means that I don't have to pay for hotel Internet, I don't have to pay for airport Internet, I just use my iPhone. Granted it's still at the speed of my phone, but for basic stuff it's fast enough. Cost is $20 a month. To activate it, just call 611 from your iPhone, or if you have another phone, call your carrier. It's just the coolest thing ever.

Communication

Mark Fleming (Faculty & Magazine Editor) — Tue, 05 Apr 2011 00:00:00 -0700

Recently, I had the opportunity to attend the IDS. It was a great experience. I had the opportunity to see an incredible number of different booth areas with many, many products. Sometimes, I would ask for a demo. When that was the case, I was asked what language I spoke and then had someone who spoke English explain the product to me. Most of the time, English was not their first language. They would take their time explaining, making sure I understood and were constantly apologizing for their English. I told them their English was MUCH better than what I could speak to them in their native language. This experience got me thinking about what goes on in our offices. We as dentists speak a foreign language - dentalese. A lot of times we just blow through our conversations with patients and they have no clue what we are talking about. We should make a concerted effort to make sure we explain ourselves well, ask questions and ask them to feedback to us what they heard so we know our message is coming across clearly. Maybe even bring in someone else to talk with them like an auxiliary who speaks the patients' language better than we do. Communication is key to everything we do. Take the time to do it well!

Planting Seeds

Peter Gardell (Faculty) — Mon, 04 Apr 2011 00:00:00 -0700

Snow has finally melted and I can see my lawn again. I never remember having a winter like this past one. Springtime is coming quick, the sun is stronger and the days are longer. Baseball's opening day is here. It's an exciting time of the year. The trees are starting to bud and the tulips are poking through the dirt. Looking forward to seeing if the seeds that were planted last fall develop into something special, something exciting. When we take a course, a lot of times we have idea "seeds" planted, interesting stuff that sometimes takes time to develop. We need to check on and sometimes tend to the seeds to get them to mature. I just got back from a course that was chock full of info. Some of what I learned is the 'hear it Friday, enact it Monday morning' stuff, some requires more attention, some reading, some discussion with others. A lot of times it is easy to say I got a few pearls out of this and am happy. It's the follow up that can turn good CE into excellent CE. We are very lucky that when it comes to CEREC CE that there are mechanisms in place to help us grow these idea "seeds" into something more, something permanent. Make sure that after you experience Scottsdale Center or listen to one of the Mentors or Faculty, you participate in the forum, pose questions, make comments. It will help to expand the dynamic group collectively known as cerecdoctors.com. Even if the seeds I planted last fall don't all grow, it still is better than having to shovel the driveway anymore!

Germany!

Sameer Puri (cerecdoctors.com co-founder) — Fri, 01 Apr 2011 00:00:00 -0700

Well the trip started out like many others - on a plane. I had just finished a lecture in Baltimore and it was time to catch my red-eye flight to Frankfurt to attend the IDS. Luckily the gods were smiling, and I was able to upgrade my flight and sit with some extended legroom. Being 6'4" I don't take these things lightly, and frankly for me the flights out and home set the mood for the entire trip. [legroom.jpg] Lucky for me the in-flight entertainment system had plenty of TV to watch. I have not been able to ever sleep much on planes, so movies were on the menu for me. Now if my kids had been with me, they would have been in heaven as there were tons of Disney shows. Having a couple of pre-teen girls in the house means that you get to know shows like Wizards of Waverly Place, Good Luck Charlie and The Suite Life on Deck. [inflighttv.jpg] After flying all night from Baltimore and landing in Frankfurt, it was time to hop on a high-speed train for the short 50-minute journey to Koln where the IDS was being held. It's amazing to me how efficient the trains are. I only had about 45 minutes to make my train by the time I landed and I knew that if I was late, I would miss it. When the board says the train will leave at 10:09, they mean it - that sucker left at 10:09 and not a second later. We went at 267 km/hour flying by Porches and Mercedes on the Autobahn who must have been doing a pretty brisk pace themselves. The trains were comfortable, relatively inexpensive, and efficient. Makes me want to have more of them in the U.S. [trainstation.jpg] After arriving at the train station in Koln, I had a short walk to the hotel to get a quick shower and then was off to the IDS. Now, I had heard that the show was large, I had heard of the vast number of companies there, but until I saw it, I didn't believe it. And it's not just rinky dink booths with rinky dink companies - I'm talking amazing booths the likes of which you have never seen. All the big companies have a bar at their booth and at 5:00, it's happy hour! Amazing. The booth here is a random company that was exhibiting. Full of color and style. [booth.jpg] If there was a theme to the meeting it had to be Digital Impressions. There were at least a dozen companies showing their versions of intraoral scanners; some just utter crap, others not so bad. But so much buzz about digital impressions and obviously the Sirona booth was just massive and packed. The demos were five deep and they sold an unbelievable number of machines. [Sironabooth.jpg] One of the neat things at the meeting was getting to see the new products that are going to be coming out. This block by Dentsply, for example, is a compression of liquid and metal powder that is milled by the milling unit. The user puts the block in an oven and voila - a milled metal crown out of the CEREC MCXL. Granted this has little use for those of us who use the CEREC and mill our restorations chairside, but for labs, this is huge. Now labs can mill any material they want out of their MCXL. [Dentsply.jpg] Another great product that I got to see was this new larger can of Optispray. I love the Optispray, it works great. I loved it even more when Sirona lowered the price. Now with a bigger can, the price is even better. It sprays great, it's got a better tip and is simply a terrific product. [Optispray.jpg] After spending all day at the IDS, it was off to dinner with some friends. Sirona was host of the meeting so they took a group of us out to dinner. Now the specialty drink in Koln is called Kolsch, a local beer that is quite interesting not only for the taste but also in the distinct glasses that it's served in. We ate at a 300-year-old restaurant and it was delicious. However, be warned that you better like the beer. Trying to order a pilsner, or a dark ale or god forbid a scotch at this restaurant results in a look of annoyance on the waiter's face. All they do is beer and lots of it. Below was the appetizer before even ordering dinner. [Kolsch.jpg] And then dinner came....some people had the steak, others had the local specialty of pig knuckles (yes, you read that right), and I dabbled in a bit of everything tasting the local fare. [Kolsch2.jpg] And of course then dessert...by this point, I don't even remember whether my meal was any good or not - it tasted like chicken I think. The wheels of Kolsch did not stop - at all. It was wheel after wheel after wheel. Quite the nite. [Kolschwheel.jpg] The next morning, we hopped on a bus and took the 2.5 hour drive down to Bensheim, the home of Sirona. The plan was to visit the factory the next day and get a tour. But this night, our plan was to check into the hotel and go down to the town of Heidelberg (about 20 minutes away) to have dinner. The town is typical German town: We walked through the town square and saw this 800-year-old castle on the hill. [Bensheim.jpg] [Bensheim2.jpg] [Castle.jpg] After a glorious dinner, we headed back to the hotel, and with jet lag kicking in hard, it was time to hit the sack...at 9:30 pm. The next morning I woke up refreshed at 4:30 am...and stared at the ceiling. After a nice morning run around Bensheim, I had breakfast with the rest of the crew and hopped in the shuttle to visit the Sirona headquarters. Not only did we get a great tour of the factory, but we also got to see the new innovation center. It will house all of the research and development teams of all of the divisions of Sirona - imaging, CAD/CAM and more. Kinda cool if you think about it. There is also the showroom that has all the Sirona materials and products. [SironaHQ.jpg] [Int.jpg] [Int2.jpg] There was a demo of the first chair that Sirona made - kinda looks like what's in my office! [First_chair.jpg] We got to meet with the different departments of Sirona and got up close and personal with some of the available products. Here is the aforementioned milled metal crown from Dentsply and a full contour bridge made by the milling unit. [Metal_crown.jpg] [bridge5.jpg] Finally after meetings and tours of Sirona, it was time to go to the next city. So far we have Baltimore, Koln and Bensheim. I hopped on another high-speed train to Zurich. Now, the original plan was to visit the Ivoclar factory in Lichtenstein. However, meetings at the Sirona headquarters delayed me, and the rest of the crew that I was with had already left. So the next morning, I took the train to Zurich to catch up with them and finish off my European trip. [Zurich.jpg] I got to Zurich and had a few hours to kill so I walked around on the Bahnof Strasse, the main boulevard in Zurich where I was spending the night. I even got to check out Lake Zurich. This is by far one of my most favorite cities, and I have visited several times before with my wife. [LakeZurich.jpeg] Now anyone who knows me knows of my love and admiration for watches. Cars and watches, right...what else is a guy supposed to waste, errr...I mean spend his money on? In the window of one of the multiple watch stores I saw a piece that I had coveted forever. I'd seen it in magazines, I'd read about it, but hadn't seen one in person. It was the Audemars Piguet Bumblebee. Guess which one is the bumblebee from this photo? Great little watch but alas, I've not quite saved up to pay for it yet. And with the exchange rate so unfavorable towards the dollar, it will just have to wait. [Bumblebee.jpeg] Final night in Zurich meant one last meal. The gang at Ivoclar hosted this one. Some restaurant off the beaten path with a fixed menu that was amazing. Now the food was great, but what I distinctly remember about the night is the wine. I'm not a fan of white wine but this little bottle was some of the most amazing stuff I've ever had. Had to snap a photo of it before I forgot the name. You can bet that I will be Googling this bad boy and ordering a case! [Zweifel.jpeg] Finally, it's time to leave, so I get on the last train to the airport or Flugenhafen as it's more commonly called. Sleep patterns are getting back to normal, just in time to hop on a flight back to the states. Off to Chicago and then Scottsdale for a lecture and Level 2 and Level 4 classes. My two regrets about this amazing trip: I wish my family could have been with me and that I had taken more pictures.

The Starbucks Effect

Jeffrey Caso (Faculty) — Thu, 31 Mar 2011 00:00:00 -0700

Somewhere in a think tank there are groups of engineers and psychologists who evaluate our behavior and attempt to modify it. The trick is that they try to modify a person's behavior without them being aware of it. No, I didn't go crazy and begin to believe that there is a plot to get into our heads and make us follow an iconic leader into destruction. It's really true. Let me give you some examples. Have you noticed that as the sodas in McDonald's get bigger so does the diameter of the straw? Well, what do you finish last when eating in a McDonald's? The soda. If it takes too long for you to finish it, you will stay longer and they will need more seating. They want you out ASAP. To that end, have you noticed that the molded plastic seats are comfortable for a few minutes and then start to make your back hurt? It's not an accident. Eat and go. You have just been manipulated. How about those beautiful ceilings in Las Vegas casinos? They look like the sky with billowy clouds. That's no accident either. They replicate the best time of day for the majority of the people. It's a spring sky at precisely 7:00 pm. While you're at it, notice that the temperature and humidity of the room are keyed in to that perfect time. Why is it so perfect? Because that's when people feel the best and have the best, most uplifting outlook on life. Oh yeah, it's also when they feel the best about spending money. They just manipulated you into feeling great in a natural way, so that you will have a great time losing a ton of your money. Starbucks has a similar thing going on, but kind of the reverse of McDonald's. They want to create an intimate seating environment without giving you too much privacy. Privacy means they would need more space and that's just not going to happen. They want to bring you in and make it comfortable enough for you to feel like you want a bigger coffee to be able to stay longer. Maybe even some food. It's a nice environment, they designed it well, and yes, we are being manipulated. I am currently renovating my office. The last time I updated was six years ago, and it's time for a change. I am going for the Starbucks look. Comfortable seating, nice music, WiFi, iPads for surfing the Web and a nice color scheme. Can't we as dentists create a subliminal message that will manipulate our patients? Of course we can. My goal is to make the office a place that offers comfort and luxury. It will set the stage for a nice visit, and it makes me feel good as well. The renovation is underway and I will keep you apprised of my progress. I think it's a positive direction to create that nice, safe feeling that makes people want to come back. If not, well I will just get in early every day, drink coffee and read the newspaper in the waiting room. Maybe I can manipulate my own mind into thinking it was a good idea.

Loyalty

Mike Skramstad (Faculty) — Wed, 30 Mar 2011 00:00:00 -0700

My favorite time of the year is coming to an end this weekend. Every year I look forward to March Madness and the Final Four. This past week has been not been great for me from a basketball fan standpoint. I'm a Purdue Boilermaker through and through (and trust me, it's hard sometimes!). This week the Purdue coach, Matt Painter, was almost 'wooed' away from Purdue to the Missouri Tigers. This would have been a disaster for the Purdue program. Over the last five years, he has built one of the most consistently solid programs in basketball. So why did he almost leave? The answer is commitment. He felt that Purdue wasn't committed to building a solid program. All his assistant coaches were leaving because they weren't being taken care of. If you've ever listened to Imtiaz Manji speak, he makes a point to tell us all that 'loyalty is a myth.' I agree with this completely. Sometimes it's not about the money; it's about how you are treated. Take note of that when you are dealing with your staff and your patients. When a staff member leaves, is it because they were offered more money to take a job elsewhere? When a patient leaves, is it because there is a dentist down the street who is cheaper? This definitely happens, but I would venture a guess and say that most of all, it's because they are unhappy with the way they were treated. In the end, Matt Painter is staying at Purdue. They offered a commitment to him to stay. However, it was almost too late. Don't make a late commitment to your staff and patients. Treat them in a way that makes them feel that they are a part of something. Why? Because loyalty is a myth.

Is Dental Technology Important to Patients?

Richard Rosenblatt (Faculty) — Tue, 29 Mar 2011 00:00:00 -0700

I have a small practice in the northern suburbs of Chicago. We don't have great visibility from the street, we don't get 40 new patients a month, and I practice in an area where there is no available land for housing development construction. What that means is that I practice in a town where a whopping 19 new homes were purchased, and that has to be split among 16 dentists. Not easy to survive, but we do. One thing that keeps people coming to our practice is that we are known for technology. We had two new patients come to our practice because they were unhappy with the fact that the dentist they were seeing for many years was not keeping up with technology. Both patients were discussing their dissatisfaction with respective friends, and were told how I did crowns with a computer on the same visit. The friends talked about how I took digital pictures of their teeth and they had never seen that before. They spoke about how I offered them TV or satellite radio and headphones to minimize the sound of the procedure. They also talked about how I e-mail and text them reminders and confirmations. In the cases of these two patients, technology was the tipping point. We are living in a world where just about everyone uses technology in some way, shape or form. You may not think patients understand what our technology does, and maybe they don't, but they do understand that our office is trying to keep up with what is going on in the world of dental technology. Technology may not be valuable in the eyes of every single patient, but it is likely more important than you think.

Technology

Sameer Puri (cerecdoctors.com co-founder) — Mon, 28 Mar 2011 00:00:00 -0700

There is nothing like today's technology to make our lives easier and more productive. I type this from 35,000 feet in the air using the WiFi on my plane. Not only am I able to take care of work, but I can also keep in touch with family. I've received several e-mails already from my kids telling me how much they miss me. Without technology, this five-hour plane ride would be boring. With technology, it's productive and fun, and frankly I have gotten more work done than in the past two weeks combined. Technology at the dental office is similar. It makes the office enjoyable and productive. I don't know where I would be without my CEREC and all the other toys that we have in our office that make it fun to treat patients. I enjoy what I do immensely and I look forward to working every single day because I get to play with all my toys!

IDS-Bound

Sameer Puri (cerecdoctors.com co-founder) — Fri, 25 Mar 2011 00:00:00 -0700

I'm on my way to Europe to visit the IDS, the largest dental show in the world, which happens every few years. (Check out Mark Fleming's latest post - he's already at IDS and having a blast!) I will be posting and sending you guys updates from Cologne, and will also show you how we can apply the latest and greatest new features to our practices. There are a lot of exciting things on the horizon with regards to CEREC, and we are looking forward to bringing them all to you in the coming weeks and months. All of these developments will be summarized at the Annual meeting in July at Scottsdale Center. Hope to see you there!

Greetings from IDS

Mark Fleming (Faculty & Magazine Editor) — Thu, 24 Mar 2011 00:00:00 -0700

The International Dental Show in Cologne - what a meeting! Now I know what are German friends were talking about when we saw them at Chicago Midwinter Meeting. This meeting is at least five times the size of Chicago. Incredible number of implant and CAD/CAM booths. The busiest by far that I and others have seen...Sirona! The CEREC area has been swamped. I've included a couple of pictures, one of the crowd outside part of the booth. Only part, because the Sirona area is HUGE. [sirona.bmp] The other area that is also a favorite - the bar. This picture is from the end of the day. [bar.bmp] My wife Lori and I are already making plans to come back in two years. The area has incredible history. We went to a museum that has Roman artifacts. Beautiful Dom Cathedral was quite impressive. We also rented a car and drove down the Rhine River and even spent the night in a castle! My recommendation is if you can, make plans to be at IDS 2013. Now, I'm off to sample more German beer!

Keeping the Peace

Jeffrey Caso (Faculty) — Wed, 23 Mar 2011 00:00:00 -0700

So, here is a confusing story. Let me set up the timeline to help you keep track of the major events. Three weeks ago on a Monday, I place two premolar e.max crowns on a very nice, long-standing patient who is 82 years old. That same week on Thursday, I leave for a long weekend with the family. On Friday, the day after I leave, this same patient has a crown come out on the second molar in the same quadrant as his two new crowns. Those are the major events as they unfolded; now let me explain what happened in between. After this very nice man's crown comes out, he calls my office only to learn that I am away. Being a nervous man, he decides to see a local dentist who places a sign on roadway outside his office advertising that he welcomes walk-in emergencies. He tells the dentist (mistakenly) that his brand new crown, placed on Monday that same week, has come out. The crown was obviously very old, showed signs of wear, and had a bad case of cement sepsis as evidenced by the smell. Nothing that would have happened in just four days. In addition, just a tooth mesially sit two nice pearly white e.max crowns. After a series of X-rays and full exam, the patient is told that after he goes through the office's hygiene department, the remaining tooth will be extracted and an implant will be placed. At this point, no one has asked for a medical history or they would have found out that this patient is a diabetic who takes an aspirin a day, is on Plavix as well as a plethora of other medications. In a moment of lucidity, the patient says that he really just wants the crown re-cemented, and gets up and leaves. I return on Monday and guess who is on the phone at 9:00 a.m.? I am shocked and surprised to hear that my new crown came out just four days after it was placed. To make things worse, the patient was not available to come in for two weeks. So, I spend the next two weeks concerned and in disbelief. I eagerly await the appointment to see what has happened. Today, the patient arrives friendly and jovial as usual. I look in his mouth and am thrilled to see that it is not, in fact, one of my crowns. I tell the patient, show him the mirror, and he keeps saying, "The other dentist said that a new crown should last longer than four days." Seeing that I will never win this fight and not wanting to alienate this nice old man and his extended family who are all patients of mine, I tell him that I fully agree and will make him a new crown and cement it with the really good cement this time. Soon his shiny new e.max is in place and he is happily on his way. No big deal. CEREC is great for crazy situations like this. My sadness lies with my colleague down the block who could have saved me the problem and re-cemented the still functional crown. Instead he charged this man for a full series of X-rays and an exam. He also kept the crown, insisting that he could not return it. It's a sad state of affairs out there sometimes. I hope I run into him around town soon. It's time we had a talk...

A Tip to Deal with Tissue Control and Hemostasis

Richard Rosenblatt (Faculty) — Tue, 22 Mar 2011 00:00:00 -0700

When I try to teach dentists about being efficient, we always seem to get into a conversation about tissue control and hemostasis. Some use a laser, some use cord, some use Expasyl or Traxodent with a Comprecap; there are lots of methods to try and control bleeding in the sulcus. I use a laser most of the time, but that is not my tip. The problem is not that the tissue is bleeding, but why is it bleeding? What actually caused it? I find that when doctors are prepping, the first thing they want to do is chase all that interproximal decay out of the tooth. Where, most of the time, is that decay located? Correct...subgingival! Well what happens when we prep subgingival? Correct again...we cause the tissue to bleed. My tip is: Don't cause the bleeding and then try to stop it. Control the tissue first, then chase the decay. Rough out the prep supragingival first. It doesn't matter if there is still decay there. I know it's tempting to go after it, people! I'm one of you, remember? Don't do it. Get the ideal supragingival prep design done first. At that point, use your laser to remove the excess tissue or pack your two cords to move the tissue away from the decay. Once you have the tissue controlled, then go ahead and remove the remainder of the decay. You will be amazed at how much less you will cause tissue to bleed. The use of magnification at this step helps tremendously also. My tip for this week is to control the bleed before it happens. It's one more way to be more efficient!

The Smallest Decisions in Life Define Us

Sameer Puri (cerecdoctors.com co-founder) — Mon, 21 Mar 2011 00:00:00 -0700

Why is it that in all aspects of life, given the exact same environmental conditions, you can have two entities whose outcome will be completely different - one a success and one mired in mediocrity? These same entities can have the same barriers to success and the same market conditions, yet one entity will flourish and the other will flounder. These entities can be individuals taking a class in school, a small business such as a dental office, or a large conglomerate like a computer company. Success versus stagnation in life events can often be traced back to one or two distinct points where the decisions made had a profound impact. These decisions, while seemingly minor, have a ripple effect, impacting everything else down the road. Let's take the example of two college students taking a chemistry class. The barriers to success are the same for both - they both have to study to do well. They have the same market conditions - i.e., both are in a college class surrounded with the resources and temptations of college life. At the end of the semester, one student gets an A while the other gets a C. What is the difference? Simply that the A student decided that joining the study club early in school was more important than joining the fraternity. That one decision has a profound impact on the lives of these two students. While the study club meets and reviews the weekly homework and notes from class, the fraternity meets for beer and socializing. Studying results in an A; partying results in a C. Often in life one simple decision can have a substantial impact on our future. Be wise and deliberate in everything that you do, no matter how trivial you may think that decision is.

Things that Make You Go WOW!

Jeffrey Caso (Faculty) — Fri, 18 Mar 2011 00:00:00 -0700

What a week! The devastation in Japan really overshadowed the unrest in Libya, and that overshadowed the problems in Egypt and other parts of the Middle East. The still unfolding crisis in Japan is changing history, rocking the world economic markets, adversely affecting existing unemployment problems, and has the ability to severely devalue the U.S. dollar. More important is the developing humanitarian catastrophe and the growing inability to help due to a strong risk of radiation exposure. This is a devastating multi-faceted event to rival historical events like the great plague and the tsunami in Indonesia several years ago. As the world rushes to render assistance, the challenge is that we know what the Japanese people need, but we need to first set up an infrastructure to get the needed items there. There are few passable roads and bridges, no electricity, no sanitation, minimal housing, and hospitals are taxed to the limit. On top of that, there is the uncertain outcome of multiple nuclear reactor meltdowns, which have no historical precedent. Chernobyl was bad, but here we have the potential for multiple Chernobyls. What I find absolutely astounding is the effect that this 8.9 magnitude earthquake had on the Earth itself. Its incomprehensible amount of energy redistributed the Earth's mass, causing the entire planet to shift on its axis by 6.5 inches. Is that even possible? The outcome of this blows my mind. It caused a change in time! Every day from now until eternity will be 1.8 microseconds shorter. WOW! It's uncertain yet exactly what effect the earthquake had on the island of Japan itself. Now keep in mind Japan is no small island and is home to 127,560,000 people. At this point, the main coastline of Japan has been moved by 13 feet. This, my friends, is a cataclysmic event. Japan is a developed country that now has enumerable people who are hungry, thirsty, homeless, grieving... We have a responsibility to help out. I have found solace in donating money to two organizations that are stalwarts in disaster assistance. It's so easy to do. Grab your cell phone and make a $10 text donation. For the Salvation Army, text the words "JAPAN" or "QUAKE" to 80888. For the Red Cross, text the word "REDCROSS" to 90999. The $10 donation will be billed to your cell phone account. In times of crisis, people come together. There are so many stories of heroic efforts to save people's lives in the last week or so. Heroism takes many forms. Making a small donation to a necessary cause is heroic in and of itself. Thank you.

Great Bur for Onlays

Richard Rosenblatt (Faculty) — Thu, 17 Mar 2011 00:00:00 -0700

Here is a must-have bur if you like to do onlays: the Axis 845 KR taper. It has the perfect barrel shape for divergent walls and makes sure that your isthmus is not too thin so you won't be as likely to fracture porcelain. Since the bur is so wide at the bottom, it allows you to get a very flat floor to maximize ease of milling and accuracy of fit of the restoration. Check out the bur, I highly recommend it if you like to do inlays and onlays. [axis.jpg][axiscerec.jpg]

TEAMWORK

Mark Fleming (Faculty & Magazine Editor) — Wed, 16 Mar 2011 00:00:00 -0700

This is my favorite time of the year - MARCH MADNESS! I grew up in a small town in Indiana and have been infected with Hoosier Hysteria for a long time. I LOVE basketball, especially college basketball. I am always looking at how teamwork translates into quality play. It is more satisfying for me to watch a TEAM play rather than a 'superstar.' How much teamwork is happening in your office? Do you believe you have a team, or do you feel you are weighed down by prima donnas? Don't things seem much better when everyone is on the same page, working together? How much time as a leader do you invest in creating an environment that fosters TEAMWORK? In August, OPTIMIZING THE CEREC PRACTICE is being given at the Center by Imtiaz Manji and Sameer Puri, DDS. This is an excellent program to help you and your team become aligned to ensure practice success and high standards of patient care. What a great investment to instill the idea of TEAMWORK into your practice! Check it out. I'm sure you will find that TEAMWORK you learn can lead to a winning outcome for your practice!

Recalls

Jeffrey Caso (Faculty) — Tue, 15 Mar 2011 00:00:00 -0700

In dentistry the term "recall" has become passe, and the new politically correct term is ReCare. This post however is about a different type of recall. The recalls I am referring to are the several that have affected my cars. It amazes me that the enormous automobile industry and all of the MIT-trained engineers get things wrong on a regular basis. It's ok when they make mistakes; it's not ok when we do. Granted, we are working on people and their problems affect machines. But people drive those machines, so it truly does matter. Here's what gets me. Four recalls on three cars in three months. Two on my Chevy pickup - one kind of minor, the other potentially serious. It involved the potential for fire when the heated windshield washer fluid system was used. I know - why does a pickup have or need heated windshield washer fluid in the first place? The short answer is that it came with the truck and I never used it. That's my story and I am sticking with it. Anyway, when it was originally recalled six months prior, I went through the hassle of taking it to the dealer and they said it was fixed. So really this is a recall on a recall. This time they said they would disable the system and asked if I would like, as compensation, a gift card to Starbucks or a hundred dollar check. (I took the check in case you were wondering.) By the way, I paid $350 for the option under a year ago. So after I left the dealership, I got to thinking... I have a patient who just wasn't meant to have implants. His first one lasted four years and failed miserably. The surgeon and I redid everything for free and now three years later there is once again significant bone loss. So, here's my idea. Rather than redo this case a third time and end up with the same result, I am going to go out and get a gift card. I am thinking Amazon. I will give him a third of the cost of a redo and be done. Ok, hold on. That was a joke. No way would I do that to this poor guy! I will discuss a total change in the treatment plan and stick with him to the end. That's what we do. We treat, observe, troubleshoot and hopefully both patient and doctor live long enough to see their work fail. Helping the patient through these obstacles is what makes us caring professionals and not mechanics. Now, I am off to buy an ice scraper and I should have a lot of my hundred dollar check left over to buy something cool for my truck. Heated windshield washer fluid is for wimps!

Dentistry from Around the World

Sameer Puri (cerecdoctors.com co-founder) — Mon, 14 Mar 2011 00:00:00 -0700

So I was talking to my aunt in India the other day. I still remember how painful a process talking overseas used to be. Growing up in a small town in India, I remember the three-second delay that was present, which made having a normal conversation virtually impossible. But now, with advances in technology, my aunt sounded like she was sitting across town, not across the world. The conversation occurred because my uncle was getting a significant amount of dentistry done and he wanted my opinion on the case, specifically which material he should use. Now, I'm thinking to myself, who knows what kind of alloys or porcelain they are using in India these days as I haven't kept my subscription to 'Indian Porcelain Monthly' current. So I figured I'd advise him as best as I could. To my surprise, his material choices for his crowns were either PFM crowns or e.max. E.MAX?? In India? Right then and there I had to tip my hat to Ivoclar for two things. First, for making such a great material, and second, for an incredible job of marketing and getting the word out not only in the U.S., but all over the world. Without hesitation I recommended e.max for him. I'll post his photos when he is done and the next time I get to see him.

Extreme Practice

Peter Gardell (Faculty) — Fri, 11 Mar 2011 00:00:00 -0700

I was reflecting on the Mountain Dew Vertical Challenge, which takes place at the mountain where we ski, Killington, Vt. What these skiers and snowboarders do is unbelievable; they defy gravity, possess cat-like reflexes, and have a go-for-broke attitude. How many hours do these men and women spend perfecting their art? They don't nail the trick on the first attempt; they go through the tried and true process of practice, practice, practice. Or in the case of these diehard athletes, the process of crash, burn, repeat. They sacrifice their bodies for hours at a time, all for 30 seconds of prime-time. You really have to respect their dedication. It's amazing what can be accomplished when one has a goal, and the determination and vision it takes to attain it!

Guiding Principle

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 10 Mar 2011 00:00:00 -0700

It's amazing how simple words can make someone's day! My wife is a dentist as well, and essentially has a completely different practice, at the same location. She has been diligently working hard on social media projects for our office, including her InvisalignGal Facebook page. Fred Joyal, of 1-800-Dentist fame, did a drive-by post and paid her compliments on her efforts. She was giddy all day for the recognition from probably the most well-versed person in dentistry when it comes to marketing matters. Fred authored a book called "Everything is Marketing." And he means EVERYTHING! Take advantage of anything you do with CEREC. If patients have other indirect restorations in their mouths, make sure to point out that this experience is different than what they had done in the past. Have them hit start on the milling machine. Have them excited about their visit to the dental office so they can spread the word to their family, friends, and colleagues. Over the last 12 years, we have built our practice based on this simple principle.[fb.jpg]

More Latest and Greatest from Sirona

Sameer Puri (cerecdoctors.com co-founder) — Wed, 09 Mar 2011 00:00:00 -0700

Recent advances from Sirona are really changing the state of the market. Model milling is one exciting new feature. Obviously it won't be used by everyone - it's intended mostly for labs who want the occasional model to check their work. The initial models are good. Take a look at the attached photos of a recent set of models from the SLA process. Milled models are made from a large block of polyurethane. SLA models are made in a completely different process. As time has progressed, the quality of the SLA models has vastly improved. The milled models will also get better and better. Exciting times ahead! [model1.jpg] [model2.jpg]

Sirona Speakers Academy

Richard Rosenblatt (Faculty) — Tue, 08 Mar 2011 00:00:00 -0700

Some of the cerecdoctors.com docs and I recently attended three days at the Sirona Speakers Academy with Dr. Paul Homoly. I went in thinking that it was going to be a fun three days with some close friends enjoying lots of laughs and a few pearls mixed in to help me continue to improve my lecture technique. Well, I can say after attending, that this course will forever change how I organize and present material, not only in a public speaking format but also with my staff, patients, and in everyday conversation. There were so many great things about the course. The course size is small so there is a lot of individual attention. Paul breaks down his concepts into small steps so you can master a little at a time. Once he sees that everyone in the group has grasped what he has just taught, he builds on that with another concept. This is done until you are comfortable with all the new information, can put it all together, begin to improve, and show some consistency and improved results. These small steps reminded me of teaching CEREC and how most new CEREC doctors are certainly not comfortable when they walk into that room as they begin their journey. We need to teach them small steps until they feel comfortable and can move to the next step. I'm certainly not going to be perfect when I do my next lecture, but with building blocks from this course I know that every lecture I do will be better, more seamless and certainly more comfortable for me. I would recommend anyone who is looking to get into public speaking, or who is already doing some and would like to improve, to look into the Sirona Speakers Academy. If you're interested, visit http://www.cereconline.com/cerec/sirona-speakers-academy.html. It was a very good course and I'm going to be able to make doctors who would like to learn more about the technology much more comfortable when describing the journey. Thanks for a great three days!

Full Circle

Jeffrey Caso (Faculty) — Mon, 07 Mar 2011 00:00:00 -0700

Cleaning up cement may very well be the most stressful thing that I do. Someone needs to build a better mousetrap, but it just isn't happening. Sure, there are instruments of all kinds to address the problem, but do any really work well? They are mostly reactive instruments. Saws to open contacts after the contact is already bonded closed, scalers to pry rock like masses of material from subgingival crevasses and reciprocating handpieces to sand down the craggy remnants that just won't give up their grip. Most definitely the cements themselves have changed. They have extended gel stages and easier cleanup, but when I am struggling with the mesial contact the distal contact welds itself shut. It's great that the major manufacturers are giving it the old college try, but little real progress has been made. Using a separating agent, like BlueSep from Parkell, seems to work well, but get just a tiny bit of it on the intaglio of the restoration and it will turn you into an insomniac. Face it, do you really think you can go to bed at night and actually sleep while millions of bacteria are traveling on the superhighway you built for them under your restoration? If you were hoping that this paragraph was going to provide the answer to this conundrum, well sorry, I just don't have a perfect answer. I have, however, gone back to something that I hate to do; I have been packing the dreaded cord. It allows me to pull out gelled cement faster, and prevents it from getting subgingival in the first place. So, in addition to my extensive isolation and rigorous bonding protocol, I pack cord at some point in the procedure depending upon the situation. If I need it for imaging I pack two cords and pull one before powdering. If it's not necessary for imaging, I pack it sometime before cementation. Then at just the right moment, I pull it and it helps to clean out the interproximals very well. One more thing - something that I also have found helpful is just before cementation, I pop in an occlusal guard. No, not in the patient's mouth. In my own mouth. As I said, cleaning up cement is the most stressful part of my day. Limiting my clenching is really helping me out. I was just joking about the guard, but I wasn't joking about the cord. It does help. It's not the cure-all end-all; we are all still looking for that. But right now, it helps me a great deal.

Gold Fish

Darren Greenhalgh (Faculty) — Fri, 04 Mar 2011 00:00:00 -0700

A couple of weeks ago I helped my 11-year-old daughter clean out the aquarium. It is a bit labor intensive and requires several hands. The big worry - the aquarium is in my daughter's room - I would never get the fish smell out of the carpet if an accident were to happen! We worked together to siphon the dirty water into a couple of work buckets, scooped up Otis the large gold fish, put him into a different bowl, kept the other smaller fish Bruce in the aquarium, washed off all of the rocks and pebbles from the aquarium out in the front yard, exchanged the old water filter with a new one, and replaced everything - fresh lukewarm water, rocks, pebbles, and seaweed into the cleaned aquarium. I tell this story because I often think I can relate to those fish and what they go through - not knowing what is going on, feeling incredibly uncomfortable in your new surroundings, uncertain what the end results will eventually be. What I am referring to is: change. I don't necessarily like change; I am such a creature of habit - it is truly scary. I get up the same time every day. My morning routine is very similar every day. How many of us take the same roads to work day after day, year after year? I could take many roads home, but do I? No. In our offices it's nice to have consistency, but sometimes to our detriment. Just seeing how those fish act during this process of change is interesting. While in the bowl they seem agitated, nervous, and uneasy - little do they know that this is essential for their continued life. My suggestion: Change often! Try a different way to do things often. Change up your new patient exams, your financial policy, the décor in your office, how you approach presenting Tx plans - heaven forbid even your bur block! Some of the changes won't work, but I bet most of them will make a difference in one way or another to improve your office and especially how people value what you are giving them. Embrace change - it is vitally important. We certainly don't want to be the slow dying fish in the dirty aquarium of dentistry.

VITABLOCS RealLife

Sameer Puri (cerecdoctors.com co-founder) — Thu, 03 Mar 2011 00:00:00 -0700

Here's a quick clip on VITABLOCS RealLife machinable blocks - great for anteriors! Thanks to Mike Skramstad for his expert camera operation! [Sams_reallife_videoblog.mp4-v-]

Chicago Follow-up

Mark Fleming (Faculty & Magazine Editor) — Wed, 02 Mar 2011 00:00:00 -0700

It was an interesting time in Chicago. Wednesday night, Rich Rosenblatt, Doug Schulz and I got to see what the newest release from Sirona was going to be. Millable models and full contour zirconium crowns and bridges were some of the highlights. For the next three days on the meeting floor, I was involved with demos concerning digital impressions and CEREC Connect. It was both exciting and fun. And it got me to thinking...WHAT'S NEXT? What's next for you and your practice? Since I have been involved with CAD/CAM dentistry, there have been great advances, especially by Sirona. And I know for a fact that Sirona is not resting on its laurels. Sirona is constantly investing in R&D to make better products, to deliver better services. What about you and your practice? What are you doing to advance, to reinvent your practice? Are you moving ahead? Because if you are not, you are definitely falling behind! It may be time to take a hard look at your practice and what you can do to improve it. Many good ideas can be read in these blogs. What's next for you in these exciting times for dentistry? I hope it is about moving ahead and having fun!

Are You Part of the Digital Revolution?

Sameer Puri (cerecdoctors.com co-founder) — Tue, 01 Mar 2011 00:00:00 -0700

We CEREC geeks have been preaching the gospel of in-office milling for a while now. Nearly 11,000 dentists in the U.S. alone have a CEREC system that they use to mill restorations for their patients, providing one-visit dentistry. However, that leaves more than 100,000 dentists who for whatever reason have decided that in-office milling is not for them. How can it be that there is such a wide difference of opinion and more importantly, what does this bode for the future of CEREC? Will it be just a select few who slowly over time decide to integrate CEREC and its benefits, or will it at some point be adopted by the masses? If you look at other industries and other technologies, the CEREC pattern is following a very predictable and typical pattern for technology adoption. Most technologies have a phase of early adoption where tech geeks and those more interested in the application than the actual benefits of the technology are the ones who purchase first. You all know them - they had that Commodore 64 computer way back when and were using that computer for basic games and applications. Forget the fact that my current iPhone has the computing power of about 10,000 of these bulky computers and can do a whole lot more. It's also the reason that everyone including my mother now has an iPhone to use. There comes a critical mass where enough of the early adopters adopt and the item in question goes from geek status to chic status. A must have, can't live without; something that is just expected to be owned by everyone. Do you know anyone that doesn't have their own cell phone, let alone a smartphone which can text, e-mail, and surf the Internet? Are we past the phase of early adoption with CEREC? It certainly seems so. While the sales numbers have not yet shown that we are well past the early adoption phase, the talk at local conventions, trade shows, and study clubs sure seems that way. What used to be a conversation about CEREC that included terms like 'poor margins' and 'poor esthetics' is now devoid of all the negatives. Now the conversations evolve around whether it will fit into a certain practice, not if it can create proper margins. So if CEREC follows the path of most other technologies, we should expect to see a surge in sales, as I no doubt believe we will. But there will always be the laggard. You know the guy who still thinks that the Internet is overrated and actually prefers to read the newspaper instead of going to news.google.com to get the news. Same applies with CEREC - 100 percent of dentists will never fully embrace CAD/CAM. To them, it's just not necessary. They are doing fine just as they are. Regardless, CAD/CAM for me - specifically CEREC - has obviously been an integral part of my life, and it has transformed my practice. The same applies for all the early adopters and soon to be the majority of dentists. Trade show season is upon us, so expect to see some great new things that will help bring CEREC further into the mainstream.

The Best Big Meeting Has Passed, Now onto the Best Small Meeting!

Richard Rosenblatt (Faculty) — Mon, 28 Feb 2011 00:00:00 -0700

I just returned home from the Chicago Midwinter Meeting. If you have never been to a big meeting, or have never been to the Chicago Midwinter Meeting, don't let the weather scare you. It never fails to disappoint! Spent four days with some of my best friends in dentistry, and in life, for that matter. Once Midwinter is over, my focus shifts to my favorite small meeting...The Townie Meeting. If you don't like big meetings or winter weather, then this is the meeting for you! I will be attending my seventh consecutive Townie Meeting this year. It is a can't-miss on my schedule. You get to hear some of the best speakers in a small venue setting. There is great food, great camaraderie and fantastic CE. Plus...it's Vegas, baby!! They have amazing keynote speakers and fantastic smaller breakout sessions in all aspects of dentistry. The Townie Meeting is not your normal meeting. This is like a get-together with 1,200 of your best friends to enjoy top-notch education during the day and some of the most fun parties at night. Plus you can come in early for some special programs or a golf outing. There is also a private Texas Holdem tournament that has become one of the most popular parts of the weekend. I certainly hope to see lots of my cerecdoctors friends at this fantastic meeting. Check out the details at towniemeeting.com.

Important Memo from the Department of Redundancy Department

Jeffrey Caso (Faculty) — Fri, 25 Feb 2011 00:00:00 -0700

Redundancy is critical to the success of any small business. We need to take steps to stay operational at all times. As our offices become more technologically advanced, this principle becomes more of a challenge. Now, realistically, are you going to purchase an entire second CEREC system to put in the corner and have at the ready should your primary system fail? Of course not, but we can certainly make a good attempt at obtaining and maintaining redundant systems in other areas. There was a time, not that long ago when a dentist practiced with one, maybe two high-speed drills and an extra belt to drive his slow speed and that was about it. Prior to autoclaving drills, they lasted almost forever. Now as we all know, we need so many high speeds and even a stock of extra turbines in case of failure. Slow speeds are more reliable, but you still need a large supply to keep several rooms running while having a few more in the autoclave. Add to that extra curing lights, ultrasonic scalers, triturators and so many other supplies, it becomes mind boggling. My AED was recently recalled, and the manufacturer asked us to send it back for repair. What?! I can't be without it. But then again, I practiced for so long without one, so what's the big deal? Well the big deal is I got comfortable knowing it was there. So I arranged to send it back while we are on vacation. A few months ago, I began to worry about my compressor. What if it went out in the middle of a big CEREC case or during a tough extraction? I bought a smaller auxiliary and plumbed it into the line so the flip of a switch and turn of a valve will get me going again. A few years ago my suction pump went, and while waiting for the new one to be delivered I bought a portable unit that will get me by in a pinch. I have one last contingency plan that I will share with you. In the event of a power failure, I do not have and do not want a generator. They are costly, not easily maintained, and must be pretty massive to keep a compressor running. So, I figured a worst case scenario: six teeth prepped for veneers and no power. No problem - I switch to my battery operated headlamp with a composite filter, grab my cordless curing light and get to it making temps. I refine them out of the mouth with a cordless lab handpiece and send the patient home. Now that's not ideal but it would get the job done. I make every effort to think things through and keep my office open and running, but let's face it, with a big dental supply company like Patterson, I can get almost anything I need by the next day. I no longer keep much of an inventory of disposables or even composites, cements or bonding agents. I do keep a lot of local anesthetic around because of the rare but occasional shortages we experience in my area. So, think through your worst case scenario and arm yourself with what you need to get through it. Don't let it make you crazy enough that you have an extra milling unit sitting around; just assign an employee to keep up with the required maintenance. Just like the old adage goes - hope for the best and prepare for the worst.

The Time Machine

Peter Gardell (Faculty) — Thu, 24 Feb 2011 00:00:00 -0700

I don't care what Mick Jagger says, sometimes time is not on your side. No matter how hard I try I can only squeeze 24 hours out of a day. The stress can quickly increase, so what can one do? One answer is rewarding your best employee with some extra hours, allowing them to pick up the slack and taking some of the stress off your shoulders So I gave my best employee the new job of composite fabrication. The great thing was the employee did the task without complaining or uttering a single word. The employee helped me to more efficiently run my day, and fabricate some great restorations that I didn't have to stack by hand. Also allowed me to get emergencies in, so in effect gave me more hours in the day. Great emergence, great contacts and spot-on occlusion, all done in a fast and efficient manner. I knew that CEREC could perform this work easily and have used it sometimes in the past, but it took a swift kick in the rear end to force me to look at the options and opportunities available. I think I have to give this employee a raise.

Chicago Continued

Mark Fleming (Faculty & Magazine Editor) — Wed, 23 Feb 2011 00:00:00 -0700

Like Sam and Mike have mentioned, it's Chicago Midwinter week. Looking forward to one of my favorite cities. However, this transplanted Florida boy is NOT looking forward to the cold! But hey, I get to meet up with some of my best friends at a GREAT meeting. And once again, I have the opportunity to work with a great group of people at Sirona. Rich and I, along with Doug Schulz, will be at the Sirona booth showing off the latest and greatest. Last year was the Biogeneric crown, this year... Well, you will have to stop by, say hello and see for yourself! Look forward to seeing many of you there!

Spring Fever

Mike Skramstad (Faculty) — Tue, 22 Feb 2011 00:00:00 -0700

Living in the great white north of Minnesota, it's natural to get a bit of spring fever this time of year. Last week, much of the snow was melting, the ice dams on my roof were gone - I could even see pavement on the driveway for the first time in three months! So, naturally dreams of getting out the shorts, spring cleaning, and washing the golf clubs came to the forefront of my mind. However, like most winters, a late storm came along to crush all the hopes and dreams of spring. The depression that is Minnesota in the winter again reared its ugly head with a dumping of 18 inches of snow yesterday and today. When will it end? When will I be able to stop popping Advil like candy for my sore back from shoveling? Winter is definitely getting old! One nice thing about this week, however, is the Chicago Midwinter meeting. It's truly the best meeting of the year to see the new innovations and products debuting for the upcoming year. Looking forward to seeing many friends and enjoying all that Chicago has to offer for a few days. At least it will take my mind off of the six-foot snow drifts on each side of my driveway. I'm sure it will all melt away again soon ... just in time for the routine early April blizzard! I don't know if that furry little rodent saw his shadow or not on Feb. 2 ... but I certainly did!

Chicago Midwinter

Sameer Puri (cerecdoctors.com co-founder) — Mon, 21 Feb 2011 00:00:00 -0700

As you may know, the Chicago Midwinter meeting is when Sirona typically shows what they have been up to all summer and winter with new software and hardware updates. I'm hoping that this year is no exception, and that we get to share with you all the things that are coming in CEREC in 2011. If you will be attending the meeting, please stop by the Sirona booth and say hello. I've been asked to help out at the booth and answer questions for new and potential owners alike. It's usually a great time, and I'm looking forward to another fun meeting in Chicago!

Driving the Bus

Jeffrey Caso (Faculty) — Fri, 18 Feb 2011 00:00:00 -0700

There was a recent thread on CERECDOCTORS.COM that really hit home with me. I am all about patients taking responsibility for their own situations. When a patient starts looking to put blame for their condition on someone else, that really bothers me and sends up a red flag. Some comments that we all have heard are: - My past dentist drilled too much and that why my teeth are breaking, - My mother never made me drink milk as a child, - My wife buys the cheapest toothpaste she can find, - I never received a recall card from you and that's why I am two years overdue for a checkup, - And a slew of others. I want to say "Come on, you're an adult; don't blame anyone for your problems but yourself." These are patients who must be educated by you. Not your team - you. They need to be responsible for their own problems before you begin treatment. If they do not have this epiphany, the first issue that arises during treatment is your fault and no one else's. I move slowly with these patients and document my discussions very well. My ultimate goal is to have a patient understand that I am there to help them and my main goal is just that. To that end, I am a big fan of co-diagnosis. I use a two-pronged approach to achieve this goal. I print out a good digital photo and show it to them right away. I draw and make notes directly on this photo as I explain what happened, what needs to be done and how we can achieve it. I know I have done a good job when the patient begins to finish my sentences. We have arrived at the same conclusions, at the same time in an 'A-HA' type of moment. We have co-diagnosed. I then start a conversation on how to prevent this problem in other areas and what THEY need to do to make that happen. This photo becomes a part of their patient record and is dated and noted that this was part of a discussion regarding pending treatment. It doesn't end there, though. I make the patient a part of some of the treatment decisions as we move through the case. Nothing technical, just input on how they would like this area designed, usually while adjusting the proposal on the CEREC screen. Also, when staining a crown, I give them a mirror and ask questions along the way so they have input. This makes them proud of the result, as they have had a role in the fabrication. In essence, at various times during the treatment process, I let them "Drive the Bus." Through these techniques, we can make the patient understand that their problems are indeed THEIR problems, that they can help in the diagnosis and therefore understand the etiology and prevention, and have a role in the final say of how their restoration is designed and how it will look. By making them a part of the process you will make them happier, because who isn't happy Driving the Bus?

A Tip for Those Stubborn Contacts After Cementation

Richard Rosenblatt (Faculty) — Thu, 17 Feb 2011 00:00:00 -0700

This situation has happened to me from time to time, and maybe some of you can relate. We place the cement in our restoration and light-cure it. Then we try to get the floss through and no dice! I would just tell the patient to come back in a few days and after eating on it a bit, the contact would open up for floss to fit through. Well, I have used a few tools and tricks over the years to help open those stubborn contacts, both during cementation and direct bonding procedures, and I have fallen in love with the Axis Dental QwickStrips. They come in single- or dual-sided abrasives so you can smooth out contacts. They also have one with a serrated edge to get through bonded contacts. These work very nicely for those of you who do ortho/Invisalign and need to do some interproximal stripping of enamel. QwikStrips come in coarse, medium, fine and superfine, and are color-coated. They are very easy to handle anywhere in the mouth. I'm a big fan of these and would highly recommend them if you ever run into those stubborn contacts![qwikstripdemo.jpg][qwikstripassorted.png]

Expectations

Mark Fleming (Faculty & Magazine Editor) — Wed, 16 Feb 2011 00:00:00 -0700

You've waited all football season. Your team squeezes into the playoffs. A rough road is laid before them, but your team perseveres through it all and makes it to the BIG GAME, the SUPER BOWL! You have good luck in the ticket lottery and score a couple of tickets. You arrange to be off work, battle airline weather delays and cancellations, and make it to Dallas. You put up with the weather for a couple of days. You're going to the SUPER BOWL!!! You arrive at the stadium and find ... YOU HAVE NOOOOOOOOO SEATS. There is a problem, a problem that was known beforehand but no one bothered to tell you. You end up watching the game, THE GAME, at a local bar. Unmet expectations. When we deal with our patients, when are they most upset? When their expectations are not met. Make sure, as much as you can, that people realize what their conditions are, what it will take to correct them, and how much it will cost. Be sure that they understand these points, and confirm that you understand what their expectations are. And if ANYTHING changes that will affect their expectations, let them know ASAP! Unmet expectations are trouble. Try to keep them at a minimum and your practice, and life, will run much smoother.

The Zen of Skiing

Peter Gardell (Faculty) — Tue, 15 Feb 2011 00:00:00 -0700

On a beautiful day out of the office, I realized that skiing is actually a lot like practicing dentistry. The more we learn, the better we get. Watch the video, and you'll see what I mean.[TreeBlogCamptasia.mp4-v-]

No Greater Love

Sameer Puri (cerecdoctors.com co-founder) — Mon, 14 Feb 2011 00:00:00 -0700

It's so fun to watch my daughters grow up. What once were a couple of little girls playing with their dolls and tea sets are now turning into little women. At 9 and 11 years old, both have very distinct personalities. While one is the scholar, the other is turning into quite the athlete. It's been absolutely incredible to see their personalities develop. I wonder how they will be in another 10 years. Will the older one still enjoy reading her books? She read the entire Harry Potter series in two weeks. Will the younger one still be the tomboy athlete? She is playing on the fourth grade boys' soccer team. Regardless of how they turn out, it's been amazing to see them grow up and continue to develop their personalities. Older colleagues continuously tell me to be careful and not blink otherwise the girls will be grown up and gone before I know it. My hectic travel schedule lecturing and teaching definitely takes a toll as I miss parties and events at school. Starting this summer, I hope to be making some changes in my life and schedule that will allow me to travel less and stay at home with the family. The past few years have been an amazing ride as I've had the opportunity to lecture in virtually every state in the union. A young dentist couldn't ask for more - that is other than staying at home and helping the girls with their nightly homework!

Planes, No Trains and Automobiles

Richard Rosenblatt (Faculty) — Fri, 11 Feb 2011 00:00:00 -0700

Well you saw my video blog of the blizzard in Chicago. That was a crazy experience for sure. Well that was just the beginning for me. About two hours after that video, it had stopped snowing and I was beginning my excavation of those massive drifts of snow. While in the middle of shoveling, my phone buzzed. It was an e-mail from American Airlines telling me that my flight to Atlanta the following morning was cancelled and pushed back to Friday. I was supposed to be in Atlanta to do a lecture on Thursday night and Friday. I was between a rock and a hard place. I called Amtrak, but they were sold out. Obviously everyone had the same idea. O'Hare Airport was closed until Friday, so no chance to change airlines. My grandfather told me at a young age that your word is your bond. I told the guys in Atlanta that I'd be there, so I had to try to get there. I called a buddy in St. Louis to see what the weather was like. He said they didn't get anywhere near as much snow, the roads were pretty good and the airport was open. I called the airline to see if I could get a flight out to Atlanta. They got me on a 6:00 a.m. flight through Dallas to Atlanta. I jumped into my car at 2:00 p.m. and drove six hours to St Louis. There was black ice all the way down there, but I made it. I got to Dallas where it was two degrees and there was ice all over. But I made it to Atlanta! Unfortunately, the weather followed me. It was sleeting the evening of my first lecture. Between the weather and the ridiculous traffic in Atlanta, not many showed up. Those who did attend chuckled when I told them my weather story. The next morning I had a lecture with a great lab, Pittman Dental Lab in Gainesville, Ga. It was pouring that morning also. I just couldn't shake the bad weather. I was able to get to the airport and get on an early flight back. Of course, to rub it in my face, American made me fly through Chicago (so I could wave at my house) to get to St. Louis so I could pick up my car and drive it back home the next day. I thought that would be the end of the turmoil until I was awakened at 4:00 a.m. by the grating sound of snow plows. That's right ... I woke up to about six inches of snow on the ground and had to drive back to Chicago in another snow storm. Now I know what John Candy felt like in Planes, Trains and Automobiles!

Groundhog Day

Jeffrey Caso (Faculty) — Thu, 10 Feb 2011 00:00:00 -0700

Do we really care if the groundhog saw his shadow? No, not really. It's a nice idea to give us a ray of hope that spring is right around the corner. In our hearts, however, while in the middle of this brutal winter here in the northeast, it's hard to imagine life without snow. The biggest problem is getting around town and then actually finding a place to park. Parking spaces are down in numbers because enormous piles of snow take up the best spots available. It really looks like it's going to take a long time for all of it to melt. It's time to get creative to keep our schedules full. My practice has a large population of elderly patients and we just have not seen a lot of them in a while. I cannot blame them. One bad fall and life can change drastically for them. Hunkering down and staying home is probably the right thing for them. I have made a great effort to keep the office parking open and easy for patients to navigate, as well as keep the walkways clear of snow and ice. That's really just a basic common courtesy that we as business owners make sure that we give our patients. There are, however, other things that we can do. My office has what we call 'the sweet spot.' It's the best parking spot that we have - closest to the door and is easy in, easy out. It's the one that I would give the employee of the month if I actually chose an employee of the month. If I did do that then hey, I wouldn't be able get it for myself. Well, that's something that I offer up for my elderly or disabled patients (we do not have handicapped parking in my area). I tell them to call the office when they are on their way and we run out and move the car occupying "the sweet spot." It makes them feel special and keeps them coming in in adverse conditions. We have even been known to meet some patients at their car to help them in. That means so much to a patient, and I have gotten thank you calls from family members who appreciate the extra care. It also doesn't hurt if a passerby sees you helping a patient, as it speaks volumes to the service you are offering. Another little thing is calling in prescriptions instead of writing them out. It allows the patient to stop at the pharmacy once to pick up their medication. This saves time and helps out in poor weather. Adverse times require creativity to keep things going. My son loves to ride his skateboard every day after school and has a great time doing so. With all of the snow he has been unable to and is really missing it. Yesterday I saw him running past the office with his skateboard in his hand. I was wondering where he was going to skate when I realized that had taken the wheels off and turned it into what he calls a snowskate. Pretty cool way to adapt. We need to do the same.

It's All About Context

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 09 Feb 2011 00:00:00 -0700

I really like this recent blog from Imtiaz. http://www.speareducation.com/2011/02/a-classical-exercise-in-perception/ As you may know, Imtiaz Manji has consulted with thousands of dental offices throughout the years, and most of us are disciples of his teachings. This particular concept really struck a chord with me today. It features one of the world's foremost violinists playing a $3.5 million violin in a Washington, D.C. Metro station. Most people walked by, not paying any attention to him, whereas just the day before, people paid $100 a ticket to see him perform the same music at a symphony hall. I have always thought about how our appearance and office setting influences the decisions people make with regards to their health care. There is no doubt in my mind that we have to create the right environment and setting for people to have the confidence in us to perform their desired care. In our next huddle tomorrow morning, I am going to play this for my staff and I am going to have them write down five things they can all do to enhance our patients' experiences at our office. I don't want our patients to even consider going elsewhere once they find comfort in the context of our practice.

Dennis Kucinich

Sameer Puri (cerecdoctors.com co-founder) — Mon, 07 Feb 2011 00:00:00 -0700

Did you hear? Dennis Kucinich, a politician from the great state of Ohio, is suing the House cafeteria for $150,000 because he bit down on an olive pit and broke a tooth. Now it seems to me that I need to raise my fees - I only charge $250 for an extraction. His dentist must be charging a lot more to be able to get that kind of settlement. All kidding aside, the sheer audacity of this supposed leader, and I use that term loosely, is appalling. What kind of a precedent does this set for the people of this country? That if you have an accident - yes, it was an accident that broke his tooth - someone should be accountable? Whatever happened to dumb luck? Sometimes things just go bad and there is no one to blame; sometimes life is not perfect. It's bad enough that our elected politicians have spent us into oblivion. It's bad enough that people are looking more and more for handouts and for bailouts instead of trying to work hard on their own to provide for themselves and their families. Now we have to deal with frivolous lawsuits like this. In the end, who pays? You and I in the form of higher taxes and higher insurance premiums. Political affiliations aside, these types of lawsuits are just bad for us all.

Chairside Assistants

Peter Gardell (Faculty) — Fri, 04 Feb 2011 08:30:15 -0700

The chairside assistant has the potential to be the strongest advocate and the most beneficial team member for the CEREC process in one's office. Just as the hygienist has credibility with the patient, so does the chairside assistant. They can connect with patients on their level. They aren't the dentist, so sometimes they get the questions that patients really want to ask. You would be surprised what can go on while you are out of the room. Patients are impressed with CEREC technology and they will have questions, which is understandable, about new procedures they are about to experience. The patients may feel the doctor's answer would be biased, while the assistant's response would be impartial. The chairside assistants are not practice owners, so the patient doesn't think there is any financial incentive for them to "push" a procedure. The efficiency of the CEREC visit strongly depends on the assistant being motivated, having the ability to grasp the technology, and staying a step ahead of the doctor. There are many steps in the CEREC process; if the doctor has to wait at each step for the assistant, then efficiency goes down the tubes. A comfortable 90-minute visit can balloon into two hours very easily. A motivated assistant can also take over some of the workload of the CEREC visit if you take the time to ensure they have proper training. Assistants can design proposals, which frees up the doctor's time. Most assistants also enjoy stain and glaze, and can become quite good at it. If you empower the assistant to do these parts of the process, the CEREC visit takes no more doctor time than a traditional crown and bridge visit. Production can go through the roof, and doctors will feel less stressed. The investment of taking them to a class with you or sending them to an assistant-specific course can reap many rewards. Take the time to evaluate your chairside assistants: Are they motivated and efficient? Have you give them resources for success? Having the right person chairside can make a big difference in your practice.

Referrals

Mark Fleming (Faculty & Magazine Editor) — Thu, 03 Feb 2011 07:34:03 -0700

There are certain dental procedures I do not enjoy doing. Because of that, I refer these procedures to specialists in my area. My expectation of these specialists is simple: Treat my patients the same as I would treat them at my office. Make their visits as comfortable as possible, see them on time, communicate clearly, etc. I first convey these expectations to the specialists. I do not want to assume they know what I want. I also check with the patients after their treatment with the specialists. Once again, I don't want to assume that the specialists have met my or my patients' expectations. What about you? Do your specialists know what you want or are you just assuming? You may want to check it out!

Chicago's Winter Weather

Richard Rosenblatt (Faculty) — Wed, 02 Feb 2011 10:04:25 -0700

Looks like I'm working from home today! Here's my view of Chicago.[video_blog_weather.mp4-v-]

Windows 7, 64-bit

Armen Mirzayan (cerecdoctors.com co-founder) — Tue, 01 Feb 2011 20:45:48 -0700

Just ordered a new PC with SSD hard drive for the OS and 24 gigs of RAM so I can play with the CEREC software. Can't wait to see how fast it cranks. I might just image with my machine and design on desktop. Here are the basics as I understand them: 32-bit processors could only utilize up to four gigs of RAM, where 64 can access much more. Trouble is a lot of software out there needs to do some serious catching up. Can't wait to test this guy out!

cerecdoctors.com Videos Now Mobile Compatible

Sameer Puri (cerecdoctors.com co-founder) — Tue, 01 Feb 2011 05:39:13 -0700

The videos on www.cerecdoctors.com are now mobile-compatible. All you iPad lovers can finally find a use for this ridiculous piece of electronics that we all got suckered into buying by Steve Jobs. I have an iPad. I got it on launch day as a 'gift' for my daughter. For some reason, it ended up in my office 'cause she never used it. Think about it- can't do any real work, no flash so half the websites out there are useless but it does do a nice job as a book - and to lay in bed and surf and check e-mail. That's about it. Regardless of all the limitations, the tablet is here to stay so we had to accommodate on the website as well. The videos are now iPad compatible and you should be able to watch them on your favorite mobile device. Enjoy.

Efficiency!!!!!!

Armen Mirzayan (cerecdoctors.com co-founder) — Mon, 31 Jan 2011 14:54:25 -0700

To make a long story short, we had to leave our old location for a new one. The day after the fun event at CEREC 25 I walk into the news that my old landlord was going to renovate the mall for two years for $45 million. We had to find a place, sign a lease, and build out by New Year's Day. That gave us a total of four months. I've seen lease negotiations alone take longer than that. Anyway, the most impressive part in all this was our contractor. DonRay Company from California and (New Mexico) build this place in five weeks. I am stunned with what they pulled off for us and kept us in business. And it was not around the clock type of work; it was simply orchestrated in a manner that maximized efficiency and time. Multiple trades people were present at their designated and allotted times. Not a second was wasted. Their reputation preceded them. They were referred to me through Patterson and more importantly through over a dozen colleagues who had work done by them. I completely appreciate how far that reputation has taken them and signed them without hesitation. I think concentrating on our practices and delivering services with these concepts in mind can really distinguish our practices and attract patients who seek that kind of service and quality. I just read a post in our discussion forum from Dr. Gregory Mark about how he treated an elderly woman with Parkinson's in a single visit. You can just feel how proud he was of his accomplishment. I can certainly feel how relieved her family was that they did not have a return visit. How awesome is it that we can practice in a time like this with the advancements we have in our profession!!!!

Barrel Racing

Jeffrey Caso (Faculty) — Mon, 31 Jan 2011 06:12:24 -0700

There are two distinct types of sports - team sports and individual sports. Growing up I played many years of lacrosse, obviously a team sport, and loved every minute of the game and the camaraderie. My 13-year-old son has chosen a different path and has been involved in the individual sport of barrel racing for many years. Barrel racing is a fantastic sport to participate in and watch. For those of you who are not familiar with barrel racing, it involves riding a horse around barrels set up in a particular pattern. The rider is timed as well as judged on technique. It is every bit as stressful as playing lacrosse or soccer or running in a track meet. The real difference between barrel racing and most other individual sports is that the horse can make or break the day. The rider needs to develop a relationship with the horse which can take quite some time. The horse needs to respect the rider and conversely the rider needs to show a respect for the horse and this mutual relationship will be good for both parties. The rider cannot be abusive to the horse or he will respond with lethargy. So it's a fine line that requires time and experience on the part of the rider to develop. Once the proper relationship takes hold the rider works hard to motivate the horse and the horse responds with speed and eloquence. Some horses, however, try too hard and they develop a poor trait called being barrel-headed. A horse with barrel head tries so hard to make his rider happy that he is fast but sloppy and can knock over barrels or worse buck his rider. The horse means well but becomes ineffective and cannot be barrel raced. In dentistry there are many different types of practices. Group or team practices can work very well and have their definite perks like coverage for time off or shared expenses in buying into new technologies. The individual or solo practitioner has a burden which can take its toll. Limited time off, always being on call and carrying the full load financially. One way is not right or wrong; it's what works for you. I am a solo practitioner and love it. I think that is where my son got his aspiration toward an individual sport like barrel racing. Just as the horse can make or break the rider's day, your staff has this same ability. I am constantly learning from my son's experiences, and try hard to motivate those around me while avoiding over-exuberance or the dreaded barrel head. Look around for inspiration and to gain knowledge about how to position your practice and how to advance it. Advancement can be for profit, but it also can be to evolve your practice into a smooth-running organization based upon the mutual respect of you and your employees. That way it will be a place you look forward to going each day. Work with your staff to develop that much-needed respect. Their job is a hard one that requires a balance between many different things. Respect from both sides leads to better, more efficient working conditions. It's hard and takes time but it is worth it and leads to a more profitable practice. Don't be surprised if you look hard enough that some of your best ideas and inspirations come from the experiences of a 13-year-old.

CE for Me!

Richard Rosenblatt (Faculty) — Sat, 29 Jan 2011 17:15:40 -0700

Looking forward to some CE for me this year! I have to say that the last few years seem to have been a blur. I've been so caught up the whirlwind of cerecdoctors.com and training classes that I haven't been doing as much of the other CE that I typically do annually. Being a general dentist, I did have a bit of a slowdown in my practice this year, so I have decided that 2011 will be more CE-focused for me. I have a few courses coming up over the next eight months that I will be blogging about. First, I've just finished the Sirona Speakers Academy, a fantastic three-day course on speaking with Dr. Paul Homoly. I'll tell you all about it in my next post. The next course I'm targeting is six-month smiles. I'm not necessarily into doing ortho, but I do some Invisalign. I'd like a little more control at times and I think offering this to patients could be a great benefit to them and to me. I'm continuing to add to my offerings so that my patients do not have to go elsewhere for some of the more simple things. I have heard really nice things about the course from friends and peers, and will likely be taking it at the townie meeting in May. The last thing that I will be doing is almost embarrassing to admit here. By that I mean I'm not embarrassed to admit I'm taking the course, but rather that it's taken me so long to sign up for it! This August, I will be taking Facially Generated Treatment Planning with Dr. Frank Spear at Scottsdale Center for Dentistry. I'm most excited about this course because of all the amazing feedback I've heard from people I respect tremendously in our field. I'll be giving my opinions on these as 2011 unfolds, but I can say one thing right now: I'm very excited for the things I have planned for this upcoming year!

Meetings

Mark Fleming (Faculty & Magazine Editor) — Thu, 27 Jan 2011 05:16:34 -0700

How often are you setting apart time for office meetings? I know, I know...you'd rather check hygiene every 15 minutes than have an office meeting! But think about what you may be missing. Personally, I have attempted to hire people who are smarter than I am in areas that I am weak in. I want to take advantage of their gifts and talents to help the practice be successful. An office meeting is a great time to get their feedback on what they believe is going on in the office and how the office can be better. Pretty important stuff! I talked about change in a previous blog. If you are not holding regular meetings, maybe it's time to change that. It can make a positive impact on your practice and show your team how much you value their opinion. Give it a try!

It Starts with You

Peter Gardell (Faculty) — Wed, 26 Jan 2011 04:36:14 -0700

Before you run through and pick apart all the other positions on your dental team, make sure that you look at yourself in the mirror. Can you deliver the product that your patients deserve in a predictable, efficient manner? Are you a partial coverage specialist? Are you a premolar specialist? Do you find yourself doing a CEREC differently every single time? In the middle of the process do you say, "OK, that's done. What do I do next?" Systems lead to efficiency; you don't have to reinvent the wheel. Peers and mentors on the site have gone through all the steps thousands of times; take the time to read through the threads to see what has worked and what hasn't. If it hasn't worked for the different people on the boards, I would come up with the hypothesis that it won't work for you. Watch the videos to see how the faculty members approach situations; many times they will come up with different approaches, so try them and see what works in your hands. Make the commitment to get yourself to some more advanced courses. There is no greater return on your CEREC investment than taking a course. Push yourself to expand your boundaries. It makes dentistry more fun and it makes you a better dentist. Look to technology to make your office more efficient. One of the most powerful tools to get patients to say yes to implant treatment is doing a case presentation with a cone beam scan with the CEREC proposal integrated. It's easy for them to grasp, and they understand what you are talking about. When they realize that they have a problem and can comprehend the solution, you get a committed patient. For those of you who place implants, learn the advantages of the guided surgery that is possible. Precision and efficiency go through the roof and stress drops significantly. You are the leader of the team; if your team sees you motivated and proactive, they will follow your lead. Bring in the tools that can help your team and yourself to be efficient. You will be amazed at the results.

Comfort Zone

Mike Skramstad (Faculty) — Tue, 25 Jan 2011 05:49:51 -0700

Everyone has their comfort zones and it's very difficult to do something different. You get in patterns in everything that you do and when change is presented, you have to let go and know that leaving your comfort zones can often improve both your profession and personal life. A couple weeks ago, I attended the Sirona Speaker Academy with other cerecdoctors.com faculty. Many of us were experienced speakers and thought that our style was effective. We were comfortable and had been doing it for quite some time. The first thing Dr. Paul Homoly did was put us outside our comfort zone. He made us try things that had us stuttering and confused during our presentations. It was extremely difficult for all of us. However, we pushed on and by the end of the Academy, we all were improved. It actually was quite amazing to see the transformations with all who were involved - even the most accomplished speakers were markedly improved. Moving outside our comfort zone is something that we all do when working with technology. For most of us, it started with 'buying in' to the idea of CAD/CAM and digital impressioning. What I encourage all of you to do is find that next step that can bring you outside of your current comfort zone. Maybe it's taking the next advanced training class to learn how to do posterior quadrants of anterior cases, maybe it's fabricating your own implant restorations or abutments, or maybe it's GALILEOS and learning how to place implants. Whatever it is, find out what your next step is along your journey. It will be difficult at first, but the long-term rewards will be worth it.

Cathy Cruz Marrero

Sameer Puri (cerecdoctors.com co-founder) — Mon, 24 Jan 2011 05:55:39 -0700

Have you seen the video? Cathy Cruz Marrero became an overnight Internet sensation when a mall security camera caught her walk into a fountain as she was texting. Plop - she fell right into the fountain. Pretty funny, right? It gets better. She is now suing the mall because her video was posted. Now if you do a search for 'falls in fountain while texting' on YouTube, you can see the video. What you don't see is her face, nor do you have any idea who this person is. That is until she did an interview on national television complaining that the mall put the fountain in the middle. Even funnier - her attorney said that they plan on holding all those responsible accountable for their actions. Hello? Is anyone there? Are you planning on holding Cathy responsible for not paying attention? Really? Is this what this world has come to? Next thing you know, some lady will sue McDonald's 'cause the coffee is too hot.

Support

Mark Fleming (Faculty & Magazine Editor) — Fri, 21 Jan 2011 12:19:10 -0700

Change can be difficult. A lot of times, we fight change. We are comfortable in what we are doing and want to keep doing what we have always done. The problem is, you can never grow without change, you can never get better without change, you can never move forward. Actually, you can say that change is a constant! I just spent some time with some others honing our speaking skills. It was tough at times, and it required me to make some changes. Even though I was uncomfortable, I believe I became better. I'm happy I went through it. What helped was the support I received from the other participants. Almost all of them are faculty from cerecdoctors.com. When things got tough, they were there to help push me along. It was great to have them there to help. It's like this website. We want you better in using the CEREC technology. We're here to support you through all the changes you have to grow through to do that! I'm proud to be a small part of that support. And who knows, you may have the opportunity to help support others to do the same. Be a supporter - pass it on!

Yellow Perch

Jeffrey Caso (Faculty) — Thu, 20 Jan 2011 06:36:52 -0700

It's truly an amazing story. The Yellow Perch fishery in the Northern Chesapeake Bay was decimated for the last decade and a half and many people, including myself only ever saw pictures of them in books to prove that they ever existed in the first place. Over-fishing by commercial fisherman led these fish into a decline, reducing their stocks so significantly that they were basically on the verge of extinction. Once the damage was done, the commercial fishing industry turned their sights elsewhere and left the Yellow Perch alone. These are a very slow-growing fish, living just over a decade and spawning later in their life cycle. In addition they never move very far from where they are born. This combination made a chance for a natural comeback very unlikely. So both the commercial and recreational fishermen wrote them off as a sad story. In doing so, nature was behind the scenes working its wonders unencumbered by pressure from humans. Fast forward two decades and a wondrous event unfolded. A huge natural population of Yellow Perch began to appear, and appear is exactly what happened. Some people out for a winter's stroll along the banks of the Susquehanna River at the head of the Chesapeake Bay in Maryland could actually see them in the water in huge numbers. Some have said that the schools are half a mile wide and several miles long. That's some comeback! Known in the past as Maryland's first fish because they were the first fish to show up each year, they now are a part of my New Year's day ritual. Standing on the docks in freezing cold weather and chipping ice from the eyes of my fishing pole is just an awesome way to ring in the New Year. Catching and releasing all but a few fish to take home and cook should keep the population strong. The Department of Natural Resources has stepped up and banned commercial fishing so far. I hope they never are fished commercially. The story however doesn't end here, though. Most local bait shops, struggling in this economy would close for the winter months, laying off their employees and suffering from the lack of fishing available. Well, enter a new fishery and these bait shops are now doing a booming winter business. I personally make it a point to go and spend some money in their shops to do my part to help them out. Over the years they have become friends and they are a great place to hang out and talk fishing. They wisely saw an opportunity and made it work for themselves. Some good luck, some smart business sense. As opportunities present themselves in dentistry, we must be dynamic and alter our business plans accordingly. I try very hard to add new procedures to my repertoire each year. Try to foresee the next big opportunity and strike hard. What will it be? It's not so hard to figure it out. Guided implant surgery, laser periodontal treatment, short-term orthodontics. The point is to position your practice to be one step ahead of the practice down the block. The Yellow Perch success story doesn't come by every day. Search out and find your next big windfall and jump in with both feet. Think big for 2011 and grab every opportunity.

I Hate Insurance Companies

Sameer Puri (cerecdoctors.com co-founder) — Wed, 19 Jan 2011 06:31:42 -0700

I know what you are thinking - we all hate dental insurance companies, right? But this is not about them. Indulge me while I whine about my car insurance company for a bit. As you may have read, my brand new car was involved in a hit-and-run recently. We were eating in a restaurant with the car parked on the street and some dude hit the car and took off. So I take my car to the body shop and they give me an estimate to get it fixed and tell them to proceed. The insurance company approved the claim but since I have a $1,000 deductible, I thought I would submit that to my company to waive it as I have uninsured motorist coverage. Meaning if someone without insurance hits me, my company pays for the deductible. Well they declined it. They said there was no other motorist involved (even though I have a police report on the hit and run) and that I would have to pay the $1,000. Forgive me if this sounds stupid, but if you can't find the motorist who hit you, by default doesn't that mean that there is no insurance? To me, it's bad enough that I pay all this money for insurance and pay extra to get covered in case someone without insurance hits me, but it's worse that the insurance companies - after taking your money - will do everything in their power to try to screw you.

For Us Techy Geeks Who Lose Our Phones or Keys!

Richard Rosenblatt (Faculty) — Tue, 18 Jan 2011 07:44:32 -0700

Maybe I'm the only one, but do you ever get up to leave your house and you have your keys, but not your phone or vice versa? Ever leave your phone in a cab and it drives off? I have. I called it once I figured it out and cursed out the dude that found it and took my BlackBerry! He never returned it. Well I found out about a cool device called a Zomm. It attaches to your keychain and wirelessly tethers your keys to your phone. When they get a certain distance away from each other, an alarm sounds so you won't forget one or the other. It also acts as a speakerphone for your cell phone so you can do hands-free while driving. It also has an emergency alarm. I recommended it to an employee who got it for her husband and they love it. If you have that horrible habit of forgetting your phone, check out this cool and relatively inexpensive item. You can see a video demo at www.Zomm.com. [zomm.jpg]

First CEREC of the Year Just Went in!!!

Armen Mirzayan (cerecdoctors.com co-founder) — Mon, 17 Jan 2011 15:14:21 -0700

Just placed our first CEREC of the year. We moved to our new location over the holidays and passed inspection on Saturday and opened for the first time in 2011. Man, I think I went through withdrawals. Good to get back in the saddle again.

Open Your Eyes and Talk About What You See

Peter Gardell (Faculty) — Mon, 17 Jan 2011 07:55:31 -0700

Give your hygienist permission to talk about other areas of the patient's mouth than just the gums. They spend a lot of time talking to and evaluating the patient; if they don't, be sure to give them enough time to do that. They educate the patient, and the patients usually listen to the hygienist since a lot of times they think that when the doctor recommends something it is because they have a car payment coming up. Hygienists have the clinical knowledge and the ability to evaluate restorations. Get them to start the dialogue with the patient when they see a large defective restoration. The patient needs to be aware of the situation and they need to "own" the problem. Have your hygienist talk about the benefits of all-ceramic restorations, and of the single-visit all-ceramic CEREC restoration versus a large "plastic" filling that will usually have a short clinical life. Let them plant the seed in the patient's mind so when you come in and make the recommendation to the patient, they accept that they have a problem and it needs to be addressed. Hand this committed patient off to the scheduling person so they can be put in the book promptly. A delay can give the impression to the patient that it may not be as important as the hygienist and the doctor made it seem.

Always a Learner

Mark Fleming (Faculty & Magazine Editor) — Fri, 14 Jan 2011 07:25:01 -0700

I know you know a lot. You have reached a point in your career where you have spent many hours on study and practicing. But what do you not know? For me, I'm always looking for ways to better myself. I head to a course this week to be a better speaker. After over 30 years of practice, last summer I took a Spear Education course called Restorative Design, which had a lot to do with tooth preparation. One might think they know how to prep a tooth after doing it for 30 years, but I learned a lot. It was one of the best courses I have ever taken. I know as long as I am practicing and teaching, there is ALWAYS something to learn. You know a lot. What do you NOT know? It may be beneficial to you to examine that question. I believe it is wise to always be learning!

It Would be Worth It to Go to Jail for This!

Sameer Puri (cerecdoctors.com co-founder) — Thu, 13 Jan 2011 07:20:48 -0700

Have you guys seen the movie 'Saw'? It's a glorified slasher film where some crazy guy starts cutting up people for no reason. Well, this is how I feel this morning. Last night, we were out to dinner with some friends and I parked my brand new car on the street. Toward the end of dinner, someone walks in and asks 'Hey, is that your white car parked in front of the restaurant?' 'Why yes,' I tell him. 'It is.' In my mind, I'm thinking the dude is admiring my new car. He is going to ask me how it drives, how fast is it and all the other geeky car questions that those of us predominantly testosterone-laden guys care about. Imagine my surprise when he tells me that someone just did a hit and run and completely bashed in the side of my brand new car. The side panels, the side view mirror, the rims, tires, all damaged. Granted, no one was hurt, and insurance will cover the damages, but good God man! Why? Why would you go and desecrate a man's possessions simply because you are too stupid to drive? The car that was parked in front of mine got it even worse. The perp took off, and no one got a license plate or an ID of any sort. But if you see a damaged beige SUV driving around in Newport Beach, please hold the guy down while I perform all the acts that were performed in the movie 'Saw' and make it seem like Mickey Mouse compared to what I would do to the person if I ever found him!

The Match Game

Jeffrey Caso (Faculty) — Wed, 12 Jan 2011 07:30:37 -0700

I make every attempt to keep as much work in my office as possible. Especially in today's economy, it's best to do as much as possible in-house. However, it is also important to know your limits and not get in over your head. Just as important, there are times when keeping certain procedures in your office is actually going to be counterproductive for you. Taking four visits to complete a molar endo ends up costing you money. Lastly, sometimes a procedure is so stressful for you that it's just not worth the aggravation. So, it is inevitable that some patients will need to be referred out for various treatments. Doing this with skill and eloquence is important to keeping this patient happy and having them return to your office. It is important to explain to the patient why a referral is necessary in the first place. You surely do not want them to think you are incompetent. If you handle this part well, they will respect you for your decision to refer. I make sure they know that I want to keep them in the best of offices and under my watchful eye. I assure them that I will be in touch with the treating doctor and will have a say in their continued care. If any questions arise, I assure them that the doctor can contact me while they are in his office and together we will all make any decisions related to changes in their treatment. I began thinking about this topic today after I made a referral to an endodontist, when my assistant asked me why I chose who I referred this particular patient to. My answer made me think things through and I was happy with my explanation. It is all about knowing your patient and the doctor you are sending the patient to. I make it a point to get to know all of the specialists in my area, and talk to many of them frequently. I get valuable information about their office from my patients who have been there. I question my patients about their experience there and if there were any problems. I know their locations and how easy or hard it is to get there and park. Most importantly, I evaluate their work closely. That, however, is only half the story. Spending time to get to know your patients and their quirks is essential. Do they go crazy if they have to wait for an appointment? Do they need to park close by due to a disability? As well as a dozen other questions. Then I become a matchmaker and try to match up two people in a way I am comfortable with. Do this right and it's a win for all three people involved, and you keep your patient happy. That's the most important thing because a happy patient is a happy office.

Creating the Efficient Team - The Front Desk

Peter Gardell (Faculty) — Tue, 11 Jan 2011 07:14:46 -0700

There are many areas where efficiency can be improved in the average office. By creating an all-star team your practice will run with a lot less stress. Everyone who talks with the patient has to be able to answer questions accurately. They shouldn't feel pressure to try to answer every question, but should be well-coached to answer the questions that fall within their area of responsibility. (Just like the B&H experience talked about earlier - see my blog posted here on Dec. 22). You will never master anything if you try to do a thousand things. Give them a few things to focus on, and they can be trained to be experts for those areas. Give them permission to say, "I can't give you the answer; let me direct you to the person who can help you." The front desk person should be able to answer scheduling questions in an instant. Get them in the book as quickly as possible, because if they called, the issue has to be on top of their "to do" list. Delaying the appointment could allow the issue to drop down the list. The front desk person needs triage correctly by listening to the patient. They have to narrow down the minor emergencies from the productive emergencies The front desk person needs to prepare the patient for payment when they come in for treatment. Be well-versed to answer care credit questions. Direct them to the care credit site for information and enrollment. They shouldn't be concerned with the specifics of the procedure, other than it takes about an hour and 40 minutes, and that the end result will look great. Just have them focus on these areas. The front desk is the first contact that people reach when they call with an emergency; they are the ones who need to get the patient in so treatment can be rendered.

New Blocks Coming from Ivoclar

Sameer Puri (cerecdoctors.com co-founder) — Mon, 10 Jan 2011 11:43:57 -0700

Got word that we will be having some new blocks from Ivoclar in the near future regarding the abutment software from Sirona. These blocks will allow us to fabricate full contour abutments directly with our CEREC. No zirconia meso structure necessary. This will allow clinicians to place a scan body directly on the implant and design their full contour abutment and crown as easily as they design their crowns now. Really looking forward to these new blocks in the coming months. [Screenshot20110104at10629PM.jpg]

Hey New Users, CEREC Does Not Have to Be One Visit!

Richard Rosenblatt (Faculty) — Fri, 07 Jan 2011 09:25:33 -0700

I'm sure many of my counterparts are yelling at the screen right now. They are screaming, 'If you do it in two visits, why get a CEREC?' I understand this rationale. When I speak to dentists on the fence about the technology, like I once was, I tell them about one-visit dentistry and ROI and patient appreciation for no second visit. Well then, what the heck am I talking about, right? It is easy for me to talk about doing CERECs in one visit. My office is geared for it. I've been doing it for almost eight years. I can't think of any other way. Now that being said, the same does not necessarily apply for a new user trying to incorporate this into their practice. Do I think one-visit dentistry is better? For me, absolutely! Does that mean that I think new users should stress themselves out trying to get a crown done in one visit, while trying to manage new software and procedures involved with their jump into the technology? Heck no! Patients won't know that you are doing anything different, initially. They are getting a crown as they always have done in your practice. Don't feel pressured at the beginning of your journey to get everything done in one visit if you have not determined how long this new type of procedure will take you. Utilize the time in between the two visits to design restorations with no pressure when the office is not busy, like early in the morning before the day, or during lunch. Get familiar with the software, the design process and staining and glazing. After a couple of restorations, you will likely get the hang of it and better understand how long a single visit appointment will take you and how to schedule it. I posted a blog on Oct. 22, 2010 about timing yourself to better understand which areas of the procedure need to be improved upon. Be sure to give that a read to help out more on the initial trek into CEREC. I know that some will think it is sacrilege to do a CEREC in two visits, but if you are a new user, do whatever it takes to feel comfortable with the new technology. The key is confidence at the beginning and setting yourself up to succeed. Make sure you watch the videos in the "New User" section here on the cerecdoctors.com website to speed up the process even more. In no time, you'll be doing one-visit dentistry efficiently and with confidence, and your patients will be thanking you for it!

Ask Questions.

Mark Fleming (Faculty & Magazine Editor) — Thu, 06 Jan 2011 08:52:48 -0700

We know we have a great piece of technology to treat our patients. That's a given. What is not a given is what our patients want. And without knowing this, we may not be given the chance to use this technology. The best way to find out? Ask questions. Find out what is important to them. Ask open-ended questions. Find out why they are in your office, what led to a change in dentists, what has been going on since their last visit, etc. Then LISTEN, really LISTEN. Don't form an opinion or another question until you listen to what the patient is saying. Then help them with what you have learned, not what you have taught them. Try it. You may find yourself using the CEREC technology more often!!

Happy Holidays from my Lazy Boy

Peter Gardell (Faculty) — Wed, 05 Jan 2011 08:06:09 -0700

It's New Year's Day, and I am sitting back thinking about the holidays. I did absolutely nothing --not by choice -- but nothing. Now that I don't need the pharmaceuticals, I am trying to think about what has transpired over the past few days. This has been the first time in a long time that my time away from the office wasn't spent flying around doing something related to dentistry, like a presentation or mentoring at Scottsdale Center. It wasn't time spent throwing the family in the car or on a plane rushing to get somewhere then rushing to get home. I originally thought that it would be a painfully boring time, but I was wrong, it was time enjoyed. It afforded me the luxury of time to spend with the family, unrushed, quality time that in our hectic lives can be difficult to find. It gave me an opportunity to check off some of the low priority things on my mind. I thought they were low priority, but now that they have been taken care of, it really feels great. I didn't realize how much these things can weigh you down without knowing it. Gave me an opportunity to sit back do some cleaning out of old thoughts and think anew on how to bring things up to the next level. So in a few days, I will get my butt out of the Lazy Boy and back in the office. For a time off where I did nothing, it was productive. I am refreshed and ready for 2011. It is going to be a great year, and I wish you all the best.

2010 CEREC Year end Review

Mike Skramstad (Faculty) — Wed, 05 Jan 2011 02:31:32 -0700

[CEREC2010yearinreview1.mov-v-]

2011 - What Changes Will It Bring?

Sameer Puri (cerecdoctors.com co-founder) — Mon, 03 Jan 2011 08:12:57 -0700

Here I am, sitting and thinking about 2011 and can't believe the first decade of the new century is already in the books. And like every year at this time, I often look back and reflect on things that I could have done better. Could I have taken better care of my patients? Could I have been a better father? Could I have been a better husband? Could I have been a better mentor? A better teacher? A better speaker? I think it's natural to second-guess yourself all the time. No matter what kind of year you had, hopefully there is room for improvement. If not, and you look back on your past 12 months and find that you did everything perfectly - are you really being critical of yourself and painting a true picture? If this is in fact the case, are you truly being the best you can be or are you living in a state of denial? In reality we all look back and find ways to make ourselves better at all the things that we do. You have to. That means that you truly care about improving yourself, and in essence, that means that you are becoming a better person. In the end, shouldn't that be our goal? To improve and constantly raise the bar in what it means to be the best that you can be? 2011 will be like every other year - we will constantly learn new things, explore new adventures and try to do all the things that we did in 2010, just a little bit better. Growth is what keeps us going. Growth is what gives us a reason to wake up every day and live each day as a new adventure. My hope is that you have a wonderful new year and that you continue on your journey to be the best that you can be and that you do not let anything get in the way of your dreams.

Utah Skiing

Sameer Puri (cerecdoctors.com co-founder) — Fri, 31 Dec 2010 11:10:03 -0700

Sometimes I wonder why we spend all the time working when being a ski bum would be just so much fun. Here are me and some cousins on a great sunny day (one of the few) in Utah this past Christmas. This was day five or six of skiing, so we were tired of the bumps and the powder and decided to do some easy groomers to give the legs a rest. [skiing.mp4-v-]

Snow Days

Jeffrey Caso (Faculty) — Thu, 30 Dec 2010 10:23:32 -0700

Here in the Northeast, we get our fair share of snow storms. It amazes me how prepared we think we are and how utterly miserable our response actually is. This year's first storm was impressive, and to add insult to injury it hit on a Monday morning. Since this storm was no surprise and was forecast well in advance, I awoke early and got to work clearing the office walkways and parking area. I was sitting in the warm office drinking coffee a full half hour before my first patient was to arrive. Well, now it's four hours later, and I have yet to see one person. I have called everyone scheduled, and most of the responses were something to the effect of, "I haven't even thought of getting started digging the car out." It's always so amazing to me. Get out and do it, or make the phone call and release yourself from your obligation. Bad weather is not an excuse for bad judgment. Preparedness is the key to running your office properly, no matter what Mother Nature throws at you. I offer the staff a ride into work and a ride home on days like this. It's a great time to catch up on things that just do not seem to get done when the schedule is busy. We clean cabinets, bathrooms and go through our inventory. Most of the time, however, these days end up being busy, lucrative days. Maybe just not with the people we expected and not always doing the things we planned to do. I try to make snow days fun, and allow everyone to dress down. I do, however, keep our momentum moving forward and in a productive direction. So enjoy those snow days. Expect a disruption in your schedule, but be poised for the unexpected procedures that pay the bills. Get the office clean and tidy and have fun doing it. Let's just hope we don't have too many of them.

Please Make Sure Your Kids Finish High School - A Public Service Message

Peter Gardell (Faculty) — Wed, 29 Dec 2010 07:05:48 -0700

I am on my way to mentor a course at the Scottsdale center and have just gone through security. I know it is a necessary evil and am not commenting on the steps we have to take to be safe in this new world order. But please make sure your children graduate high school and are not part of the growing field of airport security. The scanners worked well and were very efficient. I went through -- took no time at all. But I worry that the New York Times is going to do another one of their well-researched pieces (the quality of the piece would have been found in the National Enquirer until it went bankrupt) condemning the technology due to the exposure of the individual to radiation equal to a dental X-Ray. I am sure they will site some authority they have dug up to support their view (I didn't think newspapers were supposed to have views) who probably live in a cave in the eastern areas of Afghanistan. This would lead to everyone being subjected to the mass government-sponsored sexual assault. I'm not sure what is weirder, the individual who wants to perform this act thousands of times a day, or the individuals who now opt out of the imaging so they can get fondled. Strange world we now live in. So for their sake, please make sure your kids graduate high school .

Further Thoughts from the Greater New York Dental Meeting

Richard Rosenblatt (Faculty) — Tue, 28 Dec 2010 12:46:33 -0700

In a previous blog, I talked about attending the Greater NY Dental Meeting in November. I'd like to share some more thoughts and experiences I had there. It was a nice feeling walking the show this year. I usually walk the show on Monday; no crowds, and I can get some real time with the vendors I want to get info from. I get to experiment with new products and new technologies to see if they are something that fits my practice. I get to run into some old friends and classmates, much better than just friending them on Facebook. I was getting a lot of positive feedback from those manning the booths (which I didn't last year). The people visiting seemed more positive about their financial futures. The larger items had more contracts signed. A lot of people going through the Sirona booth looking at their product lines - Cone Beam, CEREC and their digital x-ray products. (As a side note, I just got the new Schick sensor in September, and it blows my old system out of the water. I am seeing things that I couldn't just a few short months ago. The interface with EagleSoft is seamless and worry-free.) I also saw some newer products that appeared to make our CAD/CAM life easier; time will tell. Cements, lasers (the Powerlase replacement looks fantastic), blocks (RealLife, Rapid Layer Technology) design aids, buccal bite aids (both from dentalcadproducts.com), retraction aids, new cord-dispensing packaging. We already have the most robust chairside software, and the buzz is that the next upgrade will be more significant than the 3.8 upgrade. Things are promising. Don't just sit back - get ready for it.

The Year in Review

Jeffrey Caso (Faculty) — Tue, 28 Dec 2010 09:28:33 -0700

As we approach the end of another year, I always become reflective and try to remember both the good and the bad that this year had to offer. I can't help it. It's just what I do. I start to accumulate year-end magazines which have articles reviewing the year. As I read through the articles, I am always amazed at things that happened earlier this year, that seem like they occurred long ago. The passing of celebrities and political figures is always something that gets you thinking. Many times, eras end in ways that are sad. But with the ending of certain eras, there is a beginning to many more. This process of reflection leads to a natural transition of hope and planning for the brand new year to come. It's funny how this happens; it's just another day, another month, but because we pass this threshold to another year, it becomes significant. I like to use this time to see what I can do to advance my practice, help my family more, and become a better dentist, husband, father, son, brother... Really, just to be a better person overall. Now that's getting pretty heavy, and it need not be all so serious. I also like to resolve to do things that are lighter in scope. I want to take better care in organizing, printing and framing my digital pictures. That's a fun thing that I just have not been able to get a handle on. I also want to maintain my "things" better. I try to do a pretty good job on that front, like oil changes in the cars, cleaning the workshop, fixing all of those little annoying problems in the house, but there is always room for improvement. This year's resolutions, however, will be great, because I have a new and entirely necessary resolution to make. This year I will spend a few minutes every morning and unsubscribe to all of the useless e-mails I receive from companies trying to jam their products down my throat. There is no reason to wake up to more than 50 junk e-mails every morning. That, my friends, will be liberating. So, bring on 2011. Let's get off to a great start with renewed energy and vigor. Let's all resolve to keep that momentum going strong for a long time. It will help us in so many ways. So, sit for a minute and reflect. Make your own resolutions and then make them happen. Life is short; live it well.

Giving Back

Tarun Agarwal — Thu, 23 Dec 2010 08:23:31 -0700

Giving back - What does that mean? To each person it means something different. For me, giving back means helping to create opportunities and dreams. The best gifts I have ever received were lessons that provoked thought and opened my eyes to dream. For dental graduation, my parents gave me an account with $10,000 in it - but there were strings. This money could only be used to further my professional career in the form of education. I used this money to attend a well-known cosmetic dentistry education program. That was a gift that still to this day keeps on giving. Each year for Christmas and my birthday (only one week apart) my parents buy me (usually and making me order in front of them using their credit card, then quickly taking their card back) a dental education DVD or CD program (like the Frank Spear DVD or CD education programs). Many are not in the position not being able to give back financially. Does this mean you can't give back? Absolutely not. This week I am hosting a 4th-year dental student at my office. She was confused about what she wanted to do after graduating - attend an advanced education program or go into practice. She has had a week of hanging out in a dental office that is equipped with the latest technology, that has integrated that technology, and does a variety of general dentistry procedures. Imagine if you had an opportunity to see all that was possible while in school or just out of school. I was amazed at some of the comments and questions she was asking. You do posterior composites? What is this CEREC thing? You mean you, as a GP, place implants? You enjoy doing molar root canals? You still use rubber dam? You actually have meetings to discuss practice numbers with your team? It was at this point that I realized how we can all give back to our wonderful profession. I am not trying to 'convert' people to our style of doing things. I am simply trying to open the eyes of dental students to all that is possible and to dream big. She left my office in amazement of what a general practice can become and has a renewed interest in private practice. So offer your local school to allow 4th-year students to spend a few days with you. Invite a local young dentist to hang out with you for a few days. Do our profession a favor and give back by creating dreams and helping others see what all is possible!

Efficiency for a Healthy Business

Peter Gardell (Faculty) — Wed, 22 Dec 2010 12:48:37 -0700

As mentioned in a previous blog, in NYC recently, I visited B&H Photo to get some stuff for my camera. It is amazing that in the city with the highest rent and associated expenses of operation, you can have a company that offers tremendous prices. They have assembled some individuals who know the products they sell and are great resources for information. They have done efficiency studies and have designed a new-world marvel. They have created an environment that doesn't allow an individual to get lost. There are people to help guide you at every turn. It makes people go past other exciting items before they can get to the items they are interested in. They create demand in a person's mind, when they might have walked into the store not knowing that they "needed" something. You are directed to particular departments for what you want. The individuals there are authorities able to answer any of the questions you may have. Standing in each of these lines you are surrounded with the latest and greatest items; you can get caught up in the feeding frenzy before you realize it. It's when you get to the counter that the magic of this particular store happens. You consult with a sales person, and two minutes after you tell them what you are interested in, they reach down into a bin and pull out that product. No sales person walking around a huge warehouse; the warehouse is brought to you. There are no sales people stumbling over one another. No wasting time; the customer is taken care of immediately and the sale is completed. They embrace the old saying, 'Strike while the iron is hot,' and are very successful. There are a lot of principles that have been put in use in this particular location that make for a very efficient operation. A lot of these can "cross-over" to a dental practice. Some are easy to implement; some a bit harder, but this visit has planted a lot of seeds, and if I can get any of these seeds to grow I will share them in the future. If you have a chance to visit B&H please do, it is an amazing place.

A Holiday Shout-out to Some Important People in My Life

Richard Rosenblatt (Faculty) — Tue, 21 Dec 2010 07:35:03 -0700

I know that Thanksgiving is supposed to be a time of thanks, but I tend to find the last few weeks of the year as the time I look back, reflect on the year, and pass along a thank you to people who left a mark on me that year. This year, without a doubt, was pretty much everything cerecdoctors. I want to just list off a couple of thank you's: 1.) I want to first and foremost thank Sameer and Armen. This website (and CEREC) has changed my life in such a profound way. We have been great friends for many years and when they asked me to be a part of this site last year I accepted, but had no idea for the ride that was to ensue. I'm very honored and proud to be part of, what I feel, is one of the most amazing educational sites in all of dentistry. They have done fantastic things with this site and continue to have ideas to improve it and the courses at Scottsdale Center. I want to thank them both for all that they unselfishly do, not only for me, but for all those affiliated with the site, from faculty to members. Thanks so much for your amazing contribution to dentistry, guys. I'm proud to be able to call you such good friends. 2.) I want to next thank the faculty. I realize that I choose to spend free hours of my time during the day patrolling the cerecdoctors site, but I'm crazy. Anyone who knows me personally will tell you that without blinking! What is amazing is that there are five other people who do the exact same thing I as I do. The faculty on this site works tirelessly to help provide content, answers to questions in a timely manner, and videos to help users who struggle with cases. It is a labor of love, and I respect their passion for the technology, the site, the profession and their peers. Mike Skramstad, Pete Gardell, Jeff Caso, Mark Fleming and Darren Greenhalgh, kudos to all of you for the tireless efforts you put in to help others and further the cause of CAD/CAM dentistry to the masses. You are great people and also great friends! 3.) I want to thank the people behind the scenes on the website and at Scottsdale Center who work so hard to ensure that whether we are online or at the Center, we are getting the most out of our experience. I love to get out to Scottsdale to be with them because, just like all the people I have previously mentioned, they love what they do and it shows in how they continuously help others. Thanks for your hard work everyone, it does not go unnoticed! 4.) I need to thank our members. This site has grown by leaps and bounds over the years. As more people enter into the world of CEREC, they venture onto the cerecdoctors site and begin to contribute. The enthusiasm of everyone on the message boards in infectious. I know it continues to inspire me to stay engaged in the site because of all the amazing feedback we get and the stories of growth and success that are shared by doctors who put in the time watching videos and practicing the techniques shared on this site. Without the excitement you bring on a daily basis and the constant input by our users, we have created a virtual family that grows larger yet stronger every day. I tip my hat to the dedication and high-quality dentistry that is shared, and the willingness for those without experience to share that climb with others so they know that they are not alone in the journey that is CEREC. Thank you for your continuing support of the site. I, for one, cannot thank you enough and you continue to make me a better dentist and person every day. 5.) Lastly, but certainly not least, is my amazing wife, Aimee. When I told her five years ago that I wanted to get into some public speaking and teaching, she was not all that thrilled. Her words to me were,' I didn't know I was marrying a traveling salesman.' She saw how much doing this meant to me. She also knows that when I'm not working or doing this kind of stuff, I'm with her and my three kids. She supports me and this crazy journey I'm on, and I express how much that really means to me. Thanks Aim, I love you, and you're the best! I want to wish a happy and healthy holiday season to everyone here and I look forward to an amazing 2011!

Lady-like!

Darren Greenhalgh (Faculty) — Fri, 17 Dec 2010 07:16:48 -0700

There are so many different ways we can be leaders, and so many different articles and books based on leadership. I have been thinking of what I wanted to do differently in my office for 2011, and last week came across a quote from Margret Thatcher. She said something very poignant about leadership: "Being powerful is like being a lady. If you have to tell people you are, you aren't." This got me thinking about my role as leader in my office. It is easy to tell who is the boss at home - my wife - l but here at the office I think we can all relate to this quote. I have really tried to foster a great working relationship with my staff. I encourage them to be self-motivated and solution-driven. We discuss things as a team, and I ultimately make the decisions. Hopefully, I have made an environment where we work as a fine-tuned engine, no one piece out of place or not working efficiently. I try every day to do things that encourage this relationship - proving to my staff, by example, that I am a leader. As 2011 approaches - let's prove to our staff that they are in the best office, with the best technology, with the best doctor, all while treating our patients with the best clinical skills. I hope you have a great lead into 2011!

Bah Humbug

Jeffrey Caso (Faculty) — Thu, 16 Dec 2010 07:25:04 -0700

As we enter the hectic holiday season, the draw upon our time becomes intense. As a previous blog mentioned, the final month of the year is the busiest time in our dental offices. Patients feel the need to use up the last of this year's insurance benefits and to close out their flex spending accounts. That's a great boost for our businesses - one that needs to be managed properly for us to enjoy a successful end to the year, a year, I might add, that was economically difficult for many. So, as the schedule fills up and the office becomes hectic with larger cases, our staffs need to be aware that sometimes our patients' thoughts are scattered in many different directions this season. I find that without vigilance in confirming upcoming appointments, our no-show rate skyrockets this time of year. To that end, keeping impeccable records and constantly updating phone numbers is the key to success. If we cannot contact them, then we cannot confirm them. Something that we started doing is offering the patient an extra phone call the morning of the appointment or at any time they want that day. We always confirm the day, and before and during that call we ask, "Would you like us to call tomorrow to remind you again, and if so at what time?" I was amazed at how many patients said that they would like this. This is especially important for Monday appointments, where the first confirmation is Friday or Saturday. I was always from the school of thought that hey, we are all adults here, you get confirmed once and that's it. We must remember, however, that the person who is hurt by a no-show is you. Actually, you lose out twice. The first time is at the no-show appointment, and the second time is at the rescheduled appointment when you could have been seeing another patient. Now I do my best to avoid the problem in the first place. This time of year, I only wait a few minutes after the appointment time to act. The patient is called before five minutes after the appointment has passed. If they cannot be reached, we try again at the 10- minute mark. If they still cannot be reached, we call another patient from our call list. We always ask patients if they would like us to call them for an earlier appointment if we get a cancellation. Many say yes. This generally fills the time. Let's face it, the holidays are hectic. Work to set up a protocol that works for your office and implement it now. It will keep you working and boost your bottom line.

Are You Passionate About CEREC? Start a Study Club!

Richard Rosenblatt (Faculty) — Wed, 15 Dec 2010 12:46:00 -0700

As many of you can guess, I'm a raving fan of CEREC. It has been this way since 2003 when I did my first crown, and has only intensified over the years. When I started doing CEREC, I think our office was the 39th CEREC machine in Chicago, or something like that. We did not have lots of places to learn more about CEREC, certainly nothing like cerecdoctors.com! I decided that I wanted to figure out a way to learn more about this technology, so with the help of my then-CEREC specialist and the local branch here, we started the Northern Illinois CEREC Study Club. It has now grown to one of the largest CEREC study clubs of its kind. It has been a great experience for me. It was my platform to learning how to lecture, and it allowed me to meet multiple times a year with peers who had the same passion for this amazing technology that I have. I would do most of the lectures, but I also invited some of the companies that we utilize to help us with materials, cementation or characterizing our restorations in a furnace. I would invite well-known speakers from around the country and fill up a room with attendees for lectures. I had people from our mother company, Sirona, come and speak to us about new releases, and what was to come. It has been a great, ride, and one that is truly appreciated by the members in my group. If this is something that interests you, feel free to contact me, or get in touch with your local CEREC specialist and see if they can help you put something together locally. It really is a win for us, Patterson and Sirona to do this. It takes a little bit of work, but it has certainly been a labor of love for me, and I have learned a great deal about CEREC along the way.

The Only Certain Things in Life are Death and .....

Sameer Puri (cerecdoctors.com co-founder) — Tue, 14 Dec 2010 07:30:30 -0700

Taxes. Here is an interesting view on taxes, considering our current political climate. Regardless of which side of the aisle you are on politically, here is one way to look at the whole tax debate.

Sameer Puri is a Techno-Geek

Peter Gardell (Faculty) — Mon, 13 Dec 2010 15:23:00 -0700

I was walking on 6th Ave. in New York on my way to meet some people, and a very tall, well-dressed tourist cut me off while I was crossing the street. Luckily for me before I yelled, "Go to hell, you stupid tourist!" I realized it was the world-famous Dr. Sameer Puri. It's always fun seeing my friend, but I could see that his attention was not with the conversation; he was eying something else. In my hand, I had a bag from B&H Photo, and he spotted it. I could have been giving out the winning lotto numbers and he wouldn't have heard me. He just said, "Is B&H near here?" I said, "Sure, it's just a few blocks away. You want to go?" "Definitely!" We walked a few blocks - of course, I should say I walked, Sam was pretty much running and hip-checking anyone in his way. I tried to point out the landmarks of NYC. MSG, Empire State Building; Penn Station; he really wasn't interested. I tried to show him some old-school 42nd street shops, and he only wanted to see B&H. We finally got to the place, a wonderful l oasis of technology. For those who haven't experienced B&H, it truly is a unique experience. Dr. Puri's eyes were like my 6-year-old's on Christmas morning, the size of pie plates. After a short visit, Dr. Puri had a satisfied look on his face. He had been to his Shangri-La; he was at peace. We left with the satisfaction that there was another satisfied tourist visiting NYC. And to top it off, we got a phone call from our President, thanking us for stimulating our economy.

John Lennon and ... Harry Potter??

Sameer Puri (cerecdoctors.com co-founder) — Fri, 10 Dec 2010 06:42:54 -0700

So I'm driving in my car with my two daughters, ages 8 and 11. They are listening to their usual drivel of Brittany Spears, etc. (I wonder if this is how my parents felt when my brother and I used to listen to Depeche Mode and Oingo Boingo!), and I ask permission to change the station to hear what else is on. Anyone with young pre-teen daughters must know that you can't just change the radio station in the car for fear of the wrath that your kids will unleash on you. So I get permission, and the DJ on another station starts talking about the Beatles and how it's the 30- year anniversary of when John Lennon was shot. Despite the kids wanting to change the station, I thought, what an opportunity to teach them about some history of music so I proceeded to explain the history of the Beatles and their significance on pop culture as John Lennon starts to sing "Imagine." I told my girls that this was an important song because it was about peace, but that he was killed by a crazy guy. Not only that, that day happened to be the anniversary of John Lennon's death. Now those of you that are into Harry Potter will understand what happens next. My 8-year-old screams at the top of her lungs in a joyous voice 'Happy Death Day John Lennon!' Considering I've only seen bits and pieces of Harry Potter, I didn't quite get the reference, but had to be schooled by my kids on how the ghosts in Harry Potter celebrate the day they die. What seemed shocking to me is just a reference to the pop culture of today. Man, I am really starting to feel old and disconnected! Next thing you know, I'll start wearing shorts with black dress socks and dress shoes like my old man!

Ethics in Your Profession

Jeffrey Caso (Faculty) — Thu, 09 Dec 2010 15:01:37 -0700

All of my life I have been intrigued by coins. Yes, that's right; I am a numismatist and an out-of-the-closet one at that. There was a time that I was embarrassed by this fact, but now, who cares? I am what I am. I find it amazing that a coin with a face value of one dollar may very well be worth thousands to a collector. But really, that's another discussion. The reason I felt compelled to write about my interest in coin collecting was to relate an experience this weekend at a coin show. With gold hitting record highs week after week, an odd thing has happened. A great deal of coins are now more valuable for their gold content in weight than their value as a collectible. These coins are now termed bullion coins and are being bought up in great quantities, melted down and sold for the going rate by weight. So, at this show, I was looking to buy some coins to add to my collection and found the dealers to be scrutinizing the purchase. This was something that I had never experienced in the past. They were asking questions about the type of collection I had, if I had plans to have the coins graded, and how I would be storing them. I found this odd and sought out a gentleman who I had bought coins from in the past and asked him what was going on. What he told me was both intriguing and amazing. He said that people who were coming to the shows to buy large quantities of gold coins to melt down were ruining the industry. Even in these poor economic times, if someone was suspected of this practice, ethical dealers were denying the sale. They would rather lose the sale and the profit from that sale for the good of the hobby. It wasn't just one dealer on a mission it was all of them. Keep in mind, that these were not wealthy people but hard-working guys trying to make a few extra bucks to help support their families. I felt a great deal of respect for them, knowing that they were doing the right thing even though it was hurting them financially. As dentists, we are in a similar position every day. We are constantly presented with problems that need to be resolved, and we must treat that patient to a very specific level. We must not over treat and we must not under treat. Sometimes the implications can be that we propose the most expensive treatment for our own benefit. The proper discussion with our patients can avoid this right away. We need to do the right thing for each and every patient to the very best of our abilities. That, I am sure, we can all agree on. There is a bigger issue to consider however, it is what we collectively need to do for the sake of our profession. Dentistry is constantly under pressure from the media about toxins in our filling materials or the outsourcing of lab work to China, as well as a plethora of other topics. YouTube is ripe with videos bashing just about every aspect of dentistry. We as stewards of our profession need to work to foster a positive public opinion about dentistry. How do we do this? Simply through our actions. We need to act professionally at all times, both at work and in our private lives. In doing so, we will be respected as people and as professionals. This will do wonders to tip public opinion in our favor. Just like those ethical coin dealers who spoke to every buyer carefully to make sure they were doing the right thing. We, through our actions, will be the ones to safeguard our livelihoods for a long, long time.

Want to Help? Join the Mentor Group!

Mark Fleming (Faculty & Magazine Editor) — Wed, 08 Dec 2010 09:48:41 -0700

I was in Scottsdale last weekend to help with Levels 3 & 4. Travel can get old (just ask Sam), but I thoroughly enjoy teaching and hooking up with Sam, Armen and all the others who help put on these courses. A lot of time and energy is expended, but there is nothing better than reading how these courses help users take their CEREC Experience to the next level. If you are interested in helping others, consider joining the Mentor Group. You will find the experience both enjoyable and rewarding.

Getting Involved

Mike Skramstad (Faculty) — Tue, 07 Dec 2010 09:23:38 -0700

I'm just flying back from a great weekend in San Francisco, reflecting on the latest CEREC Discovery/3D summit events. What a great weekend with awesome energy. The CEREC and GALILEOS word is definitely getting out to the masses more than ever. More than 400 people attended, looking into one or both of these great technologies. Another thing that I noticed is the number of existing owners who were there to support the event and tell their stories. There really isn't any other technology that I can think of that existing owners actually travel to events just to encourage others to get on board. They don't get paid... they just love what they do and want others to experience the same thing. In talking with some of these folks, I always get the same question: 'How do I get more involved?' Well, there are a number of ways you can help out. First and foremost, you can offer a tremendous amount of help and guidance by being active on the cerecdoctors.com discussion board. The great thing about the forum is that people always learn from other's questions. By helping out, you are not just helping the person that asked the question, but also potentially thousands of others who are silently monitoring the discussion. If you want to be more active in your area, start a study club. This is how many of us got started. Contact your local Patterson branch and find out if there is a CEREC study club. If not, start your own! There are plenty of people on cerecdoctors.com who have a lot of experience with this that can help and guide you. If you have aspirations to be a speaker - either on the local or national scene - consider attending the Sirona Speaker Academy and get three solid days of training with Dr. Paul Homoly to sharpen your skills. Finally, if you've taken all the courses at Scottsdale Center and want to help out sometime, drop Sam or Armen an email and find out how you can help or consider joining the Mentor Group. There are many ways to get involved with CEREC and/or GALILEOS. The most impressive thing to me is how willing all of you are to do it.

Try Digital Impressions for Lab Cases

Richard Rosenblatt (Faculty) — Mon, 06 Dec 2010 10:33:43 -0700

Boy, I love digital impressions! [3ubridgepic030.jpg] I have very small lab bills in my practice. I have some months where the only lab bill I have is the occasional retainer or bruxing appliance. Ninety-five percent of my indirect restorations are done chairside with my CEREC machine. I don't do a lot of bridges, as I prefer implants. I do my smaller anterior cases chairside, and the last few years I have not done the cosmetic cases that I used to do. This past month, I actually did three gold crowns and a bridge, which was a lot of lab cases for me. I did all the gold crowns using the CEREC software, designed the restorations myself, milled out the temp and seated with no adjustments, and sent the file to Keating Dental Arts via yousendit.com. They got the file within a few minutes, milled out my restoration in CAD Wax, invested it, cast it, polished it and sent it back to me within a day or two of getting it. I seated the gold crowns and knew there would be no adjustment, since my temps had no adjustment. It was awesome! Yesterday, I seated a three-unit bridge. A simple bridge, one would think, from 18 to 20. This was no simple bridge. My patient, who was fantastic, was a very heavy salivator. I tried three times to take impressions on her and have a bridge made. The bridges were always high, and I mean high to the point of adjusting down to metal. I had margins open every time on the three separate cases I sent. I would not seat them. I believe the poor fit had everything to do with the fact that the patient was such an extreme salivator, and this likely displaced the impression material upon placement. This patient is a young college student who came to me because of a failed bridge that was done less than 12 months previous. I didn't want the same thing to happen. We were going on seven months with her in a temp, since she was away at school and could not easily get back to the area often for appointments. As soon as the new CEREC Connect software update came out, I decided to give this a shot. I tried to use Connect on her previously, but had a tough time with the full-arch scan and the Isolite, and I prefer a full-arch scan for bridges. With the ability to image quadrants separately and then stitch them together, I placed an Isolite, kept her completely dry, and did a full-arch impression so easily. The software worked amazingly. Before I got her numb, we did the buccal bite on the opposite side so she could tell she was biting normally. I got the case back and had my fingers crossed. We already were past the 'third time is the charm' appointment! I placed the bridge, and did a minor occlusal adjustment, and it fit perfectly. We were both so happy. The bridge was done by Burbank Dental Lab, and I really appreciated their patience while we tried to get this case right. I always believed that digital impressions are even more accurate than impression material, but this case really proved it to me. So much less can go wrong when you have proper isolation and can manage the bite before the patient gets numb. I can't remember being so happy to have inserted a bridge. My patient thanked me for being such a perfectionist, and I kissed my CEREC machine because along with the lab, it saved the day. I encourage everyone to try digital impressions for lab cases. Boy I love digital impressions!

Teaching and Sharing CEREC

Sameer Puri (cerecdoctors.com co-founder) — Fri, 03 Dec 2010 06:58:49 -0700

I wanted to share this email from one of our doctors and regular contributors on cerecdoctors.com. Seems that he is enjoying the teaching, the sharing and the mentoring aspect of CEREC. How great is it to have all of our members sharing their knowledge and spreading the CEREC gospel? I want to thank Dr. Chuck for this nice email, and I'm glad he is enjoying his CEREC journey - as I hope you all are. >>> Sam and Armen: With all the new doctors looking for help, I did not want to post this on the website and push a more important topic down the list. I do want to share with the two of you that I spent the day at a University of Iowa College of Dentistry continuing ed symposium in Iowa City on digital impressions and CAD/CAM dentistry. I presented a couple of short cases at the end of the Sirona part of the program (they also had iTero, Lava COS and E4D) just to give the attendees hope that if an old geezer like me can learn to do this, they certainly can do this also). In the afternoon, I was a mentor, meaning that I helped with a hands-on session in which attendees could get their hands on the equipment, and with a little help from me, get a crown milled. It was hard work. I was perspiring when it was over. Skrammy actually did this gig last year, but I can see that he is overqualified for an activity like this. Also, it is a six-hour drive from Minneapolis to Iowa City. It only takes me an hour to get there from Geneseo. I believe that it would be way easier to help with a class in Scottsdale where the attendees are already committed and have a little experience under their belts. But it was also fun. At the end I had a GP resident buttonhole me to teach her how to use quadrant mode. We had our images and were just starting to design the first restoration when the hotel and dental school staffs kicked us out. So much for my first foray into advanced instruction. Anyhow, I am grateful for the opportunity to have participated. I hope I helped some people, and I would do it again. Happy Thanksgiving to you both. Regards, Dr. Chuck

A Friendly Reminder to Read Your Lease Once in a While!

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 01 Dec 2010 15:18:27 -0700

Do you know the exact date for your option to renew your lease? Do you know exactly how it should be exercised? If not, I want to draw attention to this very important date as it has cost me dearly. It's a long story and I am very happy with where we are headed. Our new place will be 1,000 square feet bigger, and the rental rate will be the same. Plus, we will have even more visibility than we do now with better parking. So we are very excited. You can check out the new location and pictures of the pending build out at the url below. This place has to be built in five weeks!!!! Esthetic Dentistry Dental Group It has not been stress-less, so as a courtesy, I ask you to: 1. Dig up that lease and read the terms of that option to renew. The value of your business completely depends on this 2. Read it five more times 3. Write down that date in your calendar 4. Enter that date in a digital calendar 5. Have every family member note and remember that instead of your birth-date 6. Remove the dog tags off your dog and give him a new one with that date engraved on a new tag 7. Have all your credit cards, memberships to gyms, or anything that can possibly expire to expire on the very exact date that your option to renew must be exercised so that you don't lose track 8. Ask your family to make this particular date a Family Holiday 9. Do not pay any allowances to your kids unless they can cite that date on a command 10. If this happens to save you a ton of money, I want 10 percent commission off of the savings. lol

Time to Review Procedures

Jeffrey Caso (Faculty) — Wed, 01 Dec 2010 08:29:40 -0700

Last Saturday morning, usually a busy but mellow day, I was tested by a patient, and while all turned out well, it got me thinking. A routine direct composite on tooth #7 turned into a medical emergency very quickly. I have been treating this 17-year-old patient since she was three years old. Other than hygiene, sealants and Invisalign she has never needed any other treatment. On this day she presented with an incipient Class 3 lesion on the mesial of # 7. We decided to treat it today as she has a very busy schedule and is hard to appoint. Her mother warned me that just recently she has been having difficulty accepting treatment at her physician's office, and last week fainted when having a throat culture. I spent a few extra minutes explaining to her what we needed to do and talked her through the injection. She tolerated it well, and in a few minutes I began the procedure with the high-speed drill. In a flash she passed out. I stopped immediately and repositioned the chair to lower her head. I spoke to her and she came back quickly. I held a cold compress on her forehead. Her pulse was steady, and bam, out again. This time was longer and I started to become more concerned. We train for these situations, and the staff was on it from the start. In a quiet and efficient way, the emergency kit was opened and placed by my side. The oxygen tank was placed at the ready. BP cuff, pulse ox and AED were kept out of sight but placed within reach. We all were concerned that if this skittish patient saw a lot of equipment she would only get worse. Fortunately, as soon as it began it was over. She came to, started to talk, regained her color, normal pulse, BP ok. Just embarrassed. We slowly, finished the procedure, which is a weird thing to do in light of what just happened. It was necessary to close the tooth up and I felt that creating more anxiety with reappointing her and having to go through this again was just not worth it. The remainder of the procedure was relatively easy. I followed up with a phone call at the end of the day and all was fine. The mother praised the way the office handled the situation. So, when Monday came and I had the full staff in, I rewarded them with lunch and took the opportunity to go through other emergency scenarios. We had a nice time and learned some new things and refreshed other things. Watching any patient go through this - especially a young patient - can be overwhelming. The facial color change and twitching can be frightening. Your staff needs to know what to do without thinking. Use this blog post as an opportunity to review your emergency protocol, check your equipment, if you do not have an AED in the office, get one. Retrain your staff and run scenarios right down to what each person should be doing when you call 911. Don't wait for the emergency to happen, prepare, rehearse and rest easy.

GNYDM: It's Good to be Home!

Richard Rosenblatt (Faculty) — Tue, 30 Nov 2010 07:54:03 -0700

I'm in La Guardia Airport on my way back from a quick jaunt to NYC and the Greater New York Dental Meeting. I've lived in Chicago for the last 12 years, but I grew up in New Jersey, and still consider this my home. I was asked to speak at the meeting, and decided to come in a little early on Saturday and enjoy Manhattan at my favorite time of the year. I got off the airplane and could feel the excitement of being back on the east coast. I checked into my hotel walked all afternoon in the city. I covered 60 blocks on foot and walked from Times Square to Greenwich Village. I have not been back in quite some time, and I really miss the excitement that New York City brings. I loved the smell of roasted chestnuts, pretzels and knishes. I miss seeing all the street vendors selling everything you can imagine. I miss the N.Y. pizza and bagels and delis (and made sure to get a little of all of it on my quick stay!). I miss the different sections of the city and the brashness of the people and the pace of the lifestyle here. I love living in the Chicago area, but coming to Manhattan just makes me feel alive. If you ever get a chance to come to the Greater N.Y. Dental Meeting, don't hesitate. This is a great city to visit, and there is no place like it in the world. For me, it was good to be home!!

Happy Turkey Day

Sameer Puri (cerecdoctors.com co-founder) — Thu, 25 Nov 2010 13:46:48 -0700

The Puri family wishes all CEREC fans the very best holiday season. May you have a great remainder of 2010 and that 2011 brings all your wishes and dreams to reality! [HappyThanksgiving0001.JPG]

CEREC Outside the Box

Sameer Puri (cerecdoctors.com co-founder) — Wed, 24 Nov 2010 07:02:57 -0700

Here is an example of using the CEREC 'Outside the Box.' This case was done by Dr. Tarun Agarwal of Raleigh, N.C., using the CEREC and the newly FDA-approved Sirona abutments. Instead of using the zirconia intermediary piece, he milled an emax crown directly to the Tibase metal abutment. [IMG_0897.JPG] [IMG_0902.JPG] [IMG_0904.JPG] [15xrays9.jpg] Great thinking outside the box, and a great restorative option for the patient. Total cost is far below doing anything traditional. I think 2011 will bring some incredible changes to the CEREC system, allowing all of us to do this type of work with ease. This case is an experiment in that it showcases what can be done.

Dry Land Training

Peter Gardell (Faculty) — Wed, 24 Nov 2010 06:50:49 -0700

Dry Land training is done by some sports that can be done only in certain conditions. Alpine racing is huge in my house, and I am not sure how my three boys - and now my daughter - have developed such an appetite for it. This time of year, we drive up to Vermont for the boys to participate in the dry land training, running, hiking, and agility skills. They don't gear up and do any turns. So the question is, why? What is the point? Repetition to create muscle memory for better performance is the reason for dry land. You don't have to perform the act exclusively thousands of times. You build by doing the components thousands of times. Fundamentals Building Blocks Conditioning Think about your office. All things done, do with the purpose of improving something else. In my case, I work on the bonding and esthetics of my direct composites to help with my CERECs. Bonding - There are no shortcuts, and you need flawless techniques. Anatomy - You take the time to develop lifelike directs, and you will dazzle your patient with your CERECs. I stain and glaze almost everything, so when that anterior comes in, I'm ready to create a complimentary tooth to the existing dentition. Think about the many different things you do, and how they can be dry land for you CERECs. You and your patients will be better off.

Take Time to Recharge

Mark Fleming (Faculty & Magazine Editor) — Tue, 23 Nov 2010 12:48:38 -0700

Finding yourself dragging a little? Is it affecting the way you practice? Do something that gets your juices flowing, your energy up. Last weekend and again this weekend, I'm going roller-coaster riding. I love the speed and the excitement of these rides. I marvel at how the engineers have come up with ideas that get our hearts pumping, making us want to scream with both fright and delight! Every Thanksgiving, we head up the road to Busch Gardens to ride their coasters. And we don't just settle on riding, we wait the extra time to ride in the front row. What a rush!!! So take some time to recharge, however that may be. It will help you deal with the everyday things we deal with. ENJOY! [Kumba_at_Busch_Gardens_Tampa.JPG] Kumba at Busch Gardens

Teamwork

Mike Skramstad (Faculty) — Mon, 22 Nov 2010 12:53:40 -0700

I'll just say it right now: I need to be done watching sports. I've been a football and basketball fanatic my entire life and where has it got me? If you are a sports fan, you will most likely be in store for a lifetime of disappointment and countless hours of wasted time away from the family. Why so bitter, you ask? I just finished watching my favorite team, the Minnesota Vikings, get absolutely destroyed by the Green Bay Packers. I understand losing, but the product they are putting on the field is an absolute embarrassment to the NFL and this community. I don't have time to call and vent to the radio talk shows and my wife hates sports, so all the lucky people of cerecdoctors.com get to be on the receiving end of my venting! In all seriousness. Failure of a team starts from the top. If the coach is not respected by his players and not giving them the 'right message' to perform, there is going to be a problem in the product they bring to the field. This is no different than our 'field' of dentistry. As business owners, it is our job to motivate our team to perform and act as leaders in our dental locker room. When I look back at the staff difficulties I've had over the years, it's easy to place blame on others for the job that they do. However, in retrospect, most can be traced back to my performance as a leader. If I listened better to their concerns and coached them better, most difficult situations could have been avoided. That being said, the Vikings coach Brad Childress cannot improve and needs to be fired. I need to be done watching sports ... wait, Purdue Basketball is on. Nice!

Don't Forget the Little Things

Sameer Puri (cerecdoctors.com co-founder) — Mon, 22 Nov 2010 07:36:28 -0700

As we wind down the year, it's time to reflect on the past 12 months. For me, it's been an interesting year. The travel to Scottsdale and other areas to preach the gospel of CEREC has been fun. I really enjoy seeing clinicians who have purchased a machine come through the courses at Scottsdale Center and have their practices transformed. But I have to tell you that all the travel, all the hard work takes a toll on you and your family. I'm so blessed to have a family that is supportive of all I do. My wife jokes and says, 'I thought I married a boring dentist, and here you are flying all over the world.' I'm blessed to be in the position that I am in, and more importantly, I'm really looking forward to the Christmas holidays. For the first time in I don't know how long, I will take two weeks off work and spend the time skiing in my favorite place - Deer Valley, Utah. Our family has been going there over Christmas for the past 25 years, and it has become a bit of a tradition in our household. I hope all of you are enjoying work, but more importantly don't forget the little things are the real priorities in life. Happy CERECing, and I look forward to a great 2011 with all my CEREC friends.

I Hate Barney

Peter Gardell (Faculty) — Fri, 19 Nov 2010 08:39:19 -0700

Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday. There are seven days. There are seven days in a week. My Week SUNDAY - My wife is driving and goes to stop, and with a large puff of smoke, the brakes fail. Luckily, she had the common sense to press the emergency brake and stop in time. MONDAY - I knew the cerecdoctors.com site would be down for maintenance, but I got worried when I couldn't get on when I checked for the 100th time at 3 p.m. I sent an email around and got a very helpful response: No CO. Thanks - Thank you very much TUESDAY - I go to retrieve a voicemail and notice the keypad on my phone has disappeared. Great. That won't be too inconvenient. Go to my cell phone company and they try to talk me into a new phone. WEDNESDAY - The only solution is a hard reset of my phone. So I back up my contacts - or it looked like I did. My laptop with the phone software all of a sudden cops an attitude and refuses to talk to my phone, so I have lost all contacts. It wouldn't have been a big deal, but then my network refuses to talk to my Rebel. I am used to communication issues with my teenage boys, not my computers. THURSDAY - We are having Indian Summer, and two of my AC units crap out and my landlord says they will take care of it in the spring. Why do I think it is going to be an issue in six months? FRIDAY - Just waiting on the icing on the cake. If it is like the rest of the week, this might be the last post you see from me. I don't think there is Internet access in the nut house. I hate that purple dinosaur.

Be Grateful

Mark Fleming (Faculty & Magazine Editor) — Thu, 18 Nov 2010 07:55:10 -0700

It is now the season. The season of do this, go there, buy that, etc. It can get quite hectic to say the least. Maybe it is time to take a deep breath and be grateful. I know I have many things to be grateful for: loving wife, great kids and grand kid, friends and opportunities associated with cerecdoctors.com that I never dreamed of. I am also grateful because it is one year at Thanksgiving since I completed chemotherapy for a bout of colon cancer. Even though I still have some remnants from some side effects of the treatment, I'm grateful that my health is pretty good. I've learned not to take things for granted. How about you? Taking care of yourself, so you can be there for your practice, your staff, your family and YOU! Maybe it's time to take a little time and reflect on what you are grateful for. No time like the present!

This Is It. The Calm Before the Storm!

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 17 Nov 2010 09:25:23 -0700

Mid-November is always ripe with opportunities, gearing up to close the year on a high, positive note, and for launching the new year with serious momentum. All of our staff are prepared for the flood of calls for year-end dental work. December is always the busiest time of the year. More importantly, everyone we have consulted with over this past year has been notified about opportunities with changing their plans with open enrollment, or even preparing for flex plans for next year. A lot of effort has gone in -- not just by us, but by our patients -- to prepare for new and exciting changes for next year. It is important to start January off on a good note so we don't play catch-up for the rest of the year. As we gear up for this storm, we hope that everyone has a positive experience and has planned well to propel themselves into 2011 with as much energy as possible. The next few weeks are critical for lining up the opportunities and helping our patients plan for the treatment that they want.

Plugged In!

Darren Greenhalgh (Faculty) — Wed, 17 Nov 2010 08:09:32 -0700

I was lecturing at a local CEREC study club here in Washington this past weekend. We were discussing how 3.83 has improved some of the features in 3.8. A couple of the attendees complained to the study club moderator and their CEREC specialists, wondering why they have never heard of 3.83 until this study club, since I told them that it has been out and downloadable for about a week or so. I defended the moderator and the CEREC specialist, jokingly stating, "That is why they were here at the study club meeting!" I can't think of a better way to stay plugged in than cerecdoctors.com. I love how important information is kept incredibly current in terms of updates, patches and new techniques on the website, to the point where most CEREC owners find out about this info and it is old news to us cerecdoctors. Keep plugged in, stay involved on the discussion forum, be involved with local study clubs. I can't wait to see many of you at the annual meeting. We have the best of everything CEREC right here!

The Minutes Seem Like Hours

Jeffrey Caso (Faculty) — Tue, 16 Nov 2010 06:56:24 -0700

As I sit writing this, I am trying to burn enough nervous energy to keep myself calm. My 17-year-old son is having a horizontally impacted wisdom tooth extracted at this very moment. The speed with which this once-vertical tooth turned has me concerned. A good friend of mine is doing the surgery and I have full confidence in his abilities as a surgeon and as a temporary surrogate to my son during the surgery itself. Nevertheless, thoughts of complications, anesthesia, recovery and the actual reason for this tooth turning in the first place have my head spinning. My decision to stay at work and have my wife take him has me having second thoughts as well. I want the surgeon to do his job without thoughts of me being in the next room. I now fully understand a phrase my father used a few years ago when we were sitting together in the hospital, keeping vigil over my mother during a very bad time in our lives. He kept looking at his watch saying, "the minutes seem like hours." So, as with any challenge in life, it's best to turn it positive and see what can be learned from a situation to make us better people or dentists. So many things become routine for us professionally. The next time I tell a patient that she needs root canal and she gasps, I will sit back and discuss the reason for the gasp and try harder to dispel her fears. The next time that 11-year-old boy is sitting in my chair with a broken central from a fall off his bike, I will try to do my best to calm both him and his mother, treating his broken tooth, and the patient and parent emotionally at the same time. In essence, we need to treat both the mouth and the mind. A few minutes of your time means so much to a patient, especially one in some form of distress. It helps them get through what may be routine to us, but is a crisis for them. Today I learned a lesson, and will be a better person and dentist for having gone through it. Now, only about 20 more hours until its over for my son. Oops, I mean minutes.

Do Patients Really Look for a CEREC Dentist?

Richard Rosenblatt (Faculty) — Mon, 15 Nov 2010 09:41:41 -0700

Can we get new patients and referrals because we use this fantastic technology? Sure we can. I was doing an in office training last week in San Diego. At 7:30 a.m. I got a call on my cell phone from a receptionist at another general dentist's office in my area that was on vacation. The receptionist told me that they had a patient that leaves the Chicago area for the winter and heads to Florida. She broke a tooth and needed a new crown. The problem was that she was leaving that Saturday and wouldn't be back until spring. The dentist is a CEREC dentist, and the receptionist knew that I used CEREC and asked if I could fit her in the next day. I said I'd be glad to since I was heading home that evening, and she could not be seen in their office before she left. The next morning I did a buildup and a crown, and 90 minutes later she was off and finishing her packing to leave for the winter. She was so appreciative for being taken care of, and told me that she does not understand why all dentists don't use the technology, and why it is not advertised more to create awareness. I told her when she gets back, her dentist will need to replace the crown in front of the one I just did because it had an open margin. She said that she was looking forward to removing it and having another CEREC done. Looking forward to a dental procedure??? I provided her a great service that she was happy to pay for. I filled a hole in my schedule and did not have to worry about a temp, impressions, or occupying my operatory for a second visit. This technology will get you new patients. You won't see dozens at a time, but the longer you use the technology, the more they seem to seek you out. I love days like this!

Technology Is a Wonderful Thing

Mark Fleming (Faculty & Magazine Editor) — Fri, 12 Nov 2010 08:28:54 -0700

Once again, it has come about that one-visit dentistry has a definite advantage in today's practice. Both cases happened Monday. The first: a consultant who leaves early Monday and returns home Friday afternoon. She will be working on her current project for quite awhile. She needed to have a crown done, had this week off, and we were able to accommodate her by having the service completed in one visit. A win/win for all involved. The other case is a person who is now severely limited in traveling, having to use a wheelchair to get around. She broke off an anterior tooth. Since she is in a rehabilitative center, having a new crown to allow her to smile again in as few appointments as possible was huge for her. Ah, technology, a wonderful thing!

Monitoring the Threads

Mike Skramstad (Faculty) — Thu, 11 Nov 2010 08:19:41 -0700

One of the best features of cerecdoctors.com is that the discussion threads, videos and .cdt files are monitored directly by the Sirona software engineers and people in charge of developing the software. Now, we as beta testers have the ability to communicate with them all the time. We direct some of the things we learn to the site, and try and help as much as possible. But we are dentists, not software experts. We cannot possibly explain the nuances as well as the people who actually develop the CEREC software. So, when you, as users, are having technical questions and certain challenges with software or with cases in general, you can take comfort in knowing that as members of cerecdoctors.com, you have the ability to indirectly communicate with Sirona as well! To this point, both Ingo Zimmer and Chris Goodson are scheduled to speak at the 3rd annual CEREC Owners Symposium at Scottsdale Center for Dentistry, July 15-16, 2011. I strongly encourage all of you to find the time to attend. As we move forward with the software, who better to learn from than the actual developers? Hope to see you all there next summer.

I Can't Decide What I Like More

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 10 Nov 2010 17:15:27 -0700

[secondmolar.jpg] Placing implants, doing CERECs, or restoring implants I placed with CEREC! Fun way to finish the day.

Darwinism in Dentistry

Peter Gardell (Faculty) — Wed, 10 Nov 2010 08:34:54 -0700

I just went through a bad conversion. No I'm not talking about the born-again type. I was using an older PMS that the company felt was so great that they didn't have to upgrade it. I also have made significant changes to the imaging systems in the office, so I wanted a software package that allowed me the flexibility to do what I want. I went with Eaglesoft, and they were very good with getting me the package I wanted. The problem - and it was due to me not thinking it through - was that all the patients of my former partner, and all my inactive patients were switched to be my active patients. Wonderful. Well, only one thing to do: put the tunes, on roll up the sleeves and get busy. After sitting down and going through the motions, I did start seeing a good purpose in this exercise. Usually when you are going through your reports trying to keep track of patients (more specifically, the patients you lost), it is a number you can easily overlook. What is normally a trickle, a non-factor, turned into a brick wall I just drove into. As I evaluated the "lost patient," I was able to look for trends. Were they emergency patients? Were they people that were a "1 and done" ? If they returned, was it only for another emergency? Were they a simple prophy? Did they set-up a re-care visit and no-showed? Was there a pattern on who they experienced first? You might think your systems are in place and followed, but your plans might not be followed when you are in the back treating patients. And most of the time, people who are not happy will not say anything, they just won't return. Due to the interesting economic times, were they regular patients who stopped coming two or three years ago? I have a lot of financial houses around me, and the past few years haven't been good to them. I am still evaluating a lot of the info and looking for trends. As things materialize, I will keep you in the loop. So when things happen, be an optimist and look at how you or your office can benefit from your journey to find a solution. Think Darwin.

Google Voice

Sameer Puri (cerecdoctors.com co-founder) — Tue, 09 Nov 2010 06:56:25 -0700

If you haven't done so already, consider getting a Google voice number. First of all, it's free. Yes - FREE!! You get your own personal number that you can give to your family and friends. The best part is you can assign the contacts so that only those people that you select will be able to call you. The rest goes directly to voicemail. Not only that, you then get an email and a text of the voice transcription of the message, so that you can simply read the message instead of having to go to voicemail and listen to it. Lots of other great features in it as well, including the ability to customize your ring tones, having the number forward to as many phones as you wish, and the ability to screen calls by listening to the voice mail, and if you want, simply pick up and talk to the person as they leave the voicemail. By the way, did I mention it's free? Go to www.googlevoice.com

Does Insurance Pay for Onlays?

Richard Rosenblatt (Faculty) — Fri, 05 Nov 2010 08:07:21 -0700

This is one of the most common questions I get from people. The answer is absolutely yes. This comes with a caveat. You need to document. I was at a CEREC lecture many years ago led by a respected colleague who said that when your house burns down, the homeowners insurance does not want to see what your house looked like before, or the McMansion that you built after it burned to the ground. The insurance company wants to see pictures of the destruction. They don't want to see the pristine tooth you made, or the beautiful MODL onlay prep you did, or just a two-dimensional PA of a situation, they want to see the destruction. Make sure you get out your camera and take pictures of the active decay and the undermined cusps. See pics below. [rich1_2817.jpg] [rich2_2818.jpg] Also, make sure that you print this out on real nice photo paper, and make lots of arrows and notes to the areas you want to highlight. Things like deep crack lines and thin remaining cusps with no dentin support. Make notes on this in bold letters with big arrows showing exactly what you are describing. If you take the time to do this, you will be surprised at how willing insurance companies will be to reimburse you for your effort.

Vacation

Mike Skramstad (Faculty) — Thu, 04 Nov 2010 08:50:41 -0700

I know most of you take plenty of vacations during the course of the year. However, if you are a workaholic like me, sometimes you neglect some needed time off with the family. I finally took a vacation last week, and I have to tell you, I feel more energized than I have in a long time. Don't get me wrong ... I have many "families," and everyone on cerecdoctors.com is my second family - and I maybe took a peek or two on the site during the week. Most of the time I just spent time with the family and flat-out relaxed. If you've never taken a week off and just stayed at home, I highly recommend it. Sometimes when you travel, you need a "vacation from a vacation." One thing that I did was reread a book given to me by Imtiaz Manji called "Awareness: The Perils and Opportunities of Reality." It's an excellent read about some of the challenges all of us face in life, and how to realize your potential and the potential of others. I definitely recommend everyone check it out. So please, when you have the chance to relax and reflect, take advantage of it. Life is too short to ignore what's really important.

Still Amazed

Mark Fleming (Faculty & Magazine Editor) — Wed, 03 Nov 2010 08:06:25 -0700

It still amazes me after all these years how incredible this technology is. I have two patients whose insurance benefits are running out. I was able to do their restorations and have them seated this week BEFORE benefits ran out. If I had had to wait for a lab to return the restorations, the patients would not have been able to utilize their benefits. Also, sometimes I forget how neat and fascinating the procedure is. Just had a patient ooh and ahh about everything, from the digital impression, through the design process to the final milling. There will definitely be some good word-of-mouth advertising there!

Some Things Change, Some Don't!

Darren Greenhalgh (Faculty) — Wed, 03 Nov 2010 07:48:26 -0700

I have recently been thinking about my CEREC experience over the years. What has changed: Don't some of you just miss CEREC 3 days?!?!?! Oh, the nostalgia! only two dimensions, multiple windows, all those dotted lines, and only Correlation! Most of you who got your feet wet with the CEREC 3 had good days and bad days, and none of us would EVER go back. With the addition of CEREC 3D, biogeneric inlays/onlays and crowns, buccal bite, form tools, how easy catalogs stitch, and the Bue cam - wow, what fantastic software and hardware upgrades we have seen over the years. What hasn't changed: The way CEREC has brought me many memories with the best of friends. I can look back on those CEREC 3 days when i first met many of you on various email lists, and easily say it was years before we met face-to-face. I still remember meeting both Rich Rosenblatt and Mark Fleming in a hotel in Chicago about two to three years after meeting them online, and that night trying to eat a whole chicken that had to have been part turkey, it was so huge!!!! My friends have been the same great friends over the years and many of you are new friends. What will change: Cerecdoctors has played such a huge role in CEREC education, and it isn't very old!!!! Every one of us look forward to see how big this will get and how many people we can help make this a very rewarding technology. My CEREC circle of friends will get bigger and bigger every year. So, I'm really excited to see what the future holds - both software and friendships.

You Have No Right to Complain If You Don't Get Involved

Peter Gardell (Faculty) — Tue, 02 Nov 2010 15:39:06 -0700

Here we are - November 2 - we have to do our duty and vote in the elections in the states. It doesn't matter which way you lean - vote with your conscience. Food for thought, though. The governor of New Jersey put a stop to a large public work project since there was an estimate of seven BILLION dollars in cost overruns. He said the state is not healthy and couldn't take the chance of putting this burden on the shoulders of the New Jersey taxpayers. A tough - but understandable - decision on his part and one in the best interest of his state.

Save, Save, Save

Sameer Puri (cerecdoctors.com co-founder) — Tue, 02 Nov 2010 08:01:37 -0700

A recent headline on Yahoo Finance said that equities, aka stocks, are becoming fashionable again. In 2008, after the market crashed and went down to 6,500 or so, every single person in the investment community said that this time it's different. The market is never coming back. Our financial future is ruined forever and this country will never recover. Well, it's the job of the news media to sensationalize the news and make it seem that every event that happens is the end of the world. The Great Recession, as it came to be known, was going to forever change the way we save and invest in this country. And not only that - for the vast majority of Americans, retirement would be forever delayed. Let's put the events of the Great Recession into perspective. If we were to look at the events of the past few years, they certainly seem catastrophic by any measure. The market loses 50 percent of its value; unemployment tops 10 percent, foreclosures at an all-time high. So yes, things were bad. But compared to other events of the past century, maybe the past two years were not as bad as we thought they were. World War I was certainly a larger event this country endured. As was World War II, the Vietnam War and possibly the Korean War. How about the bombing of Pearl Harbor? For those of you old enough to remember, what about the gas lines of the '70s, and smaller, more recent events like the dot-com bust of 2002 and the real estate meltdown of the '90s. All of these events had tremendous impact on this country. After all of these events, the experts claimed that this time it's different. That this time, things would forever change the way this country invested, saved and retired. Well, it's been the same every single time. After each disaster, the market has bounced back, and bounced back strong - returning double digits after crashing hard. The lesson to be learned? Stay invested; keep saving, because it's always the same. Those who don't panic and try to time the market come out smelling like a rose. Those that panic and try to buy low and sell high, usually end up buying high and selling low. Invest in your practice, invest in your savings and remember, this time is no better or worse than all those times in the past 100 years. We survived and persevered then, and we shall do so now. Good luck.

Garbage In; Garbage Out

Jeffrey Caso (Faculty) — Mon, 01 Nov 2010 07:58:51 -0700

Many years ago when I was just out of dental school and starting my own practice, I was worried about the quality of my work and what people would think of my abilities. I would stress mostly about impression-taking, and if the lab would have a problem with what I sent them. To assure myself that I was sending them the best, I would pour up models and then painstakingly sit with a scalpel and 27-gauge needle and remove small bubbles and blebs from the stone. As time went on, confidence in my abilities improved and I felt that I no longer had "prove" myself. I did, however, feel - and still do feel - that there was someone watching when I sent off that very rare impression. This feeling of needing to provide the best impression to get the best job in return is important, and helps to keep you honest in judgment of your own work. After becoming a CEREC dentist, there is no longer anyone who will see your "impression." It is easy to take shortcuts and just draw that margin line where you think it is. This is a terrible trap to fall into, and will soon lead to failure. One of the goals clinically, after the prep, is to do whatever is necessary to capture that information clearly. This is the same whether taking an impression or taking images. Laser trough, pack cord or leave your margin high and dry. Whatever your choice, do it methodically with the end result in mind. Work on building your virtual model the same way you would take a great impression. Don't be complacent and settle on a very tolerant or tolerant camera setting. Start at standard and work to move toward a strict setting. This will assure that your model will be crisp, clean and free of shake. It's the difference between an impression with drag in places or a well-defined, easily read impression. Isolate well, powder properly, take great images and you will be rewarded with a beautiful virtual model. This will set you up for an easy time through the rest of the design process, including getting the best proposal the software can give. Even though the means to the end will never leave your office, practice like you have someone watching over your shoulder. Strive for the best and sleep well at night.

It's Not All About CEREC ... Sometimes You Have to Give Back!!

Richard Rosenblatt (Faculty) — Fri, 29 Oct 2010 09:34:31 -0700

As dentists, most of the time we are caught up in our everyday endeavors. For me, first and foremost, it is my practice and the daily rigors that come with running my business. A close second seems to be how CEREC has engulfed my life with cerecdoctors.com and teaching docs about the technology and how to use it. This is certainly in a good way, but for the last few years I seem to have blinders on to those things only. A few weeks back, a colleague I recently trained in CEREC asked me to help her in her office for a day of charity dentistry, through an organization called Dentistry from the Heart. I was happy to offer my services. I arrived at the office and worked on lots of people. We offered hygiene, fillings and extractions. Many were just down on their luck and have been struck by the hard times of the past few years. Others have been dealing with hard times for much longer. Each person had a different story - some just wanted a cleaning because it had been more years then they could remember; others had pain and swelling and needed emergency extractions or fillings. There were no CERECs done. Most days I'm very sad when I don't see them on my schedule. Today I was just happy to be there to listen to their stories, and to give these wonderful and thankful people treatment that they certainly needed but could in no way afford. I know that many of us have complained that business is down over the past few years. I know that my practice is down a bit. For some reason, that didn't even come to mind today. We have the ability to do wonderful things for wonderful people. Sometimes, it is a great feeling to do just that and ask nothing in return. If you would like more info about this amazing organization, their website is dentistryfromtheheart.org. I have to say that I have not felt this good in a long time. Sometimes you have to give back!

Blogging from About 39 Feet Above Sea Level

Armen Mirzayan (cerecdoctors.com co-founder) — Thu, 28 Oct 2010 17:57:43 -0700

Sarmen Technique: Transferred a lab wax-up to this distal extension case, checked occlusion, and then Sarmenized this quadrant. 84 minutes from first optical impression of the second molar till try-in of of these 4 e.maxes today. [4mexaes.jpg]

Blogging from 30,000 Feet!

Sameer Puri (cerecdoctors.com co-founder) — Thu, 28 Oct 2010 11:48:26 -0700

No - I'm not typing this with my toes. I'm typing this from the air as I fly to Florida for the CEREC Discovery event, where I will be one of the presenters. It's amazing how far we have come with technology. I've been able to catch up on a bunch of emails, download some photos for my presentation, and more importantly I've been able to keep myself entertained! I love technology and I love the fact that we can be productive. My favorite airline now is Virgin America and Jet Blue is a close second. These companies have innovated and made the experience of flying across the country tolerable. My hope is that as innovation has spread across our world, so too it will continue to penetrate the world of dentistry. (I know Pete already posted a blog entry today, but I wanted to do it while flying 30,000 feet in the air!)

Be a Lurker No Longer!

Peter Gardell (Faculty) — Thu, 28 Oct 2010 11:06:55 -0700

Do you want to push yourself to do better? Start posting cases. This is one of the things that intimidated me so much when I first got my CEREC, but on a dare from Dr. Caso, I did it. This was on DT, not usually a "friendly" site like cerecdoctors.com. It turned out to be a great experience, since it gave me the opportunity to get a lot of feedback that made me improve the restorations I did. And as you post more, it gets easier with each case. There are a lot of great practitioners that are active on cerecdoctors.com who can give great advice to help you step it up. It is truly one of the great things of membership. Design tips, imaging tips, stain and glaze tips, and the ever-popular Skramification shortcuts and work-arounds. But to get the benefit, you've got to throw a case up. I dare you. You won't regret it.

Financial Planning

Sameer Puri (cerecdoctors.com co-founder) — Wed, 27 Oct 2010 14:18:44 -0700

One of the best things I've ever done in my life was to start working with a financial advisor. The key is you have to find the right person/firm to work with. There is no doubt that you will get 50 different opinions on this from various members on this board, and those folks will have their own biases as to what has worked for them. The important thing to remember is, don't think there is only one right way or only one wrong way. There are many paths to success and I'll share what has worked for me. Obviously you can use bits and pieces from my advice and also follow the path of others to see what works best for you. In regard to a financial advisor - unless you have boat loads of time to do the research, follow the trends of the market, etc., it's very difficult to stay the course on your own. What an advisor did for me is to set up the blueprint for investing. They set up my monthly withdrawals, they gave me my goals on what I needed to invest in each month, they gave me my retirement goals, they set up my 529 plans for my kid's college education, they advised me on the type and amount of life insurance to get, and they made sure that I follow and reach my monthly targets. When I first went to meet them, I was worried. I was worried that they would budget my wife and I, tell us not to spend money on the things we wanted to spend money on. But frankly, the initial meeting was not about how not to spend money. It was more about, 'Hey, you are spending this much; what do we need to do to make sure you can maintain this lifestyle in retirement.' What you should look for in an advisor are the following: - They don't sell you anything - If my advisor was selling me insurance, I'd be leery. If they were selling me real estate opportunities and get-rich-quick schemes, I'd be worried. Advisors simply advise. After we met and discussed life insurance, for example, I went out and got my own quotes on my term policy. - Advisors should not be actively trading stocks - No one can beat the market on a regular and consistent basis. If your advisor is telling you the latest and greatest hot stock to buy - run. They should have a plan, and they should invest regularly for you. - Advisors get paid a flat percentage - Mine takes 1 percent, and less on amounts of more than $500K. If they are making money on commissions selling stock, insurance or anything else, buyer beware. - Advisors should be available to you to help you plan - I call mine on a regular basis (included in my 1 percent) and get advice on all sorts of things, from real estate and business transactions, to tax planning, etc. Find a fee-for-service advisor - When I was making $13K a year as a resident, it wasn't really important to me to worry about what I was doing with the few hundred bucks that were left over each month. Today, when I make a lot more money, I need a team of professionals to help me manage. My financial advisor is part of my team, which includes my attorney and accountant. I work with Mercer Advisors, and have been very happy, but there are other great suggestions on these boards for other firms that do a similar service. By working with my advisor and building up my portfolio, it has allowed me to have the savings and cash to be able to invest in other businesses, real estate and anything else that I want. If I'm business- and real-estate rich, and cash poor, it really limits what opportunities I'm able to take advantage of. Good luck.

Is There Anything Easier for Restoring an Implant Than a Screw-retained e.max?

Armen Mirzayan (cerecdoctors.com co-founder) — Wed, 27 Oct 2010 13:29:58 -0700

I just seated an implant crown made extra-orally. I grabbed a fixture level impression and poured it up last week. Seated a prefabricated abutment on the model and modfied the margins to where I wanted it. Scanned with CEREC and verified seat and contact. Bonded them together outside the mouth and polished the restoration to a 'spit shine' as they say in ... well, wherever! Anyway, seating this thing was the easiest thing in the world, and not having to clean up cement was the best thing. We just need some studies that show punching a hole through emax for this purpose is a valid approach. But so far, so good!!![emaximplantcrownSmall.jpg]

Feeling Fortunate

Mark Fleming (Faculty & Magazine Editor) — Tue, 26 Oct 2010 07:38:41 -0700

I recently replaced my chairside assistant - not much of a self-starter. Never got around to learning about CEREC, even though she had ample opportunity to. Her replacement: total opposite. I had shown her staining and glazing. She is on cerecdoctors.com a lot, learning. I came back after being out of the office, and she showed me some beautiful crowns she had done. Nice!!!!! Also feeling fortunate to work with Sam, Armen and the rest of the crew teaching at Scottsdale Center. Feels good to see people really catching on to how to use this great technology. Yep, feeling fortunate!

Choices

Jeffrey Caso (Faculty) — Mon, 25 Oct 2010 08:40:25 -0700

Every day - in both our professional and private lives - we make hundreds, perhaps thousands of choices. Every decision we make is important; each one shapes and molds our day into what it will be remembered for. Was it a good day or a bad day? Did that procedure turn out well, or could different choices made along the way have changed our outcome for the better? If we manage our private life well, our physical and mental states will be at the ready to have a positive effect on our clinical needs. Get in tune with your body. Give it good healthy foods, plenty of water and daily exercise to allow it to work optimally. When the body is doing well, the mind will follow. With the mind humming along crisp and clear, you will be at the top of your game. When sitting down to treat your CEREC patient, spend a few minutes to prepare for the case. Review X-rays, clinical notes and the patient's history. Chose your design option, block type, and make sure your armamentarium is set up properly. Direct your full attention to the job at hand, block out the outside world, be dynamic, make decisions and change previous choices on the fly. The greatest part of CEREC is that it's all you. Yes, the machine does a specific thing, but it's your technique, knowledge and choices that come together to produce the final result. You should strive to be proud of each and every CEREC restoration YOU produce. CEREC puts you in control. Run with it, but don't forget to spend a few minutes admiring and evaluating your end product. By producing something that you can be proud of, you will be more fulfilled in your professional life. This, in turn, will make your private life happier, and the cycle will repeat itself in a positive manner. Strive to enjoy your work and every aspect of your life will be better.

Making CEREC Technology Profitable and Efficient

Richard Rosenblatt (Faculty) — Fri, 22 Oct 2010 08:21:56 -0700

I have to say that teaching this technology has become an extreme passion of mine. I just love helping people grasp the concept of CEREC, and help them to 'think like the computer.' The issues are usually the same for most new users. Prep, powder and picture are the big three. The other big questions I get are cementation, insurance and scheduling. CEREC is a total paradigm shift for most who embark on this CAD/CAM journey. They now have to figure out how to schedule properly to make this technology profitable and efficient. Here is my big tip: TIME YOURSELF! The CEREC procedure basically has three parts to it. For parts 1 (prep) and 3 (cementation), the dentist must be there. The middle part is where we can drastically improve our bottom line by scheduling another patient or another procedure on the patient being worked on. The key is to find out how long it will take you to get to step 2. If you time each section, you will make yourself very efficient. I know that in my practice, I can get my prep done in 30 minutes or less (usually less). At the 20-minute mark, the next patient can be scheduled for their treatment. That patient can be brought back and anesthetized. Once the prep is done, the middle portion of the procedure can be delegated to staff. Design, milling and characterization can take anywhere from 15 minutes to 40 minutes, depending on material, milling chamber and whether you polish or glaze. If I'm doing an e.max, I have at least 30 minutes to do another procedure. I can be pretty productive, even in 30 minutes. We offer the patient waiting for their CEREC a magazine, satellite radio or TV to occupy their time. You can train your staff to design, mill, characterize and even adjust the restoration. Once it is all done, the doctor is called back for part 3, final cementation. Know how long it takes to do each step. Then make sure your staff is properly trained. If you train properly and delegate accordingly, it is amazing how efficient you can become with your CEREC.

Using Biogeneric Rules for Quadrant Planning

Mike Skramstad (Faculty) — Thu, 21 Oct 2010 10:42:01 -0700

When the V3.80 software first came out, we made videos that discussed at length how the software algorithms worked to come up with your biogeneric proposal. Specifically, the software will look at the mesial 50 percent of the distal tooth (to the prep) first. If that isn't present, it will then look at the mesial tooth (50 percent of the mesial tooth to the prep). If neither is present, then the software will give you a 'generic' database proposal. These concepts are very important to understand when taking on biogeneric quadrants. You have to use these rules as a basis to which tooth should be designed first, and why. Once you understand these concepts, it will make designing biogeneric quadrants much more predictable and easy for you. The following video will illustrate this concept in detail. [biogenericquadrules.mp4-v-]

Ingo Zimmer Confirmed for 3rd Annual CEREC Owners Symposium

Sameer Puri (cerecdoctors.com co-founder) — Wed, 20 Oct 2010 08:54:34 -0700

I had to do some arm twisting, some begging, and some threatening over at Sirona, but I've managed to confirm Ingo Zimmer for the 3rd Annual CEREC Owners Symposium next year. Ingo leads the programming team for Sirona, so it's great to get his commitment that he will be speaking for us. He did an incredible job with his keynote address at the CEREC 25 meeting, and I have no doubt he will do even better at next year's CEREC Owners Symposium. Make your plans now to be at this limited-attendance event. We are planning some great speakers, and I'm biased, but I'm really looking forward to working with Ingo. Having gotten to know him over the years through beta testing, I know he will bring a world of knowledge as it relates to the world of CAD/CAM, and will give you insight into not only CEREC software development, but also a look behind-the-scenes on how the software is actually developed and how it works.

Rediscovering CEREC from an Another Perspective

Peter Gardell (Faculty) — Tue, 19 Oct 2010 08:13:38 -0700

I recently learned that I have started to take the technology in my office for granted. When I first got my CEREC, or returned from a course, the patients picked up on my excitement for CEREC, but as time has gone on, I don't think I retained the same excitement. I took the technology for granted. It had become the "standard" way of restoring teeth. I have become too comfortable with the CEREC. My staff has accepted this as the standard, and they don't pass the same excitement along as they did in the past. My existing patients already have heard the milling chamber going. A lot of my patients already have had CEREC restorations performed, and love them. They expect one-visit, all-ceramic restorations that look fantastic and feel like their own natural teeth. SO I hired this videographer who has filmed in many dental offices, and we started going through the motions of him filming our office. I took him in the back and we started filming in the ops, and I demonstrated the CEREC system. A quick buccal bite scan utilizing liquid reference, and the models stitch in an instant. In a few seconds, a very nice biogeneric crown. He was amazed, and re-filmed three times. 'No impression material,' he kept saying, 'and no temps!' What I thought would be a quick segment of the total shoot ended up being a bigger part of the morning. I thought I had so much to show this guy at the new office and he wanted to hang out seeing the CEREC in action. And this was all due to a person who has been to a lot of dental offices being wowed with the CEREC technology. If you find yourself getting too comfortable with the CEREC system, think about how you can recharge you and your staff's excitement. Push your limits by trying new techniques, taking a course - or even better, take your staff with you for a course. You won't regret your investment.

Don't Miss a Great Opportunity!

Jeffrey Caso (Faculty) — Tue, 19 Oct 2010 07:57:18 -0700

There is a shift in the way we practice when we get involved in CEREC dentistry. I am not talking about the obvious things, like providing single-visit crowns or not taking impressions, but a more subtle shift, which results in an opportunity which many of us miss. What I am referring to is the idea that we need to get patients in and out to be profitable. Suddenly, we are faced with time to mill and time in the oven, which gives us down time that we are just not used to. It is that down time that becomes our opportunity. Of course, there is always something to do to fill that time, like surf cerecdoctors.com, but let me make some suggestions that may take some getting used to. First, I never leave my patient alone in the treatment room during this down time. I offer to get them something that they might need, like their cell phone or see if they need to use the bathroom. If I absolutely must do something else, I keep the assistant who helped with the prep stage in the room. I like this consistency. In front of the patient, the room is tidied up, wiped down and made to look fresh. New instruments are put out and the patient gets a fresh, clean bib. This just shows a level of cleanliness that everyone likes and creates a feeling that we are looking after them in every way. I try to personally stay in the room as much as possible. I like to strike up a conversation about really anything that comes up. Most of the time it's not dental- related, which I actually prefer, as it helps to personalize their visit, allows us to get to know them if they are new to the practice or just chat with veteran patients. Many times the dialogue leads back to dentistry and often we are soon discussing further treatment that they might need. It can be difficult to slow things down enough to do this, but it can be very fulfilling. It makes a dental visit personal, interesting, and creates a great experience for the patient which goes beyond treatment rendered. More than that, it builds patient loyalty, which is an enormous asset to a practice in today's economy.

Register NOW for the 3rd Annual CEREC Owners Symposium at Scottsdale Center!

Sameer Puri (cerecdoctors.com co-founder) — Fri, 15 Oct 2010 11:50:14 -0700

Everyone who attended the CEREC 25 meeting is sure to enjoy the upcoming 3rd Annual CEREC Doctors Symposium. We hope to give you a peek into the future, as well as show you all sorts of interesting things that you can do with CEREC. I am scheduled to speak, along with Imtiaz Manji, Armen Mirzayan, Mike Skramstad, Ingo Zimmer and a whole host of others. Our goal is to load the program with beta testers who will be able to teach, and show you all the features that they have been testing. THIS MEETING IS A CAN'T-MISS. Seating will be limited, and you absolutely need to reserve your space as soon as possible. The meeting will be held July 15-16, 2011 at Scottsdale Center, the most advanced educational facility in the world. Make your plans, and do NOT miss the CEREC event of the year. To register, call Shayna Phipps at 480-588-9101.

CEREC, One City at a Time

Richard Rosenblatt (Faculty) — Thu, 14 Oct 2010 07:45:12 -0700

What a whirlwind weekend. Spent Thursday in Cincinnati with the fantastic Patterson branch there. I was asked to speak to more than 40 doctors wanting to learn more about this technology that us CEREC junkies can't imagine practicing without. I then woke up early Friday and hopped on a plane to Orlando for the weekend to work with Sirona at their booth at the ADA meeting. The ADA was a nice meeting. One thing that consistently surprises me as I travel around and talk to doctors about this amazing technology is how many people don't know about it! Mark Fleming and I spoke to doctor after doctor who stopped by the booth and wanted a demonstration because they have never seen it and wanted to learn about the process. There is nothing better than seeing the awe in their faces when a case is imaged, designed and milled. I know it well because it still happens to me seven years later, and that is why I continue to preach CEREC... one city at a time.

CEREC AC Connect Launched in Orlando

Mark Fleming (Faculty & Magazine Editor) — Wed, 13 Oct 2010 09:14:32 -0700

Recently, Dr. Rich Rosenblatt and I had the pleasure of working at the Sirona booth at the ADA meeting in Orlando. We helped in the launch of CEREC AC Connect, the newest, fastest, most economical way to utilize digital impressions in one's dental practice. The amazing technology of digital impressions now has an ROI! Below is a photo from the booth while displaying a certain prominent magazine.[rosenblattandfleming.jpg]

An Unexpected Source of Team-building

Peter Gardell (Faculty) — Tue, 12 Oct 2010 09:26:09 -0700

An interesting thing came to my mind this week. I took Dr Skramsadt's advice, and arranged to have a videographer come to the office to film for my updated Web site. This made me do a few things to prepare. My office is only a few months old and I thought it was looking good, but I wanted to bring it up a notch or two. I got the staff involved by having them go shopping on a day I was out of the office to get some new things for the walls. I made sure that those going asked the hygienists who are not normally in that day for ideas for their rooms. We are changing seasons, so it was needed anyway. I walked through the office with everyone. And instead of running through the place to either get in on time or running out the other way to get out early, we actually looked at the waiting room, the front desk area and the treatment rooms. The question asked were, would you want to be treated here, and would you want to come back. I needed to go through with the staff since I am color blind and have no appreciation for what color goes with what. Turned out to be a great team-building exercise. Was good for communication, and gave the people a feeling of ownership on how the practice looks. People noticed and made positive comments. We told them what we were doing and why we were doing it. And the staff took pride in the fact that they made a difference. For internal marketing you want to get the patients motivated, get them excited. Some of the patients asked if we were accepting new patients, and of course are answer is we are always looking for good patients such as you!

Sirona Announces No Scan Fees

Sameer Puri (cerecdoctors.com co-founder) — Mon, 11 Oct 2010 08:03:55 -0700

Sirona has just announced that anyone who wants to get a digital impressioning system can buy the BlueCam with the CEREC Connect software for only $26,000 and NO scan fees. In the past, every digital impression system would have the base cost (anywhere from $25,000 to $27,000) and then the user would have to pay a scan fee of $25 to $30 every time they took a scan of the patient. By eliminating the scan fee, Sirona just reduced the cost of getting into digital impressions by about $30K! Imagine - you can send unlimited impressions, and other than the cost of the system, there is no additional cost. No more PVS, no more trays! It's all done digitally. It will be curious to see how the other systems out there respond to this, and whether Itero and Lava will do the same. If so, the cost of digital impressions will come way down. I'm glad to see the manufacturers taking such an aggressive stance. My opinion is that some day there will be a generation of dental students who will go through school and will never take a physical impression with PV; that taking a PVS impression will be as foreign to them as taking a copper band impression is to us. The next logical step is to add chairside milling, which all of us CEREC users already know. But congratulations to the people who are about to at least get their feet wet with digital impressions.

Seeing the Light...

Mike Skramstad (Faculty) — Fri, 08 Oct 2010 19:47:12 -0700

I'm sitting in the airport reflecting on my day and CEREC. Today I trained an office on digital impressioning with the CEREC system. The particular office was very familiar with ALL the digital impression systems on the market today and was rather discouraged with the entire process. I spent the first part of the visit presenting 'general' information on CEREC Connect, and the advantages of this system compared to the others he's tested. He was very receptive and 'friendly' throughout the entire presentation. However, it brought a real smile to my face when he finally imaged intraorally with the CEREC camera. The first thing out of his mouth was: ' This is SOOOO much easier than the other systems I've used.' That one comment speaks volumes, and made my entire day. When someone 'sees the light,' it makes everything worth it.

Behind the Scenes

Sameer Puri (cerecdoctors.com co-founder) — Fri, 08 Oct 2010 07:54:38 -0700

This post is more for you techie types out there who are interested in servers, bandwidths, bit rates, etc. We are in the process of moving our entire server set to a whole new dedicated set of servers on a dedicated server farm. Most Web sites share servers, meaning the computer hosts multiple Web sites. With the increases in traffic and membership on cerecdoctors.com, it was necessary to do a dedicated server solution. This means faster downloads, faster response time, and to us, running the Web site, it means more stability, less work to support the site, more time dedicated to answering questions and creating videos. We have gone through about eight different solutions in the past few years, and every time we change servers, it's a nightmare from a logistical standpoint. But hopefully we have a solution in place that will be more permanent, and give us security and stability for many years to come. The new servers will allow for better searches on the Web site, the ability to play all the videos in any format on any device, and the ability to have all the videos in HD. The innovation doesn't stop here. Just as Sirona innovates the software and hardware, we will make sure that your educational experience on www.cerecdoctors.com is second to none.

The Future of CEREC

Sameer Puri (cerecdoctors.com co-founder) — Thu, 07 Oct 2010 07:53:52 -0700

CEREC 25 is a distant memory, but I think its so critical to remember and keep in mind the lecture by Ingo Zimmer -- head of the Sirona software development team. Ingo's lecture was great -- I'm very proud to call him a good friend, and I was happy to see him on the main stage giving a keynote lecture. More importantly, I sat with great concentration listening to him as he talked about the future of CEREC. What caught my attention most was when he talked about multiple units -- being able to design up to 32 units at a time, on either arch, upper, lower, different quadrants, any design technique that you want. That will be, for a lack of better word -- HUGE! With the way biogenerics has performed for single teeth, imagine being able to do a biogeneric arch. Just prep your teeth and get your proposals. Just freaking sweet. Well, that leads me to this thought: will the CAD/CAM revolution end at that point? Honestly, with the ability to do a full mouth rehab with a single click of the button, what else is there for Sirona to do? Will that mean that at that point CAD/ CAM finally just becomes another tool? Another device that is like an X-ray or the handpiece? That little incremental gains in technology are more evolutionary instead of revolutionary? Think about it. With the BlueCam, imaging is super easy. Just a bit of powder, and image away. Now, with the ability to do multiples, how many new CEREC owners will be out there in the next five years? 5,000? 10,000? More? All I know is that this Web site is going to get super busy, and the faculty better be ready with their game faces to help all the new owners out there with all their clinical and software questions.

Discovering CEREC (It's never too late!)

Jeffrey Caso (Faculty) — Wed, 06 Oct 2010 07:59:35 -0700

Back in 2000 after being in practice for 11 years, I made a personal decision, which I knew would have a great impact upon my practice. I wasn't exactly sure at the time whether that impact would be largely positive or largely negative. It was more than just a decision, I was making a stand. I was committed, and I was going to go with it and make it work no matter what. That was the year I placed my last amalgam filling. Since then, I have moved forward and while I won't say, I never looked back. I will say that I never looked back for very long. Eleven years after that decision was made, I went through the rough times. I am proud to say that my office has been amalgam-free for more than a decade. Now, keep in mind, the idea of CEREC back then was very different than it is today. CEREC was just not on my radar those days. It was an idea that intrigued me greatly; I just wasn't ready to accept it. I needed to evolve clinically. I needed to experience the pain of failure. I needed to be knocked down before I could stand tall. For me, the evolution was hard, and I fought to learn and figure out where I was headed clinically. I began doing large, labor-intensive composites that looked great for a short period of time. I then moved on to an indirect composite material called Concept. Aha, I thought I found the answer to all of my problems. Soon the material was taken off the market for a reason I never found out. Then a real breakthrough occurred. I found a material called Belleglass, promised by the manufacturer to be the best-looking, longest-lasting restorative material around. Even better, I could fabricate an indirect composite restoration in my office without using the lab, for a reasonable price, and get this -- in a single visit. This was the direction I just has to take. Soon however, I found I needed to initiate my own recall program, as these restorations began to fail miserably. I told you this evolution was emotionally difficult, financially bankrupting and just downright hard. A good friend of mine gave me a call when I was at my lowest emotional point in my practice. He was getting involved with CEREC and his practice was going through a similar thing that mine was. We were diligent clinicians who just couldn't find the right combination of materials. I jumped into CEREC with both feet. At this point in my career I was ready for it, committed to it and accepting of what it demanded from me. I spent time to get the best education possible, met great people, worked late into the night to get it right. I was rewarded with knowing I was finally giving my patients the best possible restorations. I was able to experience a revolution in materials, and am in awe of what the future holds. I went from counting the days to retirement to feeling like I can work forever. Now one final revelation. Here I am wearing a hat I never anticipated. A new descriptor: Blogger. Who would have ever thought?

Resin Cleanup During Cementation

Richard Rosenblatt (Faculty) — Tue, 05 Oct 2010 14:31:01 -0700

I recently stumbled onto a product that I have really enjoyed using to clean up resin cement during the cementation process. My hygienist started to order these disposable interdental cleaners from the Butler G-U-M company for patients who are not big fans of flossing (can you even imagine??). They are called Soft Picks. I've include photos so you can see what I'm talking about. I decided to try one to help clean cement as I allow it to get to the gel phase before I cure. I find that if you leave it until it reaches the gel phase, you can clean the cement and not worry about potential bleeding around the gumline affecting the bond of the cement to the tooth. Just before curing, I will move this interdental cleaner interproximally and it will push out much of the excess cement. It is important to wait until your dual cure cement reaches a gel phase. Try it, you may like it! [softpickinuse.JPG][GUMsoftpicks.gif]

Remembering Some Words of Wisdom

Sameer Puri (cerecdoctors.com co-founder) — Mon, 04 Oct 2010 09:25:07 -0700

I was recently invited to lecture at Midwestern Dental School in Arizona. I want to thank all the students and faculty who attended the program. What was interesting was that the dean of the school, Dr. Russ Gilpatrick was at the University of Tennessee at the same time I was there doing my AEGD residency. There is a local state meeting called the Midsouth meeting in Memphis every year. To this day, I still remember walking among the exhibits with Dr. Gilpatrick at the 1997 Midsouth meeting. At that time, Sirona was showing the CEREC 2. Dr. Gilpatrick, a man of few but very important and profound words, looked over at me and said in his slight southern drawl, 'You know, if I was in private practice, I'd get me one of them CEREC things.' Those words are burned into my mind to this day. His reasoning was that for a GP, inlays, onlays and crowns are things we do every single day. Well, why not do them with a CAD/CAM system? I took those words to heart, and in my mind knew that one day, I would have me one of them CEREC things. CEREC has been amazing in my practice. Now involved in beta testing, the future is bright with the new innovation center that Sirona is opening up in Bensheim Germany. Their R&D team is amazing and I expect to see some great stuff down the pipeline.

Monster GALILEOS and CEREC Cases Coming up

Armen Mirzayan (cerecdoctors.com co-founder) — Fri, 01 Oct 2010 10:28:21 -0700

This patient wanted her removable denture replaced years ago. She is missing her upper molars all the way to the upper right lateral. She was told she did not have enough bone, but the GALILEOS revealed differently. So she passed on another proposal for surveyed crowns and a new removable denture, and instead accepted this plan with us. I plotted all the implants in the software and she was convinced. The stent is being manufactured and we'll be placing the implants shortly. So Excited!!! [4implants.mp4-v-]

Web Site Updates Coming

Sameer Puri (cerecdoctors.com co-founder) — Mon, 27 Sep 2010 14:09:56 -0700

In an effort to make a more robust Web site, in the coming week we will be implementing some changes to www.cerecdoctors.com that will make your online experience more enjoyable. One of the first changes we have coming is a more interactive discussion forum. You will have the ability to do rich text, better quoting of posts, the ability to jump to the last reply of a thread and put smileys in posts to really let the viewers know how you truly feel. [Screenshot20100927at2.00.56PM.png] In addition, users will have the ability to place avatars, keep track of the number of posts and other useful features. In the screen shot below, notice that users will also have the ability to send private messages to each other to maintain communication. [Screenshot20100927at2.01.28PM.png] Other features, includingas HD videos and mobile streaming are also in the works. We hope you enjoy the revised Web site when it's launched in a few days. Happy CERECing.

Pictures up from CEREC 25

Sameer Puri (cerecdoctors.com co-founder) — Mon, 20 Sep 2010 22:20:21 -0700

Visit www.cerec25.shutterfly.com Lots and lots of great photos from the meeting are there. I hope you guys had a great time at the meeting and I hope you reserve the date for the CEREC Doctors annual meeting next July in Scottsdale. Details will be posted soon.

Around the CEREC with 80 Docs

Sameer Puri (cerecdoctors.com co-founder) — Mon, 20 Sep 2010 19:00:17 -0700

What an amazing -- and yet at the same time exhausting -- weekend. We had more than 80 doctors attend the Levels 2-4 courses at Scottsdale Center this past weekend. I want to thank all the adjunct faculty and mentors who were present and helped make the weekend such a success. Since so many doctors at the course asked me, I thought it would be a good idea to give an update to my iPhone situation. As you may have read, I hate my iPhone. As a device, its great. As a phone, I think I have had better sound and reception using two tin cans connected with string. Well, I'm happy to say that things have improved. Apple recently introduced a software update that makes my phone tolerable. It's not perfect, but at least it doesn't make me want to throw it out of a rapidly moving car. Regardless, those of you looking for a new phone, don't automatically settle on the iPhone. Lots of great choices out there, so do your homework. As far as the CEREC courses, it was a blast, it was a ton of fun. We learned some new things, we made some good friends and rekindled some old friendships. Much gratitude and appreciation goes to the doctors that made the trip, especially our foreign friends who flew from all corners of the world to attend. Helsinki, Australia, Puerto Rico and of course from virtually every state in the union.

Floating Crown Bug

Sameer Puri (cerecdoctors.com co-founder) — Tue, 14 Sep 2010 18:37:26 -0700

If you have the 3.8 software, you may have encountered a small bug in certain cases where you get a proposal but then it gives you an error. You reboot the case and on your models the restoration you designed is there, floating in the air. I've seen this happen during crown proposals using the buccal bite. What you can do to get rid of the crown is go back to the image catalog and remove all the images from your prep model and put the images in the yellow SAVE folder. Then bring the images back and re-create the model. This essentially resets the model and allows you to get rid of the floating crown. This will be fixed in an upcoming patch, but for the time being, if you get this weird proposal, just reset your model, and all will be well.

CEREC 25 - What an Amazing Meeting

Sameer Puri (cerecdoctors.com co-founder) — Tue, 07 Sep 2010 21:43:16 -0700

Having been involved in the planning of the CEREC 25 meeting, I can't tell you how excited I was to attend the event. There were a tremendous amount of folks behind the scenes who did an incredible job to make the event a huge success. If you were at the meeting and had a good time, make sure you let the folks at Sirona know. They worked hard and deserve much kudos. A couple of thoughts from the meeting: Meeting Dr. Werner Mormann was great. I had the pleasure of not only interviewing him for the cover of CERECDoctors.com magazine, I also spent some time with him at the meeting. Incredible energy, and the guy looks like he is 40 and ready to run a marathon. We owe him an incredible amount of gratitude for his vision and drive to bring CEREC to the masses. Dennis Miller - The dude is awesome. After the meeting I met him backstage and had a chance to chat for a bit. What a genuine person. The funniest thing he said was that he couldn't believe that 25 years later he was still doing his Saturday Night Live shtick. Ive enjoyed listening to him on the radio and watching him on TV, and meeting him was a blast. I'm not into celebrities and don't get star struck, but he was just fun. CEREC Doctors faculty - I was so proud to see our CEREC Doctors faculty do so well. Mark Fleming and Rich Rosenblatt were rock stars. Standing room only in their lectures and not only that, they had people coming out of the rooms 7-10 deep. Next time we need to get rooms twice the size for them. Everyone did great including Skramy, Darren and Pete. Armen and I couldn't ask for better partners and friends to help us in the CEREC Doctors events. If you missed the meeting, save the date for the CEREC Doctors meeting scheduled for next fall. You will have a blast in Scottsdale, and I promise that we will have another amazing event.

Information about the White Party at CEREC 25

Sameer Puri (cerecdoctors.com co-founder) — Wed, 18 Aug 2010 10:08:48 -0700

CEREC 25th Anniversary White Party Saturday, August 28 at 6:30pm PURE Nightclub in Caesars Palace, Las Vegas After two years of planning the spectacular CEREC 25th Anniversary Celebration, we are getting very close to executing the event. As you may know, CEREC 25 will culminate with the CEREC White Party by VITA at PURE Nightclub, located inside Caesars Palace in Las Vegas. The theme of this party is 'anything white,' so please be creative and upscale for this high-energy event. All CEREC 25 attendees with a badge are invited to attend. To ensure entry into the White Party, all attendees will receive a ticket in their name badge. Please take this ticket to the CEREC 25 registration desk during normal business hours on Saturday, Aug. 28, and you will exchange your ticket for a White Party wristband that will be secured to your wrist at that time. The wristband and a valid photo ID are all that is required for your entry to Pure. PURE is one of the hottest nightclubs in Las Vegas, and boasts 40,000 square feet and an amazing view of the Strip. Upon entering, you will see that PURE is divided into three downstairs rooms and a huge, gorgeous upstairs terrace. Those looking for dancing in the heart of the action will enjoy the main room; if you are seeking a beautiful outdoor view of the Las Vegas Strip, head to the upstairs terrace, or for a more intimate place to talk and hang out with friends, look to the 'Red Room.' This party will be an amazing way for Vita and Sirona to thank our customers, as well as a great opportunity to get to know many key and influential people in the CEREC world. We are very excited for this event, and know CEREC 25 will be the talk of the dental world. When it comes to your outfit, think as unique, glamorous and upscale as you would like. Just think WHITE. You can go for the traditional white party glitz and glamour with a pretty dress and heels, or white linen pants and button-down shirt. Or go even more upscale with a white tux and tails or a long slinky white gown. Dress it up with white eyelashes, long gloves, a white fedora, shiny white shoes or white aviator sunglasses. *Note that PURE will not allow any toy guns, swords or costume weaponry of any kind. Also tennis shoes, work boots, male sandals such as flip flops, ball caps, shorts, and athletic wear are not allowed in Pure. This is an extremely upscale venue, so dress accordingly.*

I Need to Vent!

Sameer Puri (cerecdoctors.com co-founder) — Wed, 04 Aug 2010 15:17:30 -0700

I'm about to come out of the closet and admit it. Many of you heard my horror story about how I waited in line almost six hours to get my new iPhone on the day it was released. Mind you, that's not what was planned. It was just that I had reserved it, and I thought I would just show up at the Apple store, they would honor my reservation and I'd be out in 15 minutes, tops. Well, apparently about 500 other people had the same idea. So there I am at 7:00 a.m., thinking I'd be first in line, and whoops, there is already a long line. Well, I had the day off; I grabbed my laptop from my car and decided to wait it out. I figured instead of 15 minutes, it would take an hour or so. Well, that hour turned into two hours and by then, it was too late to turn back and waste that morning, so I slugged it out. Bottom line is that six hours later, I had my new iPhone 4. Time for joy? Initially, yes. The phone was fast and the screen was great. Everything was dandy, until you actually had to make a phone call. Holy cow, the worst frigging phone I've ever used. It's one thing to drop a call, but multiple dropped calls a day??? And yes, I've had the stupid bumper from the very beginning, so Apple can't blame me for that. Great 'device' but a crappy phone. And don't even get me started on the iPad. At least I didn't wait in line for that thing. I'll share that story another time, but basically, iPhone sucks. Back when it first came out, the iPhone was the only game in town. Today, with so many great choices for mobile devices, if Apple doesn't clear up the call issue, I'm afraid it may be time to switch. This is coming from someone who is all in on Apple, iPad, iMac, MacBook Pro, etc., etc., etc. Get your act together, Apple. The competition is catching up!!!!

It's Great to Be Home!

Sameer Puri (cerecdoctors.com co-founder) — Mon, 07 Jun 2010 07:25:49 -0700

After about 16 hours of travel, my wife and I finally made it home from a long trip that was a combination of education and vacation. We had the opportunity to visit the Vita factory in Bad Sackingen, Germany, right on the border of Germany and Switzerland. What a great time it was, even though for most of the trip my wife was fighting a severe head cold, and I just couldn't get past the fact that between the eating and drinking, I had very little time to squeeze in my insanity workouts. The trip, however, reminded me of several things that one shouldn't forget. First - no matter how much you think you know, there is always something to learn. Having been a beta tester and trainer for a number of years, I have gotten to know the CEREC technology fairly well. However, going to Europe and listening to other testers and developers of the products of the CEREC system made me realize how much more there is to learn. We learned about bridges, materials, techniques - I will be documenting one technique in particular on the Web site that is a complete paradigm shift on how we use the CEREC technology. The second important lesson was that there is no place like home. My wife had wanted to go to Italy for her entire life. So part of this trip we took the train to Lake Como, Italy, and Venice. These are historical and gorgeous destinations, but at the end of the day, living in a hotel out of a suitcase is just not as fun as going to sleep in your own bed and waking up in your own bedroom. The trip was great, but like I said, it's great to be home. Who knows when the next international trip will be. Whenever it is, I will be happiest when I finally arrive home.

'CEREC Doesn't Work for Anteriors'

Sameer Puri (cerecdoctors.com co-founder) — Sun, 16 May 2010 20:05:01 -0700

I hear this over and over again: CEREC is fine for posteriors but its not appropriate for anterior restorations. I guess this is progress, considering how much grief CEREC owners have received over the years for its use anywhere in the mouth. Now we are at the point where CEREC is considered appropriate for posteriors, but some clinicians don't feel they can do a case in the anterior with CEREC. I think it's important to note that CEREC is just a tool. It's a tool that can replace the laboratory in the appropriate situation. When treatment planning a case, here are the criteria I use to determine whether I will work with my laboratory or with my CEREC machine. First of all, it's important to note that I am a heavy user - meaning that I look to my machine for virtually every case. I enjoy the process. After all, what the heck is the point of going to work if you don't enjoy what you do? The second step in determining the method of fabrication is to ask the question: 'Can I meet the esthetic expectations of my patient with the CEREC machine?' Lets face it, I'm a dentist, not a technician, and there are certain cases where I am just not as talented as a highly skilled ceramist to deliver a highly esthetic piece of porcelain. I'm pretty good, but not the best. In certain cases, it might be better to use CEREC Connect instead of CEREC. Next: Is the patient patient enough to sit through a procedure of this type? This particular case would take me all morning. For an inexperienced user, maybe it will take them all day or several days. Regardless of that fact, it's longer than just prepping and taking an impression, so the patient must be willing to wait all day if necessary. Certainly better than waiting weeks or months, but that must be conveyed to the patient. Finally, can our materials that we mill chairside fulfill the esthetic expectations of our case? The materials that we use are fairly translucent. If we have a dark substructure, then we need to use opaque materials to cover that dark substructure. Maybe gold or zirconia. If that is the case, perhaps it's best left to the laboratory to do the case for us. In this particular example, we have met all the criteria for a nice chairside case. The patient does not have unreasonable expectations for esthetics, he is patient, and our materials will be sufficient to cover the teeth. And I will have an absolute blast working on this case all day. More information on this can be found in the discussion thread. The immediate post-ops show some tissue irritation from the cord and bonding procedure. Once we see the patient for the final post-op, you will find the tissue and smile have met the patient's expectations. [d.jpeg] [j.jpeg] [IMG_87611.jpg]

CEREC 25 - I cant say enough about this event

Sameer Puri (cerecdoctors.com co-founder) — Mon, 10 May 2010 22:18:19 -0700

Being fortunate enough to be involved in the planning of this event, I can tell you that you absolutely need to plan on being in Vegas the last weekend of August. The event will be fantastic, with incredible speakers, exhibits and entertainment. I can imagine that some companies will use the event to possibly introduce new products or materials. After all, it's the largest gathering of CEREC users planned. Ever! One of the things that I am most excited about is the lecture by Dr. Frank Spear. Having had the opportunity to work with him and teach under him at Scottsdale Center for Dentistry, it's been fun to see him and the rest of the Spear Education faculty embrace what CEREC can do. Now, I'm a hardcore CEREC geek, and try to use it anywhere and anytime I can. But to see the Spear faculty work with the CEREC is absolutely amazing. I saw Dr. Spear stain and glaze a restoration that was the most gorgeous I had ever seen. Lee Brady, who is the executive vice president of clinical education, has been equally impressive in her CEREC journey. The former clinical director of The Pankey Institute, I enjoy listening to her as she talks about Parameters. Then there is Dr. Bob Winter. He heads up the live patient course with Dr. Brady at the Center. Obviously, the participants that use his lab get an incredible restoration back for their patients. To see his eyes light up any time one of the students uses a CEREC machine is quite amazing. To see that the CEREC passes his discerning eye shows what a long way the technology has come. If it can keep these folks happy, no doubt that you can get some incredible results as well. If you join us at CEREC 25, no doubt you will see some world-class dentistry performed with our little machine. Happy CERECing, and see you in Vegas.

Move over Arnold!

Sameer Puri (cerecdoctors.com co-founder) — Tue, 27 Apr 2010 08:49:14 -0700

A few years ago, I was watching TV and came across this infomercial for a fitness program called P90X. Im sure you guys have seen it. Grown men and women jumping around, doing push-ups and all sorts of other exercises. Well, I was dumb enough to order a set of the discs. I thought, what the heck, I've never ordered anything from an infomercial before. There is a first time for everything. The DVDs arrived and I started the program. I gotta tell you, it was tough! Probably the hardest workout that I had ever done. In fact, the very first workout, 'Chest and Back,' where you do about 300 push-ups and about 120 pull-ups along with other stuff - I pretty much almost threw up. Although the program was supposed to be 90 days, after three weeks, I quit. Not because I was fat and lazy, mind you. My wife surprised me with a gift of a personal trainer. So I stopped P90X and started with my trainer. It was a good two years with the trainer, but like many things, eventually it had to end. I just couldn't justify the money every month, and frankly, I think I had peaked with regards to the results. My body fat went down from about 24 percent to about 18 percent. My weight dropped from about 230 to about 220. It was a good move, but I had definitely plateaued and was just getting bored of the same exercises. Fast-forward to 90 days ago, when I pulled out my P90X discs that had been sitting in my office. I put the disk in the DVD player and pushed PLAY. And the next day I put the next disc in and pushed PLAY again. On and on, and before you know it, its been 90 days! Weight has gone to 205 and body fat is hovering in the 11 percent range. I've never felt so much energy and so good. Why is this in a dental blog? Well, its all about balance folks. Not everything is margins, not everything is patients. Take time to take care of your self. I have more energy, I'm in a better mood and frankly, I feel great. My clothes fit great, and I don't have the belly hanging over my pants. I'm not posting photos! :) But if you join us at CEREC 25, there will be a group of us doing P90X while celebrating the largest CEREC users meeting ever held. I hope to see you there.

The way that we practice - You say Tomato, I say Tomato!

Sameer Puri (cerecdoctors.com co-founder) — Mon, 26 Apr 2010 10:51:13 -0700

I recently had the opportunity to be a guest lecturer at the UCLA Esthetic Residency. What a fun two days it was to be at the university and work with the residents there. The residency is a 2 year program for dentists who want to enhance their knowledge and skill level in the art and science of esthetic dentistry. The program also has 20 ceramists who are attempting to gain their certificate to become Master Dental Ceramists. Dr. Ed Mclaren prepared a patient for veneers, I scanned the patient and imaged him and then all the ceramists had the opportunity to mill out the restorations with the CEREC and finish the case. It amazes me that there are people still out there who say that CEREC is not esthetic. As you can see from the final photos, the end result has nothing to do with the machine, it has everything to do with the artist. My suggestion is to get trained, learn as much as you can and become your own master. Gorgeous results are the norm if you take your time and do your cases properly. Dentistry and Lab work courtesy of Dr. Ed Mclaren [JEFF PREP2.jpg] [jeff post op2.jpg]

The Business of CEREC

Sameer Puri (cerecdoctors.com co-founder) — Sun, 04 Apr 2010 17:01:04 -0700

One of the great minds in dentistry and business that I have had the pleasure of meeting is Mr. Imtiaz Manji. He is the former CEO of Mercer and the founder of Scottsdale Center for Dentistry. In a meeting last week discussing the CEREC courses for next year at the Center, he said that this year's Business of CEREC course would be his last. My suggestion is that if you are looking for a great course to attend this summer, I would definitely check out The Business of CEREC. I have the honor of presenting a short portion of the program where we will get you guys up-to-speed with the happenings in CEREC and all the new things that are planned in the near and distant future. But the real treat will be the presentation by Imtiaz. Check out The Business of CEREC to get your business mind in tune with your clinical mind.

Looking for great CE, entertainment, food, friends, and fun...come to the Townie Meeting!

Richard Rosenblatt (Faculty) — Thu, 01 Apr 2010 06:23:30 -0700

I just want to remind everyone about the most fun annual weekend of CE on my calander every year, The Townie Meeting. It is just around the corner. The dates are from April 15-17. This has been a can't miss weekend for me the last 5 years of my life. I can not properly describe how fantastic this weekend is, but I'm going to briefly try. This will be a weekend of fantastic CE. There are some of the best speakers in the dental universe that lecture every year at the Townie Meeting. You want to hear and see the latest on CEREC, then come on down. The likes of Sameer, Armen, Mike Skramsted, Tarun Agarwal and Todd Ehrlich will be discussing the latest and greatest. That alone is worth the price of admission. Add to that a room dedicated to endo, another to practice management and hygiene for you and your staff. You can also get certified in 6 month braces and there will be other workshops to attend. On top of that, you get to come to Vegas for fun like you have never had at a CE event. Noone throws parties like the Townie Meeting. They have a costume party every year that is legendary. Toss in a golf event with tons of prizes, a wine and cheese welcome reception, and a Texas Hold-em poker tourn and you will never have experienced a more friendly and energetic atmosphere among dentists. This is like a high school reunion for many. For others it is a chance to meet people for the first time. I can not recommend this event enough. It is a memorable weekend and a great event to take your staff. It is educational, motivational and most of all....a ton of fun. I look forward to this week every year to see old friends and make new ones. I anticipate seeing many of you there!

Software version 3.8....WOW!!

Richard Rosenblatt (Faculty) — Sun, 28 Feb 2010 19:07:13 -0700

I spent the weekend at the Chicago Midwinter Meeting showing all who walked by the Sirona booth what will be coming in the next software version release. All kept hearing when I was done with the demonstration was....WOW!! I did dozens of demonstrations every day and each time the people who witnessed it, including myself, were just amazed. Between having the buccal bite registration included in the chairside version of the software, and the fantastic new biogeneric crowns, proposals of the onlays and crowns I designed were about as close to scan, click and mill as I have ever seen in the seven years I have been using the software. It was truly remarkable. No more databases to have to try and decide which type of design would best match the adjacent teeth. Now we have a way for the software to look at the adjacent teeth and create a restoration that will most closely mimic what that patient has in their mouth. This process has been 9 years in the making and is truly revolutionary. Take a look at some of the vidoes on the website and enjoy. Looks as if May or June may be the release date. Looks like Sirona has figured out a way to speed up the designs, now if I could just figure out a way to speed up time!!!

Making CEREC a Household Name

Sameer Puri (cerecdoctors.com co-founder) — Tue, 23 Feb 2010 08:41:45 -0700

We commissioned a survey here on the website. You can access the survey by clicking on the banner ad on the top that says 'Make CEREC a Household Name'. So far almost 500 clinicians have taken the survey and the results are very interesting. The survey will be up for another few weeks after which we will compile and share all the results with everyone. But I have to say that the level of interest in this campaign has blown me away. I would ask that if you have not done so, please take the survey so that we can get more accurate data and decide how best to proceed. My hope is that we can do a CEREC Superbowl ad from this. How great would that be! Way to early to tell if we have enough interest or not in this but I think we have to look at this seriously considering the level of interest so far. Please take the survey and share your thoughts.

Milling Your Own Implant Abutments

Sameer Puri (cerecdoctors.com co-founder) — Sun, 21 Feb 2010 19:15:27 -0700

Check out the videos in the inlab section. Our adjunct faculty member Dr. Mike Skramstad is becoming quite the expert in the inlab software. He has created a series of videos for those of you that want to mill your own abutments. You can do this with the CEREC and the soon to be FDA approved (sources say sometime in April or May) Abutment Software for the CEREC Inlab. Sirona will showcase this software at the Chicago Midwinter Meeting but you can get a sneak peek right here. What you will need to fabricate abutments chairside are the following: Inlab software - free from your CEREC specialist but you will need a dongle to mill anything from the software- Dongles range in price but will add about $10 to the cost of milling your restorations Tibase assembly - about $150 - this is a guess on the price as this has not been released in the US although our neighbors across the pond in Europe are already doing this Sintering oven - because you will mill zirconia as a part of the abutment complex, you will need to sinter zirconia or you may choose to send this off to the laboratory. Watch all the videos in the inlab section. Enjoy this new feature of your CEREC.

Bridges Are Here!

Sameer Puri (cerecdoctors.com co-founder) — Thu, 18 Feb 2010 20:35:11 -0700

So today I was visiting Vita and they showed how CEREC will soon be able to make permanent bridges. Anytime I speak, people ask about bridges and when we will have the ability to make them. Its always been an enigma on how to do this because we don't have a material that is strong enough and esthetic enough to mill to full contour. However Vita seems to be the first company to come out and offer a solution to this. The bridges will be milled with a zirconia framework and then a milled suprastructure will be cemented on top. This is very early and these are exclusive photos but here is the concept of milled bridges with CEREC. Done chairside. More information can be found on this discussion thread: http://www.cerecdoctors.com/ui/ViewForumNew.aspx?ForumID=3427 Here is a photo: [LAst Roll - 011.jpg]

Chicago Midwinter

Sameer Puri (cerecdoctors.com co-founder) — Wed, 17 Feb 2010 01:49:33 -0700

Chicago Midwinter meeting is a time where many CEREC owners attend. Sirona typically releases software at this show and our hope is that this year is no exception. Im planning on being in Chicago from Thursday to Saturday. If you have any plans on attending, please stop by the Sirona booth where I will be hanging out. Definitely a busy day on Saturday but I hope to say hello to many of you. You never know what new updates and features the show will bring so I hope you stay tuned. As you know anytime anything new is released by Sirona, you can find it here.

Virtual Fit Checker

Sameer Puri (cerecdoctors.com co-founder) — Wed, 10 Feb 2010 10:12:13 -0700

Did you know that you can check the internal of your restoration to see if it will bind before you mill it. During beta testing we were experiencing certain issues where the restoration would inadvertantly mill in endo mode in certain areas. One way to check that was to get rid of the base of the model by clicking on ctrl + b and then looking at the inside of the restoration. You can also adjust your spacer setting that way and dial down your spacer so that your restorations fit every time with a minimal amount of spacer. Another area you can use the virtual fit checker is if you want to mill in endo mode, you can and bump up the spacer enough so that you dont bind. Here is a short video on the virtual fit checker: [virtualfitchecker2910.flv-v-]

Manual Block Chuck Introduced for the MCXL

Sameer Puri (cerecdoctors.com co-founder) — Tue, 02 Feb 2010 12:22:39 -0700

All new MCXL units are being shipped with a manual block chuck similar to the old compact unit. As you may know, with the compact, you must use a screwdriver to tighten the block into the holder. This prevents the block from getting loose and possibly having inaccurate margins. Sirona has introduced this for the MCXL as well. Some users would experience a loose block that would result in an error every once in a while. Now by manually tightening the block chuck this doesnt happen. My suggestion is to talk to your rep about this and if you have any issues with milling errors, less than perfect margins or anything else, this might be a solution for you. Although the regular block chuck works for 99% + of the time, this will help get that success rate closer to 100%.

Here is what you can look forward to in 2010 with regards to CEREC updates

Sameer Puri (cerecdoctors.com co-founder) — Sun, 27 Dec 2009 15:19:45 -0700

A new software is coming. The CEREC Doctors faculty are beta testing it now. Sirona usually releases new software around the Chicago midwinter meeting. I think you will be pleased. Abutment software - Its here in Europe. In the US we are waiting on FDA approval. You will be able to take a fixture level impression digitally and design right off that digital model both your abutment and final crown. Labs will have this first, then clinicians. Its why Im investing in the inlab software. CEREC Galileos integration - its here and its getting better. Expect to mill your own surgical guides in 2011. Imagine being able to take a scan, place your implant digitally and then make a surgical guide from that scan. Vita - Real Life Crowns - no more triluxe, better incisal translucency. Picture below: [VITABLOCS RealLife_] Bridges - word on the street is bridges are being worked on by several companies. I dont think we will have a monolithic bridge made out of zirconia. Instead, I think it will be something like a hybrid bridge, maybe a zirconia core and another material that is layered on top. The two layers fused together somehow. Thats all I can share right now. As we get more information that we are allowed to release, we will certainly share it with you guys. Have a great 2010.

Resolutions

Peter Gardell (Faculty) — Sat, 26 Dec 2009 08:27:55 -0700

What a wonderful year. Software upgrades, the Bluecam, CerecConnect, Buccal bite, Improvement in the fit. The shortened Emax Cycle becoming Ivoclar approved Attaining goals Hard to believe the evolution of the cerec world in the past 12 months. It is not time to sit back and think the way things are now are good enough. Time to reflect and set new goals. Sirona,Ivoclar, and Vivadent are not resting they have alot of advancements coming to make our lives better. New software upgrades are being refined right now. New esthetic blocks being readied for market to help with our esthetic cases. New high strength blocks to be used in the posterior and on implants. Cerec has allowed me to ride out this terrible economy with just a small negative effect. The media is now being positive on the turnaround. Don't be behind. Make sure you are ready for the pick up, by refining you cerec skills and you experience with these new materials. Set the bar higher Cerecdoctors will help you with alot of this by keeping you on the forefront of the technology by informing you of advancements. But remember sometimes you have to push yourself out of your comfort zone to advance your skills. There is no better return on investment than a hands on course. Make ita resolution to take a course in Scottsdale to make your cerec life better. You won't regret it. 2010 is going to be a fantastic year. set some higher goals and work your tail off to meet them. I know I am Happy New Years Pete

Happy Holidays Everyone!

Sameer Puri (cerecdoctors.com co-founder) — Tue, 15 Dec 2009 21:30:52 -0700

As I get ready to wind it up for the rest of the year, I want to take this moment to wish everyone a great holiday season. We have a ton of stuff planned for next year as Sirona will be rolling out some great updates. Galileos integration, Implants abutments, a new software (hopefully santa will bring it if we are all nice) We will bring all this stuff to you guys as its rolled out. As we get it, we will be sure to share it with you guys. Enjoy the holidays and get ready for a great 2010. Happy holidays and a happy new year to everyone. Im getting ready for my annual ski vacation with the family. Its time to unwind and recharge the batteries for the coming year. enjoy.

CEREC 25 - The CEREC Meeting to Attend

Sameer Puri (cerecdoctors.com co-founder) — Wed, 09 Dec 2009 09:34:43 -0700

www.cerec25.com 3000 plus total attendees expected. There will be some great speakers, excellent parties and ofcourse all the gang from CEREC Doctors will be there. We are planning some great events and we have myself, Armen, Skramy, Tbone, Rosenblatt, Fleming and Darren all on the program. Make sure you stop by our booth and make sure you pick up a free t-shirt. We want to thank you guys for helping grow this community and we look forward to meeting you all in person at the CEREC 25th Anniversary Celebration.

The Time is Right: Indirect Resin Restorations

Jeffrey Caso (Faculty) — Wed, 02 Dec 2009 17:31:01 -0700

Getting the most from our CEREC investment is important for many reasons. Of course financial return is at the top of the list in today's economy, but there is more to be gained by using your CEREC to its fullest potential. For me, I was looking for relief from the most challenging and labor intensive thing that I do. The multiple surface direct resin restoration. To do it correctly and get a result that pleases me personally, a great many things need to be done perfectly and in a very short period of time. Using your CEREC machine to fabricate these restorations helps you out in so many ways. It breaks down the process into multiple easier segments; prep, design, fabrication and placement. It shortens and takes the back breaking, intense part of the treatment out of the mouth and onto the computer screen. I am generally happier with my end result and consistently have tighter broader contacts, better emergence profiles, nicer anatomy and better overall contours. When doing multiple restorations in a quadrant it takes a stressful procedure and makes it fun and predictable. There is no better time to start using your CEREC for indirect resin restorations. The ability to rapidly design restorations with the addition of great biogeneric proposals and to virtually seat a quadrant because of the accuracy of the blue cam and software version 3.65 is here and proven. The Buccal Bite makes for very accurate occlusion and the milling times are very fast. In addition, there is no oven time to slow the process down, 3m's Paradigm Z-100 composite blocks are a perfect material for our restorative needs. Studies show that they wear at a rate very similar to natural enamel. http://multimedia.3m.com/mws/mediawebserver?66666UuZjcFSLXTtOxM_5x46EVuQEcuZgVs6EVs6E666666-- One could imagine a very tight fit and with proper bonding technique a perfect 360 degree seal. The material is dimensionally stable and will not shrink. Cementing a quadrant with a cement like Multilink Easy http://www.ivoclarvivadent.us/multilink/easy.php makes cleanup easier than ever before and products like grip tabs from Triodent make handling there small restorations simple. http://www.triodent.com/griptab/griptab-general.html?country_code=us The only downside is the cost of the blocks which are about $20 for the size 10 blocks and higher for the 14 blocks. No matter what you factor out of your total cost (matrix bands, composite etc) using your CEREC in these situations will cost you more. Sometimes however, doing a superior job in a more relaxed way that is better for your patient and easier on your back is just plain worth it. Add to that the ability to maybe do a little more dentistry per visit changes everything. So, my challenge for you is to start doing your multiple surface direct restorations with your CEREC. Train your staff to set up a little differently and challenge yourself to get faster and more efficient. At first schedule more time and soon you will realize that you will be finishing early. You may even find that you become faster when using your CEREC. Make sure that you take a moment to see how you feel at the end of the procedure. My bet is that you will be less fatigued and happier with your end result. Go for it!!

Carrots wait for no one, so I pick them now

Peter Gardell (Faculty) — Mon, 30 Nov 2009 20:27:31 -0700

You might be wondering what a quote from a cartoon bunny from the 60's has to do with the most cutting edge dental system, just give me some time and things will fall into place. I was out of town at the Cerec Experience and a patient of mine broke her front tooth. Her name is Mary, she has been a patient for a long time.It was a tooth that broke this summer and told her she need a crown but for personnal reasons she didn't go for it. No problem Mary I can fix it up and we will see how long it lasts. She was happy and was able to go back down to the shore for the rest of the summer. Well it broke and she had some important meetings so she had to get it fixed. Went to another dentist who prepped it for full coverage and temped it. I lost the crown - stinks but she had it taken care of and that is what mattered. She came in for a recare visit and she looked worried, I thought it was about her problems she has been going through. I asked how she was and she told me what was wrong. She felt terrible that she had not had the crown done earlier she should have listened to me when I recommended to have the crown done during the summer. I told her no big deal she had it done. Of course I started to ask her how it was going with the crown. She said she hated the temp. Has fallen out, doesn't feel right, her gum is sore around the tooth, and it looks bad. To top it off Thanksgiving was coming up and her family was coming into town. The final one wouldn't be ready in time. She said her son was telling her she should have waited to get the 1 visit crown, she felt terrible. I told her that the temp was on so just wait it out for the final crown to be done, make sure that you are happy with the final one. Yes I could do a 1 visit but not in this case. But if it happens again yes I can do the 1 visit crown. BTW the gold bridge that was done 25 years ago does need to be redone as I have told you over the past few years. At the encounter I listened to Imtiaz speak again about the numbers, nudge here, low hanging fruit there, and he is right. I need to be reminded of this time to time. Got to keep your eyes open for opportunity. You can't take things for granted, got to keep your edge, but got to remember what your foundation is built on. So Mary finally commited to getting the implants to restore her failing quadrant. She didn't want anything to fail the way her front tooth did. In the last 2 weeks a number of Mary's friends have called since they have had teeth chip, recently or months ago, and wanted them fixed the right way without temps. So carrots are opportunity but not the normal in your face low hanging fruit. Carrots are there, but sometimes you need to work a bit to get them. You need to keep your eyes sharp to spot them. You don't need to dig deep for carrot, you dig deep you just end up with a bigger hole. Opportunty is there just might be presented in a way we don't expect so we have the potential of walking right by it. Spot them, work them, harvest them Even a patient that you haven't done a Cerec on can turn into a great advocate for the technology. Carrots wait for no one, So I pick them now

Happy Holidays Everyone

Sameer Puri (cerecdoctors.com co-founder) — Thu, 26 Nov 2009 14:11:24 -0700

As we embark on this holiday season and while I wait for the wife and kids to get ready for the first of our 4 thanksgiving parties today, I wanted to wish all of you a happy thanksgiving. Best wishes to all and may the years ahead be prosperous and fruitful.

What have we created here?

Sameer Puri (cerecdoctors.com co-founder) — Sun, 22 Nov 2009 13:00:13 -0700

After a long course at the Scottsdale Center - Armen and I flew home yesterday and didnt you know it, I completely forgot that we had a planning meeting with our web guys to discuss the future of www.cerecdoctors.com and what features we were going to implement next. The course in Scottsdale was great. 40 doctors plus many staff members from all over the country went away with a tremendous knowledge of the entire CEREC system. The anterior and posterior groups both loved the courses and we all had a ton of fun. That focus quickly shifted today (Sunday of all days) to our meeting. It was the only day we could meet due to our busy schedules. So we snuck away for an hour to discuss where are we taking this website. They showed us the server that is converting the hundreds of videos to flash so that its a more universal video player. Then the fun discussion started - a mobile website. Its coming - cerecdoctors.com goes mobile- We have had a lot of requests to be able to view videos on your iphone or other favorite mobile platform. This will be done in the coming future. Another neat thing that is planned is personalized profiles for the members. Members will have the ability to upload avatars, personalized data about their favorite cases, and the ability to have personalized signatures. A few more discussions on cleaning up some minor housekeeping on the site followed. About an hour and 15 minutes later, the discussion turned to the point where I knew it was time to get back home and turn on the boob tube and catch up on some football. When they started talking about megabits of downloads and converting the server from MySQL to SQL server and other inane and geeky topics, it was time to call it a day. I hope all of you enjoy your Sunday. Armen and I put in our time for the day. Time to spend some quality time with the wife and kids. Have a great day guys and I hope you enjoy some of the upcoming new features of the website.

Sitting on the CAD/CAM fence? Come to Scottsdale!!

Richard Rosenblatt (Faculty) — Tue, 17 Nov 2009 12:43:37 -0700

I just got back from sunny Scottsdale Arizona helping out with another great CEREC Discover event? What, you ask, is a CEREC Discovery event? It is a fantastic 2 day event held at the Scottsdale Center for Dentistry. It is co-sponsored by Sirona and Patterson and allows doctors on the fence about CAD/CAM and CEREC specifically, to come to the center for 2 days of lectures and hands on with the machines. There are volunteer dentists from around the country, like myself, who attend to help those with questions about how this technology will fit into their practice. The volunteers are doctors like yourself who were once on the fence and are now raving fans for what it has done for their practice. As we all know, it is one the to hear from a rep from a company what a certain product will do for your practice. It is an entirely different story when we get to hear from a colleague who has a similar practice philosophy and is making the technology a major part of their daily routine. The event is first class. For those who have not been to the Scottsdale for a course, such as Frank Spear or others, make it a destination. It is a place like nothing else for continuing education. There is great food and fantastic comeraderie. For me, it is a great chance to share my story of how a small suburban practice of less than 1000 patients makes CEREC work. You can hear from others with much larger practices how they utilize the technology. It makes those who fear the commitment realize that they are not alone, and the lectures and hands on allows them to begin to realize that this is where the future of dentistry is going. So if you are on the fence and want to learn about the technology, the science and studies behind it, and the overwhelming amount of support and comeraderie there is amongst the user base, get in touch with your Patterson rep about the 2010 discovery event schedule. It is 2 days that may change your career forever!

The Power of Many CEREC Owners

Sameer Puri (cerecdoctors.com co-founder) — Mon, 16 Nov 2009 20:34:40 -0700

We CEREC owners are 11000 strong now. Slowly becoming more and more mainstream as regular average joe dentists are finding the value of one visit dentistry. As more clinicians realize the benefits of same appointment dentistry, without messy impressions, goo, temps and all the other inconveniences of the traditional way of restoring teeth, the obvious beneficiaries are our patients. I cant tell you the number of referrals we get from happy patients who would never go back to the old way of temporaries and a second visit. How great would it be to spread the word beyond our patients? With our numbers, we might be at a tipping point. We might be at a point where we may have enough CEREC owners who if they join together can really make a mark on the consumers. The ADA hasnt done it. Sirona hasnt done it. Patterson hasnt done it. Maybe we have enough members for us to do it, to do a marketing campaign similar to the Lumineers campaign done by Denmat. If we can find a way to get consumers educated on the CEREC process, how beneficial would that be to CEREC owners? To dentistry in general? What do you think? Let us know your thoughts on the matter. Would a national marketing campaign be worth it? I dont know but Id love to get your thoughts on it. Join the discussion on this thread and let us know if this is a good idea or not. http://www.cerecdoctors.com/ui/ViewForumNew.aspx?ForumID=2976 Its a thread titled 'Im surprised this hasnt been done before'

Another Paradigm Shift. It must mean progress!

Jeffrey Caso (Faculty) — Fri, 13 Nov 2009 19:17:01 -0700

The original CEREC 3D with the red cam and compact mill was and still is a fantastic system. The key to sucess with that system was of course the 3 P's. Prep, powder and PICTURE. I capitalize picture because I always felt that it was the most important part of the three. It was necessary to take a properly aligned, non pitched or yawed image of your prep, that showed your entire margin. For each restoration, one image was great, two was OK, three was pushing the limit and over that you may have been doomed by image averaging. Averaging occurs when, because of camera angulation, a lack of powder or blood and saliva creeping onto a margin, two or more images of the same area appeared to the software to be slightly different. An average of that data, right or wrong was the result and we built our restorations to that averaged area. On the whole we still ended up with an exceptional product. Once in a great while we had a short margin or a tight fit or an open contact and we couldn't figure out why. Along comes the CEREC AC with the blue cam and we now find ourselves needing to unlearn some things and relearn others. First, extra images are not necessarily a bad thing. As long as they are good images we can take a few extra and not worry about averaging. Most importantly, we can build larger models and not be appreciably slowed down because our systems have an abundance of power and improved graphics capabilities. So what does this mean for us clinically? Well, right now we have faster transitions when we green arrow. Nicer looking virtual models with less powder needed, margins that are easily discernable and that pop out at us when we marginate and finally, larger models which allow us to tweak our proposals with greater accuracy. In the future, we can only imagine the possibilities. Proposals that can be based more upon information obtained from our larger models which show more of the adjacent teeth. Right now, inlays and onlays are built from information given by the remaining cusps and inclines. Crowns don't have remaining cusps so it only makes sense that this information will be gotten from adjacent teeth. Larger models may give way to easier quadrent work with simultaneous design capabilities. We can do it now with temporary bridges, why not with with multiple, single tooth restorations? The forward thinking of Sirona's software designers does not always make sense to us in the present. One thing needs to be introduced, become perfected and proficient in, before the next can be introduced. Thankfully, we just do our day to day work, changing and adapting as we go. We can let them worry about the logistics. We are all part of a plan that is gaining strength and momentum and will beneft us greatly as practitioners in the future. Enjoy the ride!!

The Growth of CEREC Doctors

Sameer Puri (cerecdoctors.com co-founder) — Tue, 10 Nov 2009 10:58:57 -0700

Its amazing what this website has evolved into. What started out as a way to share information and a few videos that were made by putting a camera on our CEREC machines has grown into thousands of members from all over the world. Some of the new features we have added is the ability to put videos directly into the discussion thread. Now when someone comes and asks a question about parameters, margins, etc, we can simply link the appropriate video right then and there. The next phase will include all flash videos and other features which will make the user experience better for all users. Starting in January, both Sirona and Patterson have committed dedicated members from their support team to monitor the message boards so that technical questions that the faculty cannot answer can be addressed from the corporate level. What I am most proud of is our dedicated faculty who tirelessly help out all users on the site. Armen and I used to spend hours providing support and now before we have a chance to address the users on the message board, the questions have already been answered by skramy, gardell, caso and rosenblatt. Couldnt ask for a better group of guys to work with. All in all, over the past few years, we have had some growing pains no doubt - thousands of owners a year, you are bound to have some issues. However as we move forward and Sirona continues to innovate our little CEREC machine with software updates, we hope that you make cerecdoctors your home for all things CEREC.

My impressions of the 3.65 Service pack

Jeffrey Caso (Faculty) — Mon, 09 Nov 2009 07:35:41 -0700

I just finished my first restoration after installing the 3.65 service pack. It was a full coverage emax restoration on a second molar. I prepped a high lingual margin and the tooth leaned mesially a bit. The type of prep was notorious for an open buccal margin and a slight rock with the previous software version. Not so today! The crown dropped in with the best margins ever and a solid, non rocking fit. The combination of this software upgrade and the blue cam made this restoration very simple. The mesial inclination of the tooth sometimes would lead to a light or open margin mesially due to imaging problems. It is hard to get the margin imaged as well as the distal surface of the anterior tooth. In the past it was difficult to build the contact to good or real data. The blue cam has solved this issue with ease. Finally, being able to use emax in this area is really amazing and something we should really be happy about. I will have no concerns about this restoration long term because of the great fit and the strength of emax. Recent research has been so positive regarding emax that we should all feel totally confident using it in any application. With such positive changes to hardware, software and materials, restorative challenges are overcome so easily. Today's experience was a prime example of what is possible when everything comes together so well. We make it look so easy that many times our patients just don't have any idea about the massive behind the scenes efforts that make this happen routinely. So, the take home message is, install the 3.65 service pack right away and enjoy its many benefits on your next case. Jeff

Cerec Connect Imaging

Peter Gardell (Faculty) — Fri, 06 Nov 2009 09:52:20 -0700

Awesome Buccal bite is so cool. Its been great using this with cases. I Did my first cerecconnect case posterior bridge imaging went well. I do see some areas that need improvement but all in all I think with a little bit of practice, it will be a great improvement to our workflow when restoring cases with Connect. Im looking forward to having it come in the regular software whenever Sirona implements it into the regular software. A couple of tips I noticed that made my buccal bite process a bit easier. I found that if you have an area in the prep in both prep and antagonist where you roll the camera enough to capture landmarks for stitching. The first time I did it, I had to go back to get some more images after I couldn't get the bite to 'snap' into place. I do think that with a bit more practice, this will be second nature as with anything in CEREC dentistry. I know other faculty have been testing buccal bite for a while and they have found it very easy to stitch. All in all I think its a great improvement to our software and it reinforces my decision to go with Sirona and CEREC as my cad cam of choice. Im looking forward to what else will be in the new software release in the coming months as the guys in bensheim burn the midnight oil.

3.65 Service Pack Patch

Mike Skramstad (Faculty) — Thu, 05 Nov 2009 11:52:25 -0700

Please see this discussion forum post for an important patch to Cerec Software Version 3.6. This is something you definitely want to download. Takes care of some very importants bugs in the software: http://www.cerecdoctors.com/ui/ViewforumNew.aspx?ForumID=2930

How to export a cerec connect file if you don't want to connect the machine to the net and Introducing Buccal Bite

Richard Rosenblatt (Faculty) — Wed, 04 Nov 2009 10:45:27 -0700

Anyone start doing cerec-connect yet? I love it. cases have been great. I, like others, have questioned connecting my machine to the evil internet (even though it is probably fine). Here is a 'how to' for those that want to export a connect file to another computer. Just make sure you have cerec connect on your machine. for those that don't yet, go to cerec-connect.com and click on dentist registration. 1) downoad cerec-connect onto the computer you want to send the case from. You will need the cerec connect disc 2) image the case on the machine, make sure it stitches, and draw all margins on the machine. I find that to be easier. Then save it 3) put a thumbdrive into the cerec machine and open it so you can drag the file in later 4) go to my computer>c: drive>program files>CEREC>DATA>and locate the case you just saved and click on that folder 5) There will be 2 files in here. Drag the file named 'restauration.cdt' into the thumbdrive that you opened earlier 6) You can rename the file on the thumbdrive by right clicking and hitting rename 7) Remove the thumbdrive and plug it into the computer you installed connect on 8) open the thumbdrive and find the file you dragged in there. Drag that onto the cerec connect icon and the program will open and you are ready to start filling out your digital RX form Mike Skramstad just uploaded a bunch of videos on CEREC Connect and Buccal Bite: Introducing Cerec Connect Introduction Videos and Buccal Bite By Mike Skramstad (Adjunct Faculty) Wed Nov 04, 2009 11:05 AM Just wanted to notify everyone that a new section of Cerec Connect videos has been uploaded. These videos will cover the folllowing: 1. Introduction to the Cerec Connect process 2. How to sign up for Cerec Connect 3. How to use the Cerec Connect Portal 4. Bridge case start to finish with Cerec Connect (very detailed) 5. Introduction to buccal bite 6. Full arch articulation using buccal bite. Some of you may be asking, 'what is buccal bite'. This is a brand new feature just introduces last week at the Cerec Symposium. Basically, it allows us to articulate upper and lower arch digital impressions without using bite registration material. Simply have the patient close in centric occlusion and take an image from the straight buccal. This truly is a game changer and one of the best new features in the CEREC software introduced in quite some time. I'm excited for you to watch the videos. Mike

Cerec Today

Peter Gardell (Faculty) — Wed, 04 Nov 2009 10:00:18 -0700

Sitting back cooking an Emax staight forward boring in fact Database # 14. Just told the small filling that was to be during the cook time cancelled. Kid sick Blah Blah Blah... The saving grace of Cerec is I can do that implant restoration that is sitting on my counter. Already have the implant level impression done so time sitting on my butt has turned into productive time. Get the patient in the book for the delivery. Pete