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Hey everyone. Want to wish everyone a Happy Thanksgiving. I'm very thankful for this community. I wanted to post this today because many wonder how can CEREC garner referrals. I don't have the case photos yet but wanted to show the result of doing what I did from a marketing aspect. We have a local Facebook group here in lake forest with some very active members. One of them is a die hard pt of the practice. Her daughter was getting her braces off last Friday and has a congenitally missing #7. They were going away for the holidays. I talked about doing a Maryland bridge, well she thought with the timing of the holiday and the office booked solid, that her daughter would be wearing her flipper. I decided to come in on a Saturday to see her daughter and make the bridge so she could enjoy the holidays with a permanent restoration. She would then go back to the ortho on Monday to get a new retainer made with the bridge in. I made the bridge that sat morn. By Sunday morning there was this post on our local Facebook page
On Tuesday I got a call from the ortho saying so many nice things about the treatment we did for this kid while she is waiting to be old enough to do an implant. Now I have the people in my town who follow our Facebook page know that we go out of our way for our good patients and I have a specialist that was so impressed with the technology that he'll be sure to send families our way knowing what we can do. CEREC is an amazing technology. Use it to all its advantages!
This summer I had the opportunity to go to a women in leadership meeting held by Dentsply Sirona where I met some amazing and talented women. I have been working hard to get them to post their cases but it has been a little intimidating for them due to some previous experiences so I asked if I could share a few of the cases that get sent my way. It is intimidating to share work that you created yourself because you have to own it and often we pour our heart into our work. This is the only way though as a community we can elevate ourselves and other clinicians by sharing our work, encouraging other,s and offering constructive criticism when needed. It has been disheartening to see some of the bashing that happens online on some of the Facebook groups and that is why I am so proud of the community that we have all created with cerecdoctors.com.
Look at this work!!! I was blown away. Just to be clear- These are not my cases. I would be so proud to show them as my own, but I get no credit for this talent.
Case 1- e.max crowns #26 & 27
Case 2- Empress veneer #8
Let's show these talented doctors that posting your cases doesn't have to be scary. Show your support, and if you have feedback they are hungry for it, but just be kind in how you present it please ;)
I love to use Maryland bridges as long term temporary solutions. Especially when kids are getting out of ortho and not quite ready for implants. The most difficult part is typically the connector for these types of cases. A great tip I just got at CERECdoctors.com to help with this is to design the Maryland Bridge with the connector as an intersection, get the connector to about a 3, and then go back to admin phase and switch it to anatomic. This will help bump up the connector automatically to the needed size without the ridges that anatomic normally gives (I believe it is called the Fleming technique ;)). It was a great tip that helped speed up design. That is just one more reason why I love this group. Even coming to the courses to mentor, we can always get great tips!
Here are a few examples of some fun Maryland Bridge cases with kiddos. These can be done with the wing on the facial or the lingual and there are examples of both. This is dependant on the bite. What material I use is dependant on the amount of time and the amount of characterization that is needed. If the restoration needs to last less than a year, and I don't need to prep anything, then I love using GC Cerasmart. If the restoration needs to last several years, I have personally found that e.max tends to last longer. I do warn my patients and parents that these can fall off. It doesn't happen very often, but when it does it is only at the most in-opportune times. The good news, it's very easy to recement it and typically there is no damage done. They still love this solution much more than a flipper.
1. This is an interdisciplinary case with my orthodontist and periodontist. Her centrals were hopeless due to trauma but placing two implants next to each other can be really difficult to restore. We extracted #9, moved #10 into the #9 space and are holding on to #8 as long as we can until she is ready for implants (hopefully). She is 15 yrs old at this point.
2. Post ortho, a young man missing #9 due to trauma. He is 16yr old and still growing and could not stand having a flipper.
3. A young man congenitally missing #10 and also too young for an implant.
I decided to mill this instead of building it up by hand for this young woman. It milled in 6 min and then I added color tints and a thin layer of microfill of the top to seal in the color tints.
This was one of those cases that was just fun for me to do ;) I might have gone a little intense with my translucency stain but overall I think it blended pretty well. She was really excited to not have the dark tooth anymore. Just something a little different!
Brasseler U.S.A. Dental, LLC Introduces New Procedure
Systems Developed with Cerecdoctors.com for CAD/CAM Users
Convenient and comprehensive solutions for CAD/CAM restorations
SAVANNAH, GA (October 12, 2018)– Brasseler U.S.A. Dental, LLC (Brasseler USA), a leading manufacturer of quality dental instrumentation, is pleased to announce the development of new procedure systems for use in CEREC® procedures with cerecdoctors.com. These new procedure systems incorporating Winter Restorative Concepts, a line of diamond burs and refinement instruments by Dr. Robert Winter, now provide clinicians end-to-end solutions for the preparation, finishing and polishing of ceramic CAD/CAM restorations.
Brasseler USA CAD/CAM procedure systems are available in:
- Anterior and posterior tooth preparation systems featuring the Winter Depth Limiting and Winter Shoulder Series of diamonds. These diamonds provide clinicians minimally invasive, precise preparation design ensuring more predictable outcomes for CAD/CAM dentistry.
- An intra-oral ceramic adjustment and polishing system as well as an extra-oral ceramic adjustment and polishing system featuring the Dialite® LD Feather Lite™ series of polishers. These polishers provide clinicians with flexible polishing spirals that easily adapt to any surface, leaving behind an enamel-like finish while preserving unique surface differentiation on ceramic materials, including Zirconia and Lithium Disilicate.
These procedure systems are used and taught by leading dental professionals including Spear Education and cerecdoctors.com.
For more information about Brasseler USA’s extensive product and service solutions for all dental, hygiene and laboratory professionals, please visit https://shop.brasselerusa.comor call 800-841-4522.
About Brasseler U.S.A. Dental, LLC
Brasseler U.S.A. Dental, LLC (Brasseler USA) is a leading ISO-certified healthcare company, providing quality instrumentation to healthcare professionals for use in restorative dentistry, endodontics, oral surgery and oral hygiene. Over the past five decades, Brasseler Dental has developed a reputation as an innovative market leader in diamonds, carbides, polishers, endodontics, hand instruments, and handpieces. Today, Brasseler USA offers the most comprehensive assortment of dental instrumentation under one brand in the world. For more information, please visit www.BrasselerUSA.com.
First case here - very nice work flow for sure. Hope they will keep the cost down for it to make sense for us to utilize....have more in the works will continue to post as I know others have more experience. Any questions welcomed.....
This case was pretty fun that I just finished today:
Patient wanted midline diastema and rotation fixed and also stated that she really did not like the translucency of her edges:
I scanned her at the hygiene appointment, designed two NO PREP Tetric CAD veneers over 8 and 9, and 3D printed a model to fit them on:
We bonded them in today with Variolink Esthetic light and did some minor bondings on 7 and 10
I suppose I could have done with ceramics and the esthetics would have been a touch better, but no way could I have milled them this thin. I'm liking the idea of Tetric CAD MT as a no prep veneer material
I don't get to do a lot of bleach shade cases in my neck of the woods so I am always a little surprised when I actually get the chance. Whew! They are bright and they are white!
Here is a woman who wanted some new crowns due to recurrent decay and she felt they were too yellow. My camera does not do the existing crowns justice. They were a B1!
Her concerns with her previous crowns:
1. #9 was longer than #8.
2. The incisal embrasures between the laterals and centrals were too open.
3. She also didn't like the "black pepper" look between her centrals. #8 and 9 had previous endo.
4. Her crowns were too yellow and she wanted to match her "new crowns" on upper right.
5. Her crowns were all different opacities- #8 & 9 were lava crowns, where as the others were e.max done at different times.
Her plan is replace her lower anteriors next year as well as her upper left crowns.
Here is what I love about my CEREC. This case was pretty easy because all of the hard work was already done for me. I could have done this either Biocopy or Biogeneric Individual. Personally, I chose Biogeneric Individual purely because doing the copy line is an extra step and takes more time. I do however add the Biogcopy folder in the acquisition stage, and scan the existing crowns so that I can use this as a reference point for midline and incisal length. I also have my checklist of things she didn't like and can correct that by ghosting the Biocopy model over my proposals. She did not want a lot of characterization in this case as far as staining, because she wanted Hollywood white. My rule of thumb on this is, the less staining the more contouring. It's how I can get them to pop.
This is a case I chose to do same day. Why? Because seeing one patient vs. 15 is very calming to me personally, and also because when I leave my office, I don't have time to come back and do lab work. The one visit is my scheduled lab time. This is also how I market my practice and I am comfortable with that. My husband does cases like this in two visits because for him sitting with one patient is the exact opposite of calm. He would much rather do this on his own time with no pressure of time. Is there a right way? Yes, of course- It is always the wife's way!!! (just kidding- the right way is whatever you are comfortable with!)
The new crowns are e.max BL 2 MT crowns. I needed a touch of opacity to block out the RCT on #8 and #9.
A 60 year old mother of the bride decided on a whim to fix her cracked crown before this Saturday's wedding.
A neighbor of hers told her that I could do it in 1.5 hours at their neighborhood Halloween Party on Saturday night. She called this morning and we squeezed her in.
EMAX B1 MT.
No heavy characterizations or stainings were needed in order to match the old PFM's. We've got one happy and excited Mother!
It never gets old!
It's such a great time to be in dentistry; technology and education are helping us to provide an increasingly high level of care for people, and it's such a gratifying experience. For example, taking a digital impression instead of a traditional one; the consistency, accuracy, time and cost savings, and patient experience are all terrific upgrades. CBCT technology is another great example; the incidental findings that we never would have located with 2D radiography, the increased awareness of the "whole person mindest" (thanks, TK!), the ability to make decisions on a more complete set of data, are all game changing! CAD/CAM abutments and restorations have allowed us to increase accuracy and efficiency in so many aspects of our dental lives. Dental implants have progressed in research supported design and have become a key part of the modern dental practice. Lastly, the high quality of education available to us in support of each of these examples is key to making the most of them all. Each of these are valuable in and of themselves, but by combining them they become truly advantageous to our work, and more importantly to our patients. Here's an example of one such case:
The patient was referred for implant therapy in the #19, 20, and 29 sites. Prior to CBCT, guides, and excellent clinical training, I would have considered punch access, placed 3 implants with healing abutments, all using a pano and with no regard to what was happening with the soft tissue, notably in the #19 site.
I took a digital impression, designed the future tooth positions for all 3 sites (a true prosthetically driven approach), and merged that data with the CBCT. Seeing where the teeth are supposed to be in function certainly helps to plan the correct implant positions. After all, the point of the implant is not the implant, but what eventually goes on it! Seeing the big picture in this way almost forces you to consider things such as occlusion, spacing from teeth to implants and between implants, and also soft tissue challenges, as indicated by the arrow.
Being able to see the case 3 dimensionally really helps your understanding of the clinical realities facing you, and being able to perform a virtual surgery that is prosthetically driven is also a boon. Even better is being able to reproduce these planned positions with precision using a surgical guide. Trying to achieve a copy of your virtual plan using free handed surgery is exceedingly difficult, and does not serve our patients when techniques exist to help us achieve ideal outcomes. In this case I ordered a SICAT Digitalguide and printed it in house with a Formlabs 3D printer.
Because of the virtual surgical planning, coupled with surgical education, I knew I could place the implants without bone grafting, but I also was aware that I would need to manage the poor quality mobile tissue that would be against the buccal of the #19 implant if I did nothing. I repositioned 3 or 4 millimeters of thick attached tissue from the crest to the buccal; there was some suturing involved after this photo with the healing abutments.
The combination of soft tissue management, correctly positioned fixtures, and an implant system (in this case, Astra EV and their BioManagement Complex) designed around postop bone and soft tissue maintenance, led us to this 2 month post op
The approach I would have used before adopting digital workflows would have been a fixture level, open tray polyvinyl impression. I would have placed the implant analog, made a soft tissue model and sectioned the die myself prior to sending it to a lab for an abutment (before my implant education, I would have done a closed tray impression using a stock abutment and a snap cap). When it came back I would often be disappointed by the contours of the abutment, the height of the margin relative to the tissue, and then the contours and contacts of the restoration. In this case, the digital workflow used was to image the Atlantis scanbodies and send the case via CEREC Connect to Atlantis, where they design custom abutments and send me their design (based on my preferences of contour, margin placement, etc.) to approve prior to fabrication.
Once approved, Atlantis will send a Core file, which you can load into the CEREC chairside software and produce the crowns over their abutment designs in the 3 days it usually takes them to manufacture and deliver the custom abutments. This is a far less frustrating process than dialing in the fit of the crowns chairside. In fact, the first time the crowns I produced touched the custom abutments was in the mouth; I was so confident they would fit, it didn't even occur to me to test the crown to abutment fit before seeing the patient! Here are the custom abutments immediately after seating them to spec
And finally, here are the restorations on recall
All of these technologies and techniques are valuable on their own, but combining them helps us address the patient in a more nuanced yet predictable way. It has been such a great journey adopting these work flows into my practice and seeing what they've contributed to consistent clinical success, improved patient experiences, and personal gratification. I am looking forward to what's next, and sharing those with this terrific community!