Blog Author: Richard Rosenblatt
What Parameters are you using?
I think Mike said that the key to the movements was the midline point of the incisors for movement and setting the arch into the articulator.
This is a newer pt to the office. She is a doctor and always tells us that she does not have a lot of time to come in for appointments due to her busy schedule. She called a few weeks ago telling my receptionist that she broke a veneer on the upper left and needs to get in ASAP to fix. She is very nice but very picky. I'll include a pic of how she showed up in our chair with the broken veneer on #11. The veneer she had cracked at the incisal edge. It was 9 years old. I took some composite and filled it in so I could bio copy it.
I told her it would take me about 90 minutes but she'd be leaving with the final. She could not believe it. Kept repeating that this was not possible. She came in today so I took a quick pic of the final. She told me she liked the final better than the original because I wrapped the prep to the lingual and she could not see the margin that was visible on the original. She left the office telling us that she is going to tell everyone she knows that if they need cosmetic work that they need to come to us.
The power of 1 visit dentistry, especially when it is in an aesthetic area, can be a great practice builder. when patients think you can do something that no one else can, you separate yourself from the rest. The last pic is the final of the veneer on #11. Not a huge deal, but a nice color match and she was very happy with the final result. She came in today to take impressions for a night guard and kept letting us know how much she appreciated getting the final the same day and how much she loves how it looks. I Love me some CEREC!!
I was doing a basic training last week and I received a question that I hear often from new users…..”How should I schedule my CEREC appointments when I get back to the office?” I tell all new users to schedule for success. What that means to me is that the new user must understand that things initially will take a bit longer since they are learning something new and they need to schedule accordingly. Trying to stay on time is not easy in a busy practice. Throw in some new technology for the team to try and master and it can add some pressure. My suggestion to my docs is to do one of two things. My first suggestion is to schedule about 2 hours for your first cases and schedule them up against your lunch and the end of your day. By doing this, if you run late, it will cut short your lunch or you may stay a bit later, but at least your schedule won’t have added pressure. The other suggestion is to book it on a day for the first month that you are not usually in the office and do three or so cases when there are no interruptions like hygiene checks and emergencies.
The other recommendation I have is to download the cerecdoctors.com app and use the “Track a Case” application. This will allow you to time each aspect of the CEREC appointment such as anesthesia, imaging time, prep time, design time, milling and cementation. You will get an idea of what aspects of the process you are progressing well with and what areas you may need to work on. It is a very handy tool to help you improve necessary aspects of the CEREC appointment. Once you get an idea of how long your appointment is taking, you can then start scheduling more procedures and also understanding that in the milling and characterization aspect of the appointment, you can start to schedule other dentistry to maximize profitability.
I just had my annual maintenance on my Omni and MCXL this morn. Patterson techs do such a great job when they come out. They really know the machine and give lots of great tips on maintenance for our daily routine. I got a good one today that I thought I would share. He told me that the water jets that shoot water to the tip of the burs had some clogs in them. For those that don’t know where the water jets are, this is a close up of the 3 small holes where water is aimed at the tip of each bur.
These holes can get clogged occasionally with some of the milling debris. If all 3 jets are not hitting the end of that bur, you are going to go through a lot more burs than you would like. Try these steps:
- Close the lid and hit the pump button. This will purge the water through the jets and let you see if water is coming out of all 3 ports. In the pic I have included, you can see water is coming out of all 3 but the tech told me that I had a few that were not firing water to the tip of the bur.
- Once you determine which ports may be clogged, get a 15 or 20 new endo file and insert into each individual port. You can see by the pic that there is a definitive angle you need to get to insert the file properly into the port. Do this with each clogged port and then try the pump button. Repeat until all ports are clear and freely flowing.
He recommended doing this weekly when we change the water to make sure it stays clear and free flowing. I now have my mcxl and omni with new filters, cleaned, calibrated and ready to take on whatever I can bring it. Thanks again Patterson for you service and knowledge with this technology!
Has anyone had this happen when you use spray glaze? You spray the crown to get your nice glazed finish and put it in the oven. You go to take off the crown and firing pin from the tray and you snap the bottom of the peg and it is stuck in the tray!!!
This has happened to me 2 times. If this does happen, you are likely going to have to get out a bur and run it over that to knock it out. The reason this is happening is that you are putting the crown and pin on the tray, holding the tray and then spray glazing it.
When you do this, the glaze will get into the hole in the tray and cause the pin to get stuck. What we do to avoid this is 1) to make sure you do not spray glaze the restoration on the tray and 2) hold the pin by the bottom so no spray gets on it and causes the same problem. Simple fix for an annoying issue that occurs for spray glazers.
When restoring a maxillary tooth with CEREC we take our necessary images, stitch our Buccal Bite and then go to the Model Axis. When we get to the Model Axis step, we see the mandibular model and not the maxillary one. The bases the model axis to the mandibular arch but that does not mean that you can’t see it and adjust it if you’d like to.
In this example, a crown is prepped on tooth #3. When we get to the Model Axis stage, we can see the lower arch. We try to line up the cusp tip of the canine to the distal buccal cusp of the second molar in the bottom left window. On the top left window, we set the model so we can see the buccal and lingual aspect of the arch equally when we look down the long axis of that tooth. If you want to see the maxillary arch, click on Display Objects and you will see that you have the option to click on the maxillary arch. When you click on the maxillary arch option, you will see you prep and can make minor adjustments if necessary.
I really like this combo because it mills nice, polishes nice and cleans up easy. Patient broke #30 DL cusp. The tooth had some recurrent decay. I checked it with caries detect. The tooth was slightly sensitive to cold but 1-2 seconds on cold exposure and then no more discomfort.
The procedure start to finish was about 65 minutes. I like to do partial coverage whenever I can. This is a typical case for me that gets partial coverage.
To learn more about this case visit https://www.cerecdoctors.com/discussion-boards/view/id/37973
Bensheim. "We are delighted to offer our CEREC Omnicam customers the ability to submit their digital impressions to the Invisalign® system. After 30 years of leading dentistry into a digital era, Sirona's focus has expanded to orthodontic treatment. Today's announcement is another example of our strategy to provide best-in-class products and customer support, as we integrate the market leader in clear aligner treatment into the CEREC world", highlights Jeffrey T. Slovin, President and Chief Executive Officer of Sirona. "With the seamless digital model submission to the Invisalign® Doctor's Site, we once again show our dedication to providing our customers with truly integrated systems that make dentistry better, safer and more efficient and improve the patient experience. We believe that this strategy combined with our continuous innovation will drive penetration of digital dentistry and will deliver increasing value to our important customer base and patients around the globe.”
The new CEREC Ortho SW 1.1 features a patent-pending guided scanning process and connects the CEREC world with Invisalign® treatment by allowing seamless digital impression submission. CEREC is already the most frequently used system for digital impressions, and no other system is used more often for chairside restorations – this solution is not only safe and reliable but also scientifically proven. The orthodontic treatment can be planned in the Invisalign® treatment process using the digital impression data.
CEREC Ortho Software: Easy, fast and comfortable
Digital models created from CEREC Omnicam intraoral data are transferred to Align Technology and used as part of the record submission for an Invisalign® treatment. This eliminates the laborious process of creating and sending physical impressions, which results in faster processing of the case. Patients may benefit from the earlier start of the therapy and the digital impression taking instead of conventional impression material.
CEREC’s proven digital impressioning system provides a safe and reliable step into the process for general practitioners and orthodontic specialists alike. The required new software, exclusive for CEREC Omnicam systems, will be available in selected markets by summer 2015.
To learn more about CEREC Ortho visit http://www.cerecdoctors.com/digital-learning/browse/category/379
I was doing a training recently and a newer user wanted to copy an existing crown. I figured that I would do a blog for the newer users on Bio Copy to demonstrate how to move images and use the Cut Tool to make Bio Copy imaging a lot easier. While the patient is getting numb, take an image of the quadrant that has the tooth you will be restoring. In this case I was restoring tooth 18.
I took the pre op image to make sure I have about 2 teeth anterior to the tooth I’m about to copy. I made sure to go to the pre molars. This give the machine ample data points to match up the pre op image I’m taking with the prep image I will take once I’m finished preparing the tooth. I will than drag the bio copy image to the corresponding arch folder. In this case, lower arch folder will have an exclamation point on it. The software will ask if you want to Copy or Paste, so click on Copy.
Now we have the same info in the prep arch as we do in the pre op image.
Make sure to click on the Lower Arch now to activate that box.
We are going to use the cut tool to cut out #18 from the arch. When you click on Cut, you will draw a circle around 18 and the adjacent marginal ridges of 17 and 19. It is similar to drawing a manual margin.
Once you complete the circle, click Apply and then click on the circle at the top right corner of the Cut Tool box to close out the tool.
Now the machine will make sure there is enough information to be able to match up the pre op picture with the arch that has a big hole over #18. This is why you need to make sure you have enough common information between both catalogs. If you do have enough common information, you’ll get a green check in the Bio Copy box that tells you that they will merge.
Your team member can do all this while you are doing hygiene checks or working in another room. You come back to the machine with all images taken and just the missing data over the prep. When you are done prepping, you just click on the catalog with the cut out tooth and activate your camera. Begin imaging over an area of common info, and not over the prep. The camera will being imaging and now you just need to image the prep and the adjacent walls. It is the most time efficient way to do Bio Copy.
I really love what cone beam technology allows me to do when helping to treatment plan a case with a patient. It gives me the ability to be able to “know before I go”. If I only had a pano in the case I’m about to show, I would have a much more difficult time trying to determine if this was I case that I was comfortable taking on. Having cone beam technology makes me feel sometimes like a super hero because I truly feel like I have 3D x-ray vision.
This patient came to my office wanting a permanent, non-removable solution in her anterior. She had an accident about a decade ago and had to have #s 7-10 extracted. A partial denture was placed and she has been wearing it since. She decided that she really wanted to explore a permanent option and came in to discuss it with me.
In the pano view, there appears to be plenty of length of bone to be able to place implants. She was somewhat price conscious, but even so, when I have tackled these cases as of late, I have preferred 2 implants in the #7 and #10 area and bridge between them.
I took a look at the bone in the area of #7 and #10 and you can see in this one screen shot, the bone is very thin. Time to see if my implant would even fit in the space she had.
I place Straumann bone level implants and decided to work up the case placing implants in the #7 and #10 positions. As you can see, the maxillary bone have ample length but nowhere near enough width to get a 3.3mm implant in without there being an issue of possible buccal and or lingual perforation of the implant through the bone. I knew at this point that without significant grafting, this was not going to be an option here.
Even if the bone was just thick enough (and it obviously is not), there is another view that I showed her, the 3D view, to give her an idea of the angle the implants were going to come out of the bone compared to the adjacent teeth. This case would have been significantly flared to the buccal and extremely difficult to restore, even with the area of bone that was a bit wider.
I informed the patient that this was out of my personal comfort zone and she would have to talk to one of my excellent specialists about her options. My specialists absolutely love this because I have done all the pre op work for them so they know exactly what will need to be done in this case. Such would not be the case If I was relying completely on 2D films. I love my cone beam technology and am grateful that I never have to practice another day without it.