Why CEREC?
I have to be honest. I’ve never been a big fan of CEREC machines, which is a CAD/CAM porcelain restoration milling machine (basically, a machine that makes crowns, onlays, and inlays in the office instead of sending them to a lab). Every time our local dental supply rep would bring by brochures or invite me to demonstrations, I would politely say “no”. It always seemed like a very expensive gadget costing anywhere from $70-100,000 and seemed very limited in its abilities. With the 3rd version of the CEREC machine, I was finally persuaded to do some CEREC inlays on one of my staff members, who wanted to switch out some silver fillings. Honestly, I was stunned.
I was stunned for two reasons. I couldn’t believe how easy and yet sophisticated the system was. The ability to scan a tooth preparation and custom design and mill a porcelain restoration was unbelievable. I also could not believe how well the inlays fit the preparation. The fit was a good as the lab work I typically get.
All this was great, yet I still had two big concerns: Strength and beauty. Were CEREC crowns strong enough to go the distance and would they be something patients looked at in their mouths and say “Wow!”? We have done a lot of all-porcelain crowns on front teeth but never any on the molars in the back. We had always done porcelain fused to metal or zirconia (a white substrate only Superman can break.) For esthetic problems, CERECs crowns would be milled from a solitary block of porcelain. Teeth, however, often have two to three shades as you go from the cervical collar to the cusp tip.
Well, as I debated with myself whether I should purchase a CEREC machine, I attended a meeting of the Atlanta Dental Study Group who had Dr. Jose Luis Ruiz from Burbank, California as a speaker. He didn’t specifically endorse CEREC, however, he does have a different technique for restoring teeth that doesn’t involve crowning them. He does porcelain onlays. Porcelain onlays have become very popular in dental circles in the last few years for two primary reasons. One, they are gorgeous restorations because they don’t have metal and seem to blend right into the natural tooth structure because light passes through them very similarly to tooth structure. Two, they drastically reduce the amount of tooth structure that must be removed. Some studies say that it’s about 30% less reduction and retaining an extra third of your tooth is a great thing. Dr. Ruiz also has 5 year studies that show very low breakage rate. He also mentioned that CEREC onlays were usually stronger because they are milled from a solid industrially-manufactured block of porcelain, whereas lab-produced onlays can have defects from the manual porcelain stacking process.
Well, all this convinced me to give CEREC a try and besides the two inlays, we’ve done two onlays in the last week and I absolutely love it. Yes, it’s got a large learning curve but we’ve had our trainer, Elliot in the office with us to guide us through it and it's worked very well.
These are the after photos. Unfortunately, I didn't take before photos. I have a case coming up that I will do before and after shots.
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