Isolation

CEREC is mainly an isolation game, as you've painfully figured out. Here are my tips:

1. BUY AN ISOLITE! It's sold direct through www.isolitesystems.com for about $1,700, and (in the past) they have a program where if you don't like it you can return it in 3 months. You'll buy a second one by then! If you don't need or want the light part (it's unnecessary if you wear a headlight), then get the isodry for about $900. It's literally an assistant in a box and will make CERECing (and prepping and bonding) very, very, very easy!

Note on Isolite, 3 of 10 patients will refuce the mouthpiece and another 2 of 10 will complain. These pieces are disposable, so take a blade or scissors and trim away the part that's annoying the patient. Also mention "I really like this device because it gets all of the really small mercury particles from escaping down your throat... but if you insist we can do without it."

2. SUPRAGINGIVAL PREPS when at all possible. You're not burying a metal PFM ring, so keep the preps high if you can.

3. DIODE LASERS are great to trough and get hemostasis. You can get them as cheaply as $2,500 now, and 2 minutes with the laser will save you 10-15 packing cord and hemostat. Your time and frustration are well worth the money! If you're really shaving pennies, you can bill out legitimate gingivectomies ($100-$200) once or twice a month for the really burried margins or overgrown gingiva on implants. This means your laser will pay for itself in a year or so, not to meantion your free time.

4. PACK CORD, even though you hate it. Pack it deep, far below the margin. The cord will tend to fray and cover the margin, so packing deeper than you think is necessary is actually necessary.

5. PUNT WHEN YOU'RE BEHIND. If you can't get the picture you want, snap an impression and take a picture of the PVS. If your margins are difficult to see from this shot (as PVS images can be), then pour it up in quick-set (3-5 minute) stone and scan the stone. You'll still get done in one visit, and if there's a margin problem on the stone you can check it against the real prep and modify the stone with a blade.

6. IF YOU DON'T THINK YOU SHOULD DO IT, DON'T DO IT. You know when your isolation (and picture) is bad. Don't cross your fingers and continue forward hoping it will get magically better in the margin finding step! Go back and do it right from the start. Odds are you'll have to go back anyways.