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.
Thursday, March 3, 2011
Thursday, February 24, 2011
Taking the time to do it right
Even after all these years I'm still surprised by the number of people who can never find the 2-3 hours to practice and learn, but always make time to spend 5-10 hours to correct the mistakes that would have been avoided... had they practiced and learned. This is true for CEREC as well as most other learned skills (e.g., placing implants, photography, golf, heart surgery).
My recommendation: if you're having trouble with something, practice first. If it's CEREC, ask me and I'll give you some simple homework. Or look on CADStar.org or cerecdoctors.com. A few minutes of practices goes a long way.
That's why we don't teach swimming in the ocean first....
My recommendation: if you're having trouble with something, practice first. If it's CEREC, ask me and I'll give you some simple homework. Or look on CADStar.org or cerecdoctors.com. A few minutes of practices goes a long way.
That's why we don't teach swimming in the ocean first....
Friday, February 4, 2011
Parameters
Some of you have been asking about your parameters or just changing them to random numbers. Here’s what they mean and what I recommend for settings:
Under Settings (top menu bar), click Parameters, then...(all numbers are in microns)
CONTACT STRENGTH is how heavy you want your initial interproximal contact proposal. 25 is just green, 50 is a spot of yellow, 75 is half yellow-half green, 100 is a spot of red, 125 is way too much. Start at +75.
OCCLUSAL STRENGTH is the strength of your occlusal contact. This tends to be too heavy by default. Start at -150. If they are still coming out high, lower to -200 or even -250.
OCCLUSAL OFFSET takes your restoration out of occlusion. It’s naturally 100 microns too high, so -100 is even. Start at -150. Take to -200 if you’re consistently high.
MARGIN THICKNESS gives extra around your margin to avoid submargination. I put everybody at 100.
OCCLUSAL THICKNESS is your minimal occlusal thickness, below which you will see the light blue “you’re too thin” warning. Set to 1000 (1.0mm) if you’re using emax, or 1500 (1.5mm) for porcelain.
RADIAL THICKNESS is your minimal thickness for the axial walls. Set to 500.
VENEER THICKNESS is 500. It only applies when you’re doing veneers in biogeneric, which is tedious and painful. You’ll correlate veneers.
ADHESIVE GAP is your kavo surface (margins except gingival) for inlays and onlays. It prevents binding or flash. Set to 30. Raise to 50 if your inlays aren’t going down easily.
SPACER is your internal spacer. The software gives you 100 microns immediately, but that’s not enough. Start at 30. If it feels loose, lower to 20 or 10. If it’s tight, raise to 50.
SCAN STEP is always 3, unless you’re a lab.
These aren't the "official" settings and if you find something else works better, keep it. I've found in the majority of offices these numbers are perfect, but you could be an exception. Every dentist is exceptional in some way!
Under Settings (top menu bar), click Parameters, then...(all numbers are in microns)
CONTACT STRENGTH is how heavy you want your initial interproximal contact proposal. 25 is just green, 50 is a spot of yellow, 75 is half yellow-half green, 100 is a spot of red, 125 is way too much. Start at +75.
OCCLUSAL STRENGTH is the strength of your occlusal contact. This tends to be too heavy by default. Start at -150. If they are still coming out high, lower to -200 or even -250.
OCCLUSAL OFFSET takes your restoration out of occlusion. It’s naturally 100 microns too high, so -100 is even. Start at -150. Take to -200 if you’re consistently high.
MARGIN THICKNESS gives extra around your margin to avoid submargination. I put everybody at 100.
OCCLUSAL THICKNESS is your minimal occlusal thickness, below which you will see the light blue “you’re too thin” warning. Set to 1000 (1.0mm) if you’re using emax, or 1500 (1.5mm) for porcelain.
RADIAL THICKNESS is your minimal thickness for the axial walls. Set to 500.
VENEER THICKNESS is 500. It only applies when you’re doing veneers in biogeneric, which is tedious and painful. You’ll correlate veneers.
ADHESIVE GAP is your kavo surface (margins except gingival) for inlays and onlays. It prevents binding or flash. Set to 30. Raise to 50 if your inlays aren’t going down easily.
SPACER is your internal spacer. The software gives you 100 microns immediately, but that’s not enough. Start at 30. If it feels loose, lower to 20 or 10. If it’s tight, raise to 50.
SCAN STEP is always 3, unless you’re a lab.
These aren't the "official" settings and if you find something else works better, keep it. I've found in the majority of offices these numbers are perfect, but you could be an exception. Every dentist is exceptional in some way!
Recommended Burs
I’ve been recommending burs for a long time, and I’ve finally come out with my own bur kit. It’s manufactured by Axis, sold by Patterson, and nets me absolutely no money... but I do get to say I have my own bur kit. The cost is $189 and you can get it from your Patterson rep or from the office by calling 408-746-4300 (ask
for customer service, say you want the CERECGuy bur kit). It comes with a bur block and the following burs:
- wicked course to cut off zirconia and PFMs
– 1.5mm and 2.0mm occlusal reduction burs
– course inverted cone to remove undercut
amalgams for inlays and onlays
– course cylinder to prep crowns
– fine cylinder to finish axial wall margins
– fine football to smooth internal angles
– fine mosquito tip to open interproximal
contacts for inlays and onlays
– two polishing cups for porcelain
– a robinson wheel (frilly edges) for polishing
- keys to a new Lambourghini (while supplies last)
You don't have to get this kit, but you do have to get appropriate burs to create the sharp margins and internally smooth angles necessary for CEREC. I recommend you reduce your bur inventory to no more than 10 different types (for every prep), then make 10 sets and place them in 10 bur blocks. Now no matter what you're prepping, you have a standard, familiar bur kit ready to go.
for customer service, say you want the CERECGuy bur kit). It comes with a bur block and the following burs:
- wicked course to cut off zirconia and PFMs
– 1.5mm and 2.0mm occlusal reduction burs
– course inverted cone to remove undercut
amalgams for inlays and onlays
– course cylinder to prep crowns
– fine cylinder to finish axial wall margins
– fine football to smooth internal angles
– fine mosquito tip to open interproximal
contacts for inlays and onlays
– two polishing cups for porcelain
– a robinson wheel (frilly edges) for polishing
- keys to a new Lambourghini (while supplies last)
You don't have to get this kit, but you do have to get appropriate burs to create the sharp margins and internally smooth angles necessary for CEREC. I recommend you reduce your bur inventory to no more than 10 different types (for every prep), then make 10 sets and place them in 10 bur blocks. Now no matter what you're prepping, you have a standard, familiar bur kit ready to go.
Tuesday, January 25, 2011
San Francisco Study Clubs, first half of 2011
These are worth your time and money. Always free. Always 6-8ish pm. Always open to all (doctors, associates, assistants, CEREC owners and not-now-but-really-should-be-CEREC-owners). Always with 3 CEs. Always with dinner. Always hoping you’ll RSVP so I can order enough food.
San Francisco Clubs (490 Post, Suite 301)
TUES, FEB 15… Virtually place CEREC implant on 3D conebeam scan. We’ll have our first intrepid patient Tony back (to prove he survived) and show the three unit bridge we’re replacing with two crowns and an implant, all CEREC, all documented for you. We’ll also design the surgical guide for the upcoming implant.
WEDS, MAR 16… Davy Jones (ex-Monkey, current practice consultant) will give real use-it-today tips for growing your practice. I’ll also show a variety of cases: some good, some bad, some ugly!
THURS, APR 14… Learn to stain like a pro from a pro! Master Ceramist Eddie Corrales (www.downtowndentaldesigns.com) will show his tips and answer questions on all things CEREC and aesthetic. We’ll also bring out our next semi-willing patient for a conebeam scan and implant planning. As a group we’ll look at the scan and collaborate on implant placement scenarios.
MON, MAY 16… Quadrants and speed design. My list has grown to 30 Most Common reasons you’re CERECing too slowly. I’ll review each reason with a case or two and pass out the list. (Yes, I’m lazily copying my Sunnyvale program this month.)
TUES, JUNE 14… See the new 4.0 software, or the beta version I plan to steal. Multiple unit simultaneous design, bridges, lateral excursion, slow-release botox… I’ll show you what I know (making this a 5 minute program!).
WEDS, JULY 13… We should be getting pretty good at implant cases by now. I’ll find something good---and I take suggestions if you have any!
San Francisco Clubs (490 Post, Suite 301)
TUES, FEB 15… Virtually place CEREC implant on 3D conebeam scan. We’ll have our first intrepid patient Tony back (to prove he survived) and show the three unit bridge we’re replacing with two crowns and an implant, all CEREC, all documented for you. We’ll also design the surgical guide for the upcoming implant.
WEDS, MAR 16… Davy Jones (ex-Monkey, current practice consultant) will give real use-it-today tips for growing your practice. I’ll also show a variety of cases: some good, some bad, some ugly!
THURS, APR 14… Learn to stain like a pro from a pro! Master Ceramist Eddie Corrales (www.downtowndentaldesigns.com) will show his tips and answer questions on all things CEREC and aesthetic. We’ll also bring out our next semi-willing patient for a conebeam scan and implant planning. As a group we’ll look at the scan and collaborate on implant placement scenarios.
MON, MAY 16… Quadrants and speed design. My list has grown to 30 Most Common reasons you’re CERECing too slowly. I’ll review each reason with a case or two and pass out the list. (Yes, I’m lazily copying my Sunnyvale program this month.)
TUES, JUNE 14… See the new 4.0 software, or the beta version I plan to steal. Multiple unit simultaneous design, bridges, lateral excursion, slow-release botox… I’ll show you what I know (making this a 5 minute program!).
WEDS, JULY 13… We should be getting pretty good at implant cases by now. I’ll find something good---and I take suggestions if you have any!
Sunnyvale Study Clubs, first half of 2011
These are worth your time and money. Always free. Always 6-8ish pm. Always open to all (doctors, associates, assistants, CEREC owners and not-now-but-really-should-be-CEREC-owners). Always with 3 CEs. Always with dinner. Always hoping you’ll RSVP so I can order enough food.
Sunnyvale, at Patterson Branch (333 Soquel Way)
WEDS, FEB 16… Anteriors! I’ll show the new tricks with 3.8 and crowns v. veneers, multiple units, ghosting the correlate, implants, and anything else I can steal from your collective cases. I’ll also have the new integrated shade guide—zap the neighboring tooth to get the right shade and the block placement software will select the shade and dance it into the proper position (or so I’m told…).
THURS, MAR 17 (St. Patrick’s Day)… Show your Irish, bring a green-stained CEREC, and learn how to make some green cash. After I answer any and all CEREC questions and review a few cases, Davy Jones (not from the Monkeys) an practice management consultant with 25 years’ experience, will spend an hour talking about how to grow your practice in this recovering economy.
WEDS, APR 13… Stain and Glaze tips with Eddie Corrales (www.downtowndentaldesigns.com), a CEREC Alpha Tester (and Alpha Male), San Diego master ceramist, and genuine friend to CEREC doctors venturing into large cases. He’ll also take any CEREC design or materials question you can think of. This IS NOT a hands-on class. That’s on Friday…
TUES, MAY 17… Quadrants and speed design. My list has grown to 30 Most Common reasons you’re CERECing too slowly. I’ll review each reason with a case or two and pass out the list. (Hint: first 29 reasons are the prep!)
MON, JUNE 13… The new 4.0 software should be out, or I should have stolen a beta copy by now. See designing multiple units at once (skip the virtual seat part), bridges, adjusting for excursive motion as well as the centric bite, and the new just-take-my-handpiece-and-prep-it-for-me feature.
TUES, JULY 12… I’ll think of something good.
Sunnyvale, at Patterson Branch (333 Soquel Way)
WEDS, FEB 16… Anteriors! I’ll show the new tricks with 3.8 and crowns v. veneers, multiple units, ghosting the correlate, implants, and anything else I can steal from your collective cases. I’ll also have the new integrated shade guide—zap the neighboring tooth to get the right shade and the block placement software will select the shade and dance it into the proper position (or so I’m told…).
THURS, MAR 17 (St. Patrick’s Day)… Show your Irish, bring a green-stained CEREC, and learn how to make some green cash. After I answer any and all CEREC questions and review a few cases, Davy Jones (not from the Monkeys) an practice management consultant with 25 years’ experience, will spend an hour talking about how to grow your practice in this recovering economy.
WEDS, APR 13… Stain and Glaze tips with Eddie Corrales (www.downtowndentaldesigns.com), a CEREC Alpha Tester (and Alpha Male), San Diego master ceramist, and genuine friend to CEREC doctors venturing into large cases. He’ll also take any CEREC design or materials question you can think of. This IS NOT a hands-on class. That’s on Friday…
TUES, MAY 17… Quadrants and speed design. My list has grown to 30 Most Common reasons you’re CERECing too slowly. I’ll review each reason with a case or two and pass out the list. (Hint: first 29 reasons are the prep!)
MON, JUNE 13… The new 4.0 software should be out, or I should have stolen a beta copy by now. See designing multiple units at once (skip the virtual seat part), bridges, adjusting for excursive motion as well as the centric bite, and the new just-take-my-handpiece-and-prep-it-for-me feature.
TUES, JULY 12… I’ll think of something good.
Monday, January 24, 2011
Belated Introduction
If you're here it's not by accident and you have a guess who I am (you're wrong!) and what I do (something CEREC-ish). If somebody referred you to this site, you've been given a load of bad advice and you should go to www.cereconline.com and talk to the official people at Sirona USA. They won't admit to any software errors or share any good information with you, but they will do so in a much more professional manner.
I created this blog partly to post study club information "FOR MY FRIEND" (not me, I don't attend or host them) and to vent some humor now and again. Feel free to comment and if you're having any CEREC or personal issues, send me an email and I'll do my best not to make things worse.
Enjoy!
CG
I created this blog partly to post study club information "FOR MY FRIEND" (not me, I don't attend or host them) and to vent some humor now and again. Feel free to comment and if you're having any CEREC or personal issues, send me an email and I'll do my best not to make things worse.
Enjoy!
CG
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