Info for Dentists
We've collected a series of links and tips, articles and observations on the art and science of milled chairside ceramics. If you're thinking of incorporating CadCam into your practice, here's a great place to start.
My First Year with CEREC
(What They Don't Teach You on the Intro Course)
The Product Specialist from Sirona delivered my CEREC in November 2005 and spent one and a half days with us for the training included in the cost of the unit. Two months later I attended the advanced course with Dr David Roessler in Sydney. David is also a specialist, a Prosthodontist, practising in North Sydney.
No Game Plan?
I found both courses to be well presented and informative. However, at the conclusion of both courses, I found myself without a well functioning, basic game plan on how to approach the majority of teeth. I was initially impressed with Database, which worked well in most cases, but I found that I was spending a lot of time fiddling with the design to adjust emergence profiles, and to generally make the restorations look right.
A Personal Revelation
After I'd had my Cerec for about 9 months I had my own dental mishap and needed an endo and a restoration on my 16. It wasn't until Dr Brad Wright, a Sirona Trainer at the time made a CEREC onlay for my 16 that I realised how quick and easy Correlation could be providing there is something reasonable to copy in the first place - plus the added bonus that it feels the same as the contra-lateral tooth when it's finished.
My experiences with Database showed that in my hands, there was rarely enough room for the fissures using the Lee Culp designs; I was constantly filling them with the drop tool to maintain a minimum 1.5mm thickness. This was more than a little frustrating, as I had understood that this was the 'flagship' design mode. It wasn't like I didn't know what I was doing with ceramic, either: after 8 years and 400 units of Empress I had a good idea of how much room to leave, so I wasn't keen to cut away more tooth than was necessary.
On top of this worry, some of the design proposals, especially for onlays, required a lot of time for re-design to ensure I achieved acceptable form. I found using Correlation solved these problems and I could still use the Shape and Form tools to provide a pleasing anatomy. In the cases where the tooth was short in the bite, I found Correlation combined with Articulation an easy solution.
Polishing
My other stumbling block was polishing. Everyone had a opinion on how to go about this, and I spent hours trying different techniques, but ultimately I reckon they look much better glazed, and it's less to do in the mouth and my patients appreciate that.
The system I finally settled on was suggested by my ceramist Bill Jamieson ( whose father I had bought the practice from).
Bill is also a CEREC inLab user.
He suggested I use the same silicon wheel we have been using for years to smooth the restoration before glazing. That combined with a Cerapol wheel after glazing gives a lablike finish. Any adjustments after cementation are polished with EVE points and cups. I found being able to spend some time in the lab watching how the technicians finish ceramics to be immensely helpful. In hindsight I guess life would have been a lot easier if I had started my CEREC life using Correlation where possible and eased myself into Database instead of starting there . M
Steve is in practice in Tallebudgera, Queensland, and is also ASCD, Inc Secretary. Do you have a new-user experience to share? Why not e-mail us about your experiences at info@ascd.org.au
The polishers Steve refers to look like this:
A selection of EVE contra-angle polishers, available from Erskine Dental (http://www.erskinedental.com.au), and also the House of Jewellery http://www.hoj.com.au
Bonded dental ceramic represents the state of the art in bio-mimetic replacement for worn-out teeth. Find out more about how these restorations mimic nature and provide a durable, beautiful and healthy alternative to traditional metal fillings.
