I would like to offer a rebuttal of Dr. Reinitz’s letter to the editor where he discusses the financial aspects of CEREC dentistry (May Dental Economics®, page 16). While there are numerous inaccuracies in his letter (which is all too common among doctors who have zero experience with CEREC), I am happy to report that he at least agrees that CEREC provides an excellent restoration.
His first point is that the CEREC machine costs $100,000, which equates to a payment of $2,000 a month. This is an accurate statement and, if you do the math, the payments add up to be approximately $125,000 over a five-year period. According to the doctor’s own analysis, his lab bill is $7,500 a month, which ends up to be more than $450,000 over the same five-year period.
I could end this letter right here because who wouldn’t like to save $325,000? This does not even take into account the tax deductions you can take with the CEREC machine, which saves you even more money.
Dr. Reinitz also completely ignores the fact there is a cost associated with setting up a dental chair every time a patient comes in. Industry estimates peg this cost around $50 every time an operatory is set up. So if we take Dr. Reinitz’s own example of 40 units per month, this is a $2,000 a month savings that he completely ignores when he would only have to set up his dental chair once for CEREC and twice for a lab restoration.
He also incorrectly assumes that the blocks and burs cost $27 per unit (the actual cost is closer to $20), and he ignores the fact that impression material and provisional material cost time and money. The last time I checked, no one was giving away PVS and bisacryl for free. In reality, the cost of the blocks and burs is offset by not having to take a traditional impression.
Next, he quotes Dr. Bradley Willis who said, “… milling, polishing, porcelain preparation, and cementation process all take about 45 minutes.” (“CEREC: Myth or Magic?” January DE, page 12). It is obvious from this statement that Dr. Reinitz has no exposure to the CEREC machine. Let’s first ignore cementation because you have to cement both a CEREC restoration and a lab restoration, so the times will be equal. Milling takes anywhere from 8 to 12 minutes, polishing about 2 to 3 minutes, and preparation about 1 minute. This is a far cry from the 45 minutes he is claiming. So if we look at the true times (not fabricated times by someone with no experience with the product), the extra time is a myth and this blows his argument out of the water.
In reality, the time to do a CEREC is the same as if you prep the tooth and send the impression to the lab, only you are doing it in one appointment. Yes, there is a learning curve - a short one - but this should not keep you from learning new techniques. If this were the case, we would not do endo, implants, perio surgery, or any other procedures in our offices. Further, if he wants to seat his lab crown while another patient is getting numb, he will have two opportunities to do this because he will probably have to get his patient numb twice with a lab restoration and only once using CEREC. With CEREC, a doctor also can take advantage of the 15 minutes (or so) of downtime while the restoration is milling by seeing another patient or doing another procedure on the same patient, which skyrockets hourly production even more.
Using Dr. Reinitz’s same numbers ($150 lab bill, 40 units a month), the practice would spend $2,000 on CEREC and $2,000 to set up the chair for the patient, for a total of $4,000 per month. The time is the same; blocks and impression materials are a wash. This same office, if it sends these 40 units to the lab, will spend $10,000 a month - $6,000 for the lab bill and $4,000 to set up the dental chairs twice.
Pardon my math, but it seems that the CEREC dentist is saving $6,000 a month, and again, this is before any tax benefits are taken into consideration. Even if you assume that the office still has a $1,500 lab bill with CEREC - because he is correct that CEREC can’t do everything - the savings are still $4,500 a month.
Ignoring the cost of impression material and provisional material and claiming that it takes 45 minutes to mill and seat a CEREC is laughable and wholly inaccurate. CEREC dentistry is profitable for the office, a great service for the patient, and a win-win all around.
Sameer Puri, DDS
Tarzana, Calif.
