I would like to offer my insight into the letter by Dr. Bradley Willis, “CEREC: Myth or Magic?” (January Dental Economics®, page 12). I feel the issue of how to assess CEREC from an economic basis is not solely based on the strict cost differential between laboratory-based crown fabrication or via the CEREC machine.
Having said that, the first important consideration is the cost of the purchase or lease of a CEREC machine. The unit cost is approximately $100,000, and during five years the monthly lease/note payment is approximately $2,000. Second, while the CEREC machine can do a lot, it cannot totally replace the laboratory. There are cosmetic cases that require customization by a dental laboratory to achieve the desired results, which means the savings achieved by the CEREC will be reduced by at least 20 percent.
Nevertheless, while all businesses must address the issue of cost, the average lab cost in most dental practices is probably no more than 8 to 10 percent, while the fixed costs, salaries, rent, insurance, etc., average about 40 percent. This means our real enemy is time. Dr. Willis, in his rebuttal of Dr. Pescatore’s article (October 2005 Dental Economics, page 110), states that the “milling, polishing, porcelain preparation, and cementation process all take about 45 minutes.” This seems consistent with what my colleagues who have CEREC tell me. And Dr. Willis concludes that this means an appointment of 60 to 70 minutes. In my office, this results in an appointment about 15 to 20 minutes longer than for a conventional crown preparation and laboratory crown fabrication. When I seat the crown, I book the seating appointment along with another patient who requires anesthesia, which takes about five minutes. Consequently, the seating appointment is done at a zero cost, so CEREC would take me an additional 15 to 20 minutes. Dr. Willis seems to think that the time necessary for seating a crown is 30 minutes. If so, he needs to switch to a different dental lab. If we again assume, as Dr. Willis does, a production rate of $750 per hour, then if I were to use CEREC, I would have an additional time cost of $162.50 to $250, which greatly exceeds the lab cost savings with CEREC.
Putting all this into real numbers, I will assume a production rate of 50 restorations per month. I will assume that 10 of these cases will require laboratory fabrication and further assume a lab cost of $150 per unit. So with CEREC, my monthly total cost would be:
If I did the same 50 units conventionally, the total monthly cost would be:
It is true that there are additional expenses for impression material, etc., and the monthly note payment goes away after five years, but there will still be a cost differential of more than $3,000 to $6,000 per month with CEREC. This also does not take into account the steep learning curve that comes with learning the intricacies of CEREC.
Perhaps my practice is unique, but I don’t think so. I also think the CEREC restoration is probably excellent. Unfortunately, unless you can justify its use economically or perhaps intend to employ it as a marketing tool and charge a premium for the service, it is frankly too expensive to justify as a means of replacing the dental laboratory.
Richard J. Reinitz, DDS