Everyone's catching CEREC fever

by Lewis Morrison, DDS

Doctors, staff, and patients all agree - the CEREC3 can be a red-hot addition to your practice.

Mastering the CEREC system is not easy, but the rewards are definitely worth it. Implementing this system into my practice was a difficult and sometimes rocky road, but the benefits we've reaped have greatly exceeded our wildest expectations.

I opened my general practice in January 1973. In 1989, I built a state-of the-art dental office with 3,800 square feet, eight operatories, and a staff of 10. We all work hard, and while our production is in the top 5 percent, we maintain a 55 percent overhead.

When I made the decision to purchase a CEREC, my son was a premed student. (He has seen the light and will enter Buffalo dental school in the fall of 2002). I mention this because, at 57 years old, I was thinking about the things we all think about at this age: taking more time off, bringing in someone who will eventually buy my practice, and retiring. I made some inquiries with practice-sales professionals and sent them some numbers that reflected the financial health of my practice. As far as I was concerned, I made more money than I spent and, therefore, everything was fine. Also, my income was still increasing slightly each year.

After all the years of continued success, imagine my surprise when the consultant said that, although I was doing fine, my practice was in a state of decline and would not easily accommodate an associate! I would either have to postpone hiring an associate until I was ready to reduce my income significantly or build up the practice.

I did not want to wait another five to 10 years to bring in an associate, but I did not know how to market my practice more aggressively. I did incorporate many suggestions that I read about in journals and heard about from colleagues, which helped. But they were far from a total solution.

In 1990, I took a course on CEREC, but I was unimpressed with the restorations and unwilling to put forth the effort to make the system work for my practice. However, in 2000, when I started searching for ways to distinguish my practice, I felt that CEREC might be an answer. One-visit restorations that did not require impressions seemed to be a significant differentiating factor that would impress prospective patients. I knew of a colleague in another town who had purchased a CEREC and heard that things were going fairly well for him. I do tend to be a ready-fire-aim type of person, so after a few visits with the sales person, I took the plunge and ordered my CEREC3.

Here are some of the factors that influenced my decision to buy the CEREC:

• It's a technology that obviously was making an impact on the industry.
• It had been in the market place for 10 years, which means staying power in my book.
• The company's sales also were increasing and their updates in software and hardware appeared regularly.

I also have a competent staff who I felt would be able to learn the system. My hygienist/assistant had been with me for more than 20 years and was excellent at fabricating temporary crowns. My staff is so competent that I thought I would not have to get too involved with the system. (After all, I don't know how to take a Schick X-ray, and we have had the system for five years).

However, the most important factor in my fairly rapid decision was timing. I wanted to market my practice aggressively and being one of the first doctors to acquire this technology would be a significant advantage.

My decision was not without its detractors - namely, my staff and my wife. They didn't believe that the system could do everything its manufacturer promised. They believed the cost was ridiculous, and they were concerned that insurance companies and patients would never pay the increased costs necessary to justify its use.

Heeding their concerns, I ordered the system in late October 2000. I spent the required time on Saturdays and other days off working on the typodont and making crowns and inlays. My hygienist, Georgiana, learned to use the system during office time. When we felt that we had developed some rudimentary ability with the system, we started to schedule patients.

Instead of the usual five total units to prep, take impressions, make temporaries, and cement at a later visit, we doubled that time. Some problems occurred. For example, I would do the prep and take the optical picture and leave my dental hygienist/assistant to design and mill the restoration. We organized things this way so that we could still have some semblance of production. But if Georgiana ran into a snag in the design phase, it was hard for me to break away from my routine to work it out. (There was also no guarantee that I could work it out!) Sometimes, after making patients wait three or four hours, we took a rubber impression, made a temp, and sent them home. We did the procedures for a modest fee to counter the inconvenience.

A good percentage of our patients were returning with sensitive teeth. We took a two-day course on technique in April, and this side effect improved somewhat. Finally, we reached the point where I did a crown prep and the optical impression, Georgiana designed the crown, and we cemented a well-fitting, beautiful restoration in less than one hour. Our sense of accomplishment was gratifying! However, we were still inconsistent. The staff still tended to cringe a bit with the start of each case, fearing a massive schedule upheaval. The cost issues were improving and the sensitivity problems had been overcome as we refined our technique, but I was still not completely satisfied.

I did some research to find out "who was who" in CEREC continuing education. Dr. Mark Morin's course in Detroit, Mich., came with strong recommendations. I attended this course, and, thanks to Dr. Morin and Dr. Doug Voiers, my staff and I learned how to prepare teeth and cement crowns. I learned that "Onlays are king!" I also learned how to sell them, how to code them, and, most importantly, how to design them.

This extra attention to education and technique worked! We now do five or more CEREC restorations per day. Discussing fees with patients is easier than ever before because we know how much each insurance company will pay as well as what the patient's responsibility will be. I'm excited about the service I am providing and so is my staff, which makes it easy to get patients excited as well.

Here is what I now say to my patients when I show them an intraoral picture of a broken-down tooth: "Now we can restore your tooth with a long-lasting, natural restoration without drilling down to a nub like we used to. Did you see that box in the reception room? That's where we keep the "Cam" part of the CAD/CAM and it mills your restoration right there. Let me show you a CASEY video on the process. We can even do the other teeth in that quadrant at the same visit. I'll have one of the administrative staff go over the costs and possible insurance benefits for the procedures"

My administrative assistant, Anne, calls it "CEREC Fever." After patients have a CEREC onlay, they often ask when they can be scheduled for another quadrant!

The outcome of this investment of time and money has been significant increase in production - almost 20 percent.

We also have many happy patients who are referring their friends. We have had a dramatic increase in new patients - 50 last month, which is up from our previous 10-year average of 30 per month. Many of our new patients feel that their old dentists were not keeping up with the latest in technology and heard that our practice is cutting edge. I've also reached my main goal - hiring a full-time associate!

We have been on a bonus plan for a number of years. My team members - all 10 of them - are now receiving bonuses in the range of $500-$1,000 per month. Needless to say, I have a very happy staff!

What is most satisfying is the good feeling I get when I see a beautiful CEREC onlay on a tooth that I know I would have crowned otherwise. These are more conservative preparations, which I believe have better margins well above the gingival.

I also like the realization that I am one of the "old guys" to whom Dr. Gordon Christensen was offhandedly referring to in a recent lecture. He stated, "You guys over 50 probably will not be interested in this technology." Sixty is not that far away for me.

My associate and I will be starting a CEREC lab to do quick turnarounds on the all-porcelain onlays and crowns. I certainly did not plan that when I bought the CEREC.

We all face many situations in life that don't go as planned. We have a choice: keep whining, or get off our duffs and do whatever it takes to make it work. Not everyone is willing to take on a $100,000 project with few assurances; I understand and appreciate this attitude.

What about starting with some of the small stuff that you have procrastinated on because you don't have all the answers? For example, how about leaving a PPO? How about raising your fees? Ours are set by an outside agency according to parameters we decide. What about working fewer hours, taking that expensive, but interesting, continuing education course, hiring that extra person, or firing the one who isn't performing up to expectations?

You may not want to jump out of a plane like former president George Bush did at 75, but surely there are other exciting challenges to be met. Do it!