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Three Ps in a pod

Nov. 1, 1999
Dentists are bearing the fruits of patient satisfaction, precision, and profits thanks to the CEREC 2 from Sirona

Dentists are bearing the fruits of patient satisfaction, precision, and profits thanks to the CEREC 2 from Sirona

Kevin Henry

Let`s get the price out of the way first. The CEREC 2 system from Sirona costs in the neighborhood of $79,000, making it the single-most expensive piece of equipment that a dentist can purchase. No matter how you look at it, that`s a pretty big chunk of change for most dentists.

Now that you`re over the initial shock, take a deep breath and keep reading. While some dentists see nothing more than the price tag and walk away, other dentists have taken the proverbial "leap of faith" and purchased the system. The majority can look back now and say the up-front expense of the system has been swallowed by a reduction in laboratory expenses and an increase in productivity and referrals.

"I looked at the machine and saw the price tag, but I thought that, even if it was a break-even decision, it would benefit the patients and it would be worth it," said Dr. Joe Palmer of Piedmont, S.C.

What is this machine that scares and thrills dentists across the country? The CEREC 2 is a CAD/CIM milling system that takes a three-dimensional picture of the tooth using infrared imaging. From there, the dentist instructs the machine to make ceramic fillings, veneers, onlays, and/or crowns, based on the three-dimensional picture. The CEREC (short for Chairside Economical Restorations of Esthetic Ceramics) turns what was a two- or three-visit procedure with the patient wearing a temporary into a one-stop fitting, benefiting both the patient and the dentist.

"I can`t tell you the number of referrals I`ve gotten because of the CEREC 2," said Dr. Mark Melson of Raytown, Mo. "Rather than sticking gooey, nasty impression material in someone`s mouth, we`re able to take a picture. Next to getting a shot, my patients hate the nasty taste in their mouth worse than anything."

Melson should know plenty about the CEREC 2. He`s a certified CEREC 2 trainer (one of only a handful in the nation), and he often introduces dentists to the benefits of the system. Another dentist praising the CEREC 2 is Dr. Douglas Voiers of Avon Lake, Ohio. Voiers and Dr. Mark Morin of Detroit will soon be travelling across the country on behalf of the CEREC 2.

"In my PowerPoint presentation, my first slide makes a bold statement. It says that the CEREC 2 is the gold standard in the metal-free era of the new millennium," Voiers said. "I believe this will replace gold. In the future, dentists will look back on this and say this was the dawning of a new era in restorative dentistry."

Using the CEREC 2, dentists have the choice of using a more conservative approach when it comes to restoring the tooth. The entire tooth doesn`t need to be cut down to make room for a temporary. Using the CEREC 2 and adhesives, dentists can be conservative and, at the same time, helping the "new" tooth become even stronger than the original.

"In studies over the last 10 years, it`s been proven that bonded ceramics can strengthen the tooth," Melson explained. "We know that old silver fillings and composites can weaken the tooth. With the CEREC 2, the new tooth has 103 to 115 percent of the strength of a virgin tooth. That`s pretty remarkable."

Dr. Carl Boscketti of Exeter, N.H., added, "If we can tell patients that we are going to use a conservative approach which will preserve the natural tooth structure, while saving them money and time, that`s a great benefit to the patient. It`s ideal for the patient. Two or three appointments can be done in one, and the work costs less than a crown."

While there are many benefits to the patient, there also are several for the dentist and his or her practice.

"Three years ago, my partner and I had about $12,000 per month in lab bills. Now we`re busier and our lab expenses are around $3,000 to $4,000 per month," Melson said. "Our bills have decreased so much because we used to have to pay the lab to make restorations. That would average around $125 per restoration. On the CEREC 2, we can do it for around $22.

"And there are other costs that you have to factor in. Sterilizing a room costs around $17. An impression costs around $10. A temporary costs around $5. I save those costs as well with the CEREC 2. Plus, there are the untold savings of confirming second appointments and fewer failed appointments. I figure we save around $130 every time we use the CEREC 2. When you factor in the cost to purchase the machine, you probably need to do around 12 to 15 per month to break even. We do around 30 per month. It`s a great benefit to the practice and makes us much more productive."

"If you look strictly at the numbers, it`s very easy to make a profit. It`s definitely impacted my bottom line," echoed Palmer.

Obviously, the CEREC 2 redirects the work previously performed by the laboratory back on the dentist, which could cause some concern in terms of quality and precision. But Melson and Palmer are quick to dispel those thoughts.

"A common particle size from the lab is 20 to 25 microns, which is about the diameter of a single human hair," Melson said. "Still, there can be a lot of abrasive tendencies, even with the particles being that small. The CEREC 2 produces a common particle size of 4 microns in its ceramics. That means it`s almost identical to the original enamel."

"Studies show that when you learn to use the machine and make impressions, the margins are equal or better than the lab," Palmer added. "You can`t beat the quality."

More than 4 million CEREC 2 restorations have been produced by more than 5,000 dentists worldwide. Based on an average of 20 restorations per month for each unit/doctor, a CEREC 2 restoration is placed in a patient`s mouth somewhere in the world every 20 seconds. It`s a safe bet that those numbers will continue to escalate as word of the system continues to spread.

"My patients think I`m the smartest dentist in the world," laughed Palmer. "Those who have gone through a procedure the other way have been spoiled by me using the CEREC 2. I have patients who drive more than two hours to come and see me because they`ve either heard about the CEREC 2 from some of my other patients, or they`ve had the procedure done previously."

"My work schedule has been reduced because I can take a couple of hours and use the CEREC 2 rather than use a temporary and send something to the lab," Boscketti said. "It takes less time for my patients, and helps me work with more energy."

"Everyone`s busy, and temporaries can be rough, or break, or come off, or be sensitive," Melson said. "With the CEREC 2, you have total control over the precision of the machine. You know exactly what you are going to get."

How Easy Is It To Use?

That`s a common question when dentists are trying to decide if the CEREC 2 system is right for them. And the com-mon answer is: It`s easy to use, once you learn about it.

"For some I think it`s going to be very easy from the very start, while others are going to have a learning curve," said Dr. Doug Voiers of Avon Lake, Ohio. "I equate it to how long it takes to learn how to use an intraoral camera. I learned the CEREC 2 in a four-hour course, and then came back to my office and did a restoration on the machine that same day."

Steve Sutton, Sirona`s United States product manager for CEREC, emphasizes that his company is committed to making sure the dentist/customer is happy.

"When a doctor pur-chases the CEREC 2, he or she gets a two-day clinical class with a CEREC 2 trainer," Sutton ex-plained. "They travel to meet with one of our trainers, which we have positioned strategically throughout the country. And, before that training, they have received instructions from the Patterson (Dental Company, the exclusive supplier of the CEREC 2 system) and have been supplied with manuals.

"It`s very similar to working with Windows on your PC. Some people will pick it up quicker than others. We`ve had dentists who were very comfortable with it after 10 restorations, and others who have needed 30 or so. But our company has made the commitment to the doctor to do whatever is needed for them to be successful with the system. We`re willing to invest the time and the effort."

For more information, call (800) 873-7683.

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Left: Teeth with amalgam fillings.

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Left: The same teeth filled with restorative materials from the CEREC 2.