Joel Benk, DDS
From the beginning, my goal as a dentist has been to help people preserve their teeth, so they can maintain the ability to chew for a lifetime. When I graduated from dental school in June of 1980, the main restorative materials available for posterior restorations were amalgam, gold, and porcelain-fused-to-metal crowns.
Gold provided the patient with the most predictable long-term success. Since my own mouth was full of amalgam fillings, I was aware - even then - that they were not lifetime restorations for my teeth, but future dental problems waiting to happen. Since then, cosmetic dentistry has evolved, and many materials promising long-term clinical performance have come onto the market. Many have been successful, but almost all require the use of an outside laboratory. Materials that require two appointments, temporization of teeth, final impressions, and many steps open the door for error by the lab or office staff. For the last 10 years, I have been looking for and found successful indirect materials and techniques to meet the aesthetic demands of my patients.
A year ago, I found what I consider to be one of the biggest breakthroughs in restorative practice and material application since the implementation of bonding in the posterior: CEREC 3 CAD/CAM technology.
After reading about the CEREC system in the literature and speaking with dentist-friends who have one, I decided to buy the system. I was aware of the learning curve, but I knew I could get through it since many others had made the transition successfully.
The introduction of CAD/CAM technology into my practice brought much more than I expected. I became more excited about going to the office than at any time that I previously could remember. I knew that success with CEREC would bring these rewards:
- Reduced crown-and-bridge lab bills
- Single-appointment porcelain restorations
- No temporaries
- No crown-and-bridge impressions
Jumping the hurdles
The learning curve was the first hurdle that I encountered in implementing CAD/CAM technology. Once the machine was delivered, the Patterson CEREC consultant was in my office setting it up and showing me how it works. After making inlays, onlays, and crowns with practice blocks on a dentiform, I started doing some of the simpler inlays and onlays on my patients. One patient became so excited about getting CAD/CAM inlays that she had all four quadrants of amalgam fillings replaced the first month I had the machine. She was so pleased with the aesthetic result that she sent her husband in to have his done.
Next, I attended my Patterson-sponsored training, which was part of the purchasing package. Afterwards, I was more confident and able to produce more complicated inlays and onlays. Two-and-a-half months later, I enrolled in an advanced posterior course, which further perfected my ability to produce CAD/CAM restorations and gave me confidence about doing quadrant dentistry on any restoration that I might come across. Within six months, I was able to perform quadrant dentistry and was on my way to enjoying the fruits of my investment.
With the introduction and implementation of the intraoral camera, codiagnosis exams have become standard in my practice. They show patients the inferior material characteristics of amalgams and worn posterior composites. When patients see the cracks, material fatigue, and occlusal wear of their own dentition, they usually are quick to ask what can be done to fix these newly discovered dental problems.
When given treatment options, patients always want the best-looking restorations that last the longest, cost the least, are the least painful, and are done quickly. CAD/CAM restorations fulfill all of these qualifications.
The main concern of one new patient - a busy computer programmer who spent the majority of his time out of town servicing his clients - was the need for crown- lengthening prior to placing a crown on a molar. I was able to provide him with a treatment alternative: CAD/CAM onlays in one visit. The quick procedure saved him from multiple-appointment, crown-lengthening surgery at the periodontist's office, as well as multiple crown-and-bridge appointments. It also saved him a good bit of money to boot! He went from requiring four appointments for a regular crown and crown-lengthening procedures to one appointment for a CAD/ CAM onlay.
The scheduling efficiency of CEREC 3 has been one of its strongest benefits. I am thrilled that I can complete the procedure in one appointment and not have to send these cases to the lab. My fee for a two-appointment crown or onlay is $850 to $900, with the first appointment tying up one chair for an hour and requiring about 30 minutes of my time. The second nonproduction appointment ties up a chair for 40 minutes and requires about $50 of material setup expense, not to mention the lost production time.
The entire appointment for a single CAD/CAM restoration may tie up a chair for 40 to 60 minutes, depending on the complexity of the restoration. Doing a CAD/CAM restoration has be come one of the most productive appointments in my practice, turning it into a simple, routine restorative procedure. Now that I am confident enough to place multiple restorations, hourly production has climbed to more than $1,400, with fewer patient visits needed per day. Thistranslates into lower related costs and higher patient satisfaction.
When I compared the costs of the restorations after the first year, I realized I had done 338 restorations, mostly onlays (or about 50 percent of the total), with crowns and inlays making up the remaining 50 percent. My lab charges $130 to $160 for Em press inlays, onlays, and crowns. At an average cost of $145 per restoration, the 338 restorations would have cost me $49,010. Instead, they actually cost me about $6,000 for the blocks.
In the first year with my CAD/CAM system, I generated $43,000 in cash flow to pay for the machine. Since I took out a five-year loan to pay for the system (it can be leased, but I chose a bank loan) - with a monthly payment of $2,630 (as little as $1,900 per month on lease) - I was left with a positive cash flow of $11,440 the first year, easily exceeding my expectations.
My own personal experience with CAD/CAM dentistry shows that everyone wins. I can place conservative onlays that routinely preserve healthy tooth structure. These restorations will outlast any composite or amalgam, thus reducing the need for a crown in the future. That means they actually cost the patient less over the life of the restoration.
Benefits of CAD/CAM after one year
After 12 months of working with the system and placing 338 restorations, I found that success with CAD/CAM consists of much more. Here are some of the benefits I now enjoy:
•Ninety percent of my single crowns now are CEREC restorations.
•As one of the first dentists in Atlanta with a CAD/CAM machine, it has differentiated me and my practice from the competition. My patients view me as an expert in high-tech dentistry.
•I'm able to provide a single-appointment restoration from start to finish in 40 to 60 minutes, giving my patients the ultimate in customer service!
•CAD/CAM technology has converted my practice from a routine restorative practice using amalgam fillings to a high-tech, aesthetic practice doing procedures that warrant the highest production rate per hour. It's a win-win situation because the patient saves over the long run due to the superior quality of the milled porcelain material.
•My commitment to restoring teeth predictably, with minimally invasive techniques, has totally revitalized my commitment to the profession and my own pride in my work when I see the beautiful ceramic onlays, inlays, and crowns I now produce.