You Still Have to Be a Great Dentist First
I’ve had the opportunity to be a CEREC user for close to a decade. This technology is the CAD CAM market leader and I’ve made a conscious effort to use it exclusively in courses that I teach.
Before I delve into the technology, I think its important to first take a step back and talk about what it meant to be a CEREC dentist 27 years ago when the system was first introduced. Frankly, the technology was lacking and it was really difficult to use. The clinical results were marginal at best (pardon the pun) and the learning curve was months and years instead of what it is today. Despite these shortcomings, clinicians were able to make the system work by practicing great dentistry.
The system has become easier to use and more accurate margins and occlusion are now possible. The one thing that hasn’t changed is the fact that no matter how good the technology has become, or even how much easier the system is to use, in order to be a great CAD CAM dentist, you still have to be a great dentist first.
I remember a story a few years back of a clinician who bought a CEREC and after a few months, began complaining how the system was terrible. Looking deeper at the cases by this clinician, I noticed fractured restorations that were un-esthetic. The restorations that did not fracture had recurrent decay and were just un-esthetic and poor; this is the common criticism of CEREC restorations.
It would be easy to quickly jump to a conclusion and blame the device for the poor restorations. However, this would be about as accurate as saying that a gun is inaccurate because the shooter is trying to hit a target facing the wrong direction while blindfolded.
Further investigation into the cases revealed that the restorations were created with a central groove thickness of less than .5mm and were made of feldspathic porcelain. This was done on first and second molars. I then discovered that the clinician not only used feldspathic porcelain crowns, but also used a resin cement for the restorations without a bonding agent. Not a self-etching resin cement like a Unicem mind you, but a resin cement with no bonding agent.
If you practice dentistry like this and experience failures, this has about as much to do with the CEREC as it does when a driver blames his Ferrari for not going fast when sitting in traffic.
My move to Scottsdale was great not only because of the time I’m able to spend on my passion of working with the CEREC doctors, but also because of my exposure to the Spear faculty and courses. The influence on me has been significant. I sit through most of the seminars and workshops. I’ve learned more this past year than I have in the past 20 years since I started dental school.
Sameer Puri, DDS, is co-founder of www.cerecdoctors.com, a website dedicated to CEREC online education. He serves as the director of CAD CAM.
These are some great comments, Sameer. In my conversation with skeptics, I remind them that CEREC is simply a method of fabrication. It is well proven. Requirements of the chosen material have to met for predictability no matter what fabrication technique is used, whether it is chair side CAD/CAM, lab based CAD/CAM, wax and press, whatever. Becoming proficient in the method of fabrication is another thing altogether. The newest version of the CEREC software, for me, was the game changer in becoming proficient at this method of fabrication.
I totally agree with this post Sameer! Although I haven’t dived into CAD/CAM yet, I see examples of a lack of fundamental understanding all the time. Heck, after just a week of enrolling in the digital learning here and already getting 10 CE hours between the restorative curriculum and wear curriculum, it’s amazing how much I DIDN’T know! It takes constant dedication to learning. Whether your restorations are made in your office or in the lab the rules of the physical properties of your procedures and materials do not change.
Nice comments Sam. Is this an endorsement for CEREC or spear education or both:)