'CEREC Doesn't Work for Anteriors'
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I hear this over and over again: CEREC is fine for posteriors but its not appropriate for anterior restorations. I guess this is progress, considering how much grief CEREC owners have received over the years for its use anywhere in the mouth. Now we are at the point where CEREC is considered appropriate for posteriors, but some clinicians don't feel they can do a case in the anterior with CEREC. I think it's important to note that CEREC is just a tool. It's a tool that can replace the laboratory in the appropriate situation. When treatment planning a case, here are the criteria I use to determine whether I will work with my laboratory or with my CEREC machine. First of all, it's important to note that I am a heavy user - meaning that I look to my machine for virtually every case. I enjoy the process. After all, what the heck is the point of going to work if you don't enjoy what you do? The second step in determining the method of fabrication is to ask the question: 'Can I meet the esthetic expectations of my patient with the CEREC machine?' Lets face it, I'm a dentist, not a technician, and there are certain cases where I am just not as talented as a highly skilled ceramist to deliver a highly esthetic piece of porcelain. I'm pretty good, but not the best. In certain cases, it might be better to use CEREC Connect instead of CEREC. Next: Is the patient patient enough to sit through a procedure of this type? This particular case would take me all morning. For an inexperienced user, maybe it will take them all day or several days. Regardless of that fact, it's longer than just prepping and taking an impression, so the patient must be willing to wait all day if necessary. Certainly better than waiting weeks or months, but that must be conveyed to the patient. Finally, can our materials that we mill chairside fulfill the esthetic expectations of our case? The materials that we use are fairly translucent. If we have a dark substructure, then we need to use opaque materials to cover that dark substructure. Maybe gold or zirconia. If that is the case, perhaps it's best left to the laboratory to do the case for us. In this particular example, we have met all the criteria for a nice chairside case. The patient does not have unreasonable expectations for esthetics, he is patient, and our materials will be sufficient to cover the teeth. And I will have an absolute blast working on this case all day. More information on this can be found in the discussion thread. The immediate post-ops show some tissue irritation from the cord and bonding procedure. Once we see the patient for the final post-op, you will find the tissue and smile have met the patient's expectations.
