CEREC 25 concludes its celebration of CAD/CAM

The final day of CEREC 25 once again started with break out sessions allowing attendees to pick and choose from an impressive selection of speakers on topics ranging from techniques to optimize use of Sirona’s CAD/CAM technology, to growing a practice or lab around CEREC restorations to discussions of the materials and other aspects of practicing dentistry in a high tech environment.

James Glidewell spoke about the CEREC inLab system, while Dr. Paul Feurstein canvassed the present and future of digital impression systems. CLINICIANS REPORT CEO Dr. Paul Child discussed the technology powering the movement toward digital dentistry, while Dr. Paul Homoly followed up his keynote presentation from the previous afternoon with an extended session on tactics to reach patients and get them to accept case presentations.

Dr. Tiffany Lee covered the importance of involving a practice’s dental team in the CEREC workflow, while Dr. Rich Masek showed how CEREC can be used for more than just inlays, onlays and crowns. Materials selection, handling and properties were the topics of separate presentations from William Mrazek, CDT and Dr. Russell Giordano. Dr. Giordano showed the data from a wide range of studies showing that when handled properly and bonded into the mouth, milled restorations work as well or better when compared to pressed or layered ceramics.

“Nobody thought this would work, so they did lots of studies on it,” he joked when explaining why there is so much clinical data in support of CAD/CAM restorations.

Prof. Dr. Albert Mehl discusses the tooth library used to create CEREC's Biogeneric software.

The final afternoon session began with Professor Dr. Albert Mehl speaking about the development of Sirona’s Biogeneric software that is capable of automatically designing custom crowns based on the patient’s own anatomy. Dr. Mehl began by discussing the accuracy of CEREC’s digital impression technology and presented data showing the scans are now as accurate as a physical impression.

Dr. Mehl continued by detailing the creation of Biogeneric software from studies and digital scans of a large number of actual teeth. He said genetics determines each individual’s tooth morphologies, and the software uses an algorithm that creates a suggested crown based on a range of factors gleaned from the tooth library. As he described it, the library of scanned teeth was used to find the average tooth for each place in the mouth and then those averages are customized to each specific case.

“I’m guessing this might be the largest high quality tooth library in the world,” he said.

The weekend’s final clinical presentation came from Dr. David Roessler who discussed the importance of bonding and the fact that studies show proper bonding is the real key to success when placing ceramic restorations. The entertaining Australian clinician opened with a bit of his clinical history, detailing his progression from placing anterior amalgam crowns to using CEREC for highly esthetic work.

His main message was that resin cements make ceramic crowns stronger, and more space is needed for the cement than most people use when they create their crowns. The data he used to back up his points showed that a thicker layer of resin cement creates a strong bond, durable bond, and failed crowns usually don’t cause further damage to the tooth so they can be easily refabricated and replaced.

“If the cement’s a bit thicker you’ve got a win, and you’ve got a CEREC that can make space for that cement,” he said.

The final speaker of the weekend was CEREC software designer Ingo Zimmer who gave the crowd a detailed look at the innovations coming to the CEREC system, starting with a software update that went live today. Version 3.82 of the software can handle full arch scans by breaking the scanning process into quadrant scans that are digitally stitched together.

The next innovation Sirona is busy working on is a system for digital articulation. Zimmer did not offer a timetable for this development, but he did hand out 3D glasses so he could show off a 3D movie of what that system might look like on screen. The CEREC MC XL mill was next up for future enhancements. Zimmer said they are working with augmentations that will allow for the milling of both new temporary materials, as well as small, milled models.

The inLab version of the CEREC software will soon be able to design and mill implant abutments with support for the systems from many major implant companies. Zimmer said he expects the chairside version of CEREC will eventually be capable of not only milling those abutments, but also of milling surgical guides for the implant surgeries. The final enhancement Zimmer said was on the horizon was adjustments to the software’s design tools to allow for multiple restoration designs and tools to manually adjust the restoration design by nudging, pulling and pushing the proposal to the exact shape the clinician desires.

Things got improvisational to end the weekend with a customized performance from Second City. The sketch and improv specialists offered up dental and CAD/CAM themed sketches along with a number of non-dental scripted bits and spur of the moment improvisational games. The crowd left laughing, and full of the latest information about CAD/CAM dentistry and Sirona’s CEREC system.

CEREC 25 breaks out and laughs on day two

Getting an early start can be a challenge at any event in Las Vegas, but the international group of attendees at CEREC 25 seemed more than up to the challenge, packing the rooms at early morning breakout sessions during the second day of this 3-day celebration of the 25^th anniversary of Sirona’s CEREC CAD/CAM system.

An all-star line up of presenters offered talks on all aspects of the CEREC system and every angle of CAD/CAM dentistry. During the first sessions Dr. Michael Skramstad covered the importance of digital impressions to the CEREC Connect workflow, while Nobert Ulmer, MBA discussed marketing the digital lab. Marketing a CEREC practice was the topic covered by 1-800-DENTIST founder Fred Joyal, while Chris Leinweber, RDT, CDT, had a standing room only crowd spilling out of the doorways for his presentation on understanding the CEREC system’s nuances to optimize the fit of milled restorations.

One room over a smaller, but just as engaged crowd listed to Vanik Jinoian, MDT discuss the new VITA Rapid Layer Technology that is available for fabricating milled bridges with zirconia substructures with precisely matching ceramic layers over the top. Jinoian showed the ins and outs of the system he helped design that takes a new approach to the design of the substructures and allows the entire piece to be designed at one. The technique can be applied to designing implant abutments and crowns, as well as other restorations relying on substructures for support.

The system provides low cost restorations with a fast production time and the machined pieces are both repeatable and easily repairable, even after having been cemented in the patient’s mouth. Jinoian stressed that systems such as this which increase the productivity of dental labs is critical for the future because digital impressions and chairside CAD/CAM will continue to grow and change the way dentists use their labs.

“There is no future for crowns in the dental lab,” he said bluntly.

The second morning sessions saw overflow crowds pack rooms to hear Dr. Brian LeSage talk about prepping for CAD/CAM crowns and Dr. James Klim showcase the esthetic possibilities of CAD/CAM restorations. On the lab side of things Tom Nieting, CDT, discussed how CEREC brings labs and dentists closer together, while and engaging Eddie Corrales, CDT, explained how he is pushing using the CEREC system and digital communications technologies to provide better service for his dentist clients.

Corrales showed off a range of his esthetic work and explained that in the digitizing dental market labs need to find ways to stay valuable to dentists. For him, that path has involved handling cases via digital file transfer even before the advent of CEREC Connect, teaching dentists to be better users of their CEREC systems and even working with dentists chairside either in person or via Skype and LogMeIn computer software that allows him to take virtual control of a dentist’s CEREC computer.

“This technology is here to stay, and that’s just the way it is,” he said.

After lunch, a pumped up Sirona Chairman Jost Fischer took the stage to blaring Metallica for a brief presentation about the company where he reiterated Sirona’s commitment to remaining the leader in dental technology and touted the company’s sizable R&D commitment. That commitment is being punctuated next month with the groundbreaking of a new Bensheim, Germany facility dedicated to developing new dental technologies.

Dr. Ed McLaren presents at Sirona's CEREC 25 event.

Next up the general sessions turned back to a focus on dentistry with Dr. Ed McLaren fighting through illness to discuss the possibilities of CAD/CAM dentistry with a focus on the materials available for use. Dr. McLaren stressed that the key to materials success or failure is not the material’s chemical structure, but rather how uniform that structure is due to the way it was manufactured.

“All of the materials are working,” he said.

However, Dr. McLaren explained the keys to successfully using the materials are the techniques with which they are used in a clinical situation. Proper etching and bonding procedures are a big key and understanding which materials fit which clinical situations can mean the difference between success and failure with CAD/CAM restorations.

Dr. Sameer Puri was the next to the stage and while he and Dr. McLaren traded friendly barbs about who drives what care, the bulk of his presentation focused on how he maximizes the use of his CEREC system for as many cases as possible. Dr. Puri said he now does all single unit posterior crowns in house and is doing many single anteriors as well.

He believes the restorations he produces with his system are better than anything he’s had before and the technology is a big marketing tool for his patients. He said the keys to his success with CAD/CAM are understanding the system and planning how he will work for maximum efficiency. While he uses the CEREC system a lot, and even for complex multi-unit cases such as the ones he presented via detailed videos and slides, he thinks it will be even more useful as in-office CAD/CAM bridges and other larger restorations become the norm.

“Pardon the pun, but we are on the cusp of something big,” he stated.

Materials was once again the subject as Dr. Dennis Fasbinder took over with a more academic presentation that focused on the properties, uses and benefits of Ivoclar Vivadent’s e.max lithium disilicate material. Like Dr. McLaren before him, Dr. Fasbinder explained how success is a technique sensitive prospect and taking shortcuts with the material weaken it structurally, and thus cut the effectiveness of its clinical use.

Both firing times and cementation of e.max restorations have an impact on how it works as a long-term restorative solution. However, Dr. Fasbinder said that when proper procedures are followed, the material offers strength and esthetics that are hard to match and makes full-contour crowns an option for numerous indications. He said CAD/CAM produced restorations are showing very positive results in clinical studies and the fabrication technology is definitely ready for more widespread use as long as materials are handled to the right specifications.

“It’s not about the box,” he said referring to the CEREC system. “The box works. It’s what we’re going to do with the box.”

The focus of the end of the day turned away from CEREC specifically, as Dr. Paul Homoly engaged the audience with humorous anecdotes that illustrated his practical advice on how to understand patients to increase case acceptance. Dr. Homoly said the way to reach patients is to gain an understanding not just of their clinical problems, but of the way those problems impact them emotionally. If a dentist presents the case as solving the deeper emotional issues caused by the clinical issues, the patient is more likely to say yes to treatment.

“Understanding what’s going on in people’s heads, that has to be analog,” he said at the open of talk before later summing things up with, “What we’re talking about is behavioral benefit.”

Comedian Dennis Miller on stage at CEREC 25.

Comedian Dennis Miller was called upon to end the day on a lighter note. He eschewed the easier dental jokes to present his right-wing political humor to a crowd that definitely agreed with his politics and ate up his literary and referential punch lines.

The final day of CEREC 25 awaits in the morning, provided the attendees make it through one more night in Las Vegas.

CEREC 25 kicks off CAD/CAM’s anniversary celebration

Part celebration, part classroom and a little bit of a revival meeting for missionaries of CAD/CAM dentistry, Sirona’s CEREC 25 event attracted about 3,000 dentists, assistants, lab technicians and dental manufacturer reps to Caesers Palace Hotel and Casino on the Las Vegas strip for three days of education, inspiration and fun that kicked off today.

Four generations of the CEREC CAD/CAM system

Well actually, things got underway last night at a Dental Products Report-sponsored wine and cheese reception. But after all the socializing and post-reception fun in Las Vegas, it was impressive to see the large crowds up early for the pre-meeting breakfast in an exhibit hall featuring more than 50 exhibitors.

After the crowds migrated downstairs to the general session ballroom, Sirona President Michael Augins welcomed the crowd and relayed just how far adoption of the CEREC CAD/CAM system has come during the last five of the technology’s 25 years. In 2001 there were 1,300 CEREC owners and now there are more than 27,000 worldwide, with 11,000 residing and working in the United States. Augins welcomed all the attendees and said they are important because they share the dream that soon “CEREC will just be the way that dentistry is performed all day, every day.”

Dr. Imtiaz Manji next took over the wide stage, which is backed by a massive video screen and flanked by another pair of screens. Serving as the MC for the weekend, Dr. Manji provided a pep talk spiced with details supporting the usefulness and efficacy of CEREC and CAD/CAM dentistry.

Besides offering clinical advantages in terms of time and patient advantages in terms of convenience and quality, Dr. Manji explained how the return on investment really works with CAD/CAM systems and the technology can make dentists better at what they do. He lauded the improvements in the system added that CEREC and chairside CAD/CAM actually offers the potential to make the partnership between dentists and dental labs more effective for patients.

“With CEREC Connect we’re able to work with our labs and make sure that the right cases get done with our CEREC and the right cases get done with our labs,” he explained.

The focus turned to esthetic outcomes with the next keynote speaker, Dr. Frank Spear of the Spear Institute for Advanced Dental Education, who demonstrated how fundamental dental knowledge and the ability to correctly diagnose and plan a case is the real key to achieving esthetic and functional success with CAD/CAM dentistry. Getting patients to accept treatment presentations is really about finding the solution to fit that individual patient, he explained, and provided examples of a range of different tooth wear cases that all hinged on understanding the cause of the wear in order to successfully address the case.

“The key to making the most of CEREC is knowing how to recognize when it can be used,” he said, and later added, “The patients are in your practice. You have to see them and learn how to talk to them.”

For the midmorning presentations, the stage was turned over to Drs Gordon and Rella Christensen, co-founders of CLINICIANS REPORT who used their respective times on stage to explain different aspects of why CAD/CAM is a big part of the future of dentistry.

Dr. Gordon Christensen speaks about CAD/CAM's impact on the dental industry.

“This is an evolution in dentistry that requires some missionaries,” Dr. Gordon Christensen told the crowd after pointing out that CAD/CAM dentists still make up just a small percentage of the American dentist population.

He continued by saying he believes all general practitioners could make use of CAD/CAM and the technology allows dentists to provide better, less invasive treatments such as inlays and onlays rather than just crowns. He expects all-ceramic restorations to continue their growth in the industry with the growth of full-contour zirconia and lithium disilicate occurring at an astoundingly fast pace. His research shows that when done to high clinical standards, all-ceramic restorations have the same or better longevity than any other material and technique choice available today.

While Dr. Gordon Christensen said he sees a CAD/CAM future for the industry, it will need smaller, less complex and more multi-faceted systems that offer less expensive restorations before it really becomes the true norm.

His wife of 51 years Dr. Rella Christensen then stepped to the podium to present findings from her research on materials used with CAD/CAM and traditional restorations. While she said every restoration eventually leaks, dentists who are careful about their techniques and precise in their work can achieve even better and longer lasting results by using CAD/CAM technology. In fact, most of the failed crowns in her studies are due to dental errors and not problems with the materials.

“My message today is that machines and materials can deliver. The dentist is the variable,” she said.

The afternoon sessions turned toward the cutting edge of technology with Dr. Jay Reznick explaining how CAD/CAM fits into an implant workflow. Demonstrating the new capability of CEREC to work in concert with Sirona’s Galileos cone beam system, Dr. Reznick said it is now possible for guided implant surgery to be performed more quickly and accurately than ever before.

The system combines the intraoral scan and the 3D imaging technologies to allow the crown design to come first and the implant planning to be based on supporting that design. Dr. Reznick said this allows for optimal function and esthetics when the case is restored.  It’s a move from a surgical model to a prosthetic model when it comes to case planning, and it means better results for patients.

“The way we did dentistry 20 years ago has changed. I can do things for you now that didn’t exist 20 years ago,” he said. “We update our phone, why would we not update the way we do things in our practice.”

Dr. Mark Morin was up next to provide a live demo of some of the CEREC systems latest software updates and to encourage the crowd to be excited about the work they do with the system. Dr. Morin related the story of the first CEREC restoration he placed in 1989 and showed that it was still in good shape 20 years later when the patient had that tooth extracted for unrelated reasons. A firm believer in the power of CAD/CAM, he provided an exciting voice in praise of what CEREC can do for a practice.

“I believe this technology is built for speed, precision and profitability,” he said. “The key to our success is going to be able to do a crown efficiently in one visit.”

The crowd rose to their feet when CEREC inventor. Dr. Werner Mörmann took the stage to walk everyone through the history of his invention. The Swiss professor talked about coming up with the concept in the early 80s and overcoming numerous technological hurdles such as the lack of three-dimensional imaging technologies, suitable materials for milling or any software to make it all work.

The system which gets its name from shortening the term “ceramic reconstruction” finally came together in 1985 and has been improved upon continuously since then. While he plans to retire soon, Dr. Mörmann said he looks forward to seeing future developments in both the design of the system components such as the scanning wand and the materials used to mill esthetic and durable restorations.

“This is definitely a highly exciting field of research,” he said.

To close out the day, gold medal winning Olympic wrestler Rulon Gardner shared his story of overcoming obscurity and adversity on and off the matt. Tomorrow the event continues with break out sessions on a range of CAD/CAM topics on more keynotes from leading lights of the dental industry.