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Love it When I see a Quad of CL II's on my Schedule

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Yes, it's true.  Love seeing something like this on the schedule; 18-MO, 19-MOD, 20-MOD, 21-DO.  Why?  CEREC.  Prior to having my CEREC system, a quadrant of CL II direct composites was not cause for celebration.  Why?  Because I would be tied-down to one operatory, start-to-finish, unable to do another/more profitable (and fun!) procedure.  Sorry, but tinkering with matrix bands, wedges and clamps doesn't excite me.  And sometimes, despite my best efforts, I'd remove a matrix band and find a void or open contact or...

With CEREC, my attitude (and how I approach the case) has completely changed.  Let's look at a recent case:  

 

Carmen presented with failing amalgams and interproximal decay in the LLQ; #18-MO, 20-MOD, 21-DO

My workflow with CEREC is fast, predicable and results in better restorations that I can provide by hand.  In this case, I designated #18 & 20 as BIOCOPY restorations using the 3M MZ100 blocks.  These blocks are resin, not porcelain.  And unlike a composite that I place in my office, these are already polymerized; no shrinkage.  The result, better fit and longer lasting.  

I delivered anesthesia and captured BIOCOPY images.  

I prepared both #18 and #20...initial designs.  

Only small changes were required before both designs were complete.  To leverage my time while the restorations were milling, I prepared #21.  Once #18 & #20 were seated, I built the contact against #20.  

 

Take Homes:

1.  Don't forget about the MZ100 blocks.  I find them useful for fillings, tempoary crowns, etc.

2.  If you have an EDDA and your state allows it, have them mill/deliver the restorations.  

3.  CEREC allows you to leverage your time.  While the restorations are being designed/milled, you're free to perform other dentistry.  

 


I'm with ya dude.  composites or partial coverage in general I love doing with the awesome hybrid and composite materials we have.  The time leveraging is huge.  thanks for sharing!

 


Wonderful workflow! I couldn't agree more.. no one loves placing matrix bands and wedges. This is a simple more elegant solution to Class II restorations. Nice case!   


I agree they are superior to direct resin but how do you charge them out? Sometimes I charge an additional 50 for block but I still end up taking twice as much time to do with cerec. Insurance does not pay for inlays so hard to tell patients they owe 800 plus for an inlay vs 300 for direct. Just wonder what others are doing about this.


James, I don’t charge anything above my usual direct resin fee. I used to stress over this and charge a block fee (nickel & dime the patient), submit an inlay code, etc but ultimately stopped. Why?

I find that the appointment is faster (I have 2 mills and an EDDA), leads to a better clinical result and it allows me to complete other, more profitable dentistry instead of being tied to one op/procedure.


Nebraska does not allow assistants to bond them in so it takes me longer. I can see how you would make it work especially when doing 2 or 3 at a time. I invariably end up messing with one of them because of an undercut and it doesn’t seat initially or a contact that had a big sprue right in the middle of it. So for me I always end up feeling I got the short end of the stick because I charged for a composite and they got a Tesla for a Volt price. More often than not inlays do not just seat themselves. Path of insertion is critical as well so they all draw on the same path or you will end up with contact problems. I agree the 3 MOD resins on the 15 year old pop drinker at 3:45 in the afternoon is brutal but 3 MOD inlays can also kick your butt.


Great post and case! I just love those big broad contacts that you have complete control over instead of that hopeful wish when you remove the matrix band and wonder if the patient likes a "floss friendly" contact ;)


On 4/23/2018 at 7:52 pm, James McCaslin said... Nebraska does not allow assistants to bond them in so it takes me longer. I can see how you would make it work especially when doing 2 or 3 at a time. I invariably end up messing with one of them because of an undercut and it doesn’t seat initially or a contact that had a big sprue right in the middle of it. So for me I always end up feeling I got the short end of the stick because I charged for a composite and they got a Tesla for a Volt price. More often than not inlays do not just seat themselves. Path of insertion is critical as well so they all draw on the same path or you will end up with contact problems. I agree the 3 MOD resins on the 15 year old pop drinker at 3:45 in the afternoon is brutal but 3 MOD inlays can also kick your butt.
 
Like you, I initially had trouble seating inlays; path of draw, contact strength, etc.  But like anything we do, the more practice we have the more proficient we become.  Today, the resins (for the most part) drop in after removing the sprue.  I could understand your Tesla-Volt reference if I delivered a porcelain restoration.  But as it's nothing more than resin, why charge more?  I'm simply using the existing technology in my office to provide the same material type/restoration; it's only the delivery that's different.  At its core, that's exactly what CEREC is.  Even without EDDA's in your state, you're free to leave the room and do other procedures while your asst designs the inlays and you're waiting for them to mill.  The increased production more than makes up for the block cost.  

I have never milled resin.  How long does it take?


Inlays: 4 minutes or so


I would be curious about your protocol for the cementing, namely the material and the control of the cement cleanup


3M products for bond and cement. Blu-sep from parkell on interproxinal surface of inlays to ease in clean up. Cement all at once. Allow cement to gell and then start cleanup. I do place cord because I feel it helps when cleaning the cement


Tiny financial analysis:

 

Cost of an MZ100 block is around $20.

Cost of a composite capsule is around $5.

On a large restoration like on #18 above, you will likely be using 2-3 composite capsules, so the cost differential is minimal.

Jay

 


On 5/11/2018 at 7:51 pm, Jay Stockdale said...

Tiny financial analysis:

 

Cost of an MZ100 block is around $20.

Cost of a composite capsule is around $5.

On a large restoration like on #18 above, you will likely be using 2-3 composite capsules, so the cost differential is minimal.

Jay

 

Adding to that, as mentioned before, the ROI increases even more when I'm able to do a more productive procedure elsewhere.  

 


On 5/11/2018 at 5:22 pm, Peter Gardell said... 3M products for bond and cement. Blu-sep from parkell on interproxinal surface of inlays to ease in clean up. Cement all at once. Allow cement to gell and then start cleanup. I do place cord because I feel it helps when cleaning the cement
 
In my office, cord is placed after imaging when the restorations are milling (unless fluid control is needed prior to imaging).  This way, I can image earlier, place cord during 'down time' (milling) and finish the appt sooner.