Over the last few years as I have become more involved in the CEREC community, I have had the pleasure of being surrounded by some incredibly talented dentists. Often these dentists will show me their cases and I am constantly in awe of what they have accomplished in such a short amount of time using their CEREC. What I love even more is their drive on how to improve their skills even more. My constant push (and often harassment) is to get these doctors to post their cases but posting can be intimidating. I hear over and over the same reasons why doctors won't post cases: "my work isn't good enough", "I don't have anything new to share", "people can be mean in their feedback and I don't want to be bullied", etc... As a CEREC doctor we take a lot of pride in our cases because often we create them with our own hands, so getting feedback feels personal. My point in this post is to show a progression of what you can do if you are vulnerable enough to put yourself out there and try.  

Here are some of my early cases starting in 2010. I happen to have a really poor post-op photo of my very first anterior case. I was so proud of this when I first began using my CEREC. 

One of the best pearls I got in a class was if you want to improve, start taking pictures of your cases, so I did. The problem was my photography wasn't stellar and I still didn't know what I was looking for to be able to make improvements. These restorations definitely made improvements in each of these patient's smiles, but now when I see these cases...  

Jumping ahead a few years, I got involved with the mentor group and started posting cases more often. This case in particular was one that was emotional to my entire team because we watched the physical changes that took place with this patient after we changed her smile. I was so proud of this case. After I posted, Mike Skramstad took the time to photoshop the case on ways I could improve it. My first reaction was nausea and to quite dentistry, but once I could reframe that and understand that he was truly trying to help me improve, it was so much easier to actually see what he was talking about with the photoshopped photos so that the next time I wouldn't make the same mistakes. Now did I cut the crowns off and redo the case? Absolutely not. This patient was thrilled. She could not see the nuances that we can, but what I learned from the feedback was unvaluable to my growth as a dentist. It also became a challenge over the next years to see what cases did or did not need photoshopped . 

After case after case after case, I began to actually see the nuances of line angles and color patterns and became much more comfortable with my anterior work as the cases became more repeatable. 

Now if a case like this walks in the door, it's not a huge deal to squeeze them in and get a good result for our patients. All of this is because of the constant feedback from this community.  It's fun to see how all of us have improved over the last 9 years as technology has changed, materials have changed and how we constantly challenge each other. I wouldn't change my path for anything in the world, but I do hope that it takes others a lot less time than it took me to make restorations look natural ;) 

Krisitne,

This post is great!! I love that you are willing to show your progression and critique your own work.  I take photos and do the same (and mostly get so nit picky on myself) but it is nice when you see consistent improvement.  I've been wanting to post many cases for a while but seems like it is time consuming.  

Do you import your pictures into a program or do you put them in patient's file in your practice management software?  How do you put the notes next to the photos?  

Do you post on free time from home?

Any help in quickly and efficiently posting photos of cases is greatly appreciated!!

Carmela

Great post Kris! 

Now this brings up a tough internal battle I am having; last week I offered to redo a patients single central #8 I did 3 years ago because it frankly does not look good at all and she said "I did not want to say anything, but I recently started noticing it sticking out of place sometimes in pictures."

I feel obligated in a sense of a "Thank you for being my guinea pig when I first started CEREC but now you deserve better." 

.

Thanks Carmela!

You can definitely just post before and after pictures, but when you see the words like that I am creating slides in Keynote (or PowerPoint) and then exporting it into a .jpg form to upload.

I save my photos within Eaglesoft but also keep a database of my photos in my computer. I also do this in Keynote organized by case type and material but also save some of my bigger cases in Dropbox.

I post whenever I have free moments. This can be at home late at night when I have some quiet time or in between patients. Sometimes I will prepare the slides ahead of time and then when I have time to sit in front of my computer (like now while waiting for a crown to mill) I will actually post.

It doesn't have to be anything earth shattering or long. Less content can create more discussion.  I am just wordy in general

Offering to do things over again is the way to go, even if the patients refuse. Our clinical standards keep elevating, so that we see things differently. Some of my first CEREC crowns I hate but my patients love them and won't let me do over again. Just offering increase the trust factor between doctor and patient and everyone wins.

On 7/22/2019 at 10:27 am, Jake Skowronski said...

Great post Kris! 

Now this brings up a tough internal battle I am having; last week I offered to redo a patients single central #8 I did 3 years ago because it frankly does not look good at all and she said "I did not want to say anything, but I recently started noticing it sticking out of place sometimes in pictures."

I feel obligated in a sense of a "Thank you for being my guinea pig when I first started CEREC but now you deserve better." 

.

 

Jake,

If a patient is not happy or if I really hate it and ask the patient, I am always willing to redo the crown. I learn every time I redo something and for a $30 block and some chair time it's worth it to me. Good luck!

OK here goes an attempt to post photos.  Peg lateral case.  One of just a handful of veneer cases I was brave enough to do in one visit.  I did the waxup myself and used biocopy of the waxup.  Before photos:  (post- ortho):

We whitened her teeth with GLO and performed gingival recontouring on teeth #7, 8, 10.    Restored with eMax HT BL4.  Characterized in the blue phase (Kristine - I prefer this as you do).

Here are post op photos:

My own critique:

Photos aren't consistent (some are at an angle).  Tooth #10: axial inclination is alittle off and it's slightly too bulky on the facial.  Also #10 glaze looks alittle stippled in center of tooth.

Kris and others: any feedback appreciated.

Carmela

Just need to learn to crop your photos!! I do this on my Mac with iphotos but you can also do it with Photoshop or Keynote. You can easily adjust the angle too!

As far as the case goes- Rock on!!! I am so proud of you!!!

I can see that #10 is slightly more facial and the characterization wasn't quite as strong as #7 but really beautiful case. Be proud!

Thanks Kris for challenging us to share and learn from each other! I truly am an information junkie/nerd (non stop CE courses, watching Cerec videos, reading the discussion boards). I’m definitely going to post more!!

Great job Carmela.
For photos to be consistent I find that keeping the focus on a certain number that has everything in focus and simply moving back and forth to stay in focus is best. Always be straight on or slight above when taking photos. Never looking up taking them. When doing buccal shots parallel is best and a ring flash to get more light in there. If you take a buccal picture from an angle the occlusal plane looks off. Side flashes for the anterior pictures are always better. You should see the light bounce off the middle 1/3rd of the tooth. If it bounces off the incisal then you are taking it from below. I hope that helps some.
And I like metal retractors and for my assistant to pull out and forward to get the lips out the way.
I learned many of these tips in FGTP. My pictures definitely improved after going.
You did a great job on your case. I think a little asymmetry looks great on the laterals. Keeps it more natural.

Jeff

All these pictures are insanely good. Top 1% in country good.

Great post Kris! Thanks for sharing your secrets to me and speeding up my learning curve a bit :)....a lot :)

Carmela! Awesome job! Love it! Keep posting

Jeff:  good tips, thanks.  We did a photography module at one of our Spear Study club meetings.  We all brought our equipment and that really helped.  I only use a ring flash.  I've been thinking of getting the twin (side flash).  Is it a pain to swap them out for different pics?

Dan:  Thank you!

Carmela

Phenomenal example of the importance of photography in dentistry. Great job!