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Technoteeth Forget crowns and fillings, German-made machine makes replacement teeth while you're at the dentist's office

Some Dentists Are Going High-Tech 

Dentists create teeth in a virtually painless way 

Dental procedure is an alternative to traditional crowns 

Say Ahhh (and Watch the Monitor) 

Crowning achievements of new technologies 

Dentist does 'one-visit' crowns: 

Device fixes teeth with a shorter wait 

Progess logo

Technoteeth Forget crowns and fillings, German-made machine makes replacement teeth while you're at the dentist's office

Julie Buchanan, Staff Writer

02/08/2006



COLONIAL HEIGHTS, VA - To most people, the whir of a dentist's drill is one of life's least pleasurable sounds. But how about the silent snap of a digital photo?
   With constant advances in technology, getting rid of that toothache is becoming a less painful process. Dr. J. Keller Vernon of Colonial Heights is one of a handful of dentists in Central Virginia using new technology to fill cavities, replace old fillings and repair teeth. She recently purchased a German-made CEREC CAD/CAM, an instrument that allows dentists to take a digital image of a patient's tooth and mold a perfect replacement - or what's called a "restoration" - in minutes.
   CEREC stands for Chairside Economical Restorations of Esthetic Ceramics. CAD/CAM stands for Computer-Aided Design/Computer-Aided Manufacturing. The German-invented technology has been used for decades in engineering and car manufacturing but was only recently expanded to medicine.
Today, Vernon says CAD/CAM is also used to make precise-fitting artificial joints and heart valves. She and her staff have attended five training sessions to learn how to use the advanced equipment in dentistry.
"It's a huge learning curve but it's so worth it," Vernon said. "We have [patients] in and out of here in one hour."
   After the patient is numbed, their tooth is sprinkled with a titanium powder that allows the infrared camera to photograph their tooth - it's the same powder used to paint the "M" on M & M's.
The photo is transferred to a computer where the dentist can edit and design the restoration to fit the patient's bite. Then, the 3-D image is wirelessly transmitted to an adjacent machine that robotically mills the restoration out of a small porcelain block. It is bonded to the patient's tooth where it is supposed to stay for life.
   The porcelain, Vernon says, is a more reliable and natural alternative to the traditional mercury metal fillings that have been used for years. Unlike metal, porcelain does not expand and contract or trap heat or cold.
   "Sometimes, [metal] fillings leak and the next thing you know you need a root canal," she said.
And unlike traditional crowns, there is no need to file down the existing tooth and no need to send a mold off to the lab. Patients are able to eat immediately following the procedure.
"We wouldn't be doing this if it weren't for the patients," Vernon said. "They want what's best for themselves - and who doesn't?"
   Since purchasing the $110,000 CEREC machine last summer, Vernon has fitted more than 150 patients with porcelain restorations. She and her staff will attend another training session in May to learn more about the technology and how it can help more patients.
   "That is what is so thrilling about all of this," she said. "There is just no end. I'm so excited to be riding this technological wave."
* Julie Buchanan may be reached at 722-5155.

©The Progress-Index 2006 

Jan 24, 2006 9:01 PM US/Eastern

Some Dentists Are Going High-Tech
a mooney photo
Paula Ebben Reporting Paula Ebben 

(CBS TV 4 Boston, MA) Your dentist may soon be going hi-tech. More and more dentists are using a computerized system to make perfectly shaped teeth. In addition to improving your smile, it can also cut down on the time you have to spend in the dentists chair.
 
  It’s called CEREC Restoration and is named after the manufacturer that developed the system. Here’s how it works. After preparing the tooth for a crown or a filling, the dentists takes a series of pictures with a specially designed camera. The camera then sends those images to the computer, which designs the crown or filling. The dentist then takes a block of porcelain and loads it into a milling machine. The computer then tells two robot arms how to carve the block of porcelain into a perfectly shaped tooth.

Dr. Kevin Mooney of Woburn has been using the system for several years now, but he is one of the few on the north shore to have the technology. He says patients love it because a traditional crown would take two visits and three weeks to complete. With the CEREC procedure, he can do it in less than two hours.    

“People don’t have a lot of time these days, where the can come back for a second visit,” he explained. Right now less than five percent of dentists in the country are using this technology. Dr. Dan Nathanson of Boston University Dental School says that is changing. “I envision that in five years, more than 50 percent of the dentists in America will have this technology,” he said. 

    Dr. Mooney also uses this technology to replace those old silver fillings. “Our generation has a lot of big, silver fillings” he said. “As they start to wear down, they end up splitting the tooth. ”Dr. Mooney says porcelain fillings help prevent that cracking and they can last more than 15 years.

    The price for a crown is about the same as the traditional method. But replacing a silver fillings is not cheap. Most insurance will only cover about half, so it will cost you a few hundred dollars out of your pocket.

(© MMVI, CBS Broadcasting Inc. All Rights Reserved.)

Dentists create teeth in a virtually painless way CitizenvoicelogoLG03
By Patrick Giblin
 in the Modesto Bee 
05/17/2004

When Judy Hicks cracked her tooth, a feeling of dread came over her. It wasn't just the thought of cracking one of her molars that caused her anxiety. What had her worried was all the time she expected to spend in the dentist's chair. "I previously cracked a tooth, and the temporary fell out while I was in public," she said. "Then the new crown didn't fit, so I had to return for another dental visit. "It was a nightmare," she said.

This time, her experience was just the opposite, thanks to new technology being used by her dentist, Ross Rodig. He is one of a growing number of dentists equipped with a device that creates a three-dimensional model of patients' teeth. The machine then makes crowns, caps and fillings while the patient waits. "You no longer need to have to get a temporary crown that falls out after three days," said Rodig, a dentist in Turlock, Calif. "We can create your permanent crown in 10 minutes."

The computer system is called CEREC 3, made by the Sirona Dental Co. in London. The software it uses is called Cerec 3D. It was introduced to the market about nine months ago. Rodig purchased the $98,000 system in December.

When Hicks came in to repair her tooth, she didn't have to sink her gums into the goopy, mint -flavored mold paste that has been a staple of dentistry for decades. Instead, Rodig sprayed her teeth with a coating of reflective white powder. He then used a small hand-held wand that's about the size of a dental drill. The wand beamed infrared light on Hicks' teeth and recorded the reflection. That information was then fed into the Cerec 3, which turned it into a full-color, three-dimensional model of Hicks' teeth. Rodig then looked at the image on the computer screen, zeroed in on the cracked tooth and inspected it.

The computer overlaid a model of a "perfect tooth" to show what it should look like and displayed a proposed crown to repair the damage. Because most people don't have perfect teeth, the computer also projected where the new crown might grind with upper teeth. "I can widen, shorten or lengthen the proposed crown, depending on the needs and anatomy of the patient," Rodig said. Rodig made changes to the image and sent a completed model of the crown to a computer- controlled carving machine. It cut the crown out of a small block of porcelain in 10 to 15 minutes.

"This is a quantum leap in dentistry," Rodig said. "You can get a root canal and have the permanent crown put in all in the same day."

Because there are no repeat visits necessary, Rodig can see more patients. As a result, the cost of the device has not raised his rates. "It's a wash," he said. "It cost us a lot up front, but we think we'll eventually hit even."

Hicks said she only had to be numbed once and even watched the carving machine make her crown while she waited. "The next day there was no numbness, and I was back to normal ," she said. "You can't even tell there's a crown, it matches my tooth so well." Companies like Aperio, General Electric and the German company Med3D have built other machines to give dentists a 3-D look in a patient's mouth. But repeat visits to the dentist were usually needed to complete the necessary work.
©The Citizens Voice 2004
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Dental procedure is an alternative to traditional crowns
By Lois M. Collins E-mail: lois@desnews.com
Deseret Morning News Thursday, April 29, 2004

Dixie Nielsen has a tooth that's a candidate for a crown. It has long had a large "silver" filling, which has expanded and contracted enough times over the years to change, and not for the better. At the least, it needs to be replaced.Blue model02

Garon Larsen, a dentist at the Alpine Dental Clinic in Alpine, explains that teeth with large metal fillings often at some point must be crowned. Expansion and contraction has cracked the tooth or there's decay under the filling. But if too much of the tooth is gone, replacing the filling simply isn't going to work. Besides, that filling material contains mercury, which he figures may not be really healthy.

Repairing such a tooth has, most of the time, meant the need for at least two dental-office appointments, usually two or more weeks apart. One to have the tooth prepared for a crown and an impression taken so it can be sent to a lab to have the crown manufactured. The tooth is ground down to a peg so the crown can be bonded over it, like a stocking cap on a head, then a temporary cap placed on it to prevent pain until the permanent crown comes back from the lab.

Nielsen, however, is going to get all the work done in a single visit that takes close to an hour, thanks to an increasingly popular dental repair called CEREC, which can be used on a crown, a veneer or a filling. CEREC is shorthand for "Chairside Economical Restoration of Esthetic Ceramics." With CEREC, the tooth is not ground to a nub for a crown to cover. Instead, as much of the tooth as possible is left intact. The filling is drilled out and a reflective powder is placed in the opening that's created so that it will reflect light. Then a tiny camera is placed in the mouth to take a three-dimensional photograph of the tooth, which is transmitted to a computer-aided design program on a computer. That picture is the process's equivalent of a dental impression.

Dr Glassett02It's not all automated. The dentist does some of the work of creating the design that will become an inlay or overlay. "There are always a few adjustments, but not too much," Larsen notes as he moves the mouse to outline the section of tooth that's being replaced. The goal is to get it close enough to the neighboring tooth that floss will go through, but not food.

When the dentist is happy with the image, it's sent to a special machine where a small piece of tooth-colored (there are different shades to match teeth) and very strong ceramic is shaped precisely using a high-speed diamond burr and a disk mill. After a few minutes, the piece is complete.

The restoration is etched so it will bond, then a special type of glue is applied and cured briefly with a light. Within minutes, Nielsen's tooth looks as if it never needed any work at all.

Many people have never heard of CEREC, though it's nearly 20 years old. It debuted in Europe and has undergone some changes from the original technology. It arrived in the United States more than a decade ago and has slowly caught on, aided now by a simpler 3 -D version that was introduced about a year ago.

Still, only an estimated 2-3 percent of Utah dentists have the technology, distributed solely in this country by Patterson Dental, because the technology costs around $95,000.

Larsen says there are many advantages, but it's not for every tooth. Although CEREC provides a new option for some teeth, dentists have to be selective. Some teeth still require a conventional crown. Myles Preble, a dentist in Salt Lake City, has used CEREC for almost five years. "The technology is much more user-friendly now. The new 3-D version (CEREC 3-D) is so much nicer. You cDr Glassett202an mill in more of the anatomy instead of having to cut it in."

But even with the earlier CEREC models, he says, he has had no breakage. That's a tribute to the material, he notes. It's more dense. The goal with CEREC is never to go below the gum line, Preble says, and that makes it "look like it grew there."

As many as four teeth can be done comfortably at a time, he says. And although the American Dental Association still also backs use of silver amalgam fillings, he prefers CEREC. "To me, there is no comparison. It's absolutely great. It's the best restoration technology can provide and the most toothlike. It should be there a long time."

Nelson Glassett, a dentist in Salt Lake County, says about half his patients choose a crown and half choose CEREC. It's an option that insurance covers as it would a crown. Glassett has used it for both crowns and inlays and likes the fact that he knows right away how it's going to fit. "With CEREC, we can take a picture of the bite, the opposing arch, we can make it go up and down and see where it's hitting."

He doesn't underestimate the benefits of getting the job done in a single visit, either. When a crown comes back from the lab, if it doesn't fit he has to make a new impression and send it back, adding another couple of weeks to the process. With CEREC, if he has one that didn't mill perfectly, he makes an adjustment, fixes it and fits it right then. But that's a rare occurrence.
"That's one of the biggest points. The time for the patient. The other thing is the materials used to mill the crowns or onlays or inlays are out of material that's extremely compatible with natural enamel, so it won't cause more wear to the opposing teeth. For people with a porcelain crown, it's so strong it wears away enamel over time."

He's had only one CEREC restoration break. "That result came by something I did wrong. Once I understood what it was, I haven't had one break since then."

When he can, Larsen prefers CEREC, which costs about the same as a crown. The tooth will have 95 percent to 105 percent of its original strength, he says. It looks nice and never leaves the telltale silver line around the gums, something that's the norm with crowns because of the metal understructure. Because there's no metal involved, there's no risk of a metal sensitivity reaction. And it's expected to last at least as long as a traditional crown.

With a traditional crown, the impression is made of the gap left in-between teeth. The CEREC impression is of the tooth itself, so it looks just like the original.

Perhaps most important, it preserves as much natural, healthy enamel as possible, something that may be important later should a tooth require more work. Who knows, he says, what technology will come along during the CEREC restoration's lifespan? Once the natural healthy enamel is ground away, it can't be reclaimed.

"Awesome," says Nielsen, of American Fork, holding a mirror up to check out her improved tooth.

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Below are two articles that mention CEREC 3D and Dr Andrew Spector from whom I received my CEREC 3D “basic” training in Dec 2003.

nytimes02
Say Ahhh (and Watch the Monitor) 
Jessie Scanlon. New York Times. (Late Edition (East Coast)). New York, N.Y.: Sep 4, 2003. pg. G.1 Copyright New York Times Company Sep 4, 2003

YOU sit down, you open your mouth, you say ''ahhh.'' The dentist leans down and peers in, metal probe in one hand, angled mirror in the other, and starts poking. 

That scene plays out in dentists' offices every day. But when Kevin McMahon sank into the chair in Examination Room 4 at Dr. Andrew Spector's office here for a routine checkup, the process was a bit different.

Ilene Levine, the hygienist, reviewed Mr. McMahon's chart and images on her flat-panel display, then reached for a wandlike device called a Difoti. She positioned it above each tooth in turn. As she did, light passed through the enamel in a process called transillumination. Any cavities or other irregularities altered the light pattern, and the information was captured by the wand's sensor -- a charge-coupled device, the kind used in many digital cameras -- and transmitted to a display that she and Mr. McMahon were watching. 

''This is one we need to monitor,'' Mrs. Levine said, pointing to what looked like a black-and-white photograph of a molar with an old silver amalgam filling. Shielded by the metal, the new decay would have gone undetected by X-rays.

The Difoti (the name is an acronym for digital imaging fiber optic transillumination) is one of a range of new digital technologies that are helping to close what Dr. Spector calls the diagnostic void. ''Now we're catching problems sooner,'' he said -- for example, when a cavity is too small to be seen by the naked eye or even picked up by a traditional X-ray. ''These days kids have fewer cavities, and adults aren't ending up with major crowns.''

Lasers, sonar, digital radiography and rapid manufacturing are making dental work more efficient, less painful, and of better quality. Even offices that have not made the switch to digital radiography are starting to scan their X-rays; the digitized images can be stored electronically and sent easily to specialists or insurance companies.

Moreover, companies like Logicon, a division of Lockheed Martin, and Trophy, now owned by Kodak, have introduced software that can enlarge and enhance images for specific detection tasks. ''It's the difference between radio and television,'' Dr. John Flucke, a dentist in Lee's Summit, Mo., said of the collection of new tools. ''The technology allows practitioners to see what we used to ascertain by experience and feel.''

Some dentists also say that imaging technologies play an important role in their relationship with patients. The buzzword is ''co-diagnosis,'' and the idea is that patients will gain a better understanding of their periodontitis if they can see it on a wide-screen monitor. (Hence Mrs. Levine's narrated walk-through of Mr. McMahon's mouth.) Though many patients would rather forgo the viewing pleasure, the premise is that they will be more willing to go ahead with a root canal if they have witnessed the sorry state of the root.

Another advantage of these powerful detection and imaging techniques is that they can sometimes help to reduce the discomfort of examinations and treatments. The drill, the workhorse of dentistry for more than a century, may not disappear, but several companies are hoping to sideline it.

One alternative is the soft-tissue laser, which Dr. Paul Feuerstein, a dentist in the Boston area and the technology editor of Dental Economics, calls ''the big boy of minimally invasive tools.'' First used for whitening, diode lasers are increasingly being used to shape the gum line and treat gum disease because they are much kinder to the tissue than a scalpel, and patients require no anesthetic when they are used. 

Dr. Larry Emmott, a dentist and technology consultant in Phoenix, had a patient with chronic gum disease who was not responding to traditional treatments. ''The periodontist we'd been collaborating with on the case said she'd just have to get dentures,'' he recalled. Instead, Dr. Emmott successfully treated the problem by cutting away the infected layer with a soft-tissue laser.

Then there is the Cerec 3D, a two-foot tower with a swiveling monitor and a small keypad, which aims to make getting a crown a less daunting prospect.

The standard crown procedure involves a couple of anesthetized hours during which the dentist drills away 30 percent of a tooth, takes an impression and cements on a temporary crown. Then there is usually a two-week wait for a lab to produce the crown, and another afternoon of numbness and drilling when it is attached. 

Cerec, introduced earlier this year by Sirona, lets dentists preserve more of the original tooth structure and create a crown while you wait.

For Michele Shafer, whose home is an hour and fifteen minutes from Dr. Spector's office, that meant making only a single trip for a crown; she spent more time in her car than in the chair.

Dr. Spector began Mrs. Shafer's procedure with an injection of anesthetic through a digital syringe that slows the flow of medication when it senses pressure, thereby making the injection almost painless. He used the Cerec infrared camera to create an optical impression of the original tooth. That step replaces the green paste and uncomfortable metal trays that are typically used to make an impression.

Dr. Spector then removed the diseased tissue and took a second image, which the Cerec combined with the first to create a rough 3-D model of the crown on the screen. Using a trackball, he tweaked the design, smoothing contours and adjusting the fit. He then sent the data to the milling chamber, which produced the crown in 17 minutes.

Not only is the process more convenient than waiting for the lab, Dr. Spector said, it also produces a stronger crown. Instead of enamel, the crown is made of compressed porcelain ''40 percent stronger than what a lab can press,'' he said. ''And the material has the same properties as enamel -- it wears away at the same rate, and it has the same thermal coefficient, so when you drink hot coffee it will expand just as much as the teeth around it.'' It leaves more of the original tooth intact because the material can be cemented directly to the tooth with no metal interlayer.

''No one loves getting a crown,'' said Dr. Jeffrey Katz, a San Francisco dentist. ''They hate the Novocain. They hate the gooey stuff. This transforms the whole experience.''

''The biggest thing for me is the control,'' said Dr. George Maryniuk, a prosthodontist in Brookline, Mass. ''My father was a lab technician, and I have high expectations. Now I'm guaranteed to get the results I want.''

But with its $100,000 price tag, the Cerec does not make sense for every practice. The math works out for Dr. Maryniuk, who was paying $5,000 a month in lab expenses, most of which Cerec eliminated, and now pays $2,000 a month to the Cerec leasing company. The machine reduces his costs for a crown, for example, to $30 from the usual $200 and saves him the expense of second appointments.

That savings will have no effect on the patient's pocketbook, because dentists depend on the margin to cover their Cerec payments and the other myriad overhead costs of a high-tech office. For instance, a digital X-ray machine costs some $18,000, compared with about $4,500 for a conventional one, but dentists don't charge any more for the service, and insurance companies don't make a distinction.

''When I get a claim form for a crown, I don't know if it was lab-processed or Cerec,'' said Max Anderson, the national oral health advisor for Delta Dental, one of the nation's largest insurers. In the system, a crown is a crown. Most insurers don't even cover new diagnostic services like the Difoti, meaning that the dentist must somehow absorb the $20,000 cost.

So dentists must analyze their needs before investing in the machines. A dentist who does few crowns or other restorations might be better off sticking with the labs, many of which are starting to use the Cerec technology. In any case, in an already capital-intensive business, the new devices put pressure on the bottom line.

That in turn could be leading to some unnecessary treatments. ''The question is, does a dentist make the same clinical decisions when he has a $20,000 machine to pay off,'' Dr. Anderson cautioned.

Aided by their digital cameras, Dr. Feuerstein said, some dentists are selling cosmetic procedures that they might not have suggested before. ''It's like the extreme makeover reality shows,'' he said. ''Dentists will take a patient with 'ugly' teeth and show them what they could look like with facades and laser-shaped gums.''

On balance, most dentists view the new dental technologies as a positive force. ''Today, cavities are a universal disease,'' said Dr. Frederick C. Eichmiller, director of the Paffenbarger Research Center of the American Dental Association. ''In the future, it won't be.'' Dr. Eichmiller and his team in Gaithersburg, Md. , are developing toothpastes and rinses that will help teeth repair themselves, as skin or bones do. They are also working on ''smart fillings'' that will detect decay and release a healing mixture of minerals.

What will that mean for the high-tech dentist? ''Remember,'' Dr. Katz said, ''the goal of dentistry is to put ourselves out of business.''

The following correction to the above article was made by the Times: New York Times. (Late Edition (East Coast)). New York, N.Y.: Sep 6, 2003. pg. A.2

An article in Circuits on Sept 4, 2003 about high-tech dental equipment misstated the price of one tool, Difoti, a digital imaging system for detecting tooth decay. It is $6,495, not $20,000.

The article also referred imprecisely to another tool, Cerec, used to create crowns. Its basic technology was developed in the early 1980's, and a machine on which it is used in many dentists' offices; Cerec 3D is the latest software for it, introduced this year. 

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Crowning achievements of new technologies

Jessie Scanlon. International Herald Tribune. Paris: Sep 5, 2003. pg. 14  Copyright International Herald Tribune
iht02You sit down, you open your mouth, you say ahhh. The dentist leans down and peers in, metal probe in one hand, angled mirror in the other, and starts poking. That scene plays out in dentists' offices every day. But when Kevin McMahon sank into a chair at Dr. Andrew Spector's office here for a routine checkup, the process was a bit different. Ilene Levine, the hygienist, reviewed McMahon's chart and images on a flat-panel display, then reached for a wandlike device called a Difoti. She positioned it above each tooth in turn. As she did, light passed through the enamel in a process called transillumination. Any cavities or other irregularities altered the light pattern, and the information was captured by the wand's sensor a charge-coupled device, the kind used in many digital cameras and transmitted to a display that she and McMahon were watching.

The Difoti (the name is an acronym for digital imaging fiber optic transillumination ) is one of a range of new digital technologies that are helping to close what Spector calls the diagnostic void. Now we're catching problems sooner, he said for example, when a cavity is too small to be seen by the naked eye or even picked up by a traditional X-ray. Lasers, sonar, digital radiography and rapid manufacturing are making dental work more efficient, less painful and of better quality. It's the difference between radio and television, Dr. John Flucke, a dentist in Lee's Summit, Missouri, said of the new tools. The technology allows practitioners to see what we used to ascertain by experience and feel.

New technology may not make the dreaded drill go away permanently, but several companies are hoping to sideline it. One alternative is the soft-tissue laser, which Dr. Paul Feuerstein, a dentist in the Boston area and the technology editor of Dental Economics, calls the big boy of minimally invasive tools. 

First used for whitening, diode lasers are increasingly being used to shape the gum line and treat gum disease because they are much kinder to the tissue than a scalpel. Then there is the Cerec 3D, a two-foot, or 60-centimeter, tower with a swiveling monitor and a small keypad, which aims to make getting a crown a less daunting prospect. The standard crown procedure involves a couple of anesthetized hours during which the dentist drills away 30 percent of a tooth, takes an impression and cements on a temporary crown. Then there is usually a two-week wait for a lab to produce the crown, and another afternoon of numbness and drilling when it is attached. Cerec, introduced this year by Sirona, lets dentists preserve more of the original tooth structure and create a crown while you wait.

For Michele Shafer, whose home is an hour and 15 minutes from Spector's office, that meant making only a single trip for a crown; she spent more time in her car than in the chair. Spector began Shafer's procedure with an injection of anesthetic through a digital syringe that slows the flow of medication when it senses pressure, thereby making the injection almost painless. Spector used the Cerec infrared camera to create an optical impression of the original tooth. That step replaces the green paste and uncomfortable metal trays that are typically used to make an impression.

Spector then removed the diseased tissue and took a second image, which the Cerec combined with the first to create a rough 3-D model of the crown on the screen. Using a trackball, he tweaked the design, smoothing contours and adjusting the fit. He then sent the data to the milling chamber, which produced the crown in 17 minutes. Not only is the process more convenient than waiting for the lab, Spector said, it also produces a stronger crown. Instead of enamel, the crown is made of compressed porcelain 40 percent stronger than what a lab can press, he said.

And the material has the same properties as enamel it wears away at the same rate, and it has the same thermal coefficient, so when you drink hot coffee it will expand just as much as the teeth around it.

Credit: The New York Times

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City Life Business: Dentist does 'one-visit' crowns:[Home Edition]

MARIAN DOZIER. The Atlanta Journal - Constitution. Atlanta, Ga.: Mar 27, 2003. pg. JN.3
Copyright, The Atlanta Journal and Constitution - 2003)

More than 23,000 dentists from around the world convened in Atlanta last week for the 91st annual Thomas P. Hinman Dental Meeting, one of the largest and most prestigious continuing education programs for the dental profession. Many of them took time out to listen to Joel Benk.

Benk, a dentist who has practiced in Midtown since 1982, demonstrated the Cerec machine, a computer -aided design and manufacturing system that allows dentists to --- in one visit --- design, fabricate and place esthetically pleasing ceramic restorations.

This means no follow-up visits for the patients, no impressions to take and no unattractive temporaries while an outside lab creates crowns.

Instead, the dentist paints a reflective powder over the prepared tooth and photographs it with a special camera. The picture is displayed on a color computer screen, and the dentist uses CAD technology to design the restoration. Another computer creates the restoration; then the dentist bonds it to the surface of the old tooth. It all takes about an hour. Benk calls it the "one-visit crown."

"It's very powerful technology that's good for everybody," he said.

The process is quicker, the results more durable and the look more natural than silver amalgam or composite fillings, said Benk.

Cerec restorations are a bit more expensive, but are expected to last three times longer than amalgams and composites. Most insurance covers it.

Benk trains about a dozen dentists a month from across the Southeast. The technology has been in use more than 15 years, and 6 million restorations have been done worldwide.

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Below is an older article on the older CEREC 3 system that was 2-dimensional software which was replaced with the current 3-dimensional (3D) unit and software that we use today.

The Detroit News March 28, 2001 Dental Health: Technology 
Device fixes teeth with a shorter wait
By Cathleen Simlar / Special to The Detroit News

Americans love convenience. From fast-food restaurants to online shopping to electronic airline tickets, today's consumers want fast service, fast results and no hassles. Now, consumers can add one more marvel to their must-try list: on-site dental restorations.

The days of temporary crowns and two-week delays for permanent onlays are falling victim to the modern technology of the German developed CEREC 3. An acronym for Chair-Side Economical Restoration of Esthetic, the computer-aided design device is encapsulating lengthy dental processes into a 1 1/2 hour office visit with noteworthy results.

Calling it a huge step for dentistry, CEREC 3 user Dr. Noah Levi of the Southfield Family Dental Center touts the new technology as convenient, economical and superior to traditional restorations.
"We're seeing a ceramic block sculpted precisely by a machine with the final output fitting perfectly into a tooth," he explains. "I liken the process to Michelangelo carving an idyllic image from a shapeless block. It is perfectly milled, plus we are using a ceramic material (porcelain) that will last indefinitely, unlike plastic and silver, fillings which last only three to seven years."

According to Levi, the process revolutionizes dentistry. "In the old days, when a patient came in with a large silver filling needing to be replaced, a dentist would do so with a gold onlay," he says. "First, he would make an impression and send it on to a lab. The patient was then sent home with a temporary filling until the onlay was ready -- about two to three weeks."

With the CEREC 3, a picture is taken of the tooth. The dentist then designs the restoration from which the CEREC 3 mills the porcelain. The restoration is then chemically bonded to the tooth.

"There are more studies on ceramic restorations than on any other dental product around, and it has been rated as the top restorative process in the world," says Dr. Mark Morin of Hi-Tech Family Dentistry in Southfield, the longest user of CEREC technology in North America (11 years) and one of only 10 international trainers of the device. "The material is what truly separates it from traditional dentistry."

But will it shatter, as ceramics are prone to do, under stress or from a direct blow?

"Think of it this way. If you took a ceramic cup and put cement around it, it will never break," Morin says. "Likewise, a bonded ceramic tooth restoration will not break."

Currently, Michigan and Ohio claim the highest concentration of dentists using CEREC 3 technology in the United States, with 52 dentists in Michigan providing the service. For dentists, adopting the technology requires intensive training plus a heavy cash outlay -- approximately $90,000 for the CEREC 3.

"Certainly, the cost of this machine is high, but it makes the restoration process more efficient by eliminating the expenses necessitated by using a lab," Morin says. "So in the end, CEREC 3 restorations are cost-friendly in addition to being quicker." The CEREC 3 is the most expensive and difficult machine to use in dentistry, but it is also the most rewarding, Morin says. "In today's society, time is of the essence. The CEREC 3 provides people with what they want -- less time in the dentist's chair. But it also provides them with restorations that are the closest thing to having natural teeth."

Cathleen Simlar is a Metro Detroit free-lance writer.

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