Article by Carlos A. Boudet, DDS, DICOI
NOTE FROM THE EDITOR
Digital impressions are slowly catching on with our customers at the lab. The majority of the digital impressions we
receive are from Sirona CEREC® owners, who typically use this digital impression system to design and mill a crown, such
as IPS e.max® CAD, in their own offices. However, we are seeing more CEREC dentists who want to take advantage of high strength
monolithic restorations that cannot be milled in the office, such as BruxZir® Solid Zirconia.
Many CEREC dentists find making digital impressions to be as routine as taking polyvinyl impressions, and they prefer
making a digital impression that is transmitted to the lab. Sending a digital impression automatically saves dentists $7 on
inbound FedEx shipping. If a dentist orders a monolithic restoration, such as BruxZir, IPS e.max or cast gold, Glidewell
Laboratories can make the restoration model-free (no model work is fabricated), and we pass on that $20 savings. That
means a $99 BruxZir crown becomes a $79 BruxZir crown when the case is prescribed via digital impression. For a 3-unit
posterior BruxZir bridge, that's a savings of $60. I don't foresee many dentists investing in this technology and adopting
digital impressions without laboratories offering an incentive, such as a discount on every crown prescribed.
In this article, Dr. Carlos Boudet outlines the steps transmitting a digital file to the lab via CEREC Connect.
INTRODUCTION
A common fear among dentists who purchase the latest technology in the form of a new piece of equipment is the uncertainty
of how soon it will be made obsolete. This fear is greater when it is unclear if the manufacturer will offer system
upgrades that allow the dentist to continue using the equipment when improved features and new options become available.
For years, the ceramo-metal
restoration has been the
gold standard in crown &
bridge procedures. Although
durable and time-tested, this
type of restoration may not
be the most esthetic. For
years, patients have asked
for metal-free restorations,
and the industry has accommodated
this request with
various resin composite and
ceramic systems.
THE CEREC CAD/CAM SYSTEM
There are two chairside CAD/CAM systems available today: CEREC (Sirona Dental Systems; Charlotte, N.C.) and E4D
Dentist™ (D4D Technologies; Richardson, Texas). Also available are three chairside digital impression systems: Lava C.O.S.
from 3M ESPE, iTero from CADENT1 and IOS FastScan from IOS Technologies Inc. (The last was recently released to a select
group of dentists in Southern California. A fourth chairside digital impression system developed in Israel, Densys, is not yet
available to U.S. dentists but is expected to be released stateside in late 2011.) I own a CEREC 3D Redcam system, which
now has been replaced by faster hardware and better software with Sirona's CEREC Bluecam.
Soon after I purchased the CEREC Redcam system, I had the opportunity to test out the CADENT iTero.2 I liked the system's
ability to create a very precise model that allowed me to choose virtually any material for the fabrication of crowns
& bridges from a digital impression. This got me thinking: Wouldn't it be nice if I could take digital impressions with my
CEREC unit and send them to the lab for cases that, because of the choice of materials3 or other reasons, cannot be fabricated
using the compact milling unit?
Before long, I found out that Sirona engineers had already been working on that. The company soon released newly developed
software that gave users the ability to send digital impressions to their dental laboratory of choice, not only for
CAD/CAM but also for practically all conventional restorations and materials. Sirona made this possible by first creating
a new software program called CEREC Connect, and then by allowing some owners of older hardware configurations to
upgrade their software and take advantage of this very useful feature.
I had the opportunity to work with my regular laboratory, which also happens to be an experienced CEREC Connect lab,
on a case that involved a combination of thin veneers and porcelain crowns in the mandibular anterior region. The lab's
knowledge and guidance ensured a digital case that proceeded without trouble and according to plan.
CEREC CONNECT PROCEDURE
The case highlighted is a rehabilitation in which the patient transitioned from nonrestorable maxillary anteriors and severe
attrition damage in the mandibular anteriors (Fig. 1) to interim partial dentures and, finally, implant-supported prostheses.
CEREC Connect was utilized to restore the four mandibular incisors. For the benefit of new CEREC Connect users, a brief
outline follows of the procedural steps for sending a case via CEREC Connect.
1. Register online at www.cerec-connect.com. Start by clicking on "Dentist Registration" and choosing a User ID and password that
you can remember easily. Fill out the required information. For ease of use, the acquisition unit should have a high-speed Internet
connection. A CEREC Connect representative will contact you within three business days to finalize the registration. NOTE: Write
down your User ID and password. You will need it every time you send a case through the Internet portal.
2. Download the latest CEREC Connect software. You can find the software online at www.cerec-connect.com. Follow the required
steps to send a case using CEREC Connect. Start by clicking the program icon. You will see the same familiar interface.
3. Start the digital impression by scanning the preparation(s) and defining the margins (Fig. 2). Move the cursor over the antagonist
and scan the opposing arch. Then, using the newly developed "buccal bite," take a scan of the buccal while the patient bites in
maximum intercuspation. This eliminates the need for a bite registration.
4. Manually correlate the three impressions. You can do this by dragging the buccal bite into the antagonist model; when placed correctly,
they will attach. Then drag the buccal bite over the preparation model. All three models should correlate and stitch together.
5. If there are several preparations in the impression, you do not have to trim the preparations. This step is optional. However, you
should draw the prep margins because you should be able to recognize them more easily than the laboratory.
6. Once the margins are finished, the "Connect" icon will become available. Click the icon to go to the CEREC Connect portal.
7. Enter your CEREC Connect User ID and password, which will open the "Restoration Data" tab.
8. Enter the data for each individual restoration. NOTE: If all restorations are the same design, you can enter the data once
for all restorations. This saves valuable time, given that there is good communication between you and your lab.
9. Follow the steps to your shopping cart, where you will find the case. Enter your User ID and password under "Confirmation." Then
click "Prescription" to send the case to the laboratory.
10. When the green bar appears, you will know the file was transmitted successfully to the lab.
On the following business day, you will receive a confirmation e-mail. It will state that the lab accepted your
case for fabrication of your prescribed restorations. The laboratory can create your restorations from the digital
data alone (Fig. 3). Or, if necessary, you can order digitally produced models from infiniDent, which you
see holding the milled Bluecam IPS e.max crowns in Figure 4. The case can be in your office in a few days.
The bonded restorations in this CEREC Connect case showed excellent marginal adaptation and were a great service for the
patient. You can see the finished case (Figs. 5,
6).
CONCLUSION
CEREC Connect has increased the versatility and usefulness of the CEREC chairside CAD/CAM system. It has also allowed
dentists who significantly invested in the CEREC system to expand its capabilities and to continue offering state-of-the-art
technology to their patients.
Dr. Carlos Boudetwww.boudetdds.com
ACKNOWLEDGMENTS
