CEREC, crowns, inlays and veneers without cumbersome impressions

It is simply a word creation. The name CEREC stands for CEramic REConstruction. A direct production via modern computer, scanning and milling technology.

With the CEREC procedure, areas of a tooth that have been destroyed by caries or fractured parts of the tooth can be rebuilt. For example, for inlays, crowns, veneers or small bridges. Aesthetically successful reconstructions are possible, especially for front teeth. Due to the so-called chameleon effect, molar fillings adapt very well to the existing tooth substance and its colour.

The affected teeth and their surroundings are locally anaesthetised. Then the dentist removes decayed areas and defective areas. Undercuts are removed and the surfaces are smoothed. Then the areas to be replaced are cleaned and disinfected. With an intraoral camera and integrated digital scanner, these areas are electronically recorded and processed into a data record that also takes into account the opposing jaw and the relation of the opposing and neighbouring teeth. Now the dentist or practice staff can rebuild and reconstruct the tooth on the screen. This moulded part is now produced from a block in a modern computer milling machine after the colour of the patient's own teeth has been taken and then bonded on or in the tooth. During the milling time of about 20 minutes, the patient can relax. Then the moulded part is checked for perfect fit. cleaned, disinfected, reworked if necessary and bonded to the tooth. Finally, adhesive residue is removed, the bite is checked and ground in, and a final polish is applied.

It takes between 90 minutes and 120 minutes for an inlay, crown or veneer

In the past, dentures were manufactured in the commercial dental laboratory or practice laboratory ( LAB ). In other words, they were produced in the laboratory ( Labside ). Through the use of CEREC technology, a restoration is now produced directly at the treatment chair ( CHAIR ), i.e. chairside. This eliminates the need for courier services, saves working time and, of course, personnel and laboratory equipment. The technology is correspondingly environmentally friendly, but also makes jobs in dental technology superfluous.

With a normal local anaesthetic, you will only notice the prick of a needle and the uncomfortable feeling that comes from the local anaesthetic. Depending on the skill of the dentist, such anaesthesia can be a little less or a little more painful. Modern syringes with very fine needles reduce the pain even more. Hypersensitivity to the adhesive can occur if too much tooth substance has been removed in the direction of the nerve. This is called preparation trauma, but it can be avoided or detected with an X-ray.

It is possible in exceptional cases that the patient may experience pain due to preparation trauma mentioned above or hypersensitivity to glue or gum injuries. In that case, the patient should get an appointment in order to eliminate the cause quickly.

All materials that can be purchased as blanks can be used with CEREC. Glass ceramic, disilicate and zirconium oxide are used in the dental practice. The blanks or CEREC blocks are produced in a wide variety of shades. It is even possible to use different colours in one jaw or to customise the colour of the mould.

Many restorations have been in the mouth for 20 years. Long-term clinical studies and stress tests have proven very good durability.

The development is going in this direction. However, it is still not advisable. Moreover, the current milling machines and milling blocks are not yet suitable. In cooperation with CEREC-CONNECT, however, a direction is foreseeable in which even complex large restorations will work.

Treatment with this system lends itself to. Scanners and cameras don't care whether they are scanning a patient's own tooth or an implant post. In conjunction with the CEREC-CONNECT system, it is also possible to produce large implant work in conjunction with technical high-performance milling machines, digitally created implant posts and in cooperation with milling centres or suitably equipped dental laboratories. Dental technicians here are also specially trained for these new areas.

The treatment is generally easy due to the minimal use of technology and impressions and is much more anxiety free than a normal impression. However, the treatment is also much more expensive than a simple filling. Metal-free treatment, however, is particularly suitable for children.

In general, an impression with silicone or alginate and an impression tray is no longer necessary.

CEREC offers advantages for all patients who want metal-free restorations and value gentle, substance-preserving dentures, while saving time.

All-ceramic dental materials have proven to be biologically neutral because the material used does not release any components into saliva, there is no electrochemical voltage and the moulded parts are prefabricated by machine. These components have such a high degree of purity that contamination, as in a dental laboratory, is impossible. In a dental practice, clinical conditions prevail. A laboratory is a handicraft business.

In 1985, Prof. Dr. Werner Mörmann applied the first CEREC restoration to a patient. In close cooperation with the engineer Dr. Marco Brandestini from the University of Zurich, a concept and technology was developed which, after taking pictures of the inside of the mouth, allowed 3D design on the screen and the use of modern computer milling machines via a data set. The scanner generates corresponding data sets, which are transmitted digitally to the milling unit by means of special software.
In 1987, the Siemens company brought the world's first technical equipment, called CEREC 1, together with a milling machine onto the market.
Through constant further development by the Sirona company, we now use CEREC 3D, the latest development of which is the fourth generation of equipment. The latest CEREC software 4.2 has been on the market since the beginning of 2013.

As with any specialised profession and as with any new technology, dentists need to acquire appropriate training and certification to become familiar with this computer technology and to implement innovations.
There are always trainings, courses and updates in the software. Users of this system also meet regularly to share experiences.

There are currently around 11,000 dentists in Germany who treat patients with the CEREC system. So you can find a few practices in every city. In rural areas, you as a patient may have to go to the next larger town.
But the number of these dentists is growing very quickly and steadily worldwide.

1. Massive time savings
2. Only one dental appointment necessary
3. No annoying impression taking, no gag reflex, no unpleasant taste
4. After placement, a CEREC solution is immediately loadable. A temporary restoration is not necessary
5. There is no need for temporary or provisional placement
6. Infestation with bacteria is not possible during the transitional period until incorporation
7. The patient sees the design and tooth colour immediately and can request changes even before insertion
8. Made crowns and bridges are metal-free, therefore no allergies, no dark crown margins and better aesthetics
9. Comparing the prices of CEREC crowns is very easy due to identical fabrication
10. The patient can have his teeth restored in stages. Not everything has to be done at once

As the name denture suggests, it is only the replacement of a tooth and never as optimal as the original. So even CEREC restorations have their limitations and disadvantages.
A caries that extends very far below the gum line is difficult or too inaccurate to detect with a scanner or camera.
In this case, the good old impression taking and production in a dental laboratory is still an option. In any case, the cement / adhesive should be tested for allergy potential before deciding on a CEREC restoration.

The company Sirona is the manufacturer of the CEREC systems. Only the dentist earns money from the direct production of the crowns, bridges, inlays and veneers in the practice. Now the dentist, like any entrepreneur, can influence the price via corresponding billing factors, hedgehog performance and additional positions. So it can be expensive, really expensive or extremely expensive. Favourable or even cheap is not possible here. With this system, the dentist has an eierlegende Wollmilchsau, which gives him a very good return if enough units are produced with it. The cost of a fully equipped system is just under EUR 90,000. Since 80% of such CEREC machines are leased, the monthly burden is limited to approx. 1500 EUR. In addition, there is maintenance, repairs and wear and tear. Not to forget, the employees have to be trained. This generates additional and not inconsiderable costs. In order for such a technique to pay for itself, the dentist has to produce about 8-10 crowns per month. Since the return remains in the practice and the dentist can calculate the price himself, the prices of a CEREC crown vary between 350.-EUR and up to 900.- Euro one street over. Machine, and material are absolutely identical.

In the dental practice, the production of a crown with blank, proportional leasing costs device, wear and maintenance, the personnel costs, water, energy and consumables costs about 150.- EUR. The difference to the sales price is then profit before tax.