CEREC (Porcelain Fillings)
The use of computers to restore teeth is one of our greatest distinctions at Fiddlehead. We have been using a technology called CEREC since 2003.
But the most common way we use this computer technology is to help our patients avoid "crowns" in the first place!
With the unique way we use CEREC, we essentially take a picture of your tooth with a computer and then produce a tiny porcelain puzzle-piece that fits in the hole where you might have had an old silver filling, fracture, or cavity. This computer technology is only used by about 7% of American dentists to restore teeth, and only a fraction of those doctors use the technology as conservatively as Dr. Chuck and I do.
We ONLY use CEREC to make porcelain puzzle pieces - called "onlays".
We use CEREC to avoid "crowns", because we believe in conserving all the healthy, natural enamel that we can. (You may know that when a dentist puts a crown on your tooth, they must first shave away all your natural enamel - good and bad - and shape your tooth like a "nub". ) While there are some situations where a crown is the only option, we find we can avoid them 90% of the time now with CEREC.
*To restore one tooth, the procedure takes about 1 hour - a single visit.
BEFORE AFTER
Our CEREC computers allow us to generated precision puzzle pieces that are made of porcelain - almost identical to human enamel. After nearly a decade of placing more than 5000 of these small miracles, we can confirm that if CEREC onlays are done with meticulous attention to detail, using the best cements, they are nothing less than a little miracle!.. A leap of modern dentistry. We use CEREC to replace large fillings (when needed). We use it to repair cracked teeth and teeth that have broken. We use it to improve the cosmetics of patients' front teeth.
When our patients have a single CEREC done,many of themsit up at the end of the procedure and remark "That's it?". The procedure is usually a "non-event"! Patients who have had crowns done in the past, and then have a CEREC done, would NEVER have another crown again if a CEREC onlay is an option.
Here's how it works:
Essentially, when you lose a portion of your tooth to decay or fracture, we take a picture of the tooth with a computer, and the computer designs a tiny replacement for the missing portion of the tooth. Then a space-age milling machine, with tiny robotic arms, mills the precise piece out of a block of porcelain that is about the size of a sugar cube. Once that piece is bonded into place you are immediately free to eat and smile with complete security, and you can completely forget about the process.We are 100% certain that this is the future of dentistry and we would encourage anyone who needs replacement of numerous aging silver fillings to consider this well before deciding to have numerous crowns done at a dental office that does not offer this option. CEREC is the least painful, most conservative, most cosmetic, and most economical kind of restoration being done in the world today.
These are my teeth! (Dr. Lynda)
So why don't all dentists use this technology?
Firstly, CEREC is unique in all the world. It has no competitors, so the cost of bringing this technology into a dental office has increased rather than decreased. (In 2003, when we started with CEREC, the technology costHALF as much as it does now!) This makes it almost impossible for new dentists, or dentists nearing retirement, to start with CEREC. Dr. Chuck and I started with this technology at the ideal time.
Secondly, the "learning curve" with this technology is enormous, and requires a very tech-savvy interest. Fortunately, Dr. Chuck and I took on this technology at the perfect time in our careers, when we had the time and mind-set to overcome any hurdles. I think we learned it very quickly because we both have artistic backgrounds.It takes a particular skill-setto work in CEREC's 3D computer graphicssmoothly andefficiently.
Lastly, CEREC has its critics, because many dentists (who don't use CEREC ) are worried that the onlays will break, leak or fall out. We have had very few disappointments. In short: CEREC onlaysout perform every other conservative restoration available. If we had experienced any disappointing or common failures, we would have been forced to abandon the technology long, long ago.
BEFORE- two failing fillings AFTER - two invisible CEREC's
What are the benefits for the patient?
#1 - Treatment can be completed in ONE appointment. This is a fabulous time savings for the patient. Less time away from work. And no second visit to worry about!.. That's so much easier on patients'nerves!.. One and done!
#2 - No gagging on messy impressions. We simply take a picture of your teeth with a camera about the size of your finger.
#3 - No temporary crowns to worry about for weeks after the first visit.
#4 - We also see far fewer teeth that need root canals when we use CEREC. We can't explain this, but now that we have such a long track record, we definitely see that this technology is much kinder to fragile teeth.
#5 - CEREC uses the most biocompatible material to date. This porcelain has many of the same properties as human enamel.
#6 - The restoration is white and invisible! We take before/after pictures of every CEREC and our patients marvel at the way this technology can "turn back the clock".
This webpage will give you a good understanding of how we use CEREC in our practice. You can find out even more at www.cereconline.com
How does it work?
With just three simple steps!
STEP 1.
To be sure that you are perfectly comfortable, we will use a uniquely gentle technique to numb the tooth that needs repair.
Then we will remove only the defective filling and decay. (This is much more conservative than a conventional crown. With CEREC Technology, we can leave all of your healthy enamel untouched. For a crown, the tooth must be shaved down to a stump.)
After we are finished with this step, your tooth will often be missing something shaped like a puzzle piece.
STEP 2.
With a very small camera connected to a computer, we acquire a picture of your tooth
The computer then searches its database of thousands teeth, and it determines how your tooth should be shaped if it was back to it's earliest healthy state. A 3D image of your tooth, perfectly restored, will appear on the screen. The doctor approves of this or edits it slightly.
Once finalized, the information is then wirelessly sent to a machine on-site that uses diamond-coated instruments to precision mill the restoration out of a small ceramic (porcelain) block. This milling process takes 7 to 12 minutes.
STEP 3.
After milling, the new restoration is checked for perfect fit. (Within 50-100 microns: this is close to the width of a human hair.)
We then bond this restoration to your remaining tooth with a unique light; a process that unites porcelain and tooth to the maximum extent possible.
Lastly, we complete a final polish that ensures a natural appearance making the porcelain blend with your tooth.
THE STEPS IN A TYPICAL CEREC. THAT WAS DONE IN OUR OFFICE.....
The following pictures illustrate the typical kind a problem that we treat with a CEREC.
1. This tooth below has some serious problems: it has decay in-between the teeth (which can only be seen on the X-ray) and you can clearly see how "blue-gray" the tooth looks around the silver filling. We always find decay under these blue-gray areas. There is also a crack that extends from the old silver filling down the side of the tooth, at 7 o'clock. Fractures are a very commonly associated with old silver fillings. You can also see that the filling is surrounded by a black "ditch."
2. The photo below was taken immediately after the silver filling was removed. You can see the brownish-orange decay that we found under the filling. This is a common finding under fillings that have been in place for more than 25 years. Unfortunately, the decay is not often evident on X-rays because X-rays can't pass through metal. For this reason, in our office, we do not wait to repair a tooth like this. The blue-gray hue around an old filling is enough to tell us that trouble exits. And so far, after doing more than 5000 CEREC restorations, we have not found an exception to this rule of thumb - A bluish-gray hue around an old filling means trouble.
3. The photo below shows how the tooth was shaped after we removed all the decay. This picture is a photo of our computer screen. You can see that we have left more than half of the tooth untouched and we have only removed the tooth structure that was decayed or left too thin. After this photo was taken, the CEREC. milling machine will fabricate a precise piece of porcelain that restores the tooth to its original shape and strength.
4. The photo below shows the finished, nearly invisible, restoration. The procedure took less than one hour. The "drilling time" was less than 4 minutes. The whole process was completed in one visit without putting the patient through messy impressions or temporary crowns. For many people, the experience is simply a "non-event" and as quickly as the next day they feel as though nothing happened!
A FEW OTHER CEREC CASES FROM OUR OFFICE......
1. 
This is a typical failing filling that we would always replace with CEREC Onlay instead of shaving the tooth down for a crown. We know there is decay under the filling because the tooth has a "blue-gray" hue all around the edges of the filling. There is also a crack at 9 o'clock and another at 6 o'clock.
2. 
As predicted, this is the extensive decay that we found under the filling. (It did not show up on the x-ray.) After this picture was taken we removed all this decay and the cusp that was left even more fragile.
3. 
This is a picture of our computer screen after we have finished removing the decay. The decay and stainis gone, edges smooth and we are ready for the computer to make a precise puzzle piece that will fill in the missing part of the tooth. (It will take about 10 minutes.)
4. 
This is the final onlay, seconds after being cemented in place. The tooth is dehydrated now so the onlay is visible, but within 2 hours, we often can't even see where the CEREC starts and stops.
*** This is why we happen to have all these CEREC pictures. We take a step-wise series of photos like this for every restoration, so that at later visits, we will know what we started with.
1.The filling ....2. The decay... 3. The preparation 4. The final CEREC
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1. The filling...... 2.The decay ..... 3. The preparation.. 4. The final CEREC
MORE CEREC TRANSFORMATIONS.....
Another typical CEREC Onlay procedure. Here again, the premolar in our starting picture (upper left)is clearly got that "blue-gray" color. The decay was found under the filling (upper right). After the decay was removed, an onlay was designed after decay was removed (lower left). And the final onlay was invisible (lower right).
Same principles apply for this second molar. It was obviously cracked at 6 o'clock. The final onlay was invisible.
Another "blue-gray" tooth (upper left) tells us there is a big problem under the filling. The final onlay was again - invisible (lower right photo).
Another step-wise success story!
This picture shows how we use the computer forone of our favorite kinds of emergency situations: To replace a broken old filling with a CEREC onlays in one visit!The patients are always pleasantly surprised.
And another "oldie but a goodie" after we restored the tooth with CEREC.
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We have taken these same kinds of 4-step photos of nearly every CEREC we've ever done. We have literally thousands of photos like these of our patients' teeth, before and after repair: every possible configuration of CEREC restoration.
Please call for an appointment if you would like us to evaluate the state of your older silver fillings. If they were placed more than 20 years ago, it is likely that you have a number of teeth in this condition. We have intra-oral cameras in every room which we will use to show you your teeth in an effort to partner with you for the best possible outcomes.