Instructables
Picture of How to fix a tooth with CAD/CAM (CEREC)
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This instructable is about CEREC, a powerful CAD/CAM technology designed to fix teeth.
This is important because this technology is increasingly being used nation wide.

Why this matters:
  1. It's here to stay.
    • Corporate mills, private practices, and national dental labs are adopting this because it's faster and cheaper--frankly insurance doesn't pay like it used to.
    • Patients love one visit crowns.
  2. New possibilities for patient treatment.
    • If you can do something faster, cheaper, arguably better--why not?
    • Less sensitivity--Milled restorations have much less shrinkage than composites and less thermal conductivity than silver.
    • Quickly replaceable--break it? No problem. Mill a new one from a saved file.
  3. CAD/CAM is cool

Note: Gold is the very best restoration in existence.
  • It lasts longer than a ceramic crown.
  • It spares the enamel from the opposing tooth
  • It will not fracture catostrophically
  • But it costs over $1700 an oz. 
Note:
At the time of writing, the author has no financial connections to Ivoclar, 3M, Patterson, or Sirona.

Note 2:
Sorry for taking so long! 
The community has been doing such a great job, that I couldn't think of anything of worth contributing until recently.
Feel free to PM me with any ideas you'd like covered.
 
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Step 1: Capture A Reference

Picture of Capture A Reference
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To make a restoration, the CEREC needs a 3-D model.
This model is made by taking an optical scan.

In the case of the BlueCAM (formerly state of the art), it involves stitching multiple images together.
For the OptiCAM (released late last year), the scanner creates a 3-D image by compiling from a video feed in live time.
  1. Start one tooth distal (to the back) to the main tooth to one tooth mesial (to the front of the prepared tooth).
  2. Have a steady hand.
  3. Capture the smallest area required.  For the bluecam, try to have no more than 3 images to the model.
  4. Less data-> faster processing.
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mkhiari2 months ago

hello i need to build a dental 3d scanner can some one help me please

steveastrouk9 months ago

What an honest and professional Instructable ! Fascinating. I'm amazed how much cheaper Cerec restorations are here in the UK than the USA though - around $600 at my dentists - but he doesn't like them, except for teeth where the aesthetic is less critical. We kicked around doing an UL3 because I was interested in the tech (and NEEDED a crown ;-) ) , but in the end went conventional, for about the same price.

Very cool, My mom called me up the other day (knowing how much I want a mill, and a 3d printer) and excitedly told me how she got a new crown that was made this way. She tried to explain it, and did a pretty good job, but it's neat to see how it's done. Thanks for sharing!
camidumas1 year ago
I found this post to be utterly fascinating. By making the educated public aware of the bleeding edge of a highly technical field, one moves that new functionality a bit closer to common usage. I really appreciate harmless matt taking the time to provide this kind of esoteric information (and like another poster, dream of the day I can print out a new tooth, however far off it may be).
biospot1 year ago
This seems to be for dentists. Its not the thing I can do at home and I REALLY wish I could. My wife needs implants and crowns and I need one too. The total cost will be $10-$15K when the dust settles and anything that could help by making that cheaper would be a big help. We just have empty spaces now and it will remain that way until something like this drops the price to where we can afford it.
Any idea how to get this done in more economical way that going to a dentist and having them do it? By the time big corporate makes it's profit and I have to pay my share of lost malpractice lawsuit awards, I just can't afford the costs.
This would be one answer to this problem.
Well, you might consider going abroad for that. My sister lives in Bangkok and tells me that it's cheaper to travel there, have your teeth fixed and stay at the hotel than just having your teeth fixed at home (in France for me, where health insurance is good). Don't be afraid, Thaï doctors are very good, they speak English, and the food is so good (though spicy).
I'm sorry for this comment which not really related to the instructable, but teeth are so important.
Fascinating technology anyway.
yes!! i totally agree!!
Take a vacation to another country.. have your teeth fixed there..
It'll be way cheaper (including the tickets) than your numbers, plus you get the vacation for "free"...
:)
Singapore is also quite famous for "medical-tourism"..
Or if you want to come to Bali, i can point you out to a couple international standard dentist around here..

Sorry harmless matt, I understand that it was a big investment you made, but still, what can guys like 4sc4n10 do in this case?
I can't recommend going out of the country. Not to Mex on the border anyway. I thought I had a good dr; he and his dad had been in business for 2 generations. He did 8 teeth, upper fronts for $2000. After he got through with me, he put on a bridge; not individual crowns. I developed a gum infection, when the dentist saw my teeth, she told me there was impingement and a bad tooth that caused the infection. He had told me all my teeth were good and I did not need any root canals. To make a long story short, it cost me 14,000 to fix his job. He shaved my teeth off too short, so I had to have 4 root canals. They couldn't do straight porcelain crowns, I had to have silver bases b/c my teeth were so short. I could not floss with the bridge which was another reason I needed it off. My mouth had a dull ache all the time. The Mex dr told me I just needed to get used to them. When the US dentist took off the bridge, she took photos. She said it was abuse and my gums looked like raw hamburger meat. I had dead tissue under one tooth that had to be debrided. I cried for several months while I did medicinal rinses to clear up my gums. My home dentist told me Monterrey would have been a safe place to have work done, but not the border; they do not have the same standards in other countries that we do here. Of course I know you can run into prob here as well, but less probability here. I never want anyone to go through the nightmare I had to go through.
Sounds typical.

I'd see that all the time from people flying to China, India, or Latin America for work.

It's more expensive to fix it (IF it's fixable), than to do it right the first time.
hindsight is 20/20. veneers would have been cheaper and more beautiful done in the US. Thank God when I smile and I smile a lot, my gums don't show so you don't see the gray gumline from the silver bases. I'm just thankful not to be hurting and no running pus from my gums! Matt you are right on the 'IF' it is fixable. There are dental schools in major cities.
harmless matt (author)  londobali1 year ago
4sc4n10 is the relative of a sister in Bankok.

In terms of biospot's problem, I don't have enough information to know.
I would recommend contacting the local dental society.
There are often altruistic dentists that go out of there way to help needy people.

However, I have to add that I've personally been burned helping the poor many times: at my first practice in Oakland, at a nonprofit (that will remained unnamed), and at various events like RAMM and MOM that I've served at.

I'd advise against medical tourism, but I don't have first-hand knowledge of what's done outside the US. I would recommend going to a dental school instead, as it's significantly cheaper (but slower).

For guys who really have low income and want good solid dentistry, a dental school is probably the way to go. Free clinics can offer patchwork dentistry, but aren't equipped for bigger cases usually. Most of the foreign work that I've seen is downright junk--with the exception of some of the University work from top institutions (there was a patient who's cousin was the head of the dental program in Argentina).
In response. This machine costs 150K to purchase plus software updates and revisions as well as hardware updates. As a clinician myself id love to be able to provide a crown to you for under 1k. What many forget to take into account it cost me as a clinician 8 years of upper education to be able to render these services to you, not to mention the school debt which is more than many peoples mortgages at an interest rate that is over double what the average home loan is going for.

The blocks of material that are milled into the crown are a consumable cost as are the cutting tools, I have to pay 3 different employees a fair wage so they can put food on the tables for their families and I have to pay the power company water company and garbage to make the office inhabitiable. By the time you add up all of these costs unfortunatly a crown has to cost 6-1000 dollars. There is not much of that cost that I take home at the end of the day.

When you start talking implants think about the risk involved and what we are working on is not a piece of metal that behaves the same way each time you cut into it. We have to deal with biology and physiological responses of tissues to invasive procedures. Everybody responds differently. If everything goes just like it should then an implant is profitable to the practitioner however one thing goes wrong or not as expected you will usually just be lucky to break even in costs of materials and time to follow up with that patient. For much less that 4k an implant it becomes hard to make doing these procedures worth your time.

The real problem in society today is peoples perceived value in their oral health. Most of us have no problem buying the new iPhone every year it is released or getting the new 50 inch led side lite 1080p tv.

Again I wish I could give dentistry away at far less than what it costs but that would mean companies would need to sell the things I need to do the job for far less and my education would need to be free from the govt and in the world we live in here in the united states that just is not going to happen. You can thank capitalism for that.

So not to rant but hopefully more so to educate you and anybody else reading this what goes into what we do and perhaps why costs are what they are. In my opinion we are not compensated enough for what we sacrifice in school today and the debt taken on as well as the battle constantly fought with insurance companies.

harmless matt (author)  leedawg1 year ago
Amen!

Oh, and the CEREC is more like $170,000 + now
I wish I could afford to pay the dentists so they could do this procedure. I just don't have the money. Sorry for your money problems, but I have a company provided IPHONE that I use for free. I have a 23 year old car that I bought new and I fight the cable company tooth and nail for every $3 price increase on my cable internet (ONLY) bill. I am not a rich stingy person, I am a poor stingy person, and if this option can (someday) provide I and my wife a cheaper way to replace our missing teeth, we will be very happy indeed.
harmless matt (author)  biospot1 year ago
This is for the general public.

CEREC requires a minimum of $170,000 with at least $6000 a year for technical support and software updates. It is only cheaper with volume...which can influence the owners to prescribe CEREC for everything.

In terms of the expense of dentistry, I think that we're vastly undercharging for a highly technical, highly expensive skillset. We have the most expensive education (way more expensive than MD's), high overhead (staff, supplies, equipment, school fees), and we are squeezed by insurance companies. Frankly, I'd say to drop the insurance and get a health savings account. Budget for the dentistry, and realize that it's an investment in quality of life.

Going to a good local dentist is actually the cheapest way to do it. Corporations seem cheap--until you realize that they make up the difference in volume and "upgrades." Ask your local dental society.

My answer is prevention, and I hope to create a grassroots movement to eradicate tooth decay by the end of my career.
Treknology1 year ago
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harmless matt (author)  Treknology1 year ago
I'm sorry to hear that.

Don't *thrust* this information at your dentist. This is just a tool at our disposal and cannot make up for the problem at hand.

If your case is as complicated as it sounds, you may want to see a prosthedontist.
I can think of the following issues as being complications:
1. VDO - Where your "bite" should be.
2. Possible TMJ issues - reconstructing a bite can damage your jaw joint if done wrong.
3. Bone - Do you have adequate quality and quantity for implants.
4. Expectations - If you believe that your teeth can *easily* be returned to "brilliant" condition, you may be disappointed. It takes a lot of very specialized training to do that, and to do it well.

To put this in perspective, I'm probably more advanced than most dentists 10 years out. I've dedicated this past year to dental implant training. Nevertheless, there is much, much more to learn!

Please have some respect for your dentist.
We're not perfect, but we try our best.
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harmless matt (author)  Treknology1 year ago
Without your medical history, dental history, X-rays, and you in my exam chair, I can't comment.

As to your idea, it's actually in the works.
There is bleeding edge research in tooth regeneration from stem cells at several top universities worldwide.

However, there is a very large risk of cancer.
It'll take at least 30-50 years before it may possible come to public use, and many millions of dollars in research.

Again, my expectations are tempered, but hopeful.
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harmless matt (author)  Treknology1 year ago
Let's keep this civil.

I'm a nerd dentist, and like to keep abreast of research.
I am *not* a researcher, but friends with many.
I don't consider anything that I'm presenting as cutting edge--just normal stuff.

I'm just reporting what I've read, and what I hear.
Look it up on pubmed.

I'm done responding.
ArticAkita1 year ago
That is a VERY interesting bit! I wish my dentist used this instead if porcilain, you have a bunch of well taken photos showing the process very nice!
harmless matt (author)  ArticAkita1 year ago
This *is* porcelain. It's just milled, not pressed.

Normal porcelain crowns take longer, but fit much better and last longer.

This is just faster to make and remake.
harmless matt (author) 1 year ago
I'll be taking a break from answering posts for a while.

I'm finishing implant training under Misch (I don't know if I'll ever really be finished).
I'd like to devote my efforts to really mastering the fundamentals.
There's a lot of interesting things to be developed.

If anyone's near Newport Beach, feel free to let me know if you'd like to hang out.
I'll be here until Sunday.
heibert1 year ago
For me - i don't care how it looks, but better more years to stay.
harmless matt (author)  heibert1 year ago
Go gold. Get the best dentist that you can--preferably one who casts the crowns personally.

It's not sexy, but it'll last beyond your lifetime.
Okinell1 year ago
I am a medically retired dentist. I almost killed myself (not suicide, BTW) attempting to make up for the lousy or at least marginal dental lab support. What I did was to establish my own dental lab and I was the dental technician. I wanted to prove to myself, at least, that a lab could, in fact, without any additional expenses and/or lab procedures to routinely produce, if not perfect, but excellent dental restorations.
In Europe the dental technician is actually respected as much and/or more that the dentist. Also, the technician make a guaranteed percentage of whatever the dentist charges, so there is a real emphasis on both the dentist and the technician to do there very best. Also, it takes years to finally become a licensed dental lab technician and is why most of the world class dental ceramists live in Western Europe.
I did in fact achieve that ROUTINELY!!!!!!!!!! However, my health finely gave out, as a congenital eventually "took me out" and had to walk away from a 25 yro. practice that I had built from scratch. One of the serious issues with our dental lab system in this country is that most dentists are very cheap and want the lowest cost dental restorations they can get. Eventually, the person that ultimately suffers is no less than the patient. I could never bring myself to do this, but took the exact opposite tack. I must admit that I have never seen any of these restorations and the accuracy of fit, but unless things have really changed since the Siemens days, as this technology is not new by any stretch. The only thing that has changed is the sophistication of the lasers, computers, and software. The one thing that is always a huge question is the integrity and the scruples of the dental professional. But that has never changed. Finally, surface staining never last very long and to really make a tooth, LOOK ALIVE, you have to build the colour into the body of the crown and I don't know how possible that is, and/or even possible. When you get into that aspect then just how much better and time conserving could this process be. I guess you could "grind out" posterior/back teeth, i.e., molars, etc. with less concern for colour. You could also offer a front tooth, i.e., anterior tooth, for a discount if just the base colour would suffice? Unless you're a decent dentist that's, BEEN THERE AND DONE THAT, it sounds great to the average person, but there is a great deal more to it. Also, just like Sargenti root canals of years past; that was supposed to be a quick and inexpensive attempt to save more teeth on patients that could not afford conventional root canal procedures. What ended up happening was that since these were usually a quicker one appt. procedure, dentists many times offered these at identical prices as conventional procedures.
harmless matt (author)  Okinell1 year ago
Okinell, I completely agree with you.

Personally, I'm embarrassed at the state of things in dentistry.
I want a renaissance involving the labs, the business, and the patients.
This CEREC stuff is just an alternative (and I still consider inferior) to a good, hand-made crown. It's just that I've seen many, many labs in my area give me increasingly crappy work.

I have great respect for the lab-techs from Germany.
It takes a minimum of 4 additional years of training to be a dentist.
It takes at least 8 years for their master lab tech certification.

I believe that we are kindred souls, as I'm looking forward to buying a practice so that I'd be allowed to do a lot of the labwork and to my standards of quality.

I'm thinking of publishing a series of instructables to demystify dentistry, and hopefully empower the public to make smarter choices.

Would you care to collaborate?
halfsack1 year ago
i have a genetic disorder that gives me super weak enamel on my teeth, thus leaving me with several broken/missing ones at a ripe young age of 21. even while doing everything i can to save them, they just break. currently i cant afford to get any of it fixed or replaced, so i just have big holes, more or less. but this technology could very much change that. i await patiently for the day to come when this is standard in the dental industry, and i can print out new teeth with the click of a mouse.
alzie halfsack1 year ago
Ditto, but I m not that young.
I wish there were something Way Less Expensve than
2000$ per root and crown.
Thats freakin ridiculous!!!
I have ~20K$ of work needing to be done.
Cant afford it.
harmless matt (author)  alzie1 year ago
Try the closest dental school.

You'll get decent care for much cheaper.
It'll just take a long time. Bring a book.
harmless matt (author)  halfsack1 year ago
I'd need you in my chair before I could assess anything.

Have you tried talking to the dental society?
There may be a free clinic in your area.
Sometimes, I volunteer near mine.
harmless matt (author)  halfsack1 year ago
I would advise you to curb your enthusiasm.

Without more information, I can't advise cutting all your teeth to have porcelain crowns made. It's actually a very involved and technically demanding process that only a handful of dentists are actually capable of.

It actually has been around for at least 30 years.
However, it's far from perfect. Only in the last 5 years, do I think results are acceptable for patients. It's still IMHO inferior to a good, hand-made crown in all aspects except time and cost.

Feel free to PM me for more info.
lorimc1 year ago
I would choose the fast, simple cheap option. A do it yourself option would be even better. I tried that once with some over the counter stuff but it wasn't strong, maybe it was old I don't know.
harmless matt (author)  lorimc1 year ago
Please don't try to do it yourself.

Heck, I'm a licensed dentist, and I wouldn't want to do my own dentistry either.
The over the counter stuff is just a temporary cement to fill a hole...it doesn't last.
heibert lorimc1 year ago
methinks, do-it-youself unable because of usualy needs to heal old teeth before restore with any technology
Thanks so much for this great info. I look forward to your future posts. Any idea how I could find out if there is a dentist in my area who knows about this? I'm in Richmond, VA. (unlikely, I know)
I voted for this ible!
harmless matt (author)  nice sister1 year ago
This is just a technology.

Personally, I'd recommend that you look for a good dentist regardless of tool they choose. There are three ways:

1. Yelp: subjective, spotty reviews. Some great dentists have 1 star reviews. Some horrible ones have 4 star ones.

2. Call your dental society-- These guys know all the dentists personally. They'll send you to someone who is personable and has a good reputation.

3. Call your nearest periodontist (gum surgeon) or endodontist (root canal guy) -- These guys see everyone's work, and know who is decent. This will net you the best dentist in your area.
Bioruffo1 year ago
It seems to me that it's a cool idea to get an optical scan of your own teeth while they're in good condition. Heck, it could be a good business even long before 3D-printed teeth become available and cheap.
harmless matt (author)  Bioruffo1 year ago
Well, your teeth might not be perfect to begin with.

Mine weren't, and still aren't.
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