Page 58 - CEREC Q3|2013

56 | cerecdoctors.com | quarter 4 | 2013
lot better than $300 for an Optiguide. Especially since it only
takes about 10-15 minutes of my time. Some will say that my
time is worth more, but even at 15 minutes you are talking
about a$250savings. Thatworks out to$1,000anhour. Ihave
a good practice but $1,000 an hour is still dang good produc-
tion inmy neck of the woods.
CEREC Guide is like anything else new — it takes time to
learn todo it right. The learning curve is therebut it is not that
steep. Once you learn it, youhave an inexpensiveway to fabri-
cate something as good as you get from a lab at a fraction of
the cost. Sounds kind of like something else I know(big grin).
Farhad Boltchi
Totally agree with you, Jeremy, and that’s why I
said that the two-scan protocol described above
is not the norm ... nor should it be. I have hadmy own chal-
lenges with the CEREC Guides. Now I use CEREC Guides
only for posterior, single-tooth sites. And, in a surgical
office like mine, the cost difference and difference in turn-
around time does become significant.
Jim Yankowskas | Tyngsboro, Mass.
I agree with T Bone and Darin. My assistant is
trained to do everything, and I just approve what
I see. Then I can design implant with PT in consult room. It
takes us 30 to 40 mins, but only 5 to 10 of my time. Assistant
canscanwithOmniwhileCBCTisprocessing.Workflowgets
quite smoothwith the right training.We spent a staffmeeting
break-out sessionwith a hands-on exercise in construction of
the Tak tray and placement of the marker. The cost saving is
worth the training time with a single guide.
T-Bone 3-D Implant Agarwal
The costs are irrelevant. We are doing a high-
dollar procedure that most of us wouldn’t do if
we didn’t have the Optiguide!
I also do 95% of cases with Optiguide. But lately we have
started doing a few more with CEREC Guide. I don’t find
it too difficult if you stick to some basic principles. Single
posterior teeth. For anterior, I want true guided place-
ment and prefer the precision of Optiguide. Of course, if
a patient walks in with a broken front tooth, the CEREC
Guide option comes out! ...
Oh. Time should also be a non-issue. The patient can sit and
| | | d i s c u s s i o n f o r u m
CERECGuide is like everything else, it takes practice, and
most of all know-how to delegate and train the assistants,
this way you pretty much do the tx planning and surgery.
It gets even better, my hygienist numbs my patient.
Darin O’Bryan (Faculty)
I would love to see a strictly digital approach to
making an in-office guide. The reason there is a
thermal plastic stent to start with is Sironawanted a same-day
option for clinicians. If you tried to mill out a surgical guide
out of PMAmaterial with the current burs, it would take a lot
longer,justlikemillingathree-unitbridge.Also,itishardtomill
anything past the height of contour. Youwould not have a lock
or snap intoplace feel it likeyoudowiththe thermal plastic. So
that is another limitation. With the new carbide burs, it might
be possible to mill out a PMA material for a guide. It might
only rest on teeth to the height of contour until we can reliably
mill the undercuts (can you say 5 axismilling chamber?), but it
would be a completely digital solution.
Some people say it takes too long. It takes me a whole 10
minutes to make the radiographic stent. Then there is the
milling of the guide. This takes between 10-15minutes. Hope-
fully this will speed up with the carbide burs. It is not a huge
issue since I am getting the patient numb and going through
post-op, informed consent, etc. ... This is, of course, if I am
doing it the same day. Now realize I am only involved in the
stent fabrication, which I could very easily delegate, and the
implant planning to export to the milling chamber. So my
grand total time is maybe 15 minutes. The rest is done by
either my assistant of themilling chamber.
Accuracy is not an issue once you learn how to make the
guides. Here is a case where I used the guide to create the
ostetomy and thin out the
wall of the sinus at the same
time. If the guide had been
inaccurate, I would have
torn the membrane and had
a sinus perforation. I have
other cases that needed the
same kind of accuracy and it
performed perfectly.
The inaccuracy comes from the
manufacturing of the guide. If the
guide is created correctly then it
is as accurate as an Optiguide. The
cost of the guide is $45 — this is a