Previously, dentists have outsourced their ceramic work to an experienced ceramist because they either didn't have the tools, knowledge or time to offer their patients in-house milling. 

That's all about to change. 

RipeGlobal's Digital Aesthetic and Rehab Dentistry with CEREC Associateship is designed to give you all the skills you need to make ceramics that are better than what ceramists could produce. You'll become a more effective dentist who can oversee a high standard of quality at every stage of the procedure. 

Don't just take our word for it, Dr Michael Frazis has learned how to complete in-office milling and it's completely changed how he approaches dentistry. Read on to find out how!

Hi Michael! How has using an in-office milling machine helped your dentistry?

Using the milling machine has allowed me to control all parts of the dental procedure. This doesn’t always mean that I will make every crown or that I only use the scanner for crown and bridgework. It is usually faster to scan a whole mouth with the machine than it is for the nurse to set up for dental impressions.

It also means if an area of the mouth isn’t scanned correctly it can quickly be rescanned rather than redoing the whole impression. The speed also means I am more likely to take a scan at that same appointment rather than bringing the patient back for a separate appointment which takes more time and uses up extra material costs. The easier and faster it is to do something, the more likely it is for me to do it.

I also use the scanner to quickly check the quality of my dentistry before submitting it to the lab. It is faster and easier to check the bite and fix any issues with the prep while scanning than to wait for the models to be poured up and then make the corrections. It also allows for digital records to be stored which saves precious space in the dental clinic.

As I review each and every crown prep and scan in real-time I become a better dentist as I
can see my flaws and correct them quickly.

What have you learned from Dr Lincoln Harris' teachings about digital

I learnt how to critically look at my work and that every digital scanner and mill is just a tool that is only as good as the person operating it. The basics of dental aesthetics; shape, colour and texture, are the biggest things that will influence how nice something will look. The biggest issue most dentists have is not a lack of time or skill but rather a lack of knowledge on what real teeth look like.

Lincoln is great at teaching dentists what teeth look like and all of this knowledge can easily be applied to the raw material that comes out of the mill to give it the same result that you would get from the lab.

Why do you think dentists should learn more about digitising their
dentistry with in-house milling and CAD/CAM?

As dentists get busier they try to do less of their own lab work and send things off to the lab. At the same time as this happens they may start to lose control over how the final product looks and acts. Digital dentistry gives the power back to the dentist to create what they want to create without having to train a dental technician to think like them. This speeds up delivery to patients and improves their experience.

Why have the patient in temporary crowns for weeks when in most cases it can be done the same day or within a few days?

If a patient loses a crown it is quick to rescan the area and remake a crown ready to insert later that day rather than bring the patient in a few weeks later to start the process. The decrease in material costs and medical waste also are better for the planet and the clinic’s back pocket.

Dentists can also regain a level of work satisfaction that they don’t get with other dental procedures. Most patients when they can afford to place ceramic will choose ceramic and the end result that is visible is usually made by the technician with the dentist’s hard work often hidden behind it. By having the dentist make the ceramic work as well they get the satisfaction knowing they created the smile themselves.

What is one tip regarding digital dentistry you would give other
dentists that they could implement straight away?

The biggest tip I would say to others dentists is that just like when sending the work to a lab the more quality work you put into it the better the end result will be. A dental lab is very good at masking a lot of mistakes that dentists do and so you need to make sure the work you are doing is always better than the previous day.

The machine is a tool and if you give it a bad crown prep you can not expect it to make a good crown. Even if you do a good prep you still need to adjust the crown and do all the groundwork to take it to the next level just like a lab tech would.

You can do work just as good as a lab tech, you just need to practice and put in the extra work.

What are the biggest takeaways you've gained from learning about digital dentistry?

The biggest thing I learnt was that I should have jumped into it much sooner! Digital dentistry is a great way to improve your work quickly because of the real-time feedback that you receive and it is not very difficult to get started.

What do you like most about being able to complete ceramic milling in-house?

The biggest thing I like most is the feel-good factor that I get from knowing that I made this crown or restored this smile myself. Usually, all the dentist’s hard work is hidden behind the lab tech’s ceramic but with in-house ceramic milling the dentist can show off their skill and flare as much as they want.

What would you say to someone who is hesitant to learn milling themselves and wants to continue using a ceramist?

Ceramists spend all their time learning how to make perfect teeth in ceramic. They know how teeth are supposed to look and use that to their advantage. This combined with time is the main reason crowns are perceived to look nicer when made by a lab tech compared to being made with in-house milling.

These days most labs are using scaled-up versions of in-house milling software and machines. This means that they can quickly do large cases. Most technicians spend 5 mins per tooth to shape and glaze it. This is because they have to do the work for multiple dentists and they need to scale their workload. A dentist with an in-house mill only has to do the work for one patient so the size of the machines and software don’t matter.

If the dentists take the same time as the lab and use the same techniques then they can achieve similar results. The area that most dentists struggle with is knowing what teeth are supposed to look like. If you can adjust a composite filling to look like a tooth then a milled crown is just as easy if not easier because you can do it outside of the mouth.

The machine and software do most of the work, you just spend 5-10 mins refining it as a
lab tech does and it will make all the difference. Most dentists are not aware of what lab techs actually do so they romanticise it thinking they have an exotic skill set that dentists can not learn.

Do your patients like that you can complete milling in-house? Why
do you think that is?

Patients love in-house milling. The speed of creation and perceived individualisation is its greatest strengths. As the patient has a relationship with the dentists they like that their work is being completed by them rather than being sent elsewhere. The dentist knows the patient well and can quickly customise the work to suit the patient’s need such as bulking out an area to avoid food trapping or thinning another area to stop it from rubbing on the tongue.

Speed is the other major factor that patients love. Speed doesn’t mean it has to be done within 60 mins. The same day can mean morning to afternoon or even over a few days for larger cases. Patients get to their final restorations in a timely fashion rather than waiting around for weeks in uncomfortable temporaries or even worse, getting so used to the temporaries that the ceramic feels foreign to them

Has learning more about digital dentistry helped your dentistry in any
other ways?

It has astronomically helped in other areas of dentistry. As I start to do more of the work digitally I learn all the techniques labs use to shape teeth and also to perform the work they do. By printing my own study models, I am able to better plan my cases as I can have the models the same day rather than waiting a few weeks to get work back from the lab.

As time and cost to print models is negligible it removes the laziness factor that most dentists suffer from as they get busy because they can’t find time in their appointment book to bring patients back for lengthy impression appointments to get things like study models or special trays. These are the cornerstone of quality prosthodontics which usually get forgotten for cut corners and less precision.

By having to control the whole aspect of the crown procedure from start to finish I also start to become more conservative and creative with my preps. Most conservative crown preps or veneers are difficult to place temporaries for, especially ones that are going to last for a few weeks. Most dentists avoid these more conservative techniques to the detriment of their patients. By doing the work on the same day they are able to avoid those issues while delivering a gold standard treatment to their patients.

If you're ready to take back control of your dentistry, then register your interest in the Digital Aesthetic and Rehab Dentistry with CEREC Associateship. You'll become a better, more efficient dentist and will save money in the process. 

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