CEREC 3D
The Revolution Begins!
Industrial Ceramic CAD/CAM Technology

Another Non Commercial and Unofficial Web Site by
C. David Hemp DDS Inc.


Cerec 3D is Unleashed 3/03!


"Contempt for others is bred by Conceit!"
Original Quote by Doc Hemp


Cerec 3 - 3D, the phenomenally accurate, CONSERVATIVE, computerized single visit porcelain (no impression) Veneer, Inlay/Onlay, 3/4 and full Crown tooth restoration system! .. A powdered image of the tooth from a cad/cam 3D camera accurate to 25 microns is sent to a milling machine accurate to 25microns which is closer than we need as per fusion space. The dentistry of tomorrow is finally here today! Championed by those progressive dentists (regardless of age) willing to learn new technologies and willing to reinvest their time and very substantial sums of money into the latest dental equipment for their patients, (and themselves) ... Like Cerec, Digital Xrays, Inta-Oral Cameras, New Sirona Digital XG Pans, Micro Air Abrasion, and lasers, etc.
We as dentists spend a huge part of our lives in our offices, why not surround ourselves with best technologies possible as our practices grow? Look forward to going to work!
The purpose for me of Cerec is to save as much original tooth structure that we can. Remove all of any old filling material and replace that and the fractured portion with very strong Industrial Ceramic that is made in 4 micron particle sizes without micro spaces just as our own enamel rods are. These inlay/onlays are the name of the game! .... Many are losing sight of this and doing far to many full crowns with this technology ... Some because the patients insurance might cover better with full coverage, etc. One can never allow an insurance company to do our diagnosis and dictate the standard of a patients care! We want only patients that care as much about their own teeth as we do!

Short Cut to Our New Cerec Emails Received and Cerec Instructional Link Site
Many dentists and patients have their first exposure to CAD/CAM from our wild and wacky general dentistry site to this page or from the top of numerous search engines and follow our links first. This new page is devoid of all my personal rhetoric




MEET THE CREATOR OF CEREC CAD/CAM

Prof. Dr. Werner Mormann


(As Shown and printed on Sirona's Web Site)

Werner Mormann graduated as a dentist from the University of Heidelberg and acquired his first doctoral honors with a thesis on the condensation of amalgam in 1969. He worked in private practice in the city of Mannheim and in the countryside in Schaan/Liechtenstein. From 1970 on he continuously lectured operative dentistry at the University of Zurich Dental School but parallel to that specialized in clinical periodontology completing a thesis on the gingival reaction to subgingival gold inlay margins. He used fluorescein angiography to study gingival blood supply after periodontal flap and graft procedures, as presented in a postdoctoral thesis, and produced 37 articles in the field of periodontology and preventive dentistry.

Early in 1980, Mormann anticipated the attraction of restoring posterior teeth with tooth-colored material instead of using amalgam or gold. He conducted studies and developed the clinical concept of bonded ceramic inlays, at the same time raising the issue of the fast fabrication of the ceramic restorations. He planned the idea of in-office CAD/CAM fabrication of ceramic restorations specifically to be used chair-side by the dentist to complete one or multiple ceramic restorations in a single appointment. The initial concept comprised a small mobile CAD/CAM unit integrating a computer, keyboard, track-ball, foot-pedal and opto-electronic mouth-camera as input devices, a monitor and a machining compartment as filed in a Swiss patent application together with the engineer Dr. Marco Brandestini, in December 1980.

Together they solved the problems of fast 3D capturing of tooth preparations with a mouth-camera, the form-grinding of esthetic ceramic, the manufacture of ceramic blocks and scan powder, and completed the construction of the CEREC 1 hardware and first operating software during the years 1981 to 1985. To produce the first series of 25 CEREC 1 units they founded ´┐ŻBrains´┐Ż Inc. with the Zurich based Proceq SA as a financial partner. Cooperation with Siemens started in 1986 and continued with Sirona since 1997.

The original concept carried through CEREC 1 and 2 versions. In the year 2000 CEREC 3 divided the system into an acquisition/design and a separate machining unit. Also, the "CEREC InLab", the machining unit equipped with a laser scanner or using an extra-oral scanner (inEOS) can be operated in the dental laboratory with a personal computer. The new 3D software makes the handling illustrative and easy both in office and in the laboratory.

Mormann is professor of operative dentistry, has published 100 articles and 10 books on chair-side CAD/CAM technology, related materials and clinical experience, and received the (Medical Faculty, U. of Zurich) and the Engel (Academy of Continuing Education, Karlsruhe, Germany) awards. He is founder and president of the Foundation for the Advancement of Computerized Dentistry Zurich, Switzerland, has established the Division of Esthetic and Computer Restorations at the U. Zurich Dental School and is head of this division.

Werner Mormann was born in Goppingen and raised in Mannheim, Germany, and lives with his wife, Jeanette, daughter Viviane and son Jan in Zurich, Switzerland. He loves skiing, hiking and wind-surfing.




3/11/06 ... I have just added a couple photos of and from one of our Cerec colleagues .... Alessandro Devigus ... He owns the www.cerec.net web site Tell em Doc Hemp Sentcha! ... This is also a good site to find a Cerec dentist near you.
Today he posted these photos of himself ... It does show the longevity of these Cerec restorations and why ours are doing so dang well. You must remember that this was in the year Cerec was invented and was made with one of the first Cerec prototype machines. The subsequent Cerec 2 & 3 machines have gotten even better. Below is the email and photo's Alessandro sent.

Dear colleagues

Here are 5 CEREC inlays (showing both sides) I received in 1986 as a student at the Zurich dental school... the inlays where made with the yellow CEREC prototype... they don't look nice but they are still there ... and CEREC has improved over the last 20 years.

Alessandro Devigus





Hi Doc

Thanks for putting a link to cerec.net on your site ;-) I was thinking of setting up cerec.net meetings in the future... your idea sounds good... let's work on that

kind regards
Alessandro





4/15/06 ... Below is a photo of the very first 2D (Free) MOD Cerec I ever did (at my office) about 4 years ago. The first bicuspid. There has been no stain on any of the margins. The 2D full Cerec crown on the 2nd bicuspid next to it I did a short time later when the patient fractured off an old pin and buildup crown near the gum line. You can see on the xray below the photo how little tooth was left ... Instead of a probable extraction and implant we decided to try a fused in full Cerec crown. It is still there 3 plus years later. I still don't opt for deep grooves ... want all the strength we can get. ... Oh ... and I charged for that one ... ( ;> )









8/13/07 .... Well ... We finally had our first fractured Cerec in over 5 years .... The mesial fractured in one of our large Cerec MODFL inlay/onlays ..... BUT BUT BUT .... It was on one of my very good friends that is not human! ..... I had finally gotten him to quit smoking ... but un-be-knownst to me he went to Chewing tobacco with sugar in it and kept it inside his cheek along side his teeth ... He had a decay problem before that now escalated into rampant decay with decay below the mesial and distals on the root surfaces of several teeth.
The Cerec lost it's support and fractured into the space. It had been in place for about 4 years with no problem.
Like I said this is no ordinary person ... Richard is a 2 time world champion drag boat racer that I have since gotten into car racing too after I talked him into buying a Ford GT 40 ... He wails on his teeth like he does his boats and cars! .... In fact this past year he hasn't done so well .... Everything has been breaking on his boat (and now his teeth too!). What I did was bond a Heliomolar MO into the s pace. No sense doing more until he can get back on track.

We did have one other natural facial cusp fracture off an upper bi-cuspid and it took a little bit of the Cerec with it when a gal tried to open a metal can of glue that had a metal lid with her teeth ... I simply made a chairside veneer and bonded it into the cerec.

11/24/06 Update ... Now well into our 5th year ... And .... I finally had an entire lingual natural tooth fracture off adjacent to an existing occlusal facial Cerec a couple of months ago in a very traumatic situation. I sand blasted, pinned and fused back into the existing Cerec ... no more problems yet. ... But ... We still have not had even one Cerec fracture yet and than includes an inordinately large amount of 2nd molars too.
... Reflecting our extraordinary success rate I feel it may be due to the fact that we only do Cerecs on the deeper and larger old amalgams or fractures where this industrial strength porcelain has a lot of thickness for strength ..... areas where I routinely have 2 + millimeters of minimum thickness ... not where I have to remove good tooth structure to squeeze in a minimum thickness. And we also still use the S.E. P & B along with the Tetric Flow technic on all cases ... but ... Whatever it is ... We still love it as well as the patients do!
10/07 .... In fact I recently had Doc Mike do 3 Cerec's on me with the same above technics and there is ZERO sensitivity!

1/01/06 Update .... I know many of you will not believe me but it is the truth ... Almost 4 yrs. and no Cerec failures yet ... Not one cracked, chipped or even the edge of a tooth next to one ... Plus ... Not one that is even sensitive! .... It is amazing and an extra ordinary run and only a matter of time ... but even then most should be repairable.

And our very close friend Doc Mike Birkhoff (who taught me everything I know about Cerec!) has now done over 10,000 Cerec restorations in the past 10 yrs. .... With very few fractures!

Doc Mike is like the brother I never had! ... We have been riding Harleys together for years! ... Becky and I have been over to Germany (Our Heimatland) many times and our two families are very close. He, Bridgette, Mike Jr. and Mandy stay with us over here also. His email is listed in our links below for any Cerec questions you might have. ... Just don't ask me!
And ....(Click Here for Mikey's) How to Maintain your Cerec Milling Unit to keep it for a long time
And New (3/24/08) What to do if you get a "Milling Unit Not Ready" warning like I did this morning!

11/03/07 Doc Mike Update - The Triple Mikey Concept in Cerec 3D Correlation (Click Here)
And ..

11/19/05 .... Update .... Went to another Ray Bertolotti and Tin Man lecture ... Had Ray, Ryan and families out to breakfast and our place to ride the train. Went over with Ray this amazing success we are having with these Cerec's and no fractures or even one that is sensitive! He said it is no surprise to him for virtually these 4 reasons ... The cases we choose, the time and care we take, the way we are bonding them in. and due to the fact that they are milled out of industrial strength porcelain.
At the lecture he showed PJC's fractured with Unicem .. He doesn't' recommend it! ..I also told him about others experiences of black lines around the margins usually within a year.

  • Ray Bertolotti's Adhesion DDS Site
    Ray has been a friend of mine for a lot of years .... We both started doing bondodontics and porcelain veneers over 20 yrs ago. I started after I attended one of his very first lectures. He has done more for dentistry than any other one person I know of ... Without adhesion bondodontics there would be no Cerec, etc. .... Some of us may even talk him into Cerec some day (:>))

    Now ... Back to the old stuff on this site ...
    ..... I do mostly fractured cusp and cracked tooth syndrome cases ... and anything with deep amalgams we can get an O.I. on ... I use the Cerec as a conservative tool to circumvent the need for full tooth cut downs as in full crowns. We haven't done as many per year as most ... but I pick our cases by doing the ones with the deepest fillings already with plenty of room for porcelain. .... I still us full gold especially on 2nd molars I we can't get a good O.I. ... Porcelain to gold with Gold occlusals in esthetic cases .... But our Cerec crowns are holding up very well too and look fantastic. I use these where we can get a good unobstructed image and there is plenty of room.



    10/11/04 .... You can not match the esthetics, strength, lack of sensitivity and durability of Tetric Flow with Clearfils S.E. Prime & Bond for all Cerec Inlay/Onlays, 3/4 and full crowns. The light will penetrate these too due to the 4 micron density of the industrial blocks we carve them out of. I still use Photo Bond and the Tetric Flow or a thinned down Densply TPH for our Veneers


    The milled porcelain is the same hardness, thermocoeffiecent of expansion and 4 micron particle size as our natural enamel. It is fused into and onto our damaged teeth with great strength and success! Negating the need for full caps or crowns in many cases! It is not for everything, but will decrease our initial full crown coverage by probably 75 - 85%. It is the next step in our conservative bondodontics approach to dentistry. Dr. Mark Morin has actually milled 2 anterior crowns out of human enamel grown in petri dishes ( even with Fluoride introduced so it won't decay) grown at one of our leading universities as part of the human DNA body parts reproduction experiments. So .. in the not so far future we will be able to actually fuse human enamel back into our teeth damaged by decay and weakened by old silver fillings! .... When they sort the political ramifications out.

    I love using it, especially instead of the old TMS pins and build up technic followed by the full coverage crowns! .. It is great for molars and bicuspids with one or more fractured cusps .... just remove 100% of the old amalgam and run your Cerec onlay over the missing cusp or cusps ... almost no build ups ever required any more, saving our Cerec patients these extra build up costs!! .

    I still do traditional high noble crown and bridge, Composites and amalgams .. We never recommend replacement of good, well placed amalgams where there is still plenty of tooth strength. But this Cerec phenomenon is one of the most exciting things I and our patients have ever been involved with! .... But .. if you are going to Cerec and you are already as busy as you can possibly be anyway ... don't do it simply to make more money ... you only save what you might have paid in lab bills and the difference above and beyond which you would have done during the cerec time anyway. It is not necessarily a quick pay off. Fortunately I didn't get it for that, and I refuse to work any more hours or days! The patients love and will demand the Cerec ... Our cancellation list is usually very full and I have always been booked 1 - 2 months ahead anyway. Economically It would be a great practice builder for anyone with open book time or one wanting to expand and take on an associate or put in more hours.

    2/20/04 .. Again .... This Cerec is just one more part of our armamentarium, not the only part, to treat the patient completely in the best way possible. In my opinion, old subgingival restorations, etc. are still best served with a high noble full gold crown, with bonded build ups or even Amalgam. We never use the Mercury scare tactic to unnecessarily remove all of a patient's good functioning amalgams.
    We still send most multiple porcelain veneers & crowns to the lab. It is just more energy, time and cost effective.

    6/15/03 a breaking note about cracked tooth syndrome ... We always have isolated the flexing and painful cusp with the "Tooth Slooth" and then placed only high noble full coverage which are usually sensitive for some time after placement .. but I have now done quite a few of Cracked tooth syndrome cases with Cerec porcelain inlays & onlays over the flexing cusp ... using our standard S.E. Prime & Bond with Tetric Flow ... no sensitivity on any of them from the day they were placed to only 2 weeks or so, so far during the past year and one half. .... Even with our full high noble gold crowns in the past with ZnPo4 cement, we had sensitivity for several weeks to months afterwards followed by a root canal occasionally. Cracked tooth syndrome can not be repaired with a composite filling period! .... This is one place the Cerec stands alone ... Conventional 3week laboratory porcelain inlay/onlays have never worked. The immediate fusing in of the Cerec and it's compatibility to natural tooth structure has to have a lot to do with the miraculous answer to this problem.

    Below see .. some of our very first Cerec Cases during our first week almost 11 years ago now.

    Some of the internal corners could have been rounded some more, but they have all fit very well! .. Sorry the photos are so poor, Accucam then scan = very opaque looking due to the polarizing light in the Accucam ... But in the mouth these restorations are invisible and just disappear into the tooth! Camelion Effect!
    They are a blast to do! The software is very good and easy to use now with the 3D .... just take your time and enjoy it! ..

    I did opt to minimize pronounced occlusal grooves in many cases to keep the porcelain as thick as possible, eliminate possible deep fracture lines for strength and to preserve maximum tooth structure. But .... when you have thickness, these are very easy to develop great occlusions with by analog milling with your diamonds (with the water on!) prevents micro fractures. And of course now with Cerec 3D one can do more with the software but it is important not to be game playing when one can polish it in in seconds anyway.

    12/05 ... Staining the occlusal grooves of posterior teeth and glazing is really not necessary. Staining and glazing is usually to impress other dentists (that they hope will attend their lectures, buy their videos or equipment).
    These polish up wonderfully as recommended by Sirona without glazing. The surface is the exact hardness of the enamel .. We don't need a harder glaze. The patient likes to see a nice new clean looking tooth anyway without stain ... And almost always would rather make the others like that rather than visa/Verse! It is not a cosmetic area that can be seen like a front veneer or crown where staining is required many times to match adjacent teeth. It's okay to not stain and it's okay to stain ... but those that stain won't get to heaven any quicker than those that don't! ( : > ) )
    Also .... I save the Cerec milling dust to polish with.
    "If you put stain and glaze over poor work it is still poor work! ... If you put stain and glaze over good work it is still good work!"
    Another Doc Hemp useless quote ... grin ..

    We have had ZERO sensitivity on teeth that weren't left a little high in occlusion or already sensitive and even they are better after a couple of weeks ... just like with our bondodontics ... Etch any exposed enamel, Clearfil S.E. Prime & Bond, Tetric Flow , Best long term results over 16 years in the mouth as per Dr. Mark Morin with over 20,000 Cerec's and less than 1% failure = fracture or chip!


    Lower Bicuspid
    By the time he came back in the entire
    Amalgam had fractured out along with
    some more of the tooth.


    This above is a Powdered prep of my 2nd Cerec ever (the box angles could be more rounded) taken off the screen of the computer. In the past, I would have placed 4 TMS pins and Ti-Core Build up. And then the full crown. But, the Cerec just bonds into the prep as shown without a build up (saving the patient the old Pin & B.U. fee) or more exterior weakening tooth reduction necessary for a full crown. This is what Cerec means to me! Conservative Dentistry ... Fewer Crowns! If one is replacing a large failed amalgam and or one or two cusps fractured of a tooth or an old porcelain crown on a tooth that had major tooth reduction done already, a Cerec crown or inlay/onlay is a great option in my opinion.



    After photo
    Designed in Extrapolation
    Raised the lingual cusp up a little in MR in Projection.



    Before Photo

    After Photo




    Powdered prep taken off the computer


    An xray showing Cerec bonded with S.E. Prime & Bond and seated with Tetric Flow

    Below is a photo of a crown we did in June 03 .... the patient a bruxer had fractured off a long time bridge at the anterior abutment (attachment) just above the gingival (gum) line ... ( wasn't wearing her night guard) ... I cut the bridge off at the mesial of the posterior abutment crown ... prepped the fractured stump ... placed a preformed temporary over it .. adjusted the bite perfectly ... took a Cad/Cam photo of it and then removed it and took the image of the stump ... and the Cerec milled out a perfect crown shown below here .. no adjustments at all .... we are now in the process of placing 2 implant crowns where the pontics (old missing teeth on the bridge) were .. again .. sorry the photo is so bad as per after scan off the Accucam .. in the mouth this is absolutely perfect!






    I must say Sirona has done a wonderful job in designing this Cerec 3 - 2D and now the 3D! History will show they have revolutionized dentistry! They have some of the best engineers in the world! They have the best manufacturing in the world! Patterson Dental has taken the bull buy the horns with this technology and run with it! Have invested millions and brought it to main stream dentistry. They should be applauded for this.

    After 38 years of dentistry now! .. Almost 63 yrs old ... (7-20-2013 UPDATE!! - NOW ALMOST 71yrs OLD) still going strong and enjoying myself immensely! "When we as dentists work because we want to, instead of because we have to, we have reached our personal Nirvana!" And some of us have been blessed with that attitude throughout our whole career. And we will not be financially stressed If we reinvest back into our practices regularly

    Maybe you can use some of the insights from our many pages.
    .. I enjoy all phases of dentistry and life in general ... My open attitude and humor irritate, offend and shock some ... No one can please everyone and no one has all the answers! ... So .."Use what you can, can what you can't! You can can it can't you?" "Use the best ... shine the rest!" "Don't be a Pest" ..... Remember ..."Contempt for others is bred by Conceit!".... Right J.K.? ...
    I for one, plan on still doing dentistry into my 80th year if my health holds out. Metamucil has already contacted me to sponsor our sites! (grin) ....



    Here is a quote I ran across on the Cerec Chat group by William Davidson DDS which he gave me permission to use, which I think has merit in some cases.
    "Some people who put down CEREC need to do so to justify their decision not to make a large investment in bettering their patient care. No argument will convince someone who is being righteous to cover up being cheap!"
    William Davidson DDS.





    The custom brochure I made just for our waiting room and our existing patients. The before and after is only an example .. not one of our own ... You can see a few of our very first ones we did above.
    These brochures have long since gone now, but the photo is cute .... And no ... I didn't position her middle finger on the doll ... We didn't even notice it till after we made the brochures .... l ;>)

    11/30/06 ... Me and my Elvis Experience Becky rented this suit to suprise a long term very favorite patient that always calls me Elvis ... We did a Cerec on her today .... a lot of laughs! ... We always have a lot of fun and the patients love it ... They usually say if we had a bar they'd stay all day .... ; - )





    1. Doc Mike's How to Maintain Your Cerec Milling Machine
    2. 11/03/07 Doc Mike Update -
      The Triple Mikey Concept in Cerec 3D Correlation (Click Here)
    3. Cerec Instructional Link Site
      Our New Cerec Emails Received and Cerec Instructional Link Site
      Many dentists and patients have their first exposure to CAD/CAM from our wild and wacky general dentistry site to this page or from the top of numerous search engines and follow our links first. This new page is devoid of all my personal rhetoric
    4. Ray Bertolotti's Adhesion DDS Site
      Ray has been a friend of mine for a lot of years .... We both started doing bondodontics and porcelain veneers over 20 yrs ago. I started after I attended one of his very first lectures. He has done more for dentistry than any other one person I know of ... Without adhesion bondodontics there would be no Cerec, etc. .... Some of us may even talk him into Cerec some day (:>)) ... And Ray and Family Ride on our Steam Train
    5. dochemp@shasta.comEmail Doc Hemp
    6. The World's 1st International Cerec 3D Lecture.
      "During the first days of june 2003, 17 dentist from 7 different countries and 4 continents met in a secret place deep in the heart of Germany to learn all the tricks about the new 3D software!" .. Plus ... Many photos of the Rhine, Castles, German Cadillac Car Club!
    7. Go on Doc & Becky's 2003 Oct Germany Trip
    8. My Philosophy of Dentistry
    9. Return to Doc Hemp's Dental Site
    10. Return to our Dental Student Only Page
    11. Doc Hemp's KaVo Electric Handpiece Page
    12. GOOGLE IT! CEREC 3D
      .. For other Cerec links and much more info!
    13. Doc Mike Visits Us in 1998
    14. Free German/American Translation Online
      And many other languages too.

      "A great life is a combination of good health, family, friends, hobbies, and a job we love to go to!"...
      Another Doc Hemp original quote.





    After perusing this page ... Click on the above photo courtesy of Mikey Birkhoff to ride our private Steam Railroad we built that runs at our home.