USING THE E4D CAD CAM FOR CHAIRSIDE SINGLE VISIT TOOTH AND IMPLANT SUPPORTED RESTORATIONS

While the concept and capability to offer same day restorations with a
chairside CAD CAM system has been around for nearly 25 years, it
hasn't been until the new generations of systems (E4D Dentist System, CEREC
AC Bluecam) that the true potential and ease of use have been realized for
the clinician and dental assistant. Creating metal-free restorations with
no compromise in form, fit and function in a single appointment or even two
appointments provides every dental professional and dental practice
incredible benefits. I use the E4D Dentist system in my practice for a
variety of indications selecting from a variety of high strength ceramic
materials (IPS Empress, IPS e.max CAD) to provide my patients with unequaled
service and convenience. Patients are amazed at the change in dentistry
that is taking place and no longer dread the long temporary phase or making
another appointment weeks from the first.

Once you have become confident in your use of the technology and proficiency
in the system, you can offer your patients beautiful restorations on
anterior and posterior teeth. Taking time to custom stain and glaze can provide
the results shown here in as little as 2 hours.

If you haven't looked at chairside CAD CAM dentistry firsthand in the last
few months you haven't looked at chairside CAD CAM dentistry. Do yourself,
your patients and your bottom line a favor and check them out. It isn't a
matter of if you will incoporate it but simply when.

James M. Stein D.M.D.

http://www.steinesthetics.com/

Julian, Thank you for your comments on this topic. Just to clarify: it will be a long time before any of us will discontinue our usage of elastomeric impression systems. I often use them in conjunction with the E4D system when the digitally scanned impression technique is not practical due to the patient's individual anatomy. Many procedures are completed in the tradition multiple visit format. My daily patient scheduling has been greatly modified to ensure productivity. While the restoration is being produced by the cad cam mill I am being productive with the treatment of other patients or doing an additional procedure on the same patient. Recent clinical results in terms of marginal integrity and esthetics show that the same quality restoration achieved by the dental technician is possible. The key factor is case selection and mastery of the E4D design software in my opinion.

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Comments

james m. stein December 17, 2010 at 6:57pm

Don, 1:20 for an eMax is truly amazing and I hope to reach your level of efficiency someday. Likewise, I am sure we will meet. Thanks again and Happy Holidays. Jim
Don Deems, DDS, FAGD December 17, 2010 at 6:37pm

That's great! I am doing eMax single units in 1 appointment of about 1:20, from start to finish. And it "all depends" on multiple units. Tuesday I completed 3 eMax in under 2 hours, #12-14. Also, because I am using a "punch" approach to most implants I do, I can count on the tissue level staying where it is, so most of the time I take an impression at placement of the implant, then have 3-4 months to do the abutment and crown with the E4D, so when they come back, assuming all is well, the abutment and crown is delivered. I wouldn't do it if the implant was "iffy", but it's a nice time-saver for me and the patient - and the patients love it. Hope to see you at a CADapalooza or D4D sometime.
james m. stein December 17, 2010 at 6:11pm

Don, Thank you for your comments. While those E4D clinical examples were from earlier this year my skills have developed. Just yesterday I was able to perform single visit Empress CAD restorations on teeth 7,8,9,10 in just 4.5 hours. Prepared, scanned, milled and bonded. No messy impressions, no working casts and no laboratory delay. This is a great patient service. Dentists are embracing this E4D technology and Tufts has purchased 6 E4D systems in order to train their students. Jim
Don Deems, DDS, FAGD December 16, 2010 at 9:44pm

Awesome work. I have been doing CAD-CAM dentistry myself for a few years and couldn't imagine not doing it now. It will take a long time for dentists to adopt it, for some reason, but I can't wait to see what happens when critical mass I reached!
Cary Feuerman, DMD May 16, 2010 at 5:03pm

Jim- Once again, great CAD/CAM digital dentistry using the E4D system. Congratulations on achieving such life-like results!
james m. stein April 5, 2010 at 5:29pm

Julian, Thank you for your comments on this topic. Just to clarify: it will be a long time before any of us will discontinue our usage of elastomeric impression systems. I often use them in conjunction with the E4D system when the digitally scanned impression technique is not practical due to the patient's individual anatomy. Many procedures are completed in the tradition multiple visit format. My daily patient scheduling has been greatly modified to ensure productivity. While the restoration is being produced by the cad cam mill I am being productive with the treatment of other patients or doing an additional procedure on the same patient. Recent clinical results in terms of marginal integrity and esthetics show that the same quality restoration achieved by the dental technician is possible. The key factor is case selection and mastery of the E4D design software in my opinion.
Dr. Dobrina Mollova April 5, 2010 at 2:56pm

Do you know about the 4th CAD/CAM & Computerized Dentistry Int'l Conference in Dubai 13-14 May 2010?Two hours Open Discussion Forum "Zirconia - The Truth"will put on the stage resurchers, clinicians and manifacturers to answer all your questions.
Julian Osorio, DMD, MScD April 5, 2010 at 10:39am

I agree with Jim. It isn't a matter of if but when. However that when is not here yet, in my opinion. On the data capturing side, even though the technology is quite remarkable, I can not use it in 100% of my cases so I am not willing to invest and train my staff on it until I can put all my VPS and Polyethers away good. I am hoping the day will come soon. I have used some of the systems for extended periods of time, on a variety of cases.
On the CAD/CAM restorations, the same applies. I can not still produce the same quality restoration my technician can in the amount of time I willing to devote to it. I love the new materials and use almost exclusively E-Max crowns and E-Max and Lava bridges today. In the amount of time required to produce that restoration, I can prepare a few more crowns, more implant crowns and more veneers. It is just not cost effective in my hands yet.
james m. stein March 30, 2010 at 6:23pm

Giovanni, Thank you. The beauty of the chairside E4D cad cam digital technology is that often you can avoid the sometimes messy and always unpleasant elastomeric impression. I am still learning with each procedure but know that soon the elimination of the non digital impression phase will be eliminated. I completed my first anterior 3 unit fixed bridge prosthesis just today and the future potential is unlimited with careful case selection.
Giovanni Castellucci, DMD March 30, 2010 at 6:07pm

Nice cases Jim.
I presume you are are scanning vs. taking impression as well.
The patients must love not having all that goop in their mouths.
You should present your work at one of our study club meetings.

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