PRODUCTIVE CAD/CAM · I was shocked to hear G ordon Christiansen last year state that single-tooth dentistry has risen from 7 0 percent to 9 0 percent over the past decade. We are

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CAD/CAM technology was fi rst introduced in E urope in the 19 7 0s. The advances

from CE RE C 1 to today’s digital optical readers have been transformative. If you’ve been

sitting on the sidelines waiting until CAD/CAM becomes mainstream, the time has come.

I have the privilege of lecturing on productivity throughout the country, and typically

I see that dentists spend most of their time focusing on diagnosis using risk factors, patient

relationships and personal communication skills rather than effi ciency. Without the ability

to treatment plan the entire need, and communicate it in a way that makes sense to the

patient, you’ll never realiz e your full clinical potential.

I’d like to share some of the fundamental clinical techniques and scheduling tips that

help me to provide outstanding care and produce more than $ 2 ,5 00 per hour. The corner-

stones are technology and a highly trained team. I use lasers, digital radiography, cone

beam imaging, sleep apnea technology and a paperless charting system. B ut, by far CAD/

CAM has had the biggest impact on my productivity.

PRODUCTIVE

CAD/CAM DENTISTRY

by Bruce B. Baird, DDS

General Practice_Baird_Productive CAD-CAM2.indd 68 9/23/14 12:46 PM

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If you’ve been sitting on the sidelines waiting until CAD/CAM becomes mainstream, the time has come."“


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continued from page 69

To be productive with this technology, I think we fi rst have to take a look at some of

the common myths and misconceptions. As I lecture, doctors who don’t use CAD/CAM

share fears and beliefs like:

• The materials are not as durable as lab milled restorations.

• I am more effi cient with current techniques.

• I can’t fi gure out how to schedule it properly — I’m always running late.

• I just can’t afford it. I use a lab that is very reasonable.

Here is the startling truth: These technologies become cost prohibitive unless you have

a system in place to diagnose, enroll and schedule patients for care. L et me ask you this: If

you needed fi ve or six crowns, would you rather do them one at a time over the course of

fi ve years, or take care of them all at once? The reality is that most of us, if money were no

problem, would prefer to have the treatment completed in one or two visits. Our patients

are no different. We’ve simply conditioned them to take care of one tooth at a time.

I was shocked to hear G ordon Christiansen last year state that single-tooth dentistry

has risen from 7 0 percent to 9 0 percent over the past decade. We are actually providing less care than in 2 004 .

Practitioners who’ve embraced CAD/CAM know that new materials such as e.max,

E namic and L ava Ultimate, and the ability to make our own custom abutments for

implants produce high quality results in fewer visits. That is a patient wow factor — and a

great thing to be known for in your community.

I believe in this technology so much, I recently had my entire mouth rebuilt from the

ground up in one day using the techniques I’m about to teach you. I have a combination

of inlays, onlays, full crowns and veneers using e.max materials. My good friend, E ddie

Coralles, fl ew in from San Diego to be the ceramist.

So how do we do this? How do we overcome the obstacles of scheduling and materials

handling to make this procedure productive and profi table? Here is what I do in my offi ce.

Technique and effi ciency B egin by knowing you are not leaving the room from the time you give the injection

until your smile designers take over to mill the restoration. With new software like 4 .2

software from Sirona, it literally takes minutes to design a beautiful restoration. With the

MCX L milling machine using e.max blocks it’s possible to make a crown in less than an

hour with doctors’ time being less than 2 0 minutes.

With the advent of onset anesthesia buffering, which allows the patient to be pulpally

anesthetiz ed in 9 0 seconds, I can walk in the room, give the anesthetic, wait 9 0 seconds,

and then begin the preparation. I prep dry using electric handpieces and spend about 10 to

15 minutes prepping. For years I did my own design on all of my CAD/CAM restorations.

Today I have trained two team members (smile designers) to do all of that work for me.

When I’m complete with prep, I walk out of the room, go see other patients while one of

my smile designers scans, designs, mills, tries in, bakes, polishes, isolates, takes a pre-cemen-

tation radiograph, steams, treats and then comes and gets me 4 5 minutes to an hour later.

I am currently using Scotchbond Universal Adhesive from 3M E SPE to treat the inside

of the restoration and the tooth. Next, I apply RelyX Unicem 2 Automix self-adhesive resin

cement to seat the restoration. Clean up is quick and easy. I then recheck the bite and fi nish

my margins. This entire process takes less than 10 minutes.

Is this productive? You bet. Average production per hour nationally is $ 4 00 per hour.

I’ve spent 30 minutes working on a crown and produced $ 1,000 worth of dentistry —

that’s equivalent to $ 2 ,000 per hour! The best part is that patients thank me for not wasting

their time and creating such a great result. continued on page 71

"I believe in this technology so

much, I recently had my entire

mouth rebuilt from the ground up in

one day using these techniques."


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continued from page 70

Scheduling and team work Although the prep visit is longer with CAD/CAM restoration, you are eliminating an

entire non-productive second visit. In designing your offi ce, I recommend adding a couple of treatment rooms with the intent to utiliz e these as holding treatment rooms while the design, milling, polishing and fi nal preparation of the restoration can be accomplished by your smile designer.

Over the last 10 years my productivity has steadily risen from $ 7 00 per hour to $ 1,2 5 0. Today we average over $ 2 ,5 00 per hour. As I said earlier, I was doing most of the CAD/CAM design myself because I loved doing it and seemed to have plenty of time to do so. Now I think a little differently and it’s bumped my productivity another $ 5 00 per hour! It’s amaz ing to grow 2 0 percent when you think you’ve topped out.

We still schedule to productivity in my primary two ops. The difference is that I’ve now added two additional ops for my smile designer. Her goal is $ 5 00 per hour and she has two chairs to work out of. Same principles of time management apply:

Advanced cases Now that we’ve covered the basics, let’s think about the fun stuff — multiple units

using CAD/CAM. For the last 17 years while using CE RE C, my preference for anterior restoration has been to send out to the laboratory. I use Root L aboratory in K ansas City.They still do a signifi cant amount of my dentistry, especially anything where there are multiple units with teeth missing and I’m doing crowns and bridges, and extensive full-mouth rehabilitations.

With the new 4 .2 software from Sirona, I have been venturing out on veneer cases, and smile design cases up to 12 single units. I am using a ceramist, E ddie Corrales, who fl ies in from San Diego once a month for three or four days and we will do three or four smile design cases start to fi nish in a single day. E ddie’s company is CAD Smiles. With these cases E ddie does cutbacks and adds porcelain for custom incisal edges and character-iz ation. He also is a teaching expert in all aspects of CE RE C 3 software and technology.

Yeah … butThis all sounds good for you, B ruce, but you don’t understand my patients, you might

say. They would never go for something like this; they barely do one tooth at a time! I understand, I used to think that way too. Today, when I do a comprehensive exam-

ination on a patient, I diagnose everything in the mouth that needs to be done. I don’t look at one tooth at a time, and I don’t look at one quadrant at a time.

My preference is to gain permission from the patient to ask them the question, “ Is it okay if I look around your mouth to get an idea of what’s going on?” I then give them a treatment plan with 7 0-8 0 percent of the posterior restorations utiliz ing CAD/CAM tech-nology. The other posterior restorations in non-loadbearing areas are usually done with composite resins. I take the pressure off the patient by saying, “ It doesn’t matter if it takes us four months or four years to do this work, we can do it at whatever pace you would like. Does that make sense?”

L earning the verbal skills to help patients connect the dots is step one. Step two is making sure they are able to afford the care they need. I’m a fee-for-service practice in the very small town of G ranbury, Texas. Trust me, I know people struggle. B ut we found

1 crown $1,000 = 2 hours in one chair 2 inlay/onlay $2,000 = 4 hours in one chair 8 units $8,000 = 16 hours = one patient all day!


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Author’s Bio

Dr. Bruce B. Baird has long been known as one of the most productive dentists in the country. He has lectured internationally for over 25 years on technology, dental implants, cosmetic dentistry and full mouth reconstruction. He is the founder of the Productive Dentist Academy and Comprehensive Finance.

a way to overcome that. We offer traditional third-party options for the 50 percent of our patients that may qualify, and use Comprehensive Finance for those whose credit score may have been impacted by the rough economy but are still very payment worthy. Comprehensive Finance provides us with online tools to quickly approve patients, generate truth in lending statements and set up payment arrangements.

The future of dentistry is brighter than ever, and I’m so thankful for the cool tech-nology we have to make this easier! ■

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PRODUCTIVE CAD/CAM · I was shocked to hear G ordon Christiansen last year state that single-tooth dentistry has risen from 7 0 percent to 9 0 percent over the past decade. We are