Rich Rosenblatt As I talk to docs all over the country, both CEREC users and non-CEREC users, I get lots of questions about the CEREC process. The two most common are about powdering and bonding. These are probably the two most technique sensitive parts of the CEREC process. This does not mean that either is difficult, but steps must be taken to make sure that both are done well.
The first question that I ask these doctors is, "What are you using for isolation?" Many times, the standard answers are cotton rolls and dry angles, and four-handed or even six-handed dentistry to keep saliva at bay. To me, this is the root of the problem.
When powdering, we have a few arch enemies: saliva, weeping tissue, cheeks and tongues. These things really tend to toss a monkey wrench into what we are doing, just as they do when taking conventional impressions. It is hard to have an assistant try and control that overly active tongue, that cheek and lip that seem to want to purse when we put anything inside the mouth, and the excessive salivation that occurs in many.
These same issues also seem to rear their ugly heads when bonding. Some docs will tell me that they have the best chairside assistant ever and that they have no problem overcoming these barriers. I tell them that is great, but who is stopping that patient from breathing? Every time they exhale, there is moisture and likely a contaminated bond. This is why isolation is so important.
I know that when I mention the words “rubber dam” to doctors, they look at me as if I have spoken in an ancient language that they do not understand. I tend to get that look myself. I like to use the rubber dam on occasion, but also struggle with it for larger cases. I aspire to be like some of the CEREC docs out there who use it on every procedure (Andy and Russell, you know I'm referring to you!).
I have a list of things that I cannot practice without. One of those is the Isolite. This eliminates all the struggle of saliva, tongues, cheeks and respiration that we run into with every patient. I'm always amazed at how many people have not even heard of this device. It has been a practice-changer for me. This product hooks up to your high-speed suction and has disposable mouthpieces that keep away the cheek and tongue, and simultaneously suction the area. It allows you to work on upper and lower arches simultaneously. I use it for CEREC (even with full-arch impressions!), restorative, sealants, hygiene and sometimes even during extractions and implant placement. I cannot recommend this piece of equipment highly enough. You can get more info about it at isolitesystems.com. For those of you out there struggling with powdering and bonding, you can thank me later!
