CEREC Milestone Timeline

Technological innovation is indeed important to economic growth and the enhancement of human possibilities.

-Leon Kass

1980: CEREC process developed at the University of Zurich.

1985: The first CEREC applications were successfully carried out.

1986: Siemens obtained the license to market and further develop the CEREC method.

1987: CEREC 1, the world’s first CAD/CAM system in dentistry was launched.

1994: The CEREC 2 system was introduced and allowed for inlays, onlays, crowns and veneers.

1997: Siemens sold its dental division, which resulted in the birth of Sirona Dental Systems.

2000: The Windows-based CEREC 3 (Redcam) debuted to the market.

2003: 3D software was introduced, which allowed dentists to construct restorations based on computer generated 3-dimensional models.

2007: The MC XL milling machine was launched, making it possible to attach crowns using dental cement because of its increased precision.

2009: Sirona launched the CEREC AC Bluecam, which is based on short-wave blue light that significantly increased the precision of the scans compared to the Redcam.

2010: Biogeneric (3.8 software) made it possible to individually reconstruct the occlusal surfaces of damaged or missing teeth while achieving a natural look.

2011: The 4.0 version of CEREC software simplified the user interface with intuitive menu navigation.

2012: The latest development in CEREC technology was revealed: the Omnicam intraoral camera. This new technology allowed dentists to take powder-free digital impressions in natural color.

2013: Around 38,000 dentists worldwide use the CEREC method and thus produce 6.9 million restorations each year.

How to Force a Download to Your CEREC 3 Milling Unit

Man is a slow, sloppy and brilliant thinker; the machine is fast, accurate and stupid.

– John Pfeiffer

Whenever pairing a milling and acquisition unit together for the first time, you must force a software download to the milling unit. Here’s how:

  1. Add the milling unit in the devices window.
  2. Turn off the milling unit using the rocker switch in the back.
  3. Open the front door to reveal the water tank- look to the right for a silver button. Press and hold the button.
  4. While holding the button, turn on the milling unit and slowly count to 15.
  5. Return to the software, click on Settings/Configuration/Devices. This will start the download. The following message will appear at the bottom the devices window: Downloading Software to Mill Unit or Com1.
  6. If the devices window is already open after holding the reset button, click on refresh status. This will start the download.
  7. The download will take approximately 3-4 minutes.
  8. This process may need to be repeated several times to work.

Source: Patterson Support

How to Find Out the “Mill-age” on Your CEREC Milling Unit

It’s not the years, honey. It’s the mileage.

– Indiana Jones

Why you need to know this:

Without a doubt, the single most important selling point of any CEREC mill is its “mill-age”. This is the number of mills a CEREC has performed.  Similar to the mileage on cars, the mill-eage on CERECs gives buyers an idea of how much useful life is left on the machine and how much to expect in maintenance expenses going forward. With proper care and maintenance, we’ve seen many mills still going strong at 5,000-7,000 mills.

Procedure for Compact/Classic CEREC 3 Mills

  1. Turn on both your acquisition and milling unit. Make sure they are connected via wireless radio or an RS232 cable.
  2. Verify the date on the acquisition unit is correct.
  3. Click on the Start menu > All Programs > CEREC > Service
  4. Enter the password. It is today’s date (two digit month and day) in reverse.  For example, today is July 31, so today’s password is 7013.
  5. You will be prompted to create a new log file, select yes.
  6. Select Milling Info.
  7. Divide the total milling time by 24 and that’s the number of millings on the machine.

Notes: verify that the serial number on the top bar of the Milling Info screen matches that on the back of the milling unit. If it does not match, then the motherboard has been replaced and there is no way to tell the actual milling time of the machine.

Procedure for MC XL Mills

  1. Turn on both your acquisition and milling unit. Make sure they are connected via wireless radio, wireless access point or ethernet cable.
  2. Verify the date on the acquisition unit is correct.
  3. Click on the Start menu > All Programs > Sirona Dental Systems > CEREC SW X.X> Tools > Service.
  4. Enter the password. It is today’s date (two digit month and day) in reverse.  For example, today is July 31, so today’s password is 7013.
  5. You will be prompted to create a new log file, select yes.
  6. Choose your milling unit.
  7. You will be provided with a menu of test options, select Milling Unit Info and hit Start Test.
  8. Click on the + button to expand the field next to Machine Data Type.
  9. Find the value next to Unit Counter. This is the number of units milled.

For additional help, call (844) DTL-HERO.

Read This Before Buying a Used CEREC

Keep your eyes open and your feet moving forward. You’ll find what you need.

– Anonymous

Why You Should Read This

In my previous blog, I covered the reasons why anyone thinking about incorporating CEREC into their practice should strongly consider buying used. This post will guide you through the used CEREC marketplace and, much like a lighthouse, help you avoid the hazards.

The “B-word”

Before anything else, you want to establish a budget. I’ve often heard from consumers that they do not have a budget, which of course was not true. If you don’t have a budget, then that really means money is no object. If money is no object, then why would you buy used? Everybody has a budget- large or small. The customers “without” a budget typically haven’t put enough thought into the process and were not prepared to buy. I know the word budget often has a bad connotation in today’s spendthrift consumer age, but it is a positive step towards preparing yourself mentally to pull the trigger should an acceptable deal come along. If you establish your budget and later discover that it doesn’t quite get you what you want- rethink your budget or your expectations, but do not lowball!  I’ve never met a seller who responded well to a low-ball offer and it will significantly reduce the probability of a successful negotiation. The presence of a solid budget will help your credibility with the seller and in turn they will be more willing to work with you on getting a deal done.  If you’ve thoughtfully crafted an offer and the seller is still offended, perhaps they are simply struggling to accept the expensive reality of CEREC depreciation. I promise you, sooner or later they will come to that realization, but in the meantime keep looking.

Which CEREC is Right for You?

After you have determined how much you can afford to spend, you’ll need to identify the CEREC generation that fits within your budget and weigh it against your wants/needs. As a helpful guide, I have compiled a recent history of CEREC transactions on eBay to help produce a general price range of each unit individually or as a package:

  1. CEREC 3 with Redcam & Compact milling unit: $2,000-$7,500
  2. CEREC AC with Bluecam & Compact milling unit: $12,000-$20,000
  3. CEREC AC with Bluecam & MC XL milling unit: $25,000-$50,000
  4. CEREC AC with Omnicam & MC XL: $65,000-$120,000
  5. CEREC 3 with Redcam: $500-$2,500
  6. CEREC AC with Bluecam: $5,000-$15,000
  7. CEREC AC with Omnicam : $40,000-$50,000
  8. CEREC Compact milling unit: $1,500-$5,000
  9. CEREC MC XL: $15,000-$40,000

If you are new to CEREC, you may have little idea which generation suits your needs best. While I could replicate comparison charts and Internet research to cover that topic in depth, my intention is to write a blog post, not a novella. At the same time, I don’t want to leave you empty-handed so I will outline some basic considerations:

Milling Units

  • A chairside Compact mill, also known as a Classic milling unit, was unveiled in 2000 along with the CEREC 3 Redcam. This mill is limited to single unit restorations (inlays, onlays, crown and veneers) and can mill a crown in about 17-24 minutes.
  • In 2007, Sirona rolled out the MC XL, appropriately named as it was 37% larger and 54% heavier than the Compact. In addition to inlays, onlays, crowns and veneers, you can mill bridges, abutments and drilling guides. The milling process is also faster: the MC XL can mill a crown in approximately 11 minutes. I would suggest reading the MC XL and Compact milling unit bur charts for additional information on bur and block combinations organized by software version.
  • Recently, Sirona split up their milling unit offering into 2 models: MC X and MC XL Premium. The MC X takes the place of the earlier versions of the MC XL. The MC XL Premium comes with a touch screen, four motors and fulfills the complete chairside and labside spectrum using all CAD/CAM materials.

My suggestion: if you can find and afford a used MC X or MC XL with less than 750 mills, it’s well worth the investment!

Acquisition Units

  • The  CEREC 3 Redcam acquisition unit was introduced in 2000 and utilizes infrared light to acquire images. It has 8 MB of image acquisition memory and can process an image in 0.133 seconds. This system uses individual images to create a 3D model.
  • The CEREC AC Bluecam acquisition unit made its debut in 2009 and utilizes blue LED light to acquire images. At 16 MB, it has twice the image acquisition memory of the Redcam and can process an image almost twice as fast at a blistering .070 seconds. While this system also uses individual images to create a 3D model, the Bluecam performs the “click” automatically. Both the Redcam and Bluecam require the use of white contrast powder.
  • The latest and greatest scanner is the Omnicam, which launched in 2012. The Omnicam allows for continuous capturing of 3D color scans. This “color streaming” results in a natural color 3D model without the need for contrast powder.

My suggestion: the Omnicam is certainly tempting, but way too new and thus is still in its peak depreciating years. If you remove the “cool factor” out of the decision and just think in terms of value per dollar invested, the clear choice is the Bluecam. Sirona also still thinks highly of Bluecam- stating they continue to sell ACs with Bluecam because it “continues to be an outstanding camera, delivering highly precise restorations in a reliable manner.” (sirona.com)

The 4 Pillars of Used CERECs

Now that you’ve decided how much you can afford and what type of system you need (or want),  you will need to know some critical evaluation criteria to help you sort through the playing field.

Pillar 1: Model Year

The first thing you want to know about every unit is its year of manufacture. Some dentists will tell you the year they purchased the unit, but that’s not good enough. While auto manufacturers and their dealers will sell you 2016 model year cars in 2015, it appears Sirona and Patterson will sometimes do the opposite: sell you 2009 equipment in 2010 for example. I’ve come across this issue often and it’s important to ask the seller for a picture of the serial sticker on the back of each unit to be sure. This is especially important when evaluating mills. There are hundreds of moving parts on a CEREC mill and those parts deteriorate over time. Seals and hoses dry up, pumps go bad, gearboxes wear down, circuits blow, spindle motors breakdown…the list goes on. Just like with a vehicle, you will want to take both the age and “milleage” into consideration as they are the primary determinants of its resale value. Look for milling units with less than 750 mills.

Tip: check for signs of leaking fluid on an older compact mill by inspecting or asking for a picture of the front panel pulled down. If you see an oily brown substance along the edges or behind the face plate there’s a good chance the hoses and gaskets are leaking. Stay away as this is not a cheap fix!

Pillar 2: Hardware

The model year is also important when evaluating acquisition units because that will give you a good indication of its hardware performance, but there is always a chance it could have been upgraded. There is a two letter code on the back of CEREC 3 Redcams and CEREC AC Bluecams on the PC frame. The higher the letter combination, the newer and more capable the motherbard, CPU, graphics card and memory will be. This is the easiest method of find out if the acquisition unit has been upgraded or not. For your convenience, I have cross-referenced some Bluecam hardware specs with their PC Hardware Series:

LQ (2012): MSI X58 Pro motherboard, MSI N450GTS graphics card, Intel Core i7 CPU 950 @ 3.07 GHz, 6 GB RAM

LP (2011): MSI X58 Pro motherboard, MSI N250GTS Twin Frozr graphics card, Intel Core i7 CPU 920 @ 2.67 GHz, 6 GB RAM

LA (2010): MSI X58 Pro motherboard, MSI N250GTS graphics card, Intel Core i7 CPU 920 @ 2.67 GHz, 6 GB RAM

KA (2009): MSI P45 Neo3 motherboard, MSI N9800GT graphics card, Intel Core 2 Quad Q9400 CPU @ 2.66GHz, 4 GB RAM

HQ (2008): MSI P35 Neo3 motherboard, MSI NX8800GT graphics card, Intel Core 2 Quad Q6600 CPU @ 2.4 GHz, 4 GB RAM

The Omnicam uses a number-based system; here is what I found on its hardware:

v2.2.1: 2 graphics cards- NVIDIA GeForce GTX 550 Ti & NVIDIA GeForce GTX 570, Intel i7 CPU 3930K CPU @ 3.2 GHz, 16 GB RAM

v2.2.3: 2 graphics cards- NVIDIA GeForce GTX 650 Ti & NVIDIA GeForce GTX 660 Ti, Intel i7 3930K CPU @ 3.2 GHz, 16 GB RAM

v2.2.5: 2 graphics cards- NVIDIA GeForce GTX 650 Ti & NVIDIA GeForce GTX 760, Intel i7 3930K CPU @ 3.2 GHz, 16 GB RAM

v2.2.7: AMD R9 285 Graphics Card, Intel i7 4930K CPU @ 3.4 GHz, 16 GB RAM

v.3.2.1: AMD R9 285 Graphics Card, Intel i7 5820K CPU @ 3.3 GHz, 16 GB RAM

v.3.2.2: AMD RX 470 Graphics Card, Intel i7 5820K CPU @ 3.3 GHz, 16 GB 2133 MHz DDR4 RAM, 2 TB SSHD

Pillar 3: Number of Mills

Without a doubt, the most critical piece of information when evaluating any CEREC system is its number of mills. The number of mills on a compact milling unit is expressed in “minutes”. To determine the general number of mills on a compact, we divide the number of minutes by 24- the maximum amount of time it takes to mill a single unit. Like I mentioned before, you should ideally try to stay under 750 mills. When looking at the Milling Info screen, be sure to pay attention to the serial number shown in the top bar to make sure it matches the serial number on the back of the unit. If the numbers do not match, this means the board inside the milling unit has been swapped out and the milling time does not accurately reflect that machine’s actual use. Also, be aware that part of the 30,000 minute service involves resetting the minute count. If you see a mill with a low minute count, but the unit shows some obvious signs of heavy use – i.e. the bur shanks are pushed up against the gearbox – then the timer has likely been reset.

The number of mills on an  MC XL is more clear cut. After accessing the Machine Data Type screen, you will see a Unit Counter value. What you see is what you get, no math required. With both the compact and MC XL, you are sure to get several thousand mills out of the machine with regular maintenance.

Pillar 4: Software Version

This is perhaps the least important criteria when evaluating a CEREC system because it is the easiest to change, but there are several key things you should know. The CEREC 3 Redcam is compatible with XP or Vista operating systems only. Starting with CEREC 4.0 and later, this software requires a Windows 7 64-bit operating system. So that means 4.0 SW and above will not work with your Redcam. Most CEREC AC Bluecams and Omnicams come pre-loaded with Windows 7 64-bit Pro operating systems from the factory, but it doesn’t hurt to double check anyway. CEREC 3D 3.8 Biogeneric software will run on Windows XP, Windows Vista and Windows 7 operating systems either in 32 or 64-bit. This software does not require the use of a dongle and is obviously platform flexible. CEREC 4.0 and above on the other hand require a USB stick with an activated license key that can be moved from AC to AC as needed. It is important to note that when it comes to any of the 4.x software versions you cannot go backwards. For example, if you installed 4.3 and want to go back to 4.2 or 4.0, you will unfortunately have to perform a clean install of your operating system in order to do so. Fortunately, this problem does not apply to the 3.x software versions so you can still use 3.8 and any 4.x software on the same machine. Various software versions, license keys and vouchers are usually readily available on eBay.

Happy Hunting

Look in the mirror, you are now a master used CEREC shopper. Armed with these four pillars of CEREC knowledge, you are well on your way out of the bottom 93% of non-CEREC using dentists while also saving beaucoup cash! If you need help along the way, don’t be afraid to reach out to me through the contact page or call (844) DTL-HERO. Good luck!

Considering CEREC? Why You Should Buy Used

I had always hoped that the acquisition costs for CEREC hardware and software could come down, so that CEREC would become a more easily affordable standard equipment for every young dentist. So far, this has not happened, much to my disappointment.

– Dr. Werner Mörmann (inventor of CEREC)

Welcome

I’m happy you found your way to CADCAMHERO.com and my inaugural blog post! My name is Jhuri Lamica, I’ll be your CAD/CAM HERO- hopefully until 2052 or so. I look forward to sharing this journey with you as we navigate the past, present and future of the used CEREC marketplace. I anticipate filling these virtual pages with advice, guidelines, how-tos and market analysis in my quest to create the world’s premier used CEREC  resource. Before this current endeavor, I served as Vice President of what was heretofore the world’s only used CEREC specialty dealer. For more on my background, I invite you to read my About Me page. Without further ado, let’s get to the feature presentation.

The Numbers

Out of more than 40,000 CEREC systems sold throughout the world, 14,000 are in the hands of American dentists. These individuals are part of an elite group that make up less than 7% of the active U.S. dentist population. With a current retail price that would rival the average mortgage debt in America, it is not difficult to understand why so few dentists employ new CERECs in their practices- they can’t afford it! What’s curious is that 14,000 dentists allegedly can…or can they?

Dr. Martin Abel wrote that the average annual revenue generated by a general practice is $525,000 with $350,000 in overhead (not including the dentist’s salary). These figures corroborate data reported by U.S. News & World Report stating that an American dentist earned an average annual income of $164,570 (almost precisely the total of all payments on a financed CEREC by the way). One must also consider that the average dental student graduates with $241,097 in student loan debt and can expect to spend around $500,000 to start their own practice. Dr. Michael Schuster opined in a piece titled, “Tied to the chair,” that today’s dentist will be saddled with student loan and start-up debt until age 45 or older. So after spending 8-12 years going to school to obtain the necessary degrees and licensure, young dentists can expect to spend the next 15-20 years working to pay their creditors instead of building wealth. It is no surprise then that Dr. Schuster concludes his article by stating 90 percent of all dentists will still be “tied to the chair” by age 50-60 after having generated little wealth relative to their annual incomes.

After reading this, it’s hard to imagine any  dentist jumping at the opportunity to take on more debt in the name of CEREC, let alone 14,000; yet they do in droves and some will even re-up with the latest releases in the technology before they’ve had a chance to pay off their current system. I suspect the condition of “Doctoritis” has infected some within the CEREC ranks; this is known as the “inflammation of a doctor’s ego which leads to overspending, poor financial decisions, and ultimately, wealth destruction.” I’ve personally heard dentists refer to the Omnicam as a fun new “toy”, themselves as a “techie” and act like ordering their new CEREC is the equivalent of Christmas coming early. Well, you know what they say about Christmas: “‘Tis the season when you buy this year’s gifts with next year’s money”.

An investment in CEREC should be viewed for what it is: a significant capital expenditure on a strategic business asset in which return on investment and benefit to the patient, not emotion, are the motivating factors. CEREC has clearly demonstrated its benefit to the patient through the convenience of a single visit and aesthetically pleasing, yet durable restorations. But can the cost be justified? Is there a happy medium? How can millennial dentists mired in debt and established dentists who refused to bet the farm provide the benefit of CEREC technology without going broke? The answer to these questions is simple- buy used.

Benefits of Buying Used

Have you ever heard the statistic that your car loses at least 10% of its value the moment you drive it off the lot? It doesn’t stop there- your vehicle is only worth about 37% of its original price tag after five years.  How is this relevant? Both cars and CERECs share the unfortunate distinction of being depreciating assets; in fact, CERECs tend to lose their resale value faster and more dramatically than cars. That 2010 Bluecam and MC XL duo that sold for more than $120,000 (pre-tax) five years ago is worth about $40,000 on the used market if it was used less than 10 times per month. Does it have a factory warranty? No. Can you get service and/or join the service club? If it’s a US model unit that didn’t leak out into the market from a trade-in program and you have a Change in Ownership form, yes. Will it have scuff marks, scratches or other minor cosmetic imperfections? Probably. Is it riskier than buying a new unit from Patterson? Well, if you do your due diligence by calling Sirona with the serial number to find out where it came from and its serviceability, vet the seller to make sure it’s not some Turkish Internet scam and ask all the right questions to eliminate any surprises, I’d say it’s less risky than personally guaranteeing a $145,000 loan.

As is the case with taking on debt to purchase any depreciating asset, you run the risk of losing the benefit of the item, but keeping the debt. New cars get totaled, new CERECs sometimes go unused and then abandoned in the storage closet. Don’t believe me? Just thumb through the dentaltown classifieds or look on eBay. Those same dentists who expected to perform 35-50 restorations a month often did less than that on an annual basis. I’ll list just a few of the reasons I’ve heard a dentist say they want to sell their lightly used CEREC:

1. I’m too busy.

2. My assistant who knew how to use it left (for more money elsewhere).

3. My associate who used it left.

4. I couldn’t find a place for it in my practice.

5. I couldn’t get the results I wanted.

6. I can’t keep up with the changes.

7. The practice I purchased came with a CEREC and I have no use for it (read: I want to pay down my mountain of debt!).

Just like when you buy that cute (and expensive) Teacup Poodle at the pet shop and promise to love and care for it forever and ever. Someday when the cuteness effects wear off, the frustration from its refusal to potty train, constant barking and tearing up your expensive furniture and favorite shoes gets to you; then the next thing you know you find yourself at the SPCA giving it up for adoption because you’ve finally decided it wasn’t worth keeping anymore. It’s sad, but it happens. If you haven’t noticed, all 7 of those examples represent a lack of personal commitment to being a CEREC user. That’s okay. It’s not for everybody; but until you are 110% sure that you will own and use the heck out of that CEREC for at least 10 years, do yourself (and your wallet) a favor and buy a used system instead. That way, if it doesn’t work out after a few months, a year or even a few years, you can resell the system and recoup most of your money back once it’s past its peak depreciating years.

To Trade or Not to Trade?

If you think the effects of depreciation are offset by trading up to a new system at every upgrade opportunity utilizing Sirona’s ludicrous trade-up programs- think again. For the uninitiated, these trade-up programs offer three to four times market value in trade-up credit for your old equipment as part of their effort to push new CEREC sales. First of all, you probably paid  $54,000 for your Bluecam acquisition system and now Sirona says they only want another $40,000 from you to upgrade to an Omnicam. You are not saving $25,000 on an Omnicam, you lost $29,000 in depreciation on your Bluecam and rather than licking your wounds you are coming back for more! If you want to save $25,000 on an Omnicam, go on eBay and buy a 2013 Omnicam for $40,000, then sell your Bluecam for $10,000. Five minutes of research on Sirona and Patterson’s investor relations pages will reveal just how important these trade-up programs are to their financial success; translation: they make more money when you trade, not less.

If you’ve ever wondered why there aren’t more used CERECs for sale, it’s because Sirona acquires thousands of 5-10 year old systems every year (many of them still working) through these trade-in programs and ship them to companies to be scrapped. Wait…what!? You read that right, rather than sell these old units that were sold for $100,000-$130,000 once upon a time to the remaining 98% of the world whom can’t afford new CERECs, Sirona throws them in the recycling heap never to be seen again. You see, keeping used CERECs off the street is critical to Sirona and Patterson’s business model: to make sure you’re using the latest and most expensive CEREC system possible and forever making payments to Patterson Financial Services, all the while promoting the elitist culture of CEREC and hiding their product’s horrendous depreciation rates. Despite those efforts, there are still many quality used CEREC systems available from dentists jumping ship and moving on from CEREC entirely- most in good working condition; many with less than 500 mills; and even some with warranty remaining.

What about the tax benefits of buying new?

In previous years, the maximum Section 179 expense deduction was $500,000. As of this writing, the 2015 limit is only $25,000 and there’s no guarantee the previous limit will be restored by Congress. Also, there is no 50% bonus appreciation on new equipment in 2015 either. Since the Section 179 deduction applies to both new and used equipment and there is no bonus favoring new, you would benefit more from writing off a larger percentage of a less expensive used CEREC. It doesn’t make sense to spend $145,000 (+ $20,000 in interest) to save $25,000. If using the regular depreciation method, you can deduct 1/5 the cost of both used and new CERECs every year until fully depreciated. If you purchased a new CEREC for $145,000 and realized $29,000 in tax savings year 1, your net worth would still have dropped $36,000 because the street value of that CEREC after a year is no more than $80,000. In the end, I just don’t see a justifiable tax motive for buying a new CEREC vs. used. Even if there were, trading 5 years of indebtedness for 1 year of tax relief seems a bit short-sighted to me.

Conclusion

Throughout parts of this blog it may seem like I am anti-Sirona or anti-CEREC, but really I am pro-CEREC, anti-debt and support sound financial decisions. I’ve read the economic debate regarding CEREC vs. the Lab and I believe that the solution of buying a used CEREC is the nuclear bomb to end all arguments (at least from a financial standpoint). If you commit to this technology it will reward you over and over again and to the nth degree if you buy used. That is not to say that all used CERECs out there are created equal; you will have to sort the gems from the junk, but the reward is entirely worth the effort. When it comes down to it, you can choose whether you want to be on the paying (new) or saving (used) end of the equation. Some people must have everything new- new cars every 5 years, new phones every 8 months and new debt to go along with it. If you are reading this article, I am willing to bet that you are not one of those people. If you are one of those people, perhaps I have persuaded you to reconsider that mentality…at least when it comes to a product with this many zeroes on the price tag.

What questions do you have? Send them my way through the Contact page or call (844) DTL-HERO. Be sure to look out for my next blog, in which I show you how to evaluate a used CEREC system.