Formation of a Cerec Crown
I thought I would take a moment to go back to the basics of design... I was reminded about this as my associate left for maternity leave and my life at the office has gotten a little hectic. At the same time I have a new team member whom I am trying to train on the Cerec but there is just never enough time during the day so I created a "cheat sheet" that she could keep near the Cerec as a reminder.
My practice is run on efficiency. I want optimal results in the optimal amount of time. To do this we have to have systems. It's so easy to get off track in all of the nuances of the software with so many tools to play with- tools which I do use, but for 85% of my cases, I want a simple recipe for myself and team members to follow. Here is my "cheat sheet" listed and in printable form if you would like to use it for your own team members:
Remember F.O.C.C - Formation Of a Cerec Crown
F- Fissure
- Select “Ctrl D” and move cursor around to show cursor detail box.
- Select Shape Tool > Anatomical, 2-D > highlight the internal portion of the crown.
- Left click & hold, track ball up to lift the height of the fissure.
- Let go of click and see where new fissure height is in the cursor detail box.
O- Occlusal
- You can either use Form Tool or Shape Tool to reduce occlusal interferences. The goal is to have royal blue occlusal contacts.
- Form Tool > Remove > make sure the orange diameter is slightly bigger than the interference and either left click, or hold left click and move cursor around.
]
C- Contours
- Select Shape Tool > Circular, 2-D.
- Make sure arrow is pointed in the direction that you want to change, left click & Hold, track ball in that direction.
C- Contacts
- Select Display Objects > Trimmed Model
- Form Tool > Smooth and either left click, or hold left click and move cursor around as if you were painting that spot.
- Remember that smooth tool will only flatten so if your adjacent contact is convex, you will either have to adjust that contact in the mouth or use the remove tool to get a proper contact.
Kris, I love how clean this is. looks great. if I would amend it at all, I would not trim when doing the contacts and turn off the model box and teach people to smooth what is penetrating through the adjacent wall from the underside. Really nice job on this and even though I teach FOCC at all my courses, I may or may not be stealing pdf this for accept!
Thank you for posting!
I am going to add when I teach in my courses is refine the anatomy. If you see the contact areas with opposing teeth the occlusal contacts not in a right position. I improve cusp to fossa and marginal ridges contact to avoid create a bad occlusion. Gregory
Good old FOCC :)
I do things a bit different and would recommend a couple amendments.
- when doing the fissure, use circular 2 directional shape instead of anatomical. A great tip is to set your occlusal minimal thickness at 1000. You will notice there will be only a small area of turquoise usually in the fissure. If you raise just that little area, you will be above 1.2. Much easier
- Don't change tools and come back to them... use Circular shape and then form and then finish.
My technique is:
- Circular 2 directional shape: occlusal embrasures, cervical embrasures, fissures, occlusion
- Form smooth tool: round embrasures and contacts (I usually do not turn off model like Rich outlined).
Awesome! Way to put some time into something that can help out so much! I am trying to take time here and there right now to train the assistants on the design process,
Awesome resource Kris. Level 2 just became obsolete...Sam and Skrammy can just point to this and say, "do it!" LOL
Thanks for sharing!
Love the easy to follow pdf Kris!
One change I make is doing the contours before the occlusion. I find that after I adjust the embrasures, it normally messes with the occlusion a bit and I have to go back and touch up occlusal contacts. The only problem is that it would change it fro FOCC to F-COC.
On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)
NOPE...not going there. 
On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)
Alright Kris here you go. This is my adaptation of the FOCC.
CCC or 3C's.
Clearance: Check fissure height. I have my parameter set for 1200. Why? Because if I don't see any burn through then I can use pretty much what ever material I want. I just may have to bond if using Emax. If I am thin then I may go zirconia or if I need to use a more esthetic material then I go back in a prep if I can't design it to proper thickness using the shape tool. The shape circular 2 direction works most of the time but if a lot of the area is low then I will use anatomic 2 direction shape.
Contours: Check embrasures and marginal ridge height. Circular 2 directional for embrasures and anatomical 4 direction for raising marginal ridges.
Contacts: occlusal and IP. circular 2 directional for occlusal and smooth tool for IP. I do occlusal contacts last otherwise if I adjust them first as in FOCC then if I move the marginal ridge I will just have to go back and redo the occlusion.
On 3/15/2017 at 2:26 pm, Ernie Johnson said...On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)NOPE...not going there.
Dan!!! I'm not admitting to laughing..
Nice document.... and may pass it on with full credit to the wonderful author ;)
My flow is close, but only thing I'd add, is that in adjusting contacts, I teach the assistants, to go ahead and trim model and turn off contacts and be sure the interproximal is smooth... sometimes you see a lot of irregularities or concavities that I don't want masked by the color scheme.... then work on embrasure size and pressure, mostly like Rich suggested....
Mark
That is exactly how I teach it. Don't change a thing and don't listen to these crazy guys.
Takes 90 seconds to design a crown.
Chris,
Thanks fro sharing this document, this will be perfect for my new associate. I have discussed FOCC with him but I know this visual reference will be a huge help to him.
Don
Great job Kris! Looks great! I may have already stole this and use it for the other 4 doctors and the rest of my team. So officially thank you 
You get all these Type A Faculty members and mentors and they all want to tweak it...By the way, Skramy...I don't know what you are talking about. I set my parameters to a 1000 and my initial proposed fissure height is always around 700. The fastest way for me to raise it is with Anatomic 2D shape...maybe you are Beta testing some 4.6 version and forgot what the rest of us deals with :)
No Dan. Set at 1000 and you will have a small area of turquoise in fissure.. raise that little area with circular and it's less work than entire thing with anatomic. Initially it will be under 1mm, fix that one part and it will be 1.2. Works every time...what I teach in level 2
I am right, don't argue....LOL ;)
So people don't get confused with the bickering going on-
The important thing with efficient Cerec workflow is to develop a strategy. Sure there are slight variations with the workflows mentioned but I will assure you that those who are offering their spins use their modifications every time. Efficiency in Cerec comes from developing a strategy and sticking with it. successfully teaching others in your office a consistent workflow helps maintains the efficiency of the Cerec appointment in your office.
Designs should not be a laborious process. If it is then fall back and evaluate the other components to an efficient Cerec appointment.
Prep/ clearance
Imaging
Fall short in one of these and your design time triples.
For all the modifications mentioned the one thing to keep in the back of your mind is big movements first then refine with smaller movements. This way you are not going to waste any of your design movements
What's missing from this conversation is that if you teach your team to design, doctors verify, you will have more time with patients, produce more, and when you have another doctor, your workflow will not be affected.
But you'll have less fun. I get it.
On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)
Hey Kris, great order.
How do you pronounce it?
"Foxy" ....FOCC
Ray
Great job!
I have been laminating this (attached) and giving it to new users.
Mike Skramstad, I will have to try using the circular for the fissure.
On 3/16/2017 at 3:24 am, Peter Gardell said...For all the modifications mentioned the one thing to keep in the back of your mind is big movements first then refine with smaller movements. This way you are not going to waste any of your design movements
Agree with this, so my first step, which is often and even usually not necessary, is position and rotate, or biojaw when the proposal is way off.
On 3/15/2017 at 3:23 pm, Darin O'Bryan said...I agree that the first thing they should do is check fissure height. I also have my fissure height set at 1200. It is a good 'universal' number, and as you mentioned it allows you to use whatever material.On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)Alright Kris here you go. This is my adaptation of the FOCC.
CCC or 3C's.
Clearance: Check fissure height. I have my parameter set for 1200. Why? Because if I don't see any burn through then I can use pretty much what ever material I want. I just may have to bond if using Emax. If I am thin then I may go zirconia or if I need to use a more esthetic material then I go back in a prep if I can't design it to proper thickness using the shape tool. The shape circular 2 direction works most of the time but if a lot of the area is low then I will use anatomic 2 direction shape.
Contours: Check embrasures and marginal ridge height. Circular 2 directional for embrasures and anatomical 4 direction for raising marginal ridges.
Contacts: occlusal and IP. circular 2 directional for occlusal and smooth tool for IP. I do occlusal contacts last otherwise if I adjust them first as in FOCC then if I move the marginal ridge I will just have to go back and redo the occlusion.
For the design, I have them focus on the tool and the adjustments that tool can do. i.e. for a large adjustment such as raising the fissure I recommend using the Anatomical tool. Then I would check if there are any other large adjustments to be made (and I list them: cusps height, buccal/lingual walls, entire restoration). It is like picking up your high speed and doing everything you need to use that tool for before putting it down, and switching to low speed.
Then once the large adjustments have been taken care of, then you move to your circular tool if you need medium > small adjustments. I call the circular tool the 'flexi-tool' as it is flexible/sizeable.
Finally, just like you, I take care of occlusal contact with circular tool and interproximal with smooth.
The document I created has the tools listed in that order, as well as the movements/adjustment you can make with each one. Once you have seen/heard/gone through the process once it becomes a quick reference guide. I am unable to paste the document/image right into this reply, so I have attached the PDF file. Anyone is welcome to use it.
On 3/26/2017 at 11:24 am, Ray Kessler said...On 3/15/2017 at 1:58 pm, Kristine Aadland said... Make me up a new acronym and I'll do it :)Hey Kris, great order.
How do you pronounce it?
"Foxy" ....FOCC
Ray
"Foxy" is perfect!
On 4/24/2017 at 5:49 pm, Kristine Aadland said...Talita- I have chart envy. Great handout!
Please! Great minds think alike 
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FOCC is the only way to be!!! I love this so much! Thank you for your passion and for sharing!
