CAD/CAM international No. 2, 2012
Cover
/ Editorial
/ Content
/ New concepts in computer-guided implantology
/ CBCT-assisted implant therapy: A case study
/ Implantology—the perfect art of camouflage thanks to CAD/CAM
/ EAO publishes new guidelines on safe exposure to X-rays for dental implant patients
/ “Digital technology is becoming essential”; An interview with Dr Dobrina Mollova - Managing Director of CAPP
/ CBCT in orthodontics
/ Space management in adults using CAD/CAM aligners— Three case reports
/ Doctors implant first customised 3-D printed mandible
/ New Planmeca ProMax 3D ProFace system enables safer and faster facial surgeries
/ Industry News
/ Announce your courses in CAD/CAM!
/ 4th International CAMLOG Congress
/ IDS 2013: Organisers expect successful exhibition
/ International Events
/ Submission Guidelines
/ Imprint
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CAD0212_01_Title
CAD0212_01_Title 14.06.12 10:32 Seite 1
issn 1616-7390
Vol. 3 • Issue 2/2012
CAD/CAM
digital dentistr y
international magazine of
2
2012
| case report
CBCT-assisted implant therapy
| opinion
Implantology—the perfect art of
camouflage thanks to CAD/CAM
| interview
“Digital technology is becoming essential”
[2] =>
CAD0212_01_Title
Experience peace of mind.
Join the brand that reaches
over 200,000 clinicians.
Choose from a wide variety
of pre-polished ready-to-use
bars and attachments.
Receive direct local support.
NobelProcera Titanium Implant Bar Overdenture
It’s called NobelProcera. A complete system with the
power to give you peace of mind working with one, secure,
full-service provider. Its CAD/CAM system lets you scan,
design and send your production orders to us for qualityassured centralized manufacturing. Take comfort in having
more than just products. Find value in a solid relationship
with one partner that focuses on you with customized local
support. Choose the predictability of a premium brand and
enjoy a wide range of certified materials and products with
guaranteed satisfaction. When you par tner with Nobel
Biocare, you gain access to over 25 years of CAD/CAM
experience, the latest digital technology and precision milling
to realize every prosthetic possibility for your customers.
Their smile, your skill, our solutions.
Visit nobelbiocare.com/dental
© Nobel Biocare Services AG, 2011. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of
Nobel Biocare. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.
NP Bars LAB A4 CAD-CAM rev.indd 1
2012-06-14 10.25
[3] =>
CAD0212_01_Title
CAD0212_03_Editorial 14.06.12 10:50 Seite 1
editorial _ CAD/CAM
I
Dear Reader,
_Passion makes the world go round. Some of us are passionate about music, others
about painting, yet others about movies or photography. Passion can drive the fulfilment of
our dreams, but requires that we look ahead. It is difficult to imagine that we could pursue
our passions today with magnetic tape, film photography, analogue techniques or an ancient
computer.
In recent years, the pace of life has changed significantly: we use fast Internet, speed
couriers and require instant responses. The same is true of dentistry. Patients demand quick
and inexpensive therapeutic solutions, yet expect the highest standard of work. In order to
meet these demands, dentists have to rely on the latest technologies.
Magda Wojtkiewicz
Managing Editor
Initially, the use of CAD/CAM in dentistry was a novelty, requiring an inordinate amount
of time to produce a viable product. Over the last 30 years, the development of new equipment, materials and software has advanced digital dentistry to the next level, facilitating
the use of CAD/CAM technologies in both dental offices and laboratories. Nowadays, digital
dentistry is a part of daily practice for a growing number of dentists and dental technicians.
By incorporating CAD/CAM automation and digital imaging into their strategic business
models, dental offices and laboratories are able to save on time and labour, while improving
the quality and precision of their work.
The way ahead is digital dentistry; it saves time, enhances treatment and ensures precision
like never experienced before. Successful use of the technology, however, depends on you,
whether you wish to be a pioneer in the field or prefer to use the proven technologies.
This edition of CAD/CAM is concerned particularly with implantology and orthodontics.
You will find information on new concepts in computer-guided implantology, using CBCT
and CAD/CAM techniques, as well as the latest industry news and information on upcoming
and past meetings.
I hope that you will find the magazine informative and find inspiration to follow your path!
Yours faithfully,
Magda Wojtkiewicz
Managing Editor
CAD/CAM
2_ 2012
I 03
[4] =>
CAD0212_01_Title
CAD0212_04_Content 14.06.12 10:33 Seite 1
I content _ CAD/CAM
I editorial
03
I industry news
Dear Reader
36
| Magda Wojtkiewicz, Managing Editor
| Planmeca
I special
06
New concepts in computer-guided implantology (Part II)
38
| Dr Gian Luigi Telara
I case report
12
16
New Planmeca ProMax 3D ProFace system enables
safer and faster facial surgeries
3Shape technologies—Closing-in on complete
digital dentistry
| 3Shape
CBCT-assisted implant therapy: A case study
Straumann opens its CAD/CAM system with
CARES Visual 7.0
| Dr Nilesh Parmar
| Straumann
40
Implantology—the perfect art of camouflage
thanks to CAD/CAM
42
CEREC Club Select: additional benefits for users
| Sirona
| Robert Michalik
30
Space management in adults using CAD/CAM
aligners―Three case reports
I digital platforms
43
Course calendar
| Dr Khaled M. Abouseada
I meetings
I feature
22
24
EAO publishes new guidelines on safe exposure
to X-rays for dental implant patients
44
International CAMLOG Congress
46
IDS 2013: Organisers expect successful exhibition
“Digital technology is becoming essential”
48
International Events
| An interview with Dr Dobrina Mollova, Managing Director of CAPP
I about the publisher
I opinion
26
CBCT in orthodontics
| Prof Giampietro Farronato et al.
49
50
| submission guidelines
| imprint
issn 1616-7390
Vol. 3 • Issue 2/2012
CAD/CAM
digital dentistry
international magazine of
2
2012
I news
34
Doctors implant first customised
3-D printed mandible
| Claudia Duschek
04 I CAD/CAM
2_ 2012
| case report
CBCT-assisted implant therapy
| opinion
Implantology—the perfect art of
camouflage thanks to CAD/CAM
| interview
“Digital technology is becoming essential”
Cover image courtesy of 3shape.
[5] =>
CAD0212_01_Title
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O. Brix, Dental Technician, Germany | U. Brodbeck, Dentist, Switzerland | G. Gürel, Dentist, Turkey | C. Coachman, Dentist, Ceramist, Brazil |
A. Shepperson, Dentist, New Zealand | A. Bruguera, Dental Technician, Spain | S. Kataoka, Dental Technician, Japan | S. Kina, Dentist, Brazil
SO DOES THE SCIENCE.
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* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is
now available at: www.ivoclarvivadent.com/science_e
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Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
HPD[BVFLHQWLILFBBHB$LQGG
[6] =>
CAD0212_01_Title
CAD0212_06-11_Telara 14.06.12 10:51 Seite 1
I special _ guided implantology
high contrast
errors
resolution
data-transfer
infra-red control
technology
accuracy
New concepts in
computer-guided
implantology
Part II: Error analysis and accuracy verification
Author_Dr Gian Luigi Telara, Italy
_Abstract
In recent years, there has been a growing interest
in guided implantology. A digital work-up is certainly of great benefit for clinicians to better understand their patients’ bone morphology and density
and consequently to plan implant positions correctly, and to have their hands guided during implant placement by means of a surgical guide. There
are many systems on the market today and many
researchers have studied post-operative CT scans
and planning scans by means of superimposition,
in seeking to understand the secret to achieving
perfect correspondence and the best system, but
this perfect accuracy has not yet been found and
there appears to be a mismatch between planning
and the actual implant position.
I have developed a device (Dental Implant Positioning System, International PCT IT 2009 000192,
WO 2010/125593 A1; patent pending) that respects
06 I CAD/CAM
2_ 2012
the implant’s spiral movement in accordance with
mathematical criteria. The same criteria are also important in theorising limits and achieving accuracy
using computer-guided implantology.
_Introduction: Passive systems
and the limits of the human visual,
auditory and spatial resolution
Is it possible, using one technique, among the
many on the market, to create repeatable results
in terms of a final prosthesis? How many of the
presently marketed systems in guided implantology really are passive? Do passive infra-red systems
really facilitate repeatability?
Human visual resolution limits do not allow
for accuracy: eye, ear and fine hand movements
have not yet crossed this threshold. Human spatial
resolution can be evaluated with reference to the
modulation transfer function (MTF). This is also
[7] =>
CAD0212_01_Title
CAD0212_06-11_Telara 14.06.12 10:51 Seite 2
special _ guided implantology
a good means of evaluating the optical properties
of CT scans. Spatial frequency has been widely
studied and it is now generally accepted that line
pairs (black and white) can be perceived up to a
tenth of a millimetre (human visual acuity). The
same is true for hearing (in hertz) and hand movements (we cannot control a movement beyond
0.1 mm).
A passive device therefore appears necessary
to ensure that the same implant position can be
reproduced repeatedly and independently of the
operator within the threshold
defined above. This fulfils my
definition of “passivity”.
_The limitations
of infra-red control
systems
This last point also means
that infra-red control systems are excluded by definition, since their accuracy is
operator dependent. Apart
from spatial resolution limits, this kind of technology is affected by timedelay problems, partially due to the machine itself
and partly due to the temporal resolution limits of
the operator (eye, ear, hand). Therefore, infra-red
control should not be considered passive. These
systems are equipped with a virtual smooth sleeve
and are operator dependent. Furthermore, they can
be monitor or mouse guided, when the handpiece
is transformed into a computer mouse. Ironically,
we tend to consider the surgical tutoring toy a passive tutoring system only because it is provided
with sensors along its holes (Figs. 16a & b), but not
because of its functionality.
I
In this „little Surgeon“ toy is my hand guided
by a passive tutoring system down the hollow
to get the target?
No!
Only a red nose will notice me I’m touching
the guardrail.
Does it make sense? Is it transformed into
a passive methos if I can do the same thing with
a mouse-handpiece and looking into a screen?
No!
These are semi-active monitor-guided systems.
Fig. 16b
In Part I, I discussed smoothsleeve-related inaccuracy from
a theoretical perspective. We
must also realise that a reliable evaluation of accuracy requires measuring device. Is CT
a reliable technique? Is superimposition a good means of
evaluating accuracy in implant
Fig. 16a
placement? Does it consider all
the parameters that define the
implant position (including the hex)? To prove
validity and measurement accuracy, repeatability
should be considered as important as its underlying
mathematics.
Even if a perfect superimposition has been
carried out, CT artefacts and the voxel size (which
is 0.125 mm at the best) not being an issue, and
considering the CT scan as a continuum, its results
appear to be invalid information. Scanners, like any
Fig. 16a_The surgical tutoring toy.
Fig. 16b_Operator-dependent super
technological system.
Fig. 17a–b_CT scan MTF limits.
It is my opinion therefore that an entirely passive
device, in which all necessary information is included, is superior to semi-active devices. Furthermore, passive devices should be easy to handle and
intuitive to use, and their design should not allow
any freedom for the operator (the operator has
already decided upon the location of the implant
through planning and the surgical guide).
_Accuracy verification
Fig. 17a
Many studies on accuracy verification have
been conducted. In these, scientists have sought
to determine and measure accuracy by means of
comparing the planning data and data acquired
post-operatively. Their aim is to evaluate which of
the marketed systems delivers the most accurate
results.
Fig. 17b
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Fig. 18b
Fig. 18a
Fig. 18a–e_MTF concept.
other optical system, have optical limits and owing
to CT’s MTF and intrinsic limits, CT scans can be
considered low-resolution 3-D images. They also
achieve spatial resolution levels far from those
needed in our field to ascertain placement precision. Consequently, statistical inferences based
on superimposition cannot be said to deliver valid
proof.
_High-contrast spatial resolution
I scanned an implant using the latest NewTom
CBCT (CB3D VG-I MARK 3), and viewed the scan
using SimPlant Crystal (Materialise Dental) to verify the resolution and the precision of the measurement. The best I was able to achieve was 0.1 mm.
This means that a real measurement of 1.43 mm
could be achieved on CT within 1.33 and 1.53 mm,
and 0.3 mm is the possible measurement error
(Fig. 17a). The same difficulties also arise with MSCT
scans (Fig. 17b).
Fig. 18c
Spatial frequency is evaluated by means of MTF,
the ratio between the output and the input signal,
with one describing an ideal system with no loss of
information at the output. MTF defines limiting resolution, which describes the ability of a system to
perceive two objects as distinct. At high frequencies,
that is a high number of line pairs per mm (lppm),
MTF will approach zero (Figs. 18a & b). When taking
MTF into account, we must evaluate a CT scan according to its optical performance. When the frequency is increased, a series of square waves, corresponding to a 1:1 ratio with combined white and
black lines, changes into a series of bell-shaped
waves. This process is termed the point spread function. As a result, the contrast decreases, which
makes it increasingly difficult to visualise the edge
of the lines. MTF is the Fourier transformation of the
point spread function. When the frequency is low
and the quality ratio is one, the wave corresponds
perfectly to the square waves. When the frequency
increases, the ratio decreases and the wave becomes
increasingly bell shaped. At an MTF of 2 %, the image will be of a uniformly grey colour (Figs. 18c & d).
The CT scan limiting resolution is therefore 2 lppm
at best (Fig. 18e).
_Low-contrast spatial resolution
Moreover, we can extend our discussion to the
contrast level at which an image is observed and
analyse low-contrast spatial resolution.6 When the
contrast decreases at high frequencies, we have to
cope with a low-contrast level image that is noise
dependent. Furthermore, the optical spatial resolution properties depend on the part of the screen at
which we are looking. The resolution is at its best at
the isocentre, worsening both in the radial direction
and along the circumference, the azimuthal direction (Fig. 19). While this phenomenon holds true for
the cone beam in particular, a cone-beam effect is
also achieved with MSCT: the more slices we have,
that is, the greater the fan beam width of each
subsequent MSCT scan, the greater the cone-beam
effect (Figs. 20a & b). When the isocentre is considered the central part of the radiation fan, this effect
can be seen in the outermost slices of the radiation
fan beam especially (Fig. 20c). Axial reconstruction
algorithms report this cone-beam effect in relation
to a spiral path in the axial images (Fig. 20d).7
Compensating cone-beam reconstruction algorithms or spiral interpolation algorithms help to
solve this problem, for instance the multi-row
Fourier reconstruction. Similarly, an extension of
the advanced single-slice rebinning method (ASSR),
which combines the idea of ASSR with a z-filtering
approach, has been proposed as a solution to this
problem, but its validity has not been adequately
Fig. 18d
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Fig. 19
Fig. 18e
demonstrated. This is because, thus far, interpolation has only shown a reorientation of the optical
limits for both cone beam and MSCT.8, 9
_Errors in sleeve placement
CT is also responsible for errors in sleeve placement inside the surgical guide. These errors are
caused by an inescapable approximation in the CT
resolution limits. CT cannot exceed its MTF limit, and
this should be considered during planning and data
transfer.
There can be repercussions on the sleeve placement inside the surgical guide, both for smooth or
threaded sleeves. Sleeve position and axis are parameters associated with this procedure, and the
distance to the ridge and adjacent teeth, as well as
the sleeve axis, should be considered. However, from
a practical perspective, they have no relevant influence on this procedure, but the limits given by these
parameters are sufficient for the production of a
surgical guide. Furthermore, they respect the structures adjacent to the implant site, for example plates
and vascular adjacent structures, IANs, sinuses,
nasal cavities, pterygopalatine fossae, mental
foramina and adjacent roots.
Owing to the technical production limits of CT,
the sleeve position in the surgical guide tends to
be inaccurate, regardless of the technique applied
(STL or stone surgery).
In order to prove repeatability, each cadaver must
be scanned several times. Each scan should consider
the protocol of a different company or manufacturer. The corresponding surgical guides should be
tested on the same cadaver in order to evaluate the
precision of each technique in placing the sleeves in
the centre of the bone, according to position and
axis.
I
Fig. 19_Radial and azimuthal
resolution.
Surgical kits should fit into the mouth and
I assume that the axis should respect the palate’s
anatomy. Furthermore, drilling and implant placement should be avoided in order to prevent inaccuracy errors other than those derived from using
smooth sleeves. Likewise, a repeated scan for superimposition is not of any use. Mathematically speaking, a system can be considered reliable if its repeatability can be confirmed. In the cadaver study,
the cadaver should therefore be tested to fit several
repeated surgical guides. A similar technique proposed by Al-Harbi, in which the accuracy of the
sleeve axis is assessed via CMM (coordinate measuring machine) and laser techniques, also appears
promising.10
The study by Bou Serhal et al. is based on a cadaver
study, but once again, the cadaver was scanned according to a superimposition protocol.11 But why expect to obtain more information from a second CT
scan if we know that CT can be imprecise? There are
many articles on the reliability of CT and its correspondence to the anatomical truth, such as the studies by Lou et al.,12 Brown et al.13 and Damstra et al.14
_Evaluation of data-transfer techniques
As for data transfer in the course of producing a
surgical guide, the chosen technique should result
in the sleeve being placed in the centre of the palate
bone. In order to decide between CAD/CAM and
stone surgery for this process, a cadaver study may
help in comparing and evaluating the various techniques on the market.
However, these publications appear to restrict
their interest to the scanned fiducial landmark measurements and record an error between 0.1 and
0.5 mm for 2-D CT. It is therefore my opinion that
these studies fail to distinguish sources of error such
as the MTF limit and smooth sleeves by concentrating on the superimposition of two low-quality
3-D images.
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niques. These techniques should be designed to
avoid errors derived from using a smooth sleeve.
An ideal system, for example, would allow for a prosthesis, and the surgical guide would allow for identical implant and analogue positions both in the
model and in the mouth.
Fig. 20a
Fig. 20b
Fig. 20a–c_ Cone-beam effect.
_Reliability of STL surgical guides
The study by Stumpel15 provides important information on the accuracy of STL surgical guides.
Their reliability is ascertained via a teeth-borne surgical guide. After a stone model has been scanned
and matched to the planning, the surgical guide is
used like a jig and the correspondence between the
STL model and the mouth is measured.
An HU threshold appropriate for the bone algorithm is necessary in order to avoid producing an STL
model of inadequate size. The merging of planning
and stone model scanning can further help improve
its accuracy. The dimensional tolerance of an STL
model is about 0.3 % when SLS or LS and stereolithography (either SL or SLA) are applied. These techniques yield tolerances of +/- 0.3 % and a minimum
of +/- 0.005.
Since less resolution is needed to produce a surgical guide than to ascertain implant position, the
software can only be used for planning and STL
surgical guide production. It cannot, however, be
used for verifying the implant position. In order to
embed either smooth or thread-timed sleeves that
can guide drills and implants while respecting the
pt. anatomy, 0.1 mm is sufficient.
_Moving on
Superimposition cannot differentiate between
inaccurate sleeve placement and inaccuracies of
the sleeve position and axis of the surgical guide or
inaccuracy resulting from using a smooth sleeve.
Instead, these are confused, which leads to the conclusion that a comparison of planning and post-operative scans will not lead to any convincing results,
even if the superimposition was perfectly executed
and different kinds of software were used in unique
clinical situations. At worst, the ALARA principle
cannot be followed and patients are subjected to
an inordinate amount of radiation.
Once we accept that errors are likely when superimposition is done, we can consider other tech-
10 I CAD/CAM
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Thus, from now on, we can be extremely accurate
when working with a thread-timed device in the implant phase. After the surgical guide has been made,
we must demonstrate the accuracy of the implant
placement. The surgical guide with its repeatable
results allows us to work on an infinite number of
master casts. Our nth master cast is the mouth, and
its correctness can be evaluated by means of a jig.
In 2007, Nobel engineered a threaded device for
zygomatic implants, which was considered for use
in other Nobel implants (patent number: WO 2007/
129955 A1). Their threaded guiding sleeve functions
with a threaded implant mounter. They claim that
these devices lack any vertical fastening features
and do not use any notches to index the hex. Consequently, they warn that there may be no hex
correspondence. Therefore, additional rotation may
be needed. Additional rotation amounts to missing
depth (it is mathematics: if you go on screwing, you
deepen the screw itself); therefore, with a threaded
sleeve, missing the depth because a system has not
been adequately fastened means missing the hex
as well. Additional rotation is only approximately adjusting a device that has lost the phase and these two
parameters. These two parameters will be missed. In
order to obtain the correct final hex position (and
consequently also the depth), I invented a helical gear.
_Conclusion
Accuracy in implant placement appears to depend on the context of the respective case; for
example, it appears less relevant when immediate
loading is not the preferred option or if an impression can be taken immediately after implant placement. However, accuracy in implant placement can
help prevent cortical vascular perfusion disorders
(cortical plate perfusions) or arterial vessel damage.
This appears to be especially important in areas in
which hard- and soft-tissue stability is required for
long-term results, for example for biomechanical
concepts that require submillimetric precision. Furthermore, tissue stability should be considered in all
areas of the mouth for aesthetic and trophic reasons.
On the one hand, CT scans to date offer low-resolution 3-D images of the bone. The software available, on the other hand, delivers both good planning
and safe sleeve positions and axes independently
of the technique used to obtain a surgical stent.
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I
However, we cannot rely on the planning, since it
cannot discriminate errors. As two superimposed
low-resolution 3-D images cannot result in a high
quality image of the implant, relying on the planning
would increase imprecision in accuracy measurements. I therefore recommend platform positioning according to mathematical criteria in order to
achieve a correct, prosthetically driven position.
When sleeve placement is considered, jig correspondence between the abutments on the master
cast analogues and the same abutments’ clinical
position on the implants can help avoid inaccuracies
in terms of either the sleeve position or the axes of
the surgical guide. Furthermore, it can help evaluate
inaccuracies resulting from using a smooth sleeve.
To date, no publications have reported on such
a technique, presumably because this kind of verification can impose too much stress on any method
owing to the time required to ensure precision
this way. Indeed, repeatability seems incidental to
the thread-timed sleeve. Thread timing can be an
impasse on the way towards a precisely placed
implant, since analogues and implants cannot be
forced into the same positions both repeatedly and
operator independently. In other words, it is unlikely
that all relevant parameters, such as the position in
the ridge and the axis, the depth and the rotational
feature orientation, can be taken into account.
No publications have reported on such a technique, either, simply because no method has been
concerned with verifying accuracy so precisely.
Repeatability is incidental to a thread-timed sleeve
(that is, something able to force both analogues
and implants into place in the same repeatable and
operator-independent positions). Thread timing is
essential. If we do not accept this, we must accept
imprecision. The parameters that define the platform—position in the ridge and axis, depth and
rotational feature orientation—should all be respected. If we miss one parameter with a smooth
sleeve we miss them all. In the case reports cited,
superimposition of the planning was done after the
pts. had been scanned again post-operatively. There
was complete accuracy between the master model
and the clinical results. In order to furthermore
demonstrate how this device could work independently of the way the surgical guide is produced, no
industrially manufactured surgical guides were
used. Instead, a digital cast and a stone cast were
used with an approximate protocol for transferring
data from the software and the stone model, and
plain resin was chosen as the provisional material.
Moreover, it seemed important to understand
that comparing post-operative clinical CT results
Fig. 20c
to the planning through superimposition can be
misleading in measuring the accuracy of an implant.
Contrarily, a comparison between the clinical results
with either an STL or stone model on which analogues were placed by using the same threaded
guiding device offers better accuracy measurement.
Although software is essential to planning and creating a surgical guide with an accurately embedded
sleeve, accuracy relates to the concepts of thread
timing and implant phase and not to software. In the
case reports cited, software was therefore used to
provide qualitative data exclusively.
Fig. 20d
Fig. 20d_Cone-beam effect
interpolation.
In general, aggressive marketing tactics are an
important ethical factor when computer-guided
implant placement is considered. The Millennium
Research Group has estimated a 20 % growth in
the number of guided implant placements by 2013.
Similarly, dentists are likely to increasingly perceive
the need for planning software and drilling templates. In the future, however, CAD/CAM techniques
will not only be applied in planning, but also be
used for surgery in order to enhance prosthesis and
tissue stability. A passive device that is easy to handle and based on thread timing can pave the way to
computer-guided progress._
Editorial note: A list of references is available from the
publisher.
Part I of this series—New concepts in computer-guided
implantology was published in CAD/CAM Vol.3, Issue 1/12.
A PDF is available from the publisher.
_contact
CAD/CAM
Dr Gian Luigi Telara
Studio Odontoiatrico Lippi Telara
Via Vorno, 9/4
55060 Guamo Lucca
Italy
Tel.: +39 05 8394 7568
lippitelara@gmail.com
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I case report _ implant therapy
CBCT-assisted implant
therapy: A case study
Author_ Dr Nilesh Parmar, UK
Fig. 2
Fig. 1
Figs. 1 & 2_Pre-op presentation.
Figs. 3_Maximum intensity
projection using Sirona GALILEOS.
Figs. 4_A CBCT scan with a
CEREC Bluecam overlay showing
the ideal final result.
Figs. 5_Stage 1 of implant placement,
with healing abutments in place.
_Implant treatment in the anterior mandible
has favourable long-term success rates when compared with other areas of the mouth (Gokcen-Rohlig
et al. 2009). Placement of dental implants in the interforaminal area is considered a safe and predictable
procedure. However, perforation of the lingual cortical plate can result in a profound and potentially lifethreatening sublingual bleed (Bucal 2008). The blood
Fig. 3
supply to this area is provided by the submental, sublingual and mylohyoid arteries, which if perforated
may set off a massive internal haemorrhage in the
floor of the mouth.
Although rare, this can ultimately cause protrusion
of the tongue, resulting in airway obstruction and
necessitating surgical intervention. It has been suggested by Tepper et al. (2001) that CT imaging of this
area is warranted for visualising 3-D bone anatomy
prior to surgery, thereby reducing the possibility of
surgical instrumentation of this sensitive area.
In this case report, I shall show how CBCT coupled
with chairside diagnostic imaging can help in planning, simplifying and executing implant placement
in the anterior mandible.
_Patient history
A 44-year-old female patient who was undergoing long-term periodontal treatment presented
with mobile and painful lower incisors. She exhibited
very good oral hygiene but with a periapical area
and mobility associated with tooth #14 and Grade II
mobility of her lower incisors. The patient described
difficulty and embarrassment when eating owing to
the movement of her lower teeth and wanted a fixed
solution.
Fig. 4
_Clinical examination
Fig. 5
Fig. 6
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The patient had a lightly restored dentition with
a thin gingival biotype. As previously mentioned, her
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I
oral hygiene was good and she was a non-smoker
(gave up 11 years previously). She exhibited bilateral
canine guidance with no evidence of any para-function. Her BPE scores were 312/231.
_Treatment options
Owing to the patient’s history of periodontal disease and associated mobility, she was aware that
some form of replacement was necessary. The patient
did not want a removable restoration and preferred
a fixed solution. In this area of the mouth, either fixed
bridgework or an implant-retained prosthesis was
possible.
After discussing the options and highlighting the
increased risk of peri-implantitis in patients with
previous periodontal disease (Esposito 2006), the
patient opted for a fixed implant-retained solution.
The treatment was to be planned in such a way that
if she lost her posterior molars in the future, a fullarch fixed prosthesis could be made after subsequent
implant placement.
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
_Treatment plan
Treatment was to be carried out as follows:
1. continuation of periodontal treatment and oral
hygiene advice;
2. CBCT GALILEOS (Sirona) scan to assess bone height,
bone profile and associated anatomy;
3. extraction of all four lower incisors and tooth #14;
4. placement of two SLA active implants (Straumann);
5. restoration with a screw-retained four-unit PFM
bridge.
_CBCT
nipulated so that the lower tooth positions were in
harmony with the rest of the dentition.
This proposal was then overlaid onto the CBCT
scan and was used to facilitate implant planning.
The aim was to provide the patient with a screwretained bridge with access holes though the lingual aspects of the lower incisors, whilst maintaining a sound margin of safety from the lingual
cortical plate.
Figs. 6 & 7_Presentation
at eight weeks.
Figs. 8 & 9_Laboratory-made
screw-retained porcelain bridge
on Straumann synOcta abutments.
Figs. 10_The bridge.
Figs. 11_Appearance at fit.
Figs. 12_Pre-op presentation.
Figs. 13_CBCT scan with
CEREC integration.
It was decided to take a full-volume CBCT scan
to further assess the upper teeth and tooth #14 for
future implant replacement. The CBCT scan showed
excessive bone loss around the anterior incisors
with a small area of periapical radiolucency around
tooth #31. A cross-sectional view showed thick,
well-developed cortical plates with very little lingual
concavity. Owing to the good bone height and minimal pathology, immediate implant placement was
planned.
Owing to the patient’s bone loss, the lower incisors
had drifted, giving a less than desirable tooth position. One of the patient’s main complaints was the
gaps that had appeared between the lower incisors
and the uneven appearance of the incisal edges.
To aid implant placement in the correct angulation, a CEREC Bluecam image was taken and ma-
Fig. 13
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I case report _ implant therapy
The patient healed without incident and owing to
the favourable lingual undercuts of the lower teeth
was able to wear the denture comfortably during
the healing process. Owing to financial reasons, the
planned implant placement for the tooth #14 site
was deferred until a later date.
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Figs. 14_After eight weeks
of healing.
Figs. 15_Insertion of final bridge.
Figs. 16 & 17_Appearance
at one month review.
Owing to the patient’s previous periodontal history, it was decided to use Standard Plus implants
(Straumann) in this case. The design of this implant
incorporates a 1.8 mm polished collar above the
active surface of the implant. This results in the implant-to-abutment junction being located 1.8 mm
superiorly to the bone crest.
After eight weeks of healing, fixture-level opentray impressions were taken in Impregum (3M ESPE),
and a four-unit screw-retained bridge was fabricated. The tooth set for the denture was duplicated
on the final bridge, as the patient was happy with the
tooth size and shape. Owing to the previous bone loss,
pink porcelain was added to the bridge to improve
the emergence profile and reduce the crown lengths
of the lower incisors.
The bridge was seated and torqued to 35 Ncm
and composite placed in the access holes. A baseline
long-cone periapical radiograph was taken to serve
as a baseline for bone-level measurements. The occlusion was checked, with the patient exhibiting canine guidance in excursive movements. The patient
was shown how to clean under the bridge using super floss and TePe brushes and placed on a long-term
maintenance programme.
_Surgical procedure
_Prognosis
The patient was given 400 mg ibuprofen and a
chlorhexidine mouth rinse before the surgery began.
The procedure was carried out under intravenous
sedation using midazolam.
The lower incisors were removed using periotomes and forceps. The sockets were curetted and
thoroughly irrigated. A crestal incision with distal
relieving incisions was made. Owing to the CBCT scan
and surgical stent, only a small lingual reflection was
necessary.
Implant placement was carried out using standard ITI protocols. Two SLActive Standard Plus implants (4.1 x 10 mm; Straumann) were placed. The
implants exhibited excellent primary stability with
an insertion torque of greater than 35 Ncm. The
patient’s bone quality was estimated to be type D1–2
(Lekholm & Zarb 1985).
Owing to the high primary stability and good bone
quality, it was decided to adopt a single-stage surgical protocol, thereby placing healing abutments
over the implants. The site was closed using 5-0 PGA
sutures and a tooth-supported denture replacing
the lower incisors was fitted. Careful examination of
the denture was carried out to ensure there was no
contact, or transfer of occlusal load onto the implants
from the denture. The patient was seen seven days
after surgery for suture removal and review.
14 I CAD/CAM
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The bridge has a good long-term prognosis, as this
patient is highly motivated, and exhibits excellent
oral hygiene. She is aware of the increased risk of
complications, and the possibility of losing more
teeth in the long run, but after having worn a denture
for three months, she is determined to avoid becoming a long-term denture wearer. The patient will
see me at six-monthly intervals and sees a hygienist
every three months for maintenance._
_about the author
CAD/CAM
Dr Nilesh R. Parmar was
voted Best Young Dentist in the
East of England in 2009 and
runner-up in 2010. He is one
of the few dentists to hold
a University of London degree
from all three London dental
schools and is currently studying
for his third MSc in Orthodonticsat the University
of Warwick.He is an Astra Tech Clinical Coach and
has his own practice in Southend-on-Sea, Essex.
He also works as a visiting implant dentist at Sparkly
Smile in Blackheath and the New York Dental Office.
www.drnileshparmar.com
[15] =>
CAD0212_01_Title
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03.05.12 10:47
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I case report _ CAD/CAM in implantology
Implantology—the
perfect art of camouflage
thanks to CAD/CAM
Author_ Robert Michalik, Poland
Fig. 1
Fig. 2
Fig. 1_Initial state.
Fig. 2_Prepared Maryland bridge.
Fig. 3_Extraction.
_When I graduated from the Faculty for Dental
Technicians in Warsaw Medical School in 1987, I had
no idea that my profession would change so much
over the course of the next quarter of a century.
At that time, I enthusiastically welcomed every new
innovation, many of which I pioneered the use of in
Poland.
Looking back today after more than 20 years,
I can confidently say that dental technology has
undergone a profound technical revolution. After all,
nowadays, it is difficult to imagine a modern dental
technician’s laboratory where CAD/CAM technology remains unknown.
Fig. 4_Situation after
osseointegration.
Fig. 5a_Exposure of implant.
Fig. 5b_Impression coping.
Fig. 4
My first experience with CAD/CAM was in 2004
when I decided to buy a device from DeguDent. I intentionally use the word ‘device’ here, since it was not
Fig. 5a
16 I CAD/CAM
2_ 2012
Fig. 3
what we would today consider a CAD/CAM system
based on scanning and virtual modelling. However,
I was overwhelmed by the potential this machine
offered me at the time. For a brief while, dental technicians and dentists were divided into proponents
of and opponents against CAD/CAM. The latter were
mainly against the system because of ignorance and
a fear of new technology. I myself used the machine
for two years until at last I succumbed to the temptation and bought another technical novelty.
I first saw this machine, produced by Wieland, at
the International Dental Show in Cologne. The thing
that was so innovative about it and such a great advance on previous models was the 3Shape scanner
that was able to scan the model and transfer data
to the CAD software, thereby making it possible to
produce a virtual model of the construction.
Fig. 5b
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Fig. 6
I
Fig. 8
Fig. 7
Fig. 6_Temporary abutment.
Fig. 7_Gingiva forming
with temporary crown.
Fig. 8_Expected emergence profile.
Fig. 9_Position of implant axis
with regard to bed of crown.
Fig. 10_Properly constructed
temporary crown.
Fig. 9
The system was such a breakthrough and the
possibilities it offered so enormous that in 2006
I began using the 4820 model. The volume of orders
that my laboratory handled increased dramatically,
since in contrast to the DeguDent machine, which
could initially cut four-unit and later seven-unit
bridges, Wieland’s CAD/CAM system allowed me
to cut 14-unit constructions from various types of
material (plastic, steel, titanium).
Based on my own observations and my many
years of experience, I can boldly say that the greatest progress in terms of technology has been
achieved by scanners. The newer machines have
only increased the amount of bone that can be cut
and accelerated cutting speed. It is the scanners that
have ensured revolutionary advances in the development of CAD/CAM.
A major role in the development of scanners has
been played by 3Shape, which is currently the undisputed leader in the field. A modern user of CAD/CAM
has all he needs to ensure a perfect prosthetic appliance, i.e. everything from a temporary crown right
up to complex implant-supported restorations.
Moreover, all the work can be done today in virtual
Fig. 11a
Fig. 10
articulation, which overcomes the technological
problems that traditional methods faced.
Patients today require fast and inexpensive
therapeutic solutions, while ensuring the highest
standard of work. CAD/CAM systems help reduce
production costs significantly. Hence, the high purchase price of investing in a CAD/CAM system pays
off. The limitless opportunities it offers for co-operation between laboratories also attest to the superiority of CAD/CAM technology. Just as the development of airlines made rapid relocation to any corner
of the globe possible, so CAD/CAM promotes work
between laboratories from all over the world. And
herein probably lies its greatest success: international co-operation that connects people brings its
own benefits and satisfaction. There have been
many occasions in my professional practice when
I have performed work to order without ever being
face to face with clients. This is proof of the importance of Internet communication in the dental
industry.
Obviously, the CAD/CAM system is only half the
story, for the hands of the dental technician are still
irreplaceable when it comes to veneering porcelain
Fig. 11a_Duplicate of temporary
crown made from pattern resin.
Fig. 11b_Intra-oral examination.
Fig. 11c_Impression at implant level.
Fig. 11b
Fig. 11c
CAD/CAM
2_ 2012
I 17
[18] =>
CAD0212_01_Title
CAD0212_16-20_Michalik 14.06.12 10:35 Seite 3
I case report _ CAD/CAM in implantology
Fig. 12a
of the quality of the work. This is increasing in proportion to general advances in people’s lifestyles.
The majority of us want to remain young and look
beautiful forever. Hence, more and more people
view dentition in terms of the need not only to restore missing teeth but also to correct those they
still have. A good example of this is the boom in orthodontics, and the demand for teeth whitening
and improving their smile using veneers.
Fig. 12b
Fig. 12d
Fig. 12c
Fig. 12a_All-zirconia abutment
on the cast.
Fig. 12b_Palatal view
of all-zirconia abutment.
Fig. 12c_Preparation of the abutment.
Fig. 12d_Prepared abutment.
Figs. 13a, b & c_Finished zirconium
dioxide substructure on the cast.
Buccal view (b). Palatal view (c).
Fig. 14_Fitting of abutment
and coping.
Fig. 15_Diffusion of light in Robocam
zirconia structure.
Fig. 13a
substructure. No system can apply porcelain in such
a way that the restoration looks like a natural tooth.
Hence, the ideal is to combine the possibilities offered by CAD/CAM with the artistic abilities of the
dental technician. A properly prepared construction, good marginal seal and the choice of material
are all very important factors, but the final finish of
the crown still depends on the aesthetics attained
through the skill of human hands. The work of the
dental technician requires knowledge of many different materials and how they are fashioned, as well
as extensive manual skills in working easily with
both colour and shape.
A long-standing acquaintance of mine, the outstanding master of dental technology Klaus Müterthies, stresses repeatedly that form takes precedence over colour. The patient focuses first on the
way the prosthetic restoration harmonises with his
natural teeth. If the form is disturbed, colour defects
appear together with details that do not have too
important an influence on the overall appearance
of the crown.
Although the majority of patients do not know
how to assess a prosthetic restoration accurately,
I have noticed a growing awareness among them
Fig. 13b
18 I CAD/CAM
2_ 2012
Fig. 13c
Another very important factor in prosthetic art
is that it requires the collective effort of an entire
team—everyone from an attending dentist, an orthodontist, and a surgeon/implantologist, right up
to a dental technician. I have had the great fortune
to work with partners who have chosen to work in
the same area of technological development and
aesthetic prosthetic work. One of the doctors working closely with my laboratory on a daily basis often
remarks, “as the dentist so the technician and vice
versa”. Probably, these words reveal how close the
ties have always been between the dental technician and the dentist. The restoration case study I will
present here reflects my belief that prosthetic work
is a combination of modern technology with its
skilful use and a high level of artistry in the hands of
the technician.
_Case report
A 27-year-old female patient presented to our
dental office to achieve a more aesthetic smile. At
the age of 17, she had suffered an accident (she was
hit by a swing), as a result of which her tooth #21
had shifted significantly in an upwards direction
owing to significant bone atrophy and root resorption (Fig. 1). The young age of the patient and her still
progressing bone growth did not augur success.
Only when she was 27 did she pursue improving
her appearance. The situation required that she have
her tooth extracted, undergo an implant procedure
and have a prosthetic crown placed. The first problem that emerged during the preliminary analysis
prior to the implant procedure was that the amount
of bone and the thickness of the bone plate would
Fig. 14
Fig. 15
[19] =>
CAD0212_01_Title
CAD0212_16-20_Michalik 14.06.12 10:35 Seite 4
case report _ CAD/CAM in implantology
I
Fig. 16
Fig. 17
Fig. 18
Fig. 19a
Fig. 19b
Fig. 19c
have forced us to add grafting material. The patient
did not consent to such a solution and expected a
predictable cosmetic effect with the stress on very
good final aesthetics.
In the first stage, we made a Maryland bridge
(Fig. 2). Such a solution provided protection for the
patient during the osseointegration period. Several
months after the surgical procedure, the implant
(in this case Ankylos, DENTSPLY Friadent) was exposed. It turned out that the implant was positioned
in an excessively palatal direction. The challenge
was to restore a symmetrical line to the patient’s
cervical margins, as well as a natural biological
gingival margin. The backward position of the implant required the use of an angled abutment of 30°.
Unfortunately, the system we used effectively restricted such an approach, since at the time that the
above procedure was performed it was still impossible to achieve customisation in a dental laboratory
(this is definitely possible today).
A decision to make an all-zirconia abutment
with an angle of inclination above 15° is quite risky.
Hence, the solution we adopted was to modify the
crown while not changing the shape of the abutment. Such an approach requires the attending
Fig. 20
dentist to play a major role in the process so that the
preparation and transfer of the emergence profile
of the abutment and prosthetic crown correspond
perfectly to the natural tooth. Using composite material, the doctor shapes the temporary restoration
to retain the place for the final crown for a period of
several weeks so that it later can serve as a model for
the definitive crown. It is important to remember
that as the gingiva is being shaped the patient must
at all times be provided with a temporary restoration, guaranteeing support for the soft tissue.
Fig. 16_Abutment and coping prior to
firing and bonding.
Fig. 17_Palatal view of veneered
crown bonded to the abutment.
Fig. 18_Visible emergence area,
free of ceramic.
Figs. 19a, b & c_Finished crown
in situ.
Therefore, the doctor transferred the emergence
profile with the help of a doubling of the crown with
the abutment. After the crown had been removed,
pattern resin was applied in its place. Simultaneously, a standard zirconia abutment was modified in
the dental laboratory into the desired shape using
a water-cooled high-speed bur and then scanned.
An image of the scan was modified by superimposing a second scan over the projected emergence
profile of the crown. Both parts were joined together
in the CAD programme and the structure thereby
created was cut from the Provi Disc composite material (Robocam), which is often used for temporary
restorations. At this stage, the best approach is to
try in the cut-out substructure and if necessary im-
Fig. 21
Fig. 20_Palatal view
of screw-retained crown.
Fig. 21_Crown in full smile.
CAD/CAM
2_ 2012
I 19
[20] =>
CAD0212_01_Title
CAD0212_16-20_Michalik 14.06.12 10:35 Seite 5
I case report _ CAD/CAM in implantology
Figs. 22a & b_Pre- and post-op
situation.
Fig. 22a
Fig. 22b
prove its size and shape. Only if the fit is perfect will
a substructure be cut out from zirconium dioxide.
ods? This remains an open question, but perhaps
the profession of the dental technician will soon be
limited to working only and exclusively with computers.
The choice of material is something that should
be considered very carefully. Observing the rule of
“what, where and when?”, the choice will depend
on the position of the abutment, its colour characteristics and the quantity of light diffusion needed.
The last factor has a great impact on the natural appearance of the prosthetic restoration. For this very
reason, I try above all to use all-ceramic materials,
especially in the anterior section.
The material used in the present case study was
zirconium dioxide (Robocam), which is processed
in a machine supplied by the same company called
Robomill 5. The machine mills all available soft
materials and the water cover makes it possible to
cut IPS e.max ceramics (Ivoclar Vivadent).
_Acknowledgements
I would like to thank my wife, Dorota Michalik, for
her artistic veneering of the prosthetic restoration
presented, as well as Dr Kristian Owczarczak, for
his great contribution as a dentist, and with whom
I carried out the clinical case study._
All the prosthetic restorations were made using the CAD/
CAM Robocam, and the materials used were Robocam
zirconium dioxide, IPS e.max (Ivoclar Vivadent) and Vision
veneering ceramics.
_about the author
Following a consultation with an attending dentist, it was agreed that owing to the large superstructure of the mucosal section on the vestibular
side the restoration would have to be screw retained. Such a solution ensures that the patient’s
oral hygiene can be examined frequently in that
area. The abutment and crown were joined together
in the laboratory in order to avoid any possible
complications owing to excess cement left after the
restoration had been placed in the patient’s mouth.
The part serving as the emergence profile of the
crown from the gingiva was not covered with veneering porcelain. It was only polished to a shine
without covering it with glazing. The surface of the
zirconia prepared in such a way has a greater chance
of adhering tightly to the patient’s gingiva.
The present case study confirms that modern
prosthetics could not exist without modern solutions such as CAD/CAM.
_Summary
What other innovations will surprise us in the
not-too-distant future? Will traditional layering
and firing of ceramics be replaced by other meth-
20 I CAD/CAM
2_ 2012
CAD/CAM
Robert Michalik
graduated from the Faculty for
Dental Technicians in Warsaw
Medical School in 1987.
After two years of work in
the Medical University’s dental
laboratory, he opened his own
dental laboratory, Inter-Dent,
which he is still running. In 2003, he was the first
in Poland to start working with dental CAD/CAM
systems. In 2007, he began development of the
first Polish CAD/CAM system in collaboration with
Delcam and 3Shape. Also in 2007, he submitted
an application to patent a method of creating
telescopic crowns with intermediate crowns.
He is the author of several articles for the trade press.
Laboratorium Inter-Dent
Ul. Pustułeczki 23
02-811 Warsaw
Poland
www.inter-dent.pl
info@inter-dent.pl
[21] =>
CAD0212_01_Title
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[22] =>
CAD0212_01_Title
CAD0212_22_EAO 14.06.12 10:36 Seite 1
I feature _ EAO X-ray guidelines
EAO publishes new guidelines
on safe exposure to X-rays
for dental implant patients
Owing to its relatively low cost, as well as the growing number of potential clinical applications, there is
an increasing demand for CBCT imaging in clinical
dental practice. Although it can provide valuable clinical information, practitioners are required to minimise and balance any patient exposure to ionising
(X-ray) radiation with any net benefits to the patient
in treatment outcome.
An international panel of expert clinicians and radiologists were invited to participate in the workshop.
They were tasked with reviewing and updating the
original EAO guidelines and with reaching a consensus
on a range of relevant issues.
_The European Association for Osseointegration
(EAO) has drawn up new guidelines on the use of diagnostic imaging in implant dentistry. The guidelines
have been published online ahead of print and can
be accessed as an early view article at www.online
library.wiley.com. They will be published in print in an
upcoming issue of Clinical Oral Implants Research.
They were developed during an international workshop held at the Medical University of Warsaw in 2011.
The EAO published its first set of guidelines on diagnostic imaging in 2002. Since then, new radiographic
technologies and techniques have become available,
including cone-beam computed tomography (CBCT).
The new guidelines were drawn up in response to the
2008–2011 SEDENTEXCT project (www.sedentexct.eu),
which recommended that the EAO review its 2002
guidelines in light of the availability of CBCT.
22 I CAD/CAM
2_ 2012
The new guidelines provide a comprehensive,
authoritative and practical framework for clinicians.
They will help clinicians fulfil their obligations in
ensuring that the use of diagnostic imaging examinations in implant dentistry is justified and obtained
at the lowest radiation dose to the patient.
They also highlight the special responsibilities,
training and knowledge that are considered prerequisite for both CBCT and conventional radiographic
techniques._
_contact
Gloria Guevara
Congrex Belgium
Gloria.Guevara@congrex.com
Tel.: +32 2 6432049
CAD/CAM
[23] =>
CAD0212_01_Title
FDI World Dental Federation
Leading the World to Optimal Oral Health
2012 Hong Kong
FDI Annual World Dental Congress
29 August - 1 September 2012
1. Celebrate the uniqueness of FDI at its
100th Annual World Dental Congress;
6. Enjoy exclusive face-to-face encounters
with your peers worldwide;
2. Learn about the latest developments
from international and regional experts;
7. Develop your knowledge and skills
through a new and innovative programme;
8. Sample some of the best cuisine
in Asia: one restaurant for every 600
inhabitants!
3. Discover the newest technology,
equipment, products and materials;
4. Interact with renowned world
specialists;
5. Empower yourself through FDI
sessions on policy and public and oral
health;
9. Marvel at the breathtaking views of
Hong Kong and Macau;
10. Uncover the riches and mysteries of
mainland China.
Leading the world into a new century of oral health
www.fdicongress.org
congress@fdiworldental.org
Design: b’com · +33 (0)6 50 46 60 70
10 reasons to join FDI in Hong Kong,
World Oral Health Capital 2012
[24] =>
CAD0212_01_Title
CAD0212_24-25_Mollova 14.06.12 10:36 Seite 1
I feature _ interview
“Digital technology
is becoming essential”
An interview with Dr Dobrina Mollova, Managing Director of CAPP
Dr Dobrina Mollova
_In October, Singapore’s recently opened
Marina Bay Beach Resort will become a showcase
for everything related to digital dentistry when
the first CAD/CAM & Computerized Dentistry International Conference opens its doors to dental
professionals from all over the Asia Pacific region.
Organised by the Centre for Advanced Professional Practices (CAPP) in Dubai, the congress is
based on the successful concept of the CAD/CAM
& digital dentistry events held in the Middle
East. CAD/CAM spoke with Dr Dobrina Mollova,
Managing Director of CAPP, about the state of
preparations and the prospects of the field in
Asia.
_CAD/CAM: Dr Mollova, you recently announced that the first Asia Pacific CAD/CAM &
Computerized Dentistry International Conference
will be held in Singapore. What is behind the decision to have another conference there?
Our first Dubai conference held in 2006 was an
unexpected success and so we were able to develop
the concept further. Over the years, some of our
sponsors approached us with the idea of holding a
similar event in Asia Pacific. Following the interest,
we decided to launch preparations 18 months ago
for a conference to be held in Singapore. Since
then, we have received significant support not only
from the industry but also from government organisations such as the Singapore Tourism Board,
who fully supports our event, and the Singapore
Dental Association (SDA), who functions as the coorganiser. That is why we are confident that we will
be able to transfer this concept to the Asia Pacific
region successfully.
_Preparations for the Singapore conference
already started in late 2010. Are you on schedule?
Preparations are going very well and we will
are pushing our marketing campaign since IDEM.
Until then, we were quiet so as not to disturb
the marketing efforts of our Singapore partners.
Surprisingly, there were many dentists from the
Middle East who came to IDEM and who intended
also to participate in our Singapore conference.
24 I CAD/CAM
2_ 2012
_What are the main challenges of bringing the
concept to Singapore?
The growth of CAD/CAM dentistry alongside
new technology, materials and equipment has
seen a rapid integration into both dental offices
and laboratories. Without a doubt, digital technology is becoming essential for every dental practice
and laboratory. The question is: are we prepared
to keep up to date with this growing industry and
are we able to implement this pool of information
in our practices without the proper expertise? This
will be the main challenge for us.
_Are you planning to extend the concept to
other countries in Asia?
Our target is the entire Asia Pacific region, which
is much larger than the market in the Middle East.
Similar to Dubai, Singapore has become a commercial hub for the entire region and, for this reason, we are inviting professionals from all over Asia
Pacific to come and learn about the promising
technologies in the dental industry. According to
our sponsors, there could be potential for holding
a similar conference in China but we have not yet
decided to go there, as we want to wait for the
outcome of the conference in Singapore.
_How large is the dental CAD/CAM market in
Singapore in terms of size and penetration?
To date, we do not have meaningful statistics
for Singapore. According to MarketResearch.com,
however, the Japanese market for dental prosthetics and CAD/CAM devices was the largest in the
Asia Pacific region in 2010, followed by the Republic of Korea. In the same year, the total Chinese
and Indian markets for dental CAD/CAM grew by
7.5 per cent. The global market for CAD/ CAM is
experiencing doubledigit growth at the moment.
_Looking at Dubai, are you able to say something about the impact your conference had on
the field of dentistry and how digital technology is
perceived?
This is an interesting question, as I have just
been through the recordings of our first confer-
[25] =>
CAD0212_01_Title
CAD0212_24-25_Mollova 14.06.12 10:36 Seite 2
feature _ interview
ences. There is clearly a huge difference in view
of presentations, the knowledge we have gained
and the technology that is available. Back in 2006,
we started with only 160 participants, who were
mainly dentists. Meanwhile, this number has
quadrupled and includes dentists, dental technicians and dental assistants—basically, the entire
dental team. An increasing number of participants are specialists, who have gradually become interested in the aspects of computerised
dentistry, but at first there were only prosthodontists.
_Will the Singapore conference reflect this diversity?
The congress will not be limited to dental
CAD/CAM technology. Unlike our conference in
Dubai, this time we want to put more emphasis
on 3-D imaging systems, a technology that has
shown the potential to transform diagnostics in
dentistry completely. Besides treatment planning
and diagnostics, the list of topics will range from
the selection of materials for different indications
to the use of digital technology in more traditional
clinical areas like orthodontics.
_How many attendees do you hope for?
We are aiming at 400 attendees for the first
conference, which in my experience is a realistic
target, given the size of the market and our presence in Asia Pacific through our partners. We are already cooperating with several dental associations,
while seeking new professional partners from the
dental community who are eager to work with us.
Owing to the enthusiasm of the SDA, we believe
that we can make this event successful.
Those who are interested will be able to find
more information online at www.capp-asia.com
or www.facebook.com/cappasiapacific.
_Dr Mollova, thank you very much for this interview._
I
The Marina Bay Sands Hotel in
Singapore. The world’s most
expensive stand-alone casino
complex will be the hosting venue
for the 7th CAD/CAM & Computerized
Dentistry International Conference.
(DTI/Photo Archipoch)
Over 600 dental professionals
participated in the last CAD/CAM
& Computerized Dentistry
International Conference in Dubai.
(DTI/Photo courtesy by CAPP, Dubai)
_Will you also offer seminars or hands-on workshops during the Singapore conference?
The main goal of this conference will be to bring
a group of high-end dental professionals together
to enable them to discuss and learn about these
new technologies in detail. Therefore, we do not
plan to offer any hands-on training at the moment
unless there is a request by the industry. This does
not rule out such training in the future. At the fifth
CAD/CAM & Computerized Dentistry International
Conference in Dubai in 2011, for example, we had
seven workshops, which were well received.
CAD/CAM
2_ 2012
I 25
[26] =>
CAD0212_01_Title
CAD0212_26-29_Farronato 14.06.12 10:37 Seite 1
I opinion _ CBCT
CBCT in orthodontics
Authors_ Prof Giampietro Farronato, Dr Francesca Bellincioni, Dr Margherita Colombo, Dr Daniela Falzone,
Dr Salvadori Sara, Dr Gaia Passaler & Dr Gianfranco Santamaria, Italy
Thus, the limits of traditional CA are:
_errors in radiographic projection, resulting in enhancements and distortions;
_operator errors in the measurement systems;
_errors in the identification of the cephalometric
landmarks owing to superimposition of anatomic
structures; and
_inability to evaluate the three dimensions of the
craniofacial complex.1
Fig. 1
Fig. 2
Fig. 1_The i-CAT Classic, a cone
beam 3-D dental imaging system
(Imaging Sciences International).
Fig. 2_3-D rendering and
cephalometric landmarks.
Table I_Effective radiation dose
(background radiation 8 µSv/day).
_3-D cephalometry
The aim of orthodontic diagnosis is to identify
dento-alveolar, skeletal and functional alterations
in the maxillo-facial complex. Diagnosis and treatment planning are based on a combination of study
models, intra-oral and extra-oral images, and radiographs, traditionally consisting of panoramic and
cephalometric radiographs.
Cephalometric analysis (CA) plays an important
role in diagnosis and treatment planning. Traditional CA is based on three different X-ray projections: latero-lateral teleradiography, postero-anterior teleradiography and axial projection. However, conventional radiographs are limited because
they provide a 2-D representation of 3-D structures. The traditional system, analysing the three
dimensions separately, is insufficient because
dento-facial alterations often take place in 3-D
space.
Method
Scan parameters in kV
Dose in µSv
Cephalometric analysis
Latero-lateral teleradiography
Postero-anterior teleradiography
69 / 15 mA / 14.1 s
80
80
50
30
40
Multi-slice CT
CBCT
CBCT
120 / 400 mA / 0.5 s
120 / 5 mA / 20 s
120 / 5 mA / 10 s
2370
110
60
26 I CAD/CAM
2_ 2012
The recent introduction of CBCT in combination
with computer software allows the application of
this new methodology to different fields of dentistry, including its successful use in orthodontics
(Fig. 1).2 Owing to CBCT, the 3-D morphology of the
cranial skeletal structures can be represented properly. With CBCT, the patient is exposed to similar levels of radiation as during conventional CA and up to
20 times less than during multi-slice-CT exams
(Table I).3
At the Orthodontic Department at the University
of Milan, CA is performed with a new 3-D methodology that allows for an easy, effective and repeatable way to decrease operator-driven errors.4 It is
based on the identification of 18 points (10 median
and 8 lateral), all of which are identified on a hardtissue CT section and verified on the two remaining
CT sections. Further verification is then performed
on the volume rendering generated by SimPlant
OMS (Materialise).
The 18 points determine 36 measurements on
the sagittal, vertical and transversal dimensions
(Fig. 2). At the University of Milan, 44 skeletal Class I
normodivergent patients were selected from an
archive of 500 CBCT scans.
The cephalometric diagnosis of a skeletal Class I
normodivergent relationship is based on the School
of Milan. The same patients were then analysed
with 3-D cephalometry. The results allowed the
identification of a normal range of values for each
measurement (Table II).
The 3-D technique goes beyond the limitations of
2-D analysis in many ways:
[27] =>
CAD0212_01_Title
CAD0212_26-29_Farronato 14.06.12 10:37 Seite 2
opinion _ CBCT
_effective representation of true 3-D morphology
of the cranial structures without distortion, avoiding projection and identification errors;
_reduced operator bias because the measurements
are performed automatically;
_simplicity and repeatability in the identification of
landmarks, using true anatomic structures without superimposition or the problems of geometric
construction;
_ability to obtain CA using the three dimensions;
and
_dento-skeletal alterations can be analysed in 3-D
in order to determine appropriate treatment.
_Combined orthodontic and
surgical planning
The introduction of 3-D imaging techniques has
revolutionised the planning phase of combined
orthodontic and surgical treatment. The use of the
computer, together with dedicated software, allows
for a fast, precise and standardised procedure. 3-D
virtual planning entails the following:
_CBCT scan;
_high-definition impression;
_reference aligner;
_digital scan cast; and
_CBCT digital cast interface.
Using virtual planning, it is possible to obtain the
virtual visual surgical treatment objective and the
virtual orthodontic model. High-definition impressions are obtained using polyvinyl siloxane, which
guarantees well-defined details while allowing for
the double-pour method. Double-poured casts are
necessary to obtain an adequate scan and require
the use of both a full cast and individual dental
elements selected from a second cast. Single
dental element scans allow for proper analysis of
contact points. An optical cast scan is performed
using structured-light scanners, which produce
a 3-D image captured by a camera. In this manner,
a group of points is determined by the software,
GoSx – Me = 77,46 mm ± 2
CdSx – GoSx = 51,49 mm ± 3,69
GoDx – Me = 77,35 mm ± 2,03
CdDx – GoDx = 52,18 mm ± 3,48
S – GoSx = 80,05 mm ± 2,4
ANS PNS ^ GoSx Me = 41,12° ± 0,81
I
S – GoDx = 80,15 mm ± 2,37
ANS PNS ^ GoDx Me = 41,12° ± 0,9
S N ^ GoSx Me = 46,21° ± 1,11
S N ^ GoDx Me = 45,94° ± 1,24
CdSx GoSx Me = 118,88° ± 2,58
CdDx GoDx Me = 118,83 ± 2,51
CdSx GoSx N = 54,31° ± 1,22
CdDx GoDx N = 54,3° ± 1,2
N GoSx Me = 65,64° ± 0,98
N GoDx Me = 65,58° ± 1,09
PNS – A = 44,82 mm ± 1,1
S – N = 65,3 mm ± 1,35
N – Me = 106,33 mm ± 2,8
N – ANS = 47,92 mm ± 1,33
ANS – Me = 59,49 mm ± 1,62
S N A = 80,66° ± 0,89
S N B = 78,24° ± 0,93
A N B = 2,62° ± 0,31
Ba S N = 130,03° ± 1,76
which then determines the coordinates of the
acquired points and finally creates the 3-D image
(Fig. 3).5
Table II_Normal values range.
Moreover, the digital dental cast is then combined with the CBCT scan, which allows for a very
detailed analysis of both the bone (through the CBCT
scan) and the dental structure (through the cast
scan). CBCT does not provide enough data regarding all the dental details necessary to produce the
orthodontic model (Fig. 4).6
In order to superimpose the two records properly, a specific three-contact point bite registration
wax, known as the reference aligner, has been introduced. The reference aligner needs to be applied
to the teeth when the high-definition impressions are taken. It is made of Moyco (an extra-hard
wax) and consists of a supporting arch and three
spheres. These are made of calcium-based glass,
which has cast-pouring radiopaque properties.
The wax is applied during CBCT and is placed
between the cast arches during the optical scan
(Fig. 5).
Fig. 3
Fig. 4
Fig. 3_Digital cast.
Fig. 4_CBCT digital cast interface.
CAD/CAM
2_ 2012
I 27
[28] =>
CAD0212_01_Title
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I opinion _ CBCT
Fig. 5_Reference aligner.
Fig. 6_3-D rendering and selection
of anatomic structures.
Fig. 5
Fig. 6
It is remarkable that the wax thickness does
not significantly influence the accuracy of the radiographic scan and consequently the results of the
CA. The software is able to recognise the presence
and size of the spheres in the CBCT scan and matches
them to those corresponding areas on the cast.
This is currently the only method that allows for an
overlap with an error margin of less than 0.1 mm.7
Once the data has been collected, it is possible
to perform different kinds of analyses before the
surgical treatment. The software presents powerful
segmentation tools that allow the splitting of the
maxillo-facial complex from the mandible, providing two separate images.
This feature is relevant in orthodontic and surgical planning for calculating bone movement.
The clinician can select the tissues to be moved
following a procedure similar to the manual one.
For example, it is possible to select the osteotomic
lines in order to simulate a forwards or backwards
mandible shift, finding the exact shift needed (in
mm) to properly correct the malocclusion (Fig. 6).
Once the bone correction has been finalised, it is
possible to create a 3-D orthodontic model and
display the resulting dental correction to be obtained by the end of the treatment.
Fig. 7_Pre- and post-treatment
maxillary superimposition.
Fig. 8_Pre- and post-treatment
mandibular superimposition.
28 I CAD/CAM
2_ 2012
images using CAD/CAM techniques to track progress
towards orthodontic pre-surgical treatment.8
Virtual surgery has a twofold objective: firstly,
to verify that the planned shifts are in fact feasible;
and secondly, to position the cast according to the
ratios needed to build the surgical splint, which will
be used during the surgical procedure. The digital
cast superimposition reduces the treatment planning phase, as it is not necessary to reveal the facial
arch or to use the articulator. In fact, all the data
can be sourced from the combination of the CBCT
and cast scans. Recent studies focus on the enhancement of the system through the development
of an intra-oral scanner, which will allow direct
3-D impressions, skipping the conventional impressions, which—although precise—can be influenced
by manual errors.9,10
Although complex, using software offers many
advantages because it enhances both orthodontic and surgical techniques, while ensuring a very
high quality result. In fact, a CAD/CAM technique
allows for a standardised procedure and easy
quality checking, in comparison to traditional operator-performed techniques, which are open to inaccuracies.
Finally, shifting back the bone structure (and the
dental arch with the final model) to the original maloccluded position, it is possible to obtain the target
cast to be reached before the surgical treatment.
On the cast, it is then possible to build successive
_Creating customised multi-bracket
appliances
Fig. 7
Fig. 8
In virtual orthodontic and surgical planning, it is
possible to create a digital orthodontic model once
[29] =>
CAD0212_01_Title
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opinion _ CBCT
Fig. 9
the bone bases have been shifted towards their
proper position. The latest dental shift software
is able to perform single-element segmentation
automatically. The operator can obtain a full 3-D
visualisation of the dento-alveolar relationship and
can consequently modify tip and torque, rotate and
shift dental elements in the 3-D space in order to
simulate the orthodontic treatment.
In order to display the results of the pre-surgical
orthodontic treatment immediately, the software
shows two overlapping images, differently coloured
to distinguish the initial situation from the ideal
one (Figs. 7 & 8). As a result, a digital model is created, containing all the details to reach a functional
occlusion.
The first step in the process of creating a customised bracket is possible thanks to CAD/CAM
technology.11,12 The CAD/CAM technique entails two
phases: the design phase (CAD) and the manufacture phase (CAM),13 performed through computers
that send instructions to milling machines in order
to create the end-product.6 These machines work
either through removal (such as a CNC cutter) or
through addition—stereolithography (SLA), 3-D
print or plastic materials/composites, laser sintering
(SLS) or laser fusion (SLF) of metal materials.
The elements that allow the bracket customisation depend on its base. The base is designed
through the CAD software and placed on the centre
of the dental surface. The software will then allow us
to customise the bracket (Figs. 9 & 10). In designing
the bracket, it is possible to distinguish between
a partial and a complete customisation. The first
entails the customisation of the size and shape of
the bracket portion facing the dental surface, but
features a standard angle in the non-customisable
portion of the twin bracket. Complete customisation entails the additional modification of the angle
between the bracket base and the twin portion. This
is the ideal, considering that the spatial parameter
of the dental elements might vary according to the
different malocclusions.
I
Fig. 10
Fig. 11
Once the design phase has been finalised, the
brackets are ready for manufacture by a milling machine. These machines, which mill very small items,
need to be run in a standardised environment with
maintained conditions to guarantee high precision
while minimising the possibility of errors. Consequently, the higher the precision required, the larger
the milling machine will be. It is also necessary to
place the machine in a dedicated environment with
a special floor cover with amortising panels that
stabilise the cutter and partially absorb the vibration produced.
Figs. 9 & 10_Customised
bracket details.
Fig. 11_Bracket mesh.
Moreover, a very small cutter of approximately
0.001 mm needs to be used. For example, considering that the smallest cutters can remove up to 3 %
of a millimetre each time, three to four passes will
be required to create the mesh facing the tooth
(Fig. 11).
The technological progress represented by
CAD/CAM as described is based on the digital design
feature and the computer-automated manufacturing process.14 The main advantages are better
control of the production process and a significant
reduction in operator-driven errors, while enabling
the use of sophisticated materials, such as Grade 5
titanium, which was not possible with traditional
techniques.15_
Editorial note: A complete list of references is available
from the publisher.
_contact
CAD/CAM
Prof Giampietro Farronato
Institute for Clinical Orthodontics /
Clinical Orthodontic Institute
Via Commenda, 10
20122 Milan
Italy
giampietro.farronato@unimi.it
CAD/CAM
2_ 2012
I 29
[30] =>
CAD0212_01_Title
CAD0212_30-33_Abouseada 14.06.12 10:37 Seite 1
I case report _ CAD/CAM aligners
Space management in adults
using CAD/CAM aligners—
Three case reports
Author_ Dr Khaled Abouseada, Saudi Arabia
Fig. 1
Fig. 2
_Using CAD/CAM technology to produce
a series of clear plastic overlays is an aesthetically agreeable solution for space management. Initially, the use of aligners was restricted
to treating minor orthodontic cases only,1 but
the improvement in aligner manufacturing in
the last five years has allowed us to use aligners in a variety of malocclusion situations
today.2
Table I_Teeth movement records
for case 1.
Recently, successful outcomes have been reported with aligner treatment for more complex
Fig. 3
malocclusion.3 In the following article, I present
three such cases from my private practice.
_Case I: Space adjustment after
extraction for implant placement
Diagnosis
This case was referred to me by a colleague.
The main requirement of my colleague and his
patient was space adjustment.
Clinical examination revealed a space of 3 mm
between the lower right lateral incisor and the
lower right canine; a suspended bridge consisting of an abutment over the lower right second
molar; a pontic for the lower first right molar,
which was very small in size; and an occlusal rest
on the second lower right premolar (Fig. 1).
Treatment objectives
Our objective was to close the spaces in the
lower arch except the space of the missing lower
right first molar, which would be increased. In
planning the treatment, CAD/CAM technology
was utilised (Fig. 2).
Treatment plan
The treatment plan was to remove the old
bridge and move the lower right canine, first pre-
Table I
30 I CAD/CAM
2_ 2012
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case report _ CAD/CAM aligners
Fig. 4a
Fig. 4b
Fig. 4c
molar and second premolar mesially to close the
anterior space. This would open up enough space
to replace the missing lower right molar with an
implant.
Fig. 4d
Fig. 4f
I
Fig. 4e
Fig. 4g
Fig. 4h
Treatment objectives
Treatment progress
The patient used 19 aligners for two weeks
each. The entire treatment time was nine months
and two weeks. The movements achieved are
shown in Table I.
Results
Upon final treatment, the anterior spaces
had been completely closed and space had been
Fig. 5
The treatment objectives were:
1. maintenance of the Class I molar and canine
relationship;
2. creation of adequate space for the missing
upper right lateral incisor;
3. closure of any other spaces in the upper arch;
4. midline correction; and
5. retroclination of the upper and lower incisors.
Table II_Teeth movement records
for case 2.
Fig. 6a
Fig. 6b
Fig. 6c
Fig. 6d
Fig. 6e
Fig. 6f
created to replace the missing lower right first
molar with an implant (Fig. 3).
_Case II: Space management for
a congenitally missing tooth
Diagnosis
A 32-year-old male patient reported to my
clinic with spaces between his upper teeth and
forwardly placed incisors.
The patient was diagnosed with a Class I malocclusion with a missing upper right lateral incisor, spacing in the upper arch, proclined upper
and lower incisors, a midline shift owing to deviation of the upper midline 1 mm to the right
side, and higher upper labial frenum attachment
(Fig. 4).
Table II
CAD/CAM
2_ 2012
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[32] =>
CAD0212_01_Title
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I case report _ CAD/CAM aligners
Fig. 7a
Fig. 7b
Fig. 7c
Fig. 7d
Fig. 7e
arch. The movements achieved with each aligner
are shown in Table II.
Fig. 7f
Fig. 7g
Fig. 7h
Treatment plan
We decided to use aligners for both upper and
lower arches to manage the upper arch spaces
and to retrocline both upper and lower incisors.
The treatment plan was accomplished using
CAD/CAM technology (Fig. 5).
Results
Facial and intra-oral photographs (Figs. 7a–h)
show midline correction, closed upper spaces
(except the space of the missing upper right
lateral) and decreased upper and lower proclination.
_Case III: Generalised spacing and
protrusion
Treatment progress
Diagnosis
The treatment progress was recorded every
month as shown in Figure 6. During the first
month, the upper right central incisor was
moved mesially. In the second, third and fourth
months, more mesial movement of the upper
right central incisor occurred, as well as retraction of both upper and lower incisors. In the
fifth month, correction of the midline shift was
achieved and a frenectomy was performed. Finishing and final detailing was achieved in the last
month. After finishing the treatment, upper and
lower clear retainers were prepared and a pontic
of composite was added at the space of the missing lateral incisor.
Overall treatment time with aligners lasted
for six months and two weeks for the upper arch
and four months and two weeks for the lower
Fig. 8a
Fig. 8c
A 44-year-old female patient presented with
complaints about protrusion and spaces between her upper teeth. She had no complaints
with regard to her lower arch. All upper incisors
were covered with crowns.
She was diagnosed with a Class I malocclusion with proclined and spaced upper incisors, lower arch crowding and 1 mm overjet
(Figs. 8a–e).
Treatment objectives
The treatment objectives were to close the
upper spaces and retract the upper incisors.
Therefore, the lower teeth had to be moved back
to allow upper teeth movement.
Fig. 8b
Fig. 8d
32 I CAD/CAM
2_ 2012
Fig. 8e
Fig. 9
[33] =>
CAD0212_01_Title
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case report _ CAD/CAM aligners
I
Treatment plan
All upper incisors were covered with crowns.
The patient was satisfied with these crowns with
regard to their shade, size and shape. In such
cases, three treatment options are available:
1. new crowns for the upper anterior teeth;
2. conventional braces, which would lead to two
problems: risk of frequent bracket bonding failure
and scratching of the labial crown surfaces; and
3. aligners.
By using aligners, neither did the crowns need
to be changed nor did we face problems generally associated with brackets. Using CAD/CAM
technology, Figure 9 shows the initial situation
and the expected outcome.
Table III
Treatment progress
As shown in Table III, the first phase of treatment
focused on levelling and aligning the teeth in both
upper and lower arches. Thereafter, intrusive and
extrusive forces were applied to level the lower
incisors followed by the retraction of the teeth by
lingual tipping. The entire treatment time lasted
less than five months using only nine aligners.
such as extracted teeth, congenitally missing teeth
or generalised spacing, should be approached
with a team including an orthodontist. Aligners
Table III_Teeth movement records
for case 3.
Results
As shown in Figures 10a–e, all the spaces were
closed in the upper arch, the lower arch crowding was relieved, and both upper and lower incisors were retracted.
Fig. 10a
Fig. 10b
_Discussion
Fig. 10c
Although space management in adults can be
done using prosthetic appliances alone, cooperation with an orthodontist in such situations can
lead to better aesthetic results, especially when
teeth are moved using aligners, an almost invisible treatment option. Patient cooperation is the
critical factor in achieving a successful aligner
treatment. Aligners should be worn for at least
20 hours per day, seven days a week.4
_Conclusion
Space management in the dental arch in adult
patients, which can be caused by different factors
Fig. 10e
have the advantage of being an invisible appliance, offering better oral hygiene and patient acceptance as compared with fixed orthodontics._
Editorial note: A complete list of references is available
from the publisher.
_contact
The overall hygiene maintenance and the
level of clinical finish achieved are of satisfactory quality. The acceptance of this treatment
modality is far higher compared with conventional orthodontics.5
Fig. 10d
CAD/CAM
Dr Khaled Abouseada BDS,
MS, Orthod, Cert.
Asnani Dental Clinic
P.O. Box 122721
Jeddah 21332
Saudi Arabia
khaledseada@yahoo.com
CAD/CAM
2_ 2012
I 33
[34] =>
CAD0212_01_Title
CAD0212_34_Duschek 14.06.12 10:37 Seite 1
I news _ first 3-D-printed mandible
Doctors implant first customised
3-D printed mandible
Author_Claudia Duschek, Germany
_Belgian researchers have developed and
produced the first patient-specific, 3-D printed
titan implant. For the first time in the history of
implantology, a customised implant has replaced
a complete mandible. It restored form, function
and aesthetic aspects of a natural mandible in a
significantly shorter period
compared with
classical treatments.
The
Functional
Morphology
research group
at the University of Hasselt’s
BIOMED research
institute recently
presented the first
customised 3-D
printed mandible,
which was implanted in a patient in June
2011. The procedure was conducted on an 83-yearold woman who suffered from serious osteomyelitis,
which had affected almost the entire mandible.
Given the severe and rapidly progressive infection in this senior patient’s lower jaw-bone, treatment options were rather limited. The classical
treatment, namely removing the damaged bone,
would have resulted in a small mandible without
any support and function. Researchers faced the
challenge of restoring vital functions, such as
breathing, speech, chewing and sensation. The decision to reconstruct the entire mandible with a
customised 3-D printed implant was made to spare
the senior patient a long surgery and shorten the
subsequent stay in hospital. It was the first time that
a complete mandible was replaced.
“The introduction of printed implants can be
compared to man’s first venture on the moon:
a cautious but firm step,” said Prof Jules Poukens
of BIOMED.
34 I CAD/CAM
2_ 2012
The artificial jaw weighs approximately 107
grams, which is almost as heavy as a natural
mandible. The implant is designed to allow the direct
insertion of dental bars or bridge implants at a later
stage and therefore provides the perfect foundation
for dental restoration. Owing to perfect fit, the
surgery was completed in four hours, which is only
a quarter of the time needed with the classical
method. This spared the patient additional adjustment surgeries and speeded up recovery. According
to Poukens, the patient regained normal function
with adequate speech, swallowing and unrestricted
movement within one day after surgery.
Planned and designed by doctors and engineers
from various institutions in Belgium and the
Netherlands, the implant was produced by LayerWise, a company experienced in metal Additive
Manufacturing (AM) technology, which is a specific
form of 3-D printing used to create implants layer
by layer. A high-precision laser selectively heats
metal powder particles to quickly melt and attach
them to the previous layer. The titan model was
coated with bioceramic afterwards. AM is used to
print functional implant shapes that would otherwise require multiple metal working steps or that
cannot be produced any other way.
Metal AM is generally gaining importance in
medical implantology. The technique is increasingly
being adopted in dentistry and in other medical
fields. Many companies already use printers able to
build 3-D models for the production of prototypes
of new products because they allow the most
complex geometrics to be produced.
Researchers agree that 3-D implants are an
excellent addition to current treatment options. “As
illustrated by the lower jaw reconstruction, patientspecific implants can potentially be applied on
a much wider scale than transplantation of human bone structures and soft tissue,” said Dr Peter
Mercelis, Managing Director of LayerWise.
The revolutionary jaw implant was granted the
2012 AM Award by the Additive Manufacturing
Network in Belgium._
[35] =>
CAD0212_01_Title
Cyprus
28-29/09/12
INTERNATIONAL CONGRESS IN
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DENTISTRY
LECTURERS
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Web: nicosia.hilton.com
Information & Registration for Greece:
Omnipress
Tel: +30 210 222 2637 +30 210 213 2084
info omnicongresses.gr
www.omnicongresses.gr www.omnipress.gr
ORGANIZED BY
FIDENTALMED Ltd
SPONSORS
MEDIA SPONSORS
Smile
Dental Journal
[36] =>
CAD0212_01_Title
CAD0212_36_Planmeca 14.06.12 10:38 Seite 1
I industry news _ Planmeca
New Planmeca ProMax
3D ProFace system enables
safer and faster facial surgeries
ible images. For careful preoperative planning, the
medical professional can study the facial anatomy
thoroughly using Planmeca Romexis software,
which facilitates a detailed surgery and enhances
the aesthetic results.
“This new product clearly demonstrates our
ground-breaking R & D and best practices in imaging. Planmeca provides the most advanced tools
—3-D imaging units and software—for visualising patient anatomy, making treatment planning
and follow-up for orthodontic, maxillo-facial and
aesthetic surgeries more precise, faster and safer,”
explained Helianna Puhlin-Nurminen, Vice-President of the Digital Imaging and Software Applications division at Planmeca.
_Planmeca introduces Planmeca ProMax 3D
ProFace, a unique CBVT imaging unit with an
integrated 3-D facial scanning system. This true
3-D application is designed to fulfil the most diverse diagnostic needs of today’s maxillo-facial
and dental professionals. The Planmeca ProMax
3D ProFace unit acquires a 3-D facial image of
the patient without exposing the patient to radiation, allowing the medical or dental professional to plan surgery and document the follow-up
images.
36 I CAD/CAM
2_ 2012
The product is based on the recognized Planmeca
ProMax platform, which makes future upgrades
extremely simple. The Planmeca ProMax 3D ProFace
feature is available for Planmeca 3-D products:
Planmeca ProMax 3Ds, Planmeca ProMax 3D,
Planmeca ProMax 3D Mid and soon also for
Planmeca ProMax 3D Max._
_about the company
CAD/CAM
Planmeca is the first to introduce an integrated
3-D unit that produces a realistic 3-D facial image,
in addition to traditional digital maxillo-facial
radiography. One single scan generates both a
3-D and a CBVT image. Alternatively, the 3-D image
can be acquired separately through a completely
radiation-free process: the lasers scan the facial
geometry and the digital cameras capture the
colour texture of the face.
Planmeca Oy, established in 1971, designs and
manufactures a full line of high-technology dental
equipment, including dental care units, panoramic
and intra-oral X-ray units, and digital imaging
products. Planmeca, the parent company of the
Finnish Planmeca Group, is strongly committed
to R & D. It is the largest privately held company
in the field and the third largest dental equipment
manufacturer in Europe.
The 3-D image visualises soft tissue in relation
to dentine and facial bones, providing an effective
follow-up tool for maxillo-facial operations. As
Planmeca ProMax 3D ProFace acquires both a
3-D and a CBVT image in a single scan, the patient
position, facial expression and muscle position
remain unchanged, resulting in perfectly compat-
Planmeca Oy
Asentajankatu 6
00880 Helsinki
Finland
www.planmeca.com
[37] =>
CAD0212_01_Title
Anzeigen Stand DIN A4_Anzeigen Stand DIN A4 10.04.12 11:33 Seite 1
Dental Tribune for iPad –
Your weekly news selection
Our editors select the best articles and videos from around the world for you
every week. Create your personal edition in your preferred language.
ipad.dental-tribune.com
[38] =>
CAD0212_01_Title
CAD0212_38_3Shape 14.06.12 10:38 Seite 1
I industry news _ 3Shape
3Shape technologies—Closing-in
on complete digital dentistry
_To improve and expand their services, both
dentists and labs need to address dentistry as a
whole. 3Shape provides digital methods for improving efficiency throughout all phases of dental
treatment, starting from the intra-oral impression
scanned at the dentist’s clinic and continuing all
the way through to manufacturing.
_Labs using Dental System can receive TRIOS digital
impression scans or third-party intra-oral scans
(Sirona CEREC, Cadent iTero) from the dentist’s
clinic directly in their TRIOS Inbox and can then
start the design process immediately.
_With 3Shape’s new Model Builder, labs can use
TRIOS scans directly to design lab models, including implant models, either in-house or locally.
The digital models are fully prepared for optimised manufacturing on 3-D printers or milling
machines.
_Dental System’s Digital Temporaries feature enables labs to digitally design and produce temporaries—directly from the pre-preparation scan
and without pouring a gypsum model.
_Labs can prepare aesthetic Virtual Diagnostic
Wax-ups to send to the clinic for dentist–patient
preview before the patient’s teeth are even prepared.
Dental System 2012 offers many features specifically designed to enable labs to develop their
business as service centres for dentists. As a central
part of this strategy, 3Shape Dental System 2012 facilitates workflows relevant to all areas of dentistry.
3Shape’s TRIOS is a complete digital impression
solution for dental clinics that enables dentists to
capture the intra-oral situation directly, achieving
huge benefits in relation to traditional analogue
impression taking. 3Shape TRIOS includes intraoral scanning, intelligent software, and communication with the lab. Unique features include sprayfree scanning, complete motion and positioning
freedom while scanning, instant impression validation, and smart scan-edit tools.
_3Shape Communicate enables easy lab–dentist
collaboration during all steps of the case. Approved designs can be reused when designing
the final crown, saving time and ensuring aesthetics.
_3Shape’s CAMbridge software automatically prepares digital designs for manufacture, and Dental
System supports almost all materials and manufacturing equipment.
Digital technologies are rapidly becoming the
standard in dental clinics, labs and manufacturing centres, and now the most advanced systems
support collaboration and workflows between
them._
_contact
Digital workflows enabled by 3Shape’s solutions:
_The dentist or the clinic’s secretary creates the
digital order using a form that is customised
according to the specific lab’s requirements. The
dentist easily scans the patient’s teeth, validates
the digital impression, and immediately sends the
case to the lab while the patient is still in the chair.
38 I CAD/CAM
2_ 2012
3Shape A/S
Holmens Kanal 7
1060 Copenhagen K
Denmark
www.3shape.com
CAD/CAM
[39] =>
CAD0212_01_Title
Dental Tribune A4 CAD_CAM Singapore Ad.pdf 6/3/2012 4:48:35 PM
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One-visit chairside dentistry:
How to make CAD/CAM
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and Durable in Clinical Practice
M
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Dr. Michael Dieter,
Germany
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Joerg Voegt,
Germany
CMY
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Dr. Andreas Kurbad,
Germany
Dr. Simon Smyth,
UK
Dr. med. dent. Peter Gehrke,
Germany
•Computer Navigated
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•Esthetic Engineering
•Everyday CAD/CAM Usage: Preparation,
Practicality & Possibilities, What Benefits
You and Your Practice
•Further Possibilities of CAD/CAM:
One Visit Smile Makeovers and
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•Two-Piece CAD/CAM Zirconia Implant
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[40] =>
CAD0212_01_Title
CAD0212_40_Straumann 14.06.12 10:38 Seite 1
I industry news _ Straumann
Straumann opens its CAD/CAM
system with CARES Visual 7.0
_Having presented its new dental design software, CARES Visual 7.0, at the recent Chicago
Dental Society Midwinter Meeting, Straumann has
now begun the rollout of this new system to
CAD/CAM customers in Europe and North America.
Like all Straumann software, CARES Visual 7.0 is designed to enhance user friendliness and versatility,
but what distinguishes it is that it offers customers
the possibility of producing prosthetic elements
through third-party milling, thereby opening the
Straumann CAD/CAM system.
Using CARES Visual 7.0, customers can design prosthetic crowns, bridges, onlays, inlays, etc. by computer
and then route the design data to a milling lab either
at or outside Straumann. At Straumann, the workflow
is validated and seamless, and one of the broadest
ranges of materials and applications is offered. Importantly, prosthetic restorations delivered through
this process are covered by the Straumann guarantee.
The decision to have the prosthetic restorations
milled externally might be driven by special functional or material preferences that are not available
through Straumann. Today, many dental labs have to
invest in multiple CAD/CAM systems in order to serve
a mixed customer base with differing requirements.
This places considerable economic and administrative burdens on the labs, which could be reduced
through a single open system.
Dr Sandro Matter, Executive Vice-President of
Straumann’s Prosthetics Business Unit, commented:
“Customers want state-of-the-art functional software that offers flexibility and full assurance of predictability and reliability. CARES Visual 7.0 meets these
criteria and ensures Straumann quality. It means that
labs can now invest in a CAD/CAM system without
the fear of being locked in to a single manufacturer.”
CARES Visual 7.0 is available as an upgrade to
customers with CARES Scan CS2 scanners and comes
installed in all new Straumann CARES systems delivered as of 1 March 2012.
_Creating the open dental software
platform of the future
Digital technologies are becoming widespread in
dentistry and cover a broad spectrum of applica-
40 I CAD/CAM
2_ 2012
tions—from general practice management, treatment planning, imaging, guided surgery, digital impression taking, right through to computer-aided
prosthetic design and manufacture. As digitalisation
grows, so too does the number of incompatible systems, making dental labs reluctant to invest in technology that might become obsolete or compromise
flexibility. Software standardisation—the precondition for open systems—will go some way towards
resolving this.
A year ago, Straumann and 3M ESPE—a pioneering leader in digital dentistry—joined forces with
Dental Wings to create an open global standard software platform for use across a range of dental applications. The initiative is expected to offer enhanced
flexibility, simplicity, and convenience for users, while
saving time, costs and investment.
CARES Visual 7.0 has been developed on the
open DWOS (Dental Wings Open Software) software
platform, which—thanks to its scope, quality and
functionality—is positioned to become the future
standard software solution in dentistry.
_About Straumann CARES
Straumann CARES Digital Solutions provide
dental professionals with a complete, reliable and
precise solution. From scanning the intra-oral situation to sophisticated, prosthetic-driven backward
planning, the digitalisation of dental workflows is
bringing about new and exciting possibilities for patients, surgeons and lab technicians. The Straumann
CARES platform offers seamless connectivity to
thousands of scanners in dental practices worldwide and provides Straumann customers with access to future leading-edge developments in digital
dentistry._
_contact
Institut Straumann AG
Peter Merian-Weg 12
4002 Basel
Switzerland
www.straumann.com
CAD/CAM
[41] =>
CAD0212_01_Title
CADCAM_Abo_A4_Implants_Abo_A4 21.02.12 14:25 Seite 1
CAD/CAM
digital dentistry
international magazine of
Subscribe now!
I would like to subscribe to CAD/CAM (4 issues per year) for
€44 including shipping and VAT for German customers, €46 including shipping and VAT for customers outside Germany, unless a
written cancellation is sent within 14 days of the receipt of the
trial subscription. The subscription will be renewed automatically every year until a written cancellation is sent to Dental
Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig,
Germany, six weeks prior to the renewal date.
Last Name, First Name
Company
Street
ZIP/City/County
E-mail
Signature
Reply via Fax +49 341 48474-173 to
CAD/CAM 2/12
Dental Tribune International GmbH or per E-mail to
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Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written
cancellation to Dental Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany.
Signature
DENTAL TRIBUNE INTERNATIONAL GMBH
Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-302, Fax: +49 341 48474-173, E-Mail: n.parczyk@dental-tribune.com
[42] =>
CAD0212_01_Title
CAD0212_42_Sirona 14.06.12 10:39 Seite 1
I industry news _ Sirona
CEREC Club Select:
additional benefits for users
_In the interests of longevity and reliability
dentists should regularly maintain and update
their dental capital equipment. For some years now
CEREC Club has offered users the latest CEREC
software upgrades and updates free of charge. As
Sirona continues to develop its portfolio of dental
CAD/CAM systems, the company has now decided
to relaunch its Club membership package.
CEREC Club Select Plus comprises services that
are geared to this specific stage in the product lifecycle—i.e. software upgrades and updates as well
as new hardware components, in particular a free
of charge update PC for the CEREC AC. This ensures
that the dentist can exploit the full potential of
the software.
CEREC Club Select has been available in numerous countries since 1 April 2012. Authorized dealers can order membership packages via the Sirona
webshop.
The benefits of CEREC Club Select membership
at a glance:
_CEREC and/or inLab software upgrades and updates depending Press Release on milling unit
type;
_In addition to the manufacturer’s warranty, free
spare parts for one CEREC AC and up to two
Sirona milling units for a period of two years;
_Three maintenance kits;
_Online tutorials for a period of six months.
The new CEREC Club Select comprises an extensive range of services that have been precisely
tailored to the requirements of CEREC AC users.
Firstly, users receive regular software upgrades and updates ensuring that their equipment remains fully up to date. Secondly, special
maintenance kits and an extended spare parts
warranty protect the dentist's investment longterm. Additionally, CEREC Club Select members
are entitled to take part in online tutorials on
www.dentalusers.com free of charge over a six
month period.
CEREC Club Select membership commences
on installation of the CEREC AC (contracts can be
signed within a period of 30 days thereafter) and
runs for 36 months.
The contract covers one CEREC AC and up to
two milling units installed either at the same time
or subsequently. After the initial membership
contract has expired, the user can opt for CEREC
Club Select Plus membership for a further 36
months.
42 I CAD/CAM
2_ 2012
The benefits of CEREC Club Select Plus membership at a glance:
_Free of charge upgrade PC for the CEREC AC
acquisition unit;
_CEREC and/or inLab software upgrades and updates depending on milling unit type._
CEREC Club Select is not available in the United States
and in Canada.
_contact
Sirona Dental Systems GmbH
Fabrikstraße 31
64625 Bensheim
Germany
contact@sirona.de
www.sirona.com
CAD/CAM
[43] =>
CAD0212_01_Title
CAD0212_43_Platforms 14.06.12 10:39 Seite 1
digital platforms _ course calendar
I
Announce your courses
in CAD/CAM!
LIVE EDUCATION SYMPOSIUM AT FDI ANNUAL WORLD DENTAL CONGRESS
29 August–1 September 2012
HK Convention and Exhibition Centre, Hong Kong, China
The Dental Tribune Study Club would like to invite you to participate at our Live Education Symposium at FDI Annual World Dental
Congress. We will offer an ambitious schedule of continuing education (CE) lectures in various dental disciplines. Each day will feature a
selection of lectures led by experts in the field, providing an invaluable opportunity to learn from opinion leaders, while earning ADA CERP
C.E. Credits. We have developed a program that is both diverse and engaging, with every lecture offering you the practical guidance you
seek to take back to the practice and put to immediate use. This year marks a special edition as it is the 100th FDI World Dental Congress.
Dental Tribune America, LLC
c/o Christiane Ferret
116 West 23rd Street, Ste. 500, New York, NY 10011, USA
+1 424 744 0608
c.ferret@dtstudyclub.com
For more information and to reserve a spot for your course(s) in the upcoming issues, please contact
Vera Baptist, Product Manager CAD/CAM, at +49 152 29929405 or v.baptist@dental-tribune.com.
CAD/CAM
2_ 2012
I 43
[44] =>
CAD0212_01_Title
CAD0212_44-45_Camlog 14.06.12 10:40 Seite 1
I meetings _ CAMLOG Congress
4 International
CAMLOG Congress
th
Author_CAMLOG Foundation
has funded numerous scientific projects, has promoted continuous training and education and has
generated a broad international platform for the
exchange of knowledge between scientists, practitioners and industry.
Fig. 1
Fig. 2
Fig. 1_Prof. Jürgen Becker—
President CAMLOG Foundation.
Fig. 2_Dr Alex Schär—Chief
Technology Officer at CAMLOG Group.
Fig. 3_Jürg Eichenberger—President
of the Board CAMLOG Group.
Fig. 4
Fig. 3
_The CAMLOG Foundation is a foundation established under Swiss law. It engages in targeted
supporting of gifted young scientists, promotion of
basic and applied research, and continuing training
and education to promote progress in implant dentistry and related fields to serve the patient. Since
its establishment in 2006, the CAMLOG Foundation
Fig. 5
44 I CAD/CAM
2_ 2012
As part of its scientific mission, the CAMLOG
Foundation has assumed patronage of the International CAMLOG Congresses, which take place every
two years.
The international CAMLOG Congresses are platforms for gaining and exchanging new knowledge
and ideas and they are well known for the quality of
their lectures and their balance between scientific
evidence and practical knowledge.
[45] =>
CAD0212_01_Title
CAD0212_44-45_Camlog 14.06.12 10:40 Seite 2
I
meetings _ CAMLOG Congress
Fig. 6
_4th International CAMLOG Congress
Under the motto “Feel the pulse of science in
the heart of Switzerland”, CAMLOG had invited all
to Lucerne, Switzerland, for the 4th International
Congress—and they ALL came. More than 1,300
participants meant a new record attendance in the
internal congress ranking of the CAMLOG Group,
that with this impressive success again underscored
its claim to place among international leaders in
implant dentistry.
Fig. 7
And not to miss out on the “social networking”,
CAMLOG had invited to two raving parties. Both
on Friday and Saturday evening, happy congress
participants and partygoers made certain that
“Let’s rock the Alps” was literally experienced by all
attending on the “Rigi”, Lucerne’s “own” mountain.
Figs. 4 & 5_Lectures at the
4th International CAMLOG Congress.
Figs. 6 & 7_Culture and Congress
Center in Lucerne.
The starting shot for congress activities was given
on Thursday, May 3, a day before the actual congress,
with four German/English workshops that had been
sold out well in advance. These theoretical and practical events on all aspects of soft-tissue management
were held at 2,100 meters above sea level on Mount
Pilatus, a unique location only accessible by cogwheel
railway or aerial cableway with a fascinating view of
an ensemble of more than 70 alpine peaks.
Then on May 4 and 5 at the Culture and Congress
Center in Lucerne on Lake Lucerne directly, an internationally renowned panel of speakers presented
the state-of-the-art of implant dentistry.
The range of topics included:
_innovations in implant-abutment connections;
_long-term clinical experience with platform
switching;
_the demographic shift and increasingly aging
patients;
_current trends in digital dentistry;
_meet the experts with “complicated” cases/patients, including lively panel discussion.
As the concluding participant survey showed,
the connection between the scientific content of
the first morning of the congress and the practical
topics of Friday afternoon and Saturday was viewed
as particularly successful and instructive.
Fig. 9
Fig. 8
Against the background of this resounding
success, the CAMLOG Foundation disclosed immediately at the end of the Lucerne congress that
the 5th International CAMLOG Congress, for which
planning has already started, will be held in Spain
in 2014._
_conact
Fig. 8_Lake Lucerne.
Fig. 9_Traditional Swiss.
CAD/CAM
CAMLOG Foundation
Margarethenstrasse 38
4053 Basel
Switzerland
info@camlogfoundation.org
www.camlogfoundation.org
CAD/CAM
2_ 2012
I 45
[46] =>
CAD0212_01_Title
CAD0212_46-47_IDS 14.06.12 10:40 Seite 1
I meetings _ IDS 2013
IDS 2013: Organisers expect
successful exhibition
_Preparations for the 35th International Dental
Show (IDS), which will be hosted in Cologne in
March 2013, are already gathering pace. For the
2013 show, the organisers of the world’s largest
fair for dental medicine and technology are expecting a repeat of last year’s interest from the
dental world, when nearly 2,000 suppliers and
118,000 trade visitors made IDS 2011 the most
successful ever.
The Society for the Promotion of the Dental
Industry (Gesellschaft zur Förderung der DentalIndustrie—GFDI), IDS organiser and the commercial
enterprise of the Association of German Dental
Manufacturers (Verband der Deutschen DentalIndustrie—VDDI), and global company Koelnmesse,
who is staging the event, have mailed the regis-
46 I CAD/CAM
2_ 2012
tration forms to potential exhibitors, kicking off
preparations for next year.
Koelnmesse has already received numerous enquiries for stand space. Following the record results
of IDS 2011, with 1,954 suppliers from 58 countries
and around 118,000 trade visitors from 149 countries, the organisers are expecting similar interest
next year. “According to a representative survey,
around 90 per cent of the exhibitors of IDS 2011
are planning their participation at IDS 2013,”said
Dr. Martin Rickert, VDDI CEO. “This shows that the
IDS is a not-to-be-missed event for all those who
wish to successfully operate in the dental industry.”
As with previous shows, the first day of the fair
will be Dealers’ Day, which concentrates on the
[47] =>
CAD0212_01_Title
CAD0212_46-47_IDS 14.06.12 10:40 Seite 2
meetings _ IDS 2013
specialist dental trade and importers, thus offering
the opportunity of uninterrupted sales negotiations
at the exhibitors’ stands.
Also, 81 per cent of the German and 99 per cent of
the foreign suppliers acquired new international
contacts.
As in 2011, the IDS will occupy exhibition space
of 145,000 m². The organisers expect the dental
trade show to attract more than 1,900 national and
international exhibitors. Even at this stage, many
exhibition enquiries have been received from potential first-time exhibitors from abroad. Additionally,
12 foreign group presentations are expected so far.
According to the survey, the majority of visitors
were satisfied with last year’s IDS. Moreover, 78 per
cent of the German and 81 per cent of the foreign
trade visitors rated the product range as good to
very good._
I
All images courtesy of Koelnmesse GmbH.
According to the organisers, the undisputed
status of the IDS as the world’s leading fair for the
dental industry was also impressively underlined by
the results of an independent exhibitor and visitor
survey of IDS 2011. The event brought together
decision-makers from the dental profession, dental
technicians trade, specialist dental trade and dental
industry from all over the world, which ensured
great satisfaction among the IDS exhibitors. In addition, 97 per cent of the German suppliers reached
their key customers in the domestic market and
83 per cent reached their key accounts from abroad.
Of the foreign exhibitors, as many as 98 per cent
networked with their international customers and
95 per cent with their German customers, according
to the survey. Furthermore, 95 per cent of the German and 98 per cent of the international exhibitors
made new contacts with interested German parties.
CAD/CAM
2_ 2012
I 47
[48] =>
CAD0212_01_Title
CAD0212_48_Events 14.06.12 10:56 Seite 1
I meetings _ events
International Events
2012
IACA Conference
26–28 July 2012
Hollywood, FL, USA
www.theiaca.com
FDI Annual World Dental Congress
29 August–1 September 2012
Hong Kong, China
www.fdiworldental.org
XXI Congress of the European Association
for Cranio-Maxillo-Facial Surgery
11−15 September 2012
Dubrovnik, Croatia
www.eurofaces.com
AAID Annual Meeting
3–6 October 2012
Washington, DC, USA
www.aaid-implant.org
CAD/CAM & Computerized Dentistry
International Conference
6 & 7 October 2012
Singapore
www.cappmea.com
EAO
10–13 October 2012
Copenhagen, Denmark
www.eao.org/eao-congress
SA Society of Maxillofacial Oral Surgery
11–14 October 2012
Cape Town, South Africa
www.sasmfos.org
Nobel Biocare Symposium 2012
19 & 20 October 2012
Toronto, Canada
www.nobelbiocare.com
Nobel Biocare Symposium 2012
19 & 20 October 2012
Rimini, Italy
www.nobelbiocare.com
AAMP (joint meeting with ISMR)
27–30 October 2012
Baltimore, MD, USA
www.res-inc.com/AAMP-ISMR-Meeting/
National Osteology Symposium Brazil
8–10 November 2012
São Paulo, Brazil
www.osteology.org
Greater New York Dental Meeting
23–28 November 2012
New York, NY, USA
48 I CAD/CAM
2_ 2012
[49] =>
CAD0212_01_Title
CAD0212_49_Submission 14.06.12 10:41 Seite 1
about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:
In addition, images must not be embedded into the MS Word
document. All images must be submitted separately, and details
about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from 1,500 to 5,500 words—
depending on the subject matter. Our approach is that if you
need more or less words to do the topic justice, then please make
the article as long or as short as necessary.
We can run an unusually long article in multiple parts, but this
usually entails a topic for which each part can stand alone because it contains so much information.
In short, we do not want to limit you in terms of article length,
so please use the word count above as a general guideline and if
you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
use of italics and boldface. If you would like to emphasise certain
words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers.
Please do not use underlining.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line between paragraphs. Please do
not add tab stops.
_We require images in TIF or JPEG format.
_These images must be no smaller than 6 x 6 cm in size at 300 DPI.
_These image files must be no smaller than 80 KB in size (or they
will print the size of a postage stamp!).
Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available.)
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
your article.
Abstracts
An abstract of your article is not required.
Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
or less).
Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
CAD/CAM
2_ 2012
I 49
[50] =>
CAD0212_01_Title
CAD0212_50_Impressum 14.06.12 10:51 Seite 1
I about the publisher _ imprint
CAD/CAM
digital dentistry
international magazine of
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
International Media Sales
Matthias Diessner
m.diessner@dental-tribune.com
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Europe
Vera Baptist
v.baptist@dental-tribune.com
Product Manager
Vera Baptist
v.baptist@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
Franziska Dachsel
f.dachsel@dental-tribune.com
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Marketing & Sales
Nadine Parczyk
n.parczyk@dental-tribune.com
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
Editorial Board
Prof Albert Mehl, Switzerland
Prof Gerwin Arnetzl, Austria
Dr Stefan Holst, Germany
Hans Geiselhöringer, Germany
Dr Ansgar Cheng, Singapore
Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
The Americas
Jan M. Agostaro
j.agostaro@dental-tribune.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Nadine Parczyk
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
www.dental-tribune.com
Copyright Regulations
_CAD/CAM international magazine of digital dentistry is published by Dental Tribune Asia Pacific Ltd. and will appear in 2012 with four issues. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I CAD/CAM
2_ 2012
[51] =>
CAD0212_01_Title
Technology designed the way you work
Great new features
Dental System™ 2012 - the future proof solution
Model Builder
Create lab models directly from
TRIOS® and 3rd party intraoral
scans. Support for implant models.
TRIOS ® integration
Receive TRIOS ® digital impressions instantly from
dentists and start designing right away.
3Shape Communicate™
Upload 3D design visualizations with a single click.
Share and discuss your cases with dentists.
2nd Generation Removable Partial Design
Intuitively mimics the familiar workƃow while
signiƂcantly reducing production time.
Digital Temporaries
Create cost-effective temporaries without pouring
a model using Virtual Preparation and Virtual
Gingiva.
D800 3D scanner
Two 5.0 MP cameras. Scans a single-die in 25
seconds, captures texture and scans impressions.
Backing our users with technology, care and expertise
New Dynamic Virtual Articulation
Next Generation Telescopes
Like using your physical articulator.
Support for Occlusion Compass. KaVo
PROTAR®evo, Whip Mix Denar ® Mark
330, SAM® 2P, Artex® compatible and
more to come.
Full freedom for designing telescopic crowns. Support for attachment
crowns and open telescopes. Add
multiple bands, parametric attachments, and customized attachments.
Scan the QR code
& sign up for our newsletter
[52] =>
CAD0212_01_Title
®
Planmeca ProMax 3D
Unique product family
Perfect sizes for all needs
3D X-ray • 3D photo • panoramic • cephalometric
Romexis® software completes 3D perfection
Scan™ ProMax®
Plan bination for op 3D Pr
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en C oFa
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AD ce
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3
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Ro iqu
M
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U
More information
www.planmeca.com
Planmeca Oy
Asentajankatu 6, 00880 Helsinki, Finland
tel. +358 20 7795 500, fax +358 20 7795 555
sales@planmeca.com
)
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/ Editorial
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/ New concepts in computer-guided implantology
/ CBCT-assisted implant therapy: A case study
/ Implantology—the perfect art of camouflage thanks to CAD/CAM
/ EAO publishes new guidelines on safe exposure to X-rays for dental implant patients
/ “Digital technology is becoming essential”; An interview with Dr Dobrina Mollova - Managing Director of CAPP
/ CBCT in orthodontics
/ Space management in adults using CAD/CAM aligners— Three case reports
/ Doctors implant first customised 3-D printed mandible
/ New Planmeca ProMax 3D ProFace system enables safer and faster facial surgeries
/ Industry News
/ Announce your courses in CAD/CAM!
/ 4th International CAMLOG Congress
/ IDS 2013: Organisers expect successful exhibition
/ International Events
/ Submission Guidelines
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