CAD/CAM international No. 4, 2012
Cover
/ Editorial
/ Content
/ Clinical and diagnostics advantages of PreXion 3-D imaging system
/ Prevention of failures in oral implantology
/ Use of CBCT in implant dentistry should follow justification and optimisation
/ Traditional imaging will not disappear with CBCT
/ Early childhood anterior tooth trauma
/ CAD/CAMpatient-specific abutments and a new implant design
/ The importance of occlusion
/ Computer-aided crown design—Fabrication of CAD/CAM crowns chairside
/ Industry News
/ CAD/CAM course calender
/ Meetings
/ Submission guidelines
/ Imprint
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CAD0412_01_Title
CAD0412_01_Title 12.12.12 09:27 Seite 1
issn 1616-7390
Vol. 3 • Issue 4/2012
CAD/CAM
digital dentistr y
international magazine of
4
2012
| CE article
Clinical and diagnostics advantages of
PreXion 3-D imaging system
| opinion
Prevention of failures in oral implantology
| case report
CAD/CAM patient-specific abutments
and a new implant design
[2] =>
CAD0412_01_Title
Nobel Biocare
Global Symposium 2013 – New York
JUNE 20–23, WALDORF ASTORIA NEW YORK
REGIST
ER
NOW
nobelb
Gain insight how to treat
more patients better
ioc are.c
om
Experience the best in
implant dentistry
Learn from over 100 worldrenowned leaders
Enjoy the fascinating
city of New York
Designing for Life: Today and in the future. Join the leading
experts in implant dentistry at the event not to be missed in 2013.
This exciting four-day Nobel Biocare Global Symposium 2013 in
New York is your number one opportunity to gain the full 360degree perspective on how you can treat more patients better.
Benefit from an innovative and insightful program format designed
to maximize your learning experience. Update yourself on the
key factors for successful oral rehabilitation such as diagnostics
and treatment planning, surgical and restorative treatments and
patient follow-up. Understand how to effectively restore missing
single teeth, multiple teeth and edentulous jaws. Learn more
about important clinical themes such as minimally invasive,
graftless solutions, immediate replacement and function, soft
tissue health and esthetics. Find out how you can utilize this
knowledge to achieve even better results. Register now!
nobelbiocare.com/newyork2013
© Nobel Biocare Services AG, 2012. 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.
NYGS13_Ad_V2.2_A4.indd 1
2012-10-19 09:46
[3] =>
CAD0412_01_Title
CAD0412_03_Editorial 12.12.12 16:36 Seite 1
editorial _ CAD/CAM
I
Dear Reader,
_With 2012 drawing to a close, I would like to take a brief look back at the past and
share some thoughts with you.
While it sometimes appears that time flies by at a rapid pace, advancements in dentistry
have truly been rapid. Presumably, the extraordinary progress may not be felt as strongly by
dentists in the former Eastern Bloc countries, such as the Czech Republic, as it is by dentists
in Western Europe or the USA. However, nearly 20 years ago, most of our dental units worked
with pulleys and cables, while the offices were equipped with chairs that did not allow
treatment of a patient in a horizontal position.
Dr Josef Kunkela
President of the Czech Society
of CAD/CAM Dentistry
From a global perspective, dentistry has undergone a series of significant changes.
Not long ago, there was only one company involved in CAD/CAM technology—intra-oral
scanning and milling of dental restorations in particular. Currently, there are nearly 10 intraoral scanners and at least 20 extra-oral laboratory scanners from which to choose. Today’s
dentists can obtain intra-oral images from CBCT devices and we can manufacture implant
guides in-office while the patients wait—all of which was the realm of science fiction until
recently. I am grateful to be experiencing this exciting development.
Therefore, I am not sure that today we can still refer to 3-D technologies in dentistry
as “revolutionary”. In some areas of dentistry, these technologies have already become a
diagnostic tool, or have even established themselves as a standard operating procedure.
That is one of the reasons we decided to build, and in May 2012 opened, the Czech Society of
CAD/CAM Dentistry (CSCD) Training Center. The centre is focused primarily on the practical
education of dentists and dental technicians in the use of CAD/CAM technologies and CBCT.
Inspired by the old Chinese proverb “It’s better to see once than to hear a hundred times”,
we equipped the centre and the operating room with high-definition cameras and audiovisual data channels. This allows the participants to view the live procedures in the classroom
(in the case of large audiences, the entire process can be shown in a nearby 3-D cinema).
In the centre’s training laboratories, every course participant is equipped with his or her own
ready-to-use intra-oral scanner and a phantom head connected to the dental units—because
as dental professionals we all realise that without training and hands-on practice in proper
preparation all advantages of CAD/CAM technologies are meaningless.
I wish you not only a perfect fit for your scans and millings, but also a fulfilling personal
and professional life in the upcoming year. I also sincerely hope to see you at some of the
practical courses in the Czech Republic soon!
With kind regards and best wishes,
Dr Josef Kunkela
President of the Czech Society of CAD/CAM Dentistry
CAD/CAM
4_ 2012
I 03
[4] =>
CAD0412_01_Title
CAD0412_04_Content 12.12.12 16:36 Seite 1
I content _ CAD/CAM
I editorial
03
I industry news
Dear Reader
34
| Dr Josef Kunkela, President of the Czech Society of CAD/CAM Dentistry
| Planmeca
I CE article
06
35
Clinical and diagnostics advantages
of PreXion 3-D imaging system
| Dr Dan McEowen
Prevention of failures in oral implantology
| Dr Dov M. Almog
12
Use of CBCT in implant dentistry should follow
justification and optimisation
| A commentary by Prof. Keith Horner, University of Manchester
36
3Shape introduces CAD Points—
A unique pay-per-design service that opens up
new opportunities for dental labs
| 3Shape
38
Straumann and Align discontinue distribution agreements
for iTero intra-oral scanner
| Institut Straumann
40
I feature
14
CEREC Omnicam: Powder-free 3-D scanning in full colour
| Sirona Dental GmbH
I opinion
10
Planmeca ProMax 3D Mid—An optimal volume size
for every 3-D imaging application
CAMLOG Foundation calls for entries for its
2012/2013 research award
| CAMLOG
Traditional imaging will not disappear with CBCT
I digital platforms
| An interview with Prof. Stefan Haßfeld
41
Course calendar
I case report
I meetings
16
42
Digital dentistry conference draws over 500 to Singapore
44
EAO celebrates successful anniversary event
in Copenhagen
46
Digital developments on show at IDS 2013—
CAD/CAM technology in the spotlight
48
International Events
Early childhood anterior tooth trauma
| Dr Fred Bergmann
22
CAD/CAM patient-specific abutments
and a new implant design
| Prof. Frank Liebaug & Dr Ning Wu
I special
26
issn 1616-7390
The importance of occlusion
I industry report
30
Computer-aided crown design—
Fabrication of CAD/CAM crowns chairside
CAD/CAM
digital dentistry
international magazine of
I about the publisher
| Dr Peter Bausch
Vol. 3 • Issue 4/2012
49
50
| submission guidelines
| imprint
4
2012
| CE article
Clinical and diagnostics advantages of
PreXion 3-D imaging system
| opinion
Prevention of failures in oral implantology
| case report
CAD/CAM patient-specific abutments
and a new implant design
Cover image courtesy of crownceram – www.crownceram.com.
| Dr Andreas Bindl
04 I CAD/CAM
4_ 2012
[5] =>
CAD0412_01_Title
THE WORLD SPEAKS e.max.
*
From left: G. Ubassy, Dental Technician, France | M. Roberts, Dental Technician, USA | M. Temperani, Dental Technician, Italy | D. Hornbrook, Dentist, USA |
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.
UP TO 10 YEARS OF CLINICAL EVIDENCE.
1
2
98.2 % CROWN SURVIVAL RATE.
40 MILLION RESTORATIONS.
1 PROVEN SYSTEM:
IPS e.max
3
* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is now available at:
www.ivoclarvivadent.com/science_e
mic
a
r
e
c
l
al
eed
n
u
o
all y
1
M. Kern et al. “Ten-year results of three-unit bridges made of monolithic lithium disilicate ceramic“;
Journal of the American Dental Association; March 2012; 143(3):234-240.
2
Mean observation period 4 years IPS e.max Press, 2.5 years IPS e.max CAD.
See the IPS e.max Scientific Report Vol. 01 (2001 – 2011).
3
Based on sales.
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
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CAD0412_06-09_McEowen 13.12.12 13:03 Seite 1
I CE article _ application of 3-D imaging
Clinical and diagnostics
advantages of PreXion
3-D imaging system
Author_ Dr Dan McEowen, USA
Fig. 1
Fig. 2
Fig. 1_Saggital CBCT MPR showing
bone defect at point of dehiscence
of the implant coating.
Fig. 2_Periapical does not show the
sinus anatomy or the width of the bone.
Fig. 3_MPR showing post-op
of sinus graft and implant placement.
_ce credit CAD/CAM
By reading this article and then
taking a short online quiz, you
will gain one ADA CERP CE
credit. To take the CE quiz, visit
www.dtstudyclub.com. The quiz
is free for subscribers, who will
be sent an access code. Please
write support@dtstudyclub.com
if you don’t receive it. Non subscribers
may take
the quiz
for a
$20 fee.
06 I CAD/CAM
4_ 2012
_For nearly 100 years, dentists have relied on
2-D radiographic imaging for diagnosis and treatment planning. With the 1999 introduction of conebeam computed tomography (CBCT), all dentists
now have tools available for more accurate diagnosis and treatment.1
The ability to look at a tooth in any direction
and orientation, as well as in 3-D, eliminates much
of the guesswork commonly experienced with 2-D
radiographs.
We have been limited in most cases to only a buccal-lingual view provided by periapicals, bitewings
and panoramic radiographs with the occasional
axial view of an occlusal film. Medical CT scans and
images began in the early 1970s and were sometimes used by dentists, offering our first multiplaner
views.2
The adoption of 3-D cone-beam imaging is appropriate and has important advantages for all
modalities of dentistry. From every specialist to
the general dentist, the increased amount of radiographic information as well as increased accuracy
will aid in the most sound diagnosis possible.
Fig. 3
_CBCT description
CBCT is a single or partial rotation of an X-ray
source around the head, capturing X-rays on various flat panel arrays and sensors. The information
is converted to a series of axial slices by computed
tomography and stored as virtual anatomy in the
computer.
With the use of sophisticated software, the dentist is able to view information in several different
views, including: axial slices (head-to-toe orientation), coronal slices (front-to-back orientation),
saggital slices (side-to-side orientation) all known
as multiplaner reconstructions (MPR). The thickness
of each slice can be varied to include more or less
information.
Because the voxels (volumetric pixels 3-D) are
isotropic, other MPR images can be generated
by slices drawn at any angle, curve or thickness
through the scan to view areas critical to the final
diagnosis.3,8
The final view offered by CBCT is a 3-D view that
can be rotated and viewed in any direction.
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CE article _ application of 3-D imaging
I
Once again through software manipulation, 3-D images can be viewed
as conventional radiographs, maximum intensity projections (MIP), softtissue projections and a variety other
views.
This nearly endless ability to manipulate the data aids in the diagnosis and
identification of disease, nerve canals,
sinus morphology, dental caries, bone
density, fractures, endodontic pathology, implant placement criteria,
periodontal defects, bone pathology,
fractured teeth, iatrogenic trauma, TMJ
morphology and disease, third-molar position and
many more healthy or diseased conditions.
_Early CBCT adoption with implants
The first and primary use of CBCT for early
adopters was implant placement. As the scope and
the value of the information became better known,
dentists of all branches began to see the value of
MPRs and 3-D renderings including periodontics,
endodontics, oral surgery, treatment of TMJ, orthodontics, implantology and general dentistry.1,7,8
Clinical periapical and panoramic radiographs
for the placement of implants can be misleading
with elongation, foreshortening, superimposition
and geometrically incorrect data.7,8 A look at the
implant in the periapical shows no obvious disease
to an existing integrated implant. Clinically, a buccal
fistula was present with exudate and slight pain.
The CBCT scan (Fig. 1) reveals a more accurate view
showing a buccal defect on a saggital MPR. A surgical flap revealed a dehiscence of the coating of the
implant. Removal of the foreign body resulted in an
asymptomatic and healthy patient.
The evaluation of the available bone for the initial implant placement can be crucial for the long-
Fig. 6
Fig. 4
term success of the case. If there is inadequate bone
available, grafting may be a necessity. CBCT studies
render the most accurate information available at a
low radiation dose. The periapical shows an obvious
lack of bone height, but does not show the buccallingual dimensions or an accurate view of the sinus
morphology (Fig. 2).
Fig. 5
Fig. 4_The 3-D CBCT showing
anatomy of the maxillary sinuses.
Fig. 5_Axial MPR showing mesial
buccal roots in first, second
and third molars.
The MPR view of the CBCT shows all necessary
measurements to perform the sinus lift and grafting
with the immediate placement of the implant fixture (Fig. 3). Three-dimensional views show the floor
of the sinus and any soft-tissue pathology (Fig. 4).
Having accurate measurements in all dimensions is
an advantage of CBCT scanning.
_CBCT and endodontics
Endodontics is a field that is rapidly adopting
the use of CBCT and for good reason. The inherent
geometric deficiencies of 2-D radiographs make
the CBCT scan a valuable adjunct to investigate
the root morphology in both 3-D and MPR. The
typical periapical will show superimposed canals
in the anteriors, bicuspids and molars as well as
unwanted bone densities both buccal and lingual
to the affected tooth making the image quality
poor.
Fig. 6_Periapical showing minimal
pathology with no radiolucency.
Fig. 7_Coronal MPR showing
a short fill on the mesial lingual
and radiolucency.
Fig. 8_Saggital MPR showing
unfilled canal and radiolucency.
Fig. 7
Fig. 8
CAD/CAM
4_ 2012
I 07
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I CE article _ application of 3-D imaging
Fig. 9
Fig. 10
Fig. 9_Periapical showing a normal
fill with a radiolucency.
Fig. 10_Coronal MPR showing the
superimposed lingual root unfilled.
Fig. 11_Coronal MPR showing nerve
between roots of the third molar.
The ability to view MPR slices in cross-section,
long axis and oblique directions gives the ability
to follow all canals in any direction and show their
relationship and measurements from other known
structures. This virtual tour of the root morphology
is a great benefit to the final treatment outcome
(Fig. 5).3,4
Post root-canal infection can be difficult to diagnose with the standard periapical. The endodontic fills may appear to be normal even though other
clinical findings and symptoms are abnormal. The
patient presents several months post root-canal
treatment with pain on palpation and pressure and
avoids this side of the mouth.
A periapical radiogragh shows minimal pathology (Fig. 6). The roots appear to be filled and a small
puff of sealer extends through the apex of the mesial
roots. The distal root structure and fill appear normal. There is little indication of periapical radiolucency only a widening of the periodontal ligaments
of the mesial roots.
A CBCT scan reveals a completely different
picture. The coronal MPR reveals a short fill near the
apex of the mesial lingual root and a large radiolucency (Figs. 7 & 8) not visible on the periapical
radiograph (Fig. 6).
Missed canals are difficult to see in a buccallingual projection of the periapical radiograph as
one canal is superimposed on the other (Fig. 9). Often, as viewed in this radiograph, we see periapical
pathology with an apparent normally filled canal.
CBCT scans allow dentists to look for pathology in
MPR planes to identify the actual problem before
invasive procedures are performed on the patient.
The axial view shows a lingual canal exists and is
untreated. The coronal view confirms the diagnosis
and treatment can be completed (Fig. 10).
Today’s endodontists, as well as general dentists,
are benefiting from the diagnostic capabilities of
08 I CAD/CAM
4_ 2012
Fig. 11
the high-resolution CBCT scanners available over
conventional 2-D periapical.5,6
_Oral surgery
Oral surgery, with its inherent invasive nature, can
be better served using CBCT with MPR as well as 3-D
images. The ability to perform virtual surgery is a benefit to both the doctor and the patient. Doctors have
the advantage of seeing morphology and landmarks in
real time and space with accurate measurements, and
patients will gain a better understanding of the problems and the solutions their doctors are offering them.
Third-molar extractions can be risky based on
2-D and panoramic radiographs. These radiographs
can often superimpose nerves and sinuses over root
structures. Dentists using 2-D radiographs must
often rely on experience to assess the risks of iatrogenic trauma. The use of CBCT with MPRs and 3-D
images reduces any guessing as well as the chance
for any permanent damage to the patient. With the
adoption of CBCT, the judgment is based on solid
evidence and the risk will decrease.
A panorex of the superimosed third molars gave
no solid evidence the canal lies between the roots.
It is only with the use of CBCT and the MPRs that
the nerve can accurately be seen traversing between
the mesial buccal and mesial lingual root (Fig. 11).4,5
Other surgical advantages include the identification and the position of supernumerary or impacted
teeth. The images show accurate positions and show
definitive morphology that will aid in removal of the
proper teeth (Fig. 12). Knowing the exact position of
many of these teeth is a benefit to both the doctor
and patient. It will lead to the most precise surgical
path and the least invasive procedure.
_Periodontics
The explanation of periodontal problems are often
misunderstood by the patient. As doctors we talk about
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CE article _ application of 3-D imaging
I
pockets, point to X-rays and propose
treatment only to have patients refuse
treatment because they do not understand what we are clinically describing. Using the 3-D portion of the CBCT
scan can improve the understanding
and acceptance of treatment plans.
The images are a picture of the problem
that is owned by that patient and much
easier to understand by the layperson.
Illustrating periodontal defects and
pockets allows the patient to better
participate in the process (Fig. 13).
Fig. 12
The MPRs and the 3-D projections
aid in surgical planning for periodontists, allowing
for accurate measurements and bone analysis prior
to osseous surgery that doctors cannot get using
the periapicals or panoramics. Studies have shown
that CBCT images are more accurate than panoramic radiographs. For the periodontist placing
implants, the ability to measure bone density and
avoid important anatomy is important.4,5
_Orthodontics
Orthodontists are beginning to adopt large
field-of-view CBCT. Recent studies show that linear
measurements of bony structures are more accurate using CBCT and have less distortion than
currently used methods of measurement: lateral
cephalometric, posteroanterior (PA) and submentovertex (SMVT).5 Accurate measurements of tooth
volume and tooth position can aid in accelerated
treatment times and more precise treatment.
Along with tooth position, density of bone and size
of arches, the orthodontist also has an accurate evaluation of the temporomandibular joint and position
of the condyles. Impacted teeth are easily identified
and position either buccal or lingual can be confirmed
prior to movement or removal. Both MPRs and 3-D
projections give the clinician a complete picture of
the problems and the treatment course.
With a single CBCT scan, orthodontists can produce all of the information they need: panoramic,
cephalametric, PA, SMVT, tooth size and volume,
crowding evaluation in any plane, TMJ evaluation
and airway analysis, all with both soft-tissue and
skeletal information.5,7
_Conclusion
We treat our patients in 3-D, and now, with
conebeam computed tomography, we are changing
the way we diagnose from 2-D to 3-D. The addition
of this technology will increase your diagnostic
Fig. 13
skills with better and more complete information
at your disposal. As with any type of invasive diagnostic tool, clinicians should weigh the risk to benefit in using CBCT scans.
Fig. 12_The 3-D rendering showing
supernumary teeth and positions.
Fig. 13_The 3-D Rendering
with periodontal defects
and calculusbridge.
Judicious use of CBCT and knowledge of patient’s
lifetime doses should always be a consideration as well
as the availability of other diagnostic tests appropriate for the problems of the patient. When adopting
new technology, training is paramount. Along with
training comes the responsibility of the doctor to read
and diagnose information from CBCT scans.
Do not avoid CBCT from lack of knowledge; instead, take this opportunity to become a better diagnostician and radiologist. As you review radiology
and pathology, your use of CBCT will aid in making
the most accurate diagnosis and the most complete
treatment plans._
Editorial Note: A complete list of references is available
from the publisher.
_about the author
CAD/CAM
Dr Dan McEowen
is a 1982 graduate of Loma
Linda School of Dentistry and
has been in private practice
for 26 years. He is a founding
member of the World Clinical
Laser Institute, achieving a
mastership level of proficiency.
He has been active in FDA approval of oral surgery
techniques using Erbium lasers. McEowen has
lectured and trained internationally in techniques
using lasers in general and specialty dental fields.
He a member of the ICOI and is active in implantology.
McEowen has been involved in cone-beam
technology for more than five years and owns
3D Imaging Center in Maryland.
CAD/CAM
4_ 2012
I 09
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CAD0412_01_Title
CAD0412_10-11_Almog 12.12.12 16:37 Seite 1
I opinion_ use of CBCT
Prevention of failures
in oral implantology
Author_ Dr Dov M. Almog, USA
Fig. 1_Implant fracture.
Fig. 2_Impingement
on adjacent tooth.
Fig. 1
Fig. 3_Perforation
of the lingual undercut.
_Intra-oral and panoramic images are not
3-D and clinicians can obtain only vague measurements from them owing to magnification
changes due to positioning. In addition, they are
not efficient for viewing certain pathologies. In
response to these limitations, CBCT 3-D imaging
Fig. 2
technologies were developed. CBCT 3-D captures
a volume of data and, through a reconstruction
process, it delivers images that do not contain
magnification, distortion and/or overlapping
anatomy.
In recent years, CBCT 3-D has begun to make
significant inroads into every discipline in our
dental profession, expanding the horizons of
clinical dental practice by adding a third dimension to cranio-facial treatment planning. CBCT
uses advanced 3-D technology to provide the
most complete anatomical information on a
patient’s mouth, face and jaws areas, leading to
enhanced treatment planning and predictable
treatment outcomes.
Essentially, this represents a paradigm shift,
where measurements and anatomical relationships are precise and provide practitioners with a
clear understanding of their patients’ anatomical
relationships. According to dental practitioners
using this technology, it helps them perform
treatment more efficiently.
Fig. 3
10 I CAD/CAM
4_ 2012
Regarding oral implantology, it is estimated
that growth in implant-based dental reconstruc-
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CAD0412_01_Title
CAD0412_10-11_Almog 12.12.12 16:37 Seite 2
opinion_ use of CBCT
I
Fig. 4
tion products will outstrip all other areas of
dentistry, according to Kalorama Information.1
The traditional method of replacing a tooth with
a dental bridge has been shown to be problematic, and more permanent solutions are urgently
needed.
With a rapidly ageing population in the developed world and the resulting enormous need for
dental restoration, a large number of companies
have seen the opportunity to adopt these sophisticated dental techniques. And indeed, as some
have predicted, the growth in dental implantbased procedures has increased considerably in
recent years.
As a result, there has been a rapid increase in
the number of practitioners involved in implant
placement, including specialists and generalists,
with different levels of expertise. At the same
time, a number of unusual complications associated with these procedures have arisen.
A literature and web search revealed several
published reports of such complications, which
include implant fractures (Fig. 1), impingement
on adjacent teeth (Fig. 2), perforation of the lingual undercut (Fig. 3), sinus perforations (Fig. 4)
and implants displaced into the maxillary sinus
(Fig. 5).
The clinical management associated with
some of these complications is difficult at times
and considered very invasive. Therefore, while
the quantitative relationship between successful
outcomes in dental implant treatment and CBCTbased dental imaging is unknown and awaits
discovery through large prospective clinical trials,
I strongly believe that using CBCT- and 3-D-based
dental imaging is becoming a reliable procedure
from a precautionary standpoint based on a series
of recent preliminary clinical studies and case
reports.
Fig. 5
I also strongly believe that by taking 3-D CBCT
images prior to placing dental implants, many
of the above-mentioned complications can be
circumvented._
Fig. 4_Left sinus perforation.
Fig. 5_Implants displaced
into the maxillary sinus.
Editorial note: Dr Almog’s presentation, Introduction to
CBCT, especially as it pertains to prevention of failures
in oral implantology, at the Dental Tribune Study Club
Symposia at Greater New York Dental Meeting 2010 is
available online at www.DTStudyClub.com.
_Reference
1. Kalorama Information, “Implant-based dental reconstruction: The worldwide implant and bone graft market”,
2007 www.kaloramainformation.com/pub/1099235.html,
accessed 6 June 2011.
_about the author
CAD/CAM
Dr Dov Almog is a
prosthodontist with more than
30 years of diversified
professional experience in
clinical, academic and
research environments. His
publications include articles on
CBCT, dental implants, carotid
artery calcifications and practice management.
In 2003, in acknowledgment of his research on
incidental findings of carotid artery calcifications
on panoramic radiographs, he received the Arthur
H. Wuehrmann Award from the American Academy
of Oral and Maxillofacial Radiology. Dr Almog
currently serves as chief of the dental service
for the VA New Jersey Health Care System
of the US Department of Veterans Affairs.
CAD/CAM
4_ 2012
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CAD0412_01_Title
CAD0412_12_Horner 12.12.12 16:37 Seite 1
I opinion _ use of CBCT
Use of CBCT in implant dentistry
should follow justification and optimisation
Author_ Dental Tribune International
Prof. Horner addressing the audience
of a EAO pre-congress course
on CBCT in implant practice.
(DTI/Photo Daniel Zimmermann, DTI)
The European Association for Osseointegration (EAO) recently
updated its guidelines
for the use of diagnostic
imaging in implant
dentistry, which now
include cone-beam
computed tomography
(CBCT) and are supposed to address the
As Low As is Reasonably
Achievable principle as
well as to optimise both
conventional radiography and new procedures. A commentary by
Prof. Keith Horner, University of Manchester, UK.
_CBCT is the most significant development in
dental imaging during the last 25 years. It brings
cross-sectional imaging into the dental practice
and has obvious uses in implant dentistry. Concerns
have been raised, however, over the radiation doses,
which are usually higher than those of conventional
dental radiography.
When the word “radiation” is used, alarm bells
ring for everyone. One of the most common questions asked by dentists is how the dose of one X-ray
examination (e.g. a panoramic radiograph) relates
to another (e.g. CBCT). This is almost impossible to
answer because there is a wide range of possible
doses from any type of X-ray examination, reflecting differences in equipment, the image receptor,
the field of view and so on. Recent reviews indicate
that doses from CBCT are typically an order of magnitude greater than those from conventional dental
radiography. The health risks from such exposures
are also proportionately higher; although we can
perhaps console ourselves by remembering that
risk falls with patient age, and that many implant
patients are in the older age groups.
The foundations of radiation protection of patients are justification and optimisation. Justification
embodies the principle that all exposure to X-rays
should give a positive net benefit to the patient.
12 I CAD/CAM
4_ 2012
It is implicit within this that the X-ray imaging
strategy should be “prescribed” for each patient
and therefore that no imaging should be performed
until a history and clinical examination have been
performed. Referral criteria are an essential aid to
the justification process, being clinical guidelines
based on, at best, a solid body of evidence or, where
the evidence is lacking, consensus. Optimisation is
the principle that all exposure should be as low as
reasonably achievable. As radiation exposure factors are reduced, image quality will fall, but lowering exposure to a point at which image quality is still
adequate is an important strategy, as well as cutting
down the size of the field of view.
So, where do we go from here? CBCT is a great
technological advance, but that does not mean we
must use it if a conventional radiograph, or good
clinical examination, would be sufficient. We have
to recognise that regulatory authorities dealing
with radiation in Europe are aware of CBCT in dental
practices and are keeping a watchful eye on how we
use this technology. The best way for us to demonstrate that we are appropriate users of CBCT is to
follow the principles of justification and optimisation—and to show that we follow them. This means
only using CBCT when it is going to answer a question that cannot be answered by other methods
involving less, or no radiation.
When we use CBCT, we should never just
“press the button” using a standard exposure for
everyone, but we should adjust the exposure factors to a level that gives adequate image quality
and use the smallest appropriate field of view. These
simple steps will reassure our patients that we have
their best interests at heart; that is what we really
want—isn’t it?_
_about the author
CAD/CAM
Keith Horner is Professor of Oral and Maxillofacial
Imaging at the University of Manchester’s School
of Dentistry. He was also a contributor to the latest
revision of the EAO’s guidelines for the use
of diagnostic imaging in implant dentistry.
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CAD0412_01_Title
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CAD0412_01_Title
CAD0412_14_Hassfeld 12.12.12 16:37 Seite 1
I feature _ interview
Traditional imaging will
not disappear with CBCT
An interview with Prof. Stefan Haßfeld, Germany
_The ability to examine the craniofacial
anatomy with help of three-dimensional images
obtained through Cone Beam Computerized
Tomography (CBCT) has been praised as the new
gold standard in oral surgery. CAD/CAM recently
had the opportunity to speak with Prof. Stefan
Haßfeld from the University of Dortmund’s Department of Oral and Cranio-Maxillofacial Surgery
in Germany about the technology and its future
potential at the FDI Annual World Dental Congress
in Hong Kong.
Prof. Stefan Haßfeld
_CAD/CAM: Prof. Haßfeld, in your opinion,
has CBCT become a standard in dentistry?
Prof. Stefan Haßfeld: CBCT has been available
in dentistry for over a decade and since then has
been established as a standard for many indications.
Despite this development, I doubt that the technology will make traditional imaging obsolete any
time soon. Instead, it will be used as an aid in more
complex treatments.
_One of the areas in which CBCT is used is implant treatment planning. What are the other main
areas of application?
Nowadays, the technology is widely used in
complex oral and maxillofacial surgery procedures.
For example, we regularly examine large cysts and
deeply impacted third molars with CBCT.
“In many cases, we expect a significant
reduction in operative risks and an
improvement in surgical planning.”
Its use can also be of benefit for the diagnosis of
maxillary sinus diseases, as well as in traumatology
or the correction of anomalies and dysgnathias.
_What potential does the technology offer regarding the improvement of treatment outcomes?
In contrast to traditional imaging, CBCT allows
the human autonomy and pathology to be assessed
14 I CAD/CAM
4_ 2012
in detail in 3-D space. This can be extremely helpful
for treatment planning and the assessment of regions that present a surgical risk, like adjacent
nerves, teeth or blood vessels. In many cases, we
expect a significant reduction in operative risks and
an improvement in surgical planning.
_According to the industry, the radiation dose
for patients is significantly lower with CBCT. Do you
agree with this statement?
I would have to disagree, since compared with
traditional imaging, CBCT usually has a higher radiation dose. However, it also yields completely
different information. By taking a high number of
single images from different angles, CBCT can provide lower radiation doses only in a few exceptional
cases.
_Is this the only drawback compared with traditional imaging techniques?
As CBCT has another field of indications, comparison with traditional imaging techniques is not
appropriate. However, there are indeed some shortcomings, like higher radiation doses and costs, as
well as a lower resolution compared with dental
film.
_What role will CBCT play in dental practices in
the future?
CBCT will take root in dental practices, particularly in those with emphasis on surgery, when it
comes to certain complex treatment issues. For all
the mentioned reasons, traditional imaging methods will not disappear.
A panoramic X-ray image, for example, provides
an excellent overview of the entire jaw arch for
clinically oriented examinations, with only little
effort and at a small radiation dose. Dental film
still offers the highest resolution for viewing details. Rather, the establishment of CBCT for dental
imaging offers us additional options for daily
practice.
_Thank you very much for this interview.
[15] =>
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[16] =>
CAD0412_01_Title
CAD0412_16-20_Bergmann 12.12.12 16:38 Seite 1
I case report _ implant prosthetic restoration
Early childhood
anterior tooth trauma
Implant-prosthetic restoration with a XiVE implant following
piezoelectric bone splitting and bone grafting
Author_ Dr Fred Bergmann, Germany
Due to its cancellous bone structure, the
maxilla does not offer optimal conditions for
the primary and long-term stability of implants.
The maxillary sinus is a further factor that makes
the planning and insertion of implants in the posterior region of the maxilla difficult and requires
extensive pre-implantation measures to prepare
the implant site.
Fig. 1
Fig. 1_Along with the natural,
healthy dentition, the initial dental
orthopantomogram shows the
orthodontic brackets and archwires
in the maxilla and mandible.
Fig. 2_In the transverse DVT view,
a XiVE implant was virtually inserted
in the optimal implant position.
The buccal lamella fell short
of the necessary layer thickness
of 1 to 1.5 mm.
Fig. 3_The route of the nasopalatine
nerve can be estimated
on the axial view of the 3-D image.
16 I CAD/CAM
4_ 2012
_Introduction
Being able to replace missing teeth by means
of implants has opened up new opportunities in
patient care and revolutionised the field of prosthetic rehabilitation. Progress in implant design
and in surgical technique has increased the predictability of the treatment results and the survival rates of implants and implant-supported
prostheses. In the maxilla, however, owing to the
anatomical conditions, implant therapy currently
has its limits.
Fig. 2
Fig. 3
From an aesthetic perspective, implant treatment in the maxillary anterior region is a challenge for dentists. The smallest error in the positioning of the implant or improper handling of
the peri-implant hard and soft tissue can lead to
an irreversible cosmetic failure. Single-tooth implants in particular require all of the dentist’s
skills. In patients with a thin biotype, the visibility
of the abutment through the thin gingiva presents a common problem.
Post-operative recession, resulting in parts
of the implant becoming visible, is also common. Such recession generally occurs when a too
large implant diameter has been selected or the
implant has been positioned too close to the
vestibular surface.
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case report _ implant prosthetic restoration
Insufficient hard and soft tissue may eventually lead to the implant restoration not integrating aesthetically with the existing dentition.
Often, a reconstruction of the interdental papilla
is not possible, and the contour of the marginal
gingiva cannot be shaped harmoniously. A high
smile line does not allow any compromises at all
in soft-tissue aesthetics, since the colour and
contour of the peri-implant mucosa must correspond to the soft tissue in the region of the
neighbouring natural teeth. Careful planning,
considering all relevant clinical and patientrelated parameters, is therefore very important
for achieving a predictable and aesthetically
satisfactory treatment result in the implant restoration of a single tooth.
In a single-tooth replacement in the maxilla
following traumatic anterior tooth loss, the practitioner faces the problem of a reduced amount of
hard and soft tissue. Frequently, portions of the
bony alveolar ridge near the tooth have been lost
owing to trauma or natural resorption processes.
Careful selection of the grafting technique and
implants with an osteoconductive surface makes
treatment success predictable in terms of implant
stability and aesthetics. Along with free connective-tissue grafts and guided bone regeneration
using autogenous or xenogeneic bone materials,
piezoelectric bone splitting or bone spreading
techniques can be used for reconstruction.
Piezosurgery has been established as a successful technique in a variety of dental disciplines
over the last ten years. Thanks to the adjustable
ultrasound working frequency, different tissue
types can be treated selectively without the risk
of injury. With its narrow 60 to 200 µm width,
the frictionless and vibration-free sectioning falls
significantly below the incision width produced
by using conventional instruments.
Today, bone splitting is considered to be a safe
and simple method for the expansion of bone
tissue. In a systematic review, success rates of
95 to 100 per cent were reported using this technique in combination with a single- or two-stage
approach.
The final consideration in planning is the selection of the appropriate implant type: healing
and osseous integration are markedly dependent
on the chemical composition, loading, roughness and the morphology of the surface of
the implant. Thanks to its good bone–implant
interface characteristics and the associated increased primary stability, the XiVE implant system
I
Fig. 4
Fig. 5
Fig. 6
Fig. 7
(DENTSPLY Implants) can also be placed securely
and predictably into bone where the site is weak
and into areas of low bone density. Long-term
results demonstrate a high survival rate for XiVE
implants, which can be traced back to the macroand micro-design of the implant system.
_Case report
Anamnesis
A 23-year-old, healthy patient presented at
the practice requesting the replacement of tooth
#21. The tooth had already been endodontically
restored following an anterior tooth trauma in
the patient's childhood. Despite multiple revisions, the apical periodontitis had not healed. The
tooth had been extracted and, as a result, there
was severe bone resorption. The gap was initially
restored with an interim prosthesis. Orthodontic
treatment followed some years after the extraction, during which the gap in region #21 also had
to be widened for the implant restoration.
Fig. 4_The mucoperiosteal flap
was prepared and raised.
The periosteum was carefully
detached from the bone
in this process.
Fig. 5_At the implant site, the mark
placed using a round drill was
enlarged with a pilot hole and
prepared using the Piezotome,
with two short vestibular incisions
and a long horizontal incision
at a 90 degree angle.
Fig. 6_The alveolar bone was
gradually expanded horizontally.
Fig. 7_The implant site was prepared
with the XiVE twist drill.
Clinically and radiologically, a caries- and filling-free dentition was evident, with orthodontic brackets and archwires in the maxilla and
mandible. There was evidence of severe buccal
resorption of the alveolar process in region #21
(Fig. 1).
3-D radiological analysis
A 3-D analysis of the bony structures and the
position of the nerve and the vascular bundles
was performed for the treatment planning. Threedimensional assessment plays a central role in the
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I case report _ CAD crown design
1.5 mm necessary for the long-term retention of
the implant (Fig. 2). Since this is indispensable
for uneventful healing and an aesthetic result, the
bone splitting was to be performed to a depth of
7 to 10 mm. The 3-D image demonstrated that
the bone volume was adequate for this procedure.
In addition to the bone splitting, a final lateral
onlay graft had to be performed.
Fig. 8
Fig. 9
The axial view of the 3-D image is well suited
to estimating the position of the nasopalatine
nerve (Fig. 3). The position of the nerve is a limiting factor for the implant position in the palatal
direction. The risk of a fracture of the buccal
lamella or of damage to the nerve, however, is
small when the correct procedure is used.
Surgical procedure
Fig. 10
Fig. 11
Fig. 8_Finally, the crestal bone
preparation was carried out.
Fig. 9_The XiVE S plus implant was
mechanically inserted at a slow
rotational speed.
Fig. 10_After filling the defect
with autogenous bone chips,
a stable-volume alloplastic
bone-grafting material was placed
over the bone chips as a second
layer, and a resorbable collagen
membrane was fixed to the bone
with two FRIOS membrane tacks.
Fig. 11_A double-layered wound
closure was performed using
resorbable suture material.
Fig. 12_The radiological control
demonstrates that the XiVE implant
in region #21 was positioned nearer
to tooth #22 than to tooth #11
owing to the location
of the nasopalatine nerve.
planning of the treatment steps and the predictability of the post-operative result.
The surgical procedure was determined on the
basis of the digital volume tomogram (DVT). The
central issue was the optimal method of reconstructing the resorbed bone.
Since the horizontal bone volume was adequate,
spreading the alveolar ridge by means of bone
splitting in combination with implant placement
and guided bone regeneration was the treatment of
choice. The anatomy of the patient’s alveolar ridge
and his bone quality confirmed the decision to use
the XiVE implant, as its unique surface promotes
the stable attachment of osteogenic cells and
its apically increasing thread depth contributes to
a high degree of primary stability. In the DVT transverse view, a XiVE implant with a diameter of
3.8 mm and a length of 13 mm was virtually placed
using the software in the optimal implant position.
It was established that the buccal lamella would
have fallen short of the layer thickness of 1 to
The mucoperiosteal flap was prepared and
raised for the purposes of a full thickness flap.
The periosteum was carefully detached from the
bone (Fig. 4). Following the completion of the
implant placement, the sutures should be located
approximately over the split bone with the inserted implant. The alveolar crest at the planned
implant site was initially marked using a round
drill and then enlarged with a pilot drill.
In the next step, two small vestibular incisions
and a horizontal incision to a depth of 10 mm and
at an angle of 90 degrees were done using the
Piezotome (Acteon; Fig. 5). The two relatively deep
(5 to 7 mm) vertical incisions prevent a fracture
of the buccal lamella, improve its mobility and
protect the marginal periodontium of the adjacent teeth. The alveolar bone was then gradually
expanded horizontally using the appropriate instruments (Fig. 6). In the process, the bone was
also condensed horizontally at the same time by
compression to improve the primary stability of
the implant. Using a twist drill, the bone for the
implant site was prepared gradually (Fig. 7).
The bone chips were removed simultaneously
via the grooves in the twist drill to where they could
be collected extra-orally. The implant site was prepared at low speed in order to avoid overheating the
tissue. The vestibular lamella was stabilised by the
apically pedicled flap on the periosteum and fixed.
After the final drilling, the actual preparation of
the implant site was complete. The bone-specific
crestal preparation of the cavity was then carried
out using the crestal twist drill to adapt the preparation to the clinical situation (Fig. 8).
In the next step, a XiVE S plus implant with
a diameter of 3.8 mm and a length of 13 mm was
Fig. 12
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case report _ implant prosthetic restoration
I
mechanically inserted at a slow rotational speed
(Fig. 9). In the process, the XiVE implant thread
grips the bone palatally, while the labial lamella is
not traumatised. The implant was sealed against
saliva and bacteria using a colour-coded cover
screw in preparation for the submerged healing
phase.
The gaps in the implant site were then filled
using the autogenous bone chips collected during
the drilling process. In order to compensate for
the resorption of the autogenous bone, a stablevolume alloplastic bone-grafting material was
placed over the bone chips as a second layer.
The raspatory was placed in front of the nasopalatine nerve to protect it, as there is only a
thin bone lamella between the nerve and the
mucosa. A resorbable collagen membrane was
then placed over the augmented area and fixed
to the bone with two titanium nails (FRIOS membrane tacks, DENTSPLY Implants). In this way,
the mucoperiosteal flap prevented shifting of the
membrane.
A double-layered wound closure was performed in order to prevent dehiscence. First,
a resorbable suture (4.0) was used to attach the
periosteum to the periosteum (Fig. 11). Then the
mucosa was passively fixed with two over-andover sutures. The radiological control shows that
the XiVE implant in region #21 was positioned
nearer to tooth #22 than to tooth #11 (Fig. 12).
This distal position is typically due to the location
of the nasopalatine nerve and is unavoidable.
Uncovering and soft-tissue management
Three months post-implant placement, the
vestibular gingiva showed no signs of inflammation (Fig. 13). Measures to improve the soft-tissue
volume by extension in the aesthetic zone were
planned. The XiVE implant was uncovered (Fig. 14)
and the cover screw was replaced by a Friadent
gingiva former for this purpose (Fig. 15).
Fig. 17
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fabrication of the temporary restoration using
CAD/CAM technology in the dental laboratory
After a brief healing phase of ten days, the
patient was recalled for the actual temporary
restoration. A suitable impression coping for
transfer technique with a TransferCap was inserted into the implant for impression taking
using a polyether material (Fig. 16).
The cast model of the maxilla subsequently
fabricated in plaster was then scanned in. An
individual abutment was virtually created with
the aid of the ScanBase, which displays the scanable counterpart to the TitaniumBase (DENTSPLY
Implants; Fig. 17). The resulting construction data
was transmitted to the milling machine, where
the abutment was milled from a lithium disilicate block (Fig. 18). The finished abutment was
then cemented to the TitaniumBase. After completion, the precise position for the intra-oral
insertion was reproduced on the master cast
using a transfer key made from Pattern Resin
Fig. 18
Fig. 13_Three months post-implant
placement, the gingiva showed
no signs of inflammation.
Fig. 14_The XiVE implant
was uncovered.
Fig. 15_To improve the soft-tissue
volume in the aesthetic zone,
the cover screw was replaced
by a Friadent gingiva former.
Fig. 16_Friadent transfer post
with a suitable TransferCap in situ
prior to impression taking.
Fig. 17_Virtually created
individual abutment.
Fig. 18_The abutment was milled
from a lithium disilicate block
on the basis of the construction data.
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I case report _ implant prosthetic restoration
Fig. 20
Fig. 19
Fig. 19_The precise position of the
TitaniumBase, which was cemented
to the customised abutment, was
reproduced by means of a transfer key.
Fig. 20_The temporary crown was
virtually designed using the software
and milled from a lithium
disilicate block.
Fig. 21_The finished,
highly polished crown.
Fig. 22
(GC; Fig. 19). In the next step, the fully anatomical
provisional crown was designed using the software and milled from a lithium disilicate block
(Fig. 20). After completion, it was polished to
a high gloss (Fig. 21).
Placement of the temporary crown
Subsequently, the mucosa healed around the
gingiva former and exhibited a homogeneous,
Fig. 23
Fig. 22_The healed peri-implant
soft tissue.
Fig. 23_The crown, inserted
with the aid of the transfer key and
temporarily attached using cement.
Fig. 24_When the mouth was open,
the length of the incisal edge
conformed to the functional,
aesthetic and phonetic requirements.
Fig. 25_The final radiological control
shows a well-osseointegrated
implant, along with the radiopaque
TitaniumBase and superstructure.
Fig. 21
4_ 2012
The method of implant placement and a grafting procedure with bone splitting in a single
session described here presents a realistic alternative to conventional grafting of hard and soft
tissue in the aesthetic region. The prerequisite is
an adequate horizontal and vertical bone volume,
in order to make the deep incisions necessary
to mobilise the buccal lamella. The removal of
Fig. 24
inflammation-free structure (Fig. 22). Prior to the
screwing of the TitaniumBase abutment into the
XiVE implant, the screw channel was cleaned with
chlorhexidine then dried and the peri-implant
mucosa was cleansed.
The precise intra-oral position of the abutment
was checked using the resin transfer key. Following this, the optimal position for the temporary
crown was also determined by means of the key
and the crown was temporarily attached using
cement (Fig. 23).
Fig. 25
bone blocks from additional surgical sites can be
dispensed with for the patient.
The XiVE implant, which also guarantees primary
stability in weak bone, with its unique, osseointegration-promoting surface and its compressive
apical section, made the implant placement in this
complicated case predictable, safe and successful._
Editorial note: A complete list of references is available
from the author.
_contact
The facial view of the opened mouth and the
length of the incisal edge conformed to the
functional, aesthetic and phonetic requirements
(Fig. 24). A well-osseointegrated implant was evident, along with the radiopaque TitaniumBase
and superstructure in the final radiologic control
(Fig. 25). As the patient was very pleased and as
a stable material, lithium disilicate, had been used
for the temporary restoration, the patient initially
did not want a final restoration.
20 I CAD/CAM
_Conclusion
CAD/CAM
Dr Fred Bergmann
and Partners Dental Practice
Heidelbergerstr. 5–7
68519 Viernheim
Germany
FredBergmann@oralchirurgie.com
www.oralchirurgie.com
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I case report _ patient-specific abutments
CAD/CAM patient-specific
abutments and a new implant design
Authors_Prof. Frank Liebaug & Dr Ning Wu, Germany
_Introduction
Fig. 1_Maxillary anterior gap
in regions 12, 11, 21 and 22
(Kennedy Class IV), four months
after implant insertion.
Fig. 2_Occlusal view of the maxilla
with an interdental gap
between teeth #13 and 23.
Fig. 3_Implant exposure
four months post-op.
The objective of any dental reconstruction is the
natural, functional reconstruction of the stomatognathic system and the functionally unimpaired or
functionally treated masticatory organ. This objective can only be achieved if individual patient parameters and distinctive anatomical features are incorporated into surgical planning and the subsequent
prosthetic restoration.
Implant-prosthetic care methods must be established as independent therapy alternatives for specialists and patients, and the possibility of achieving
this objective is high. With attention
focused on the prosthetic functional
aspects of implantology, the prosthetic therapy objective is currently
becoming the focal point of all efforts.
From the point of view of the
practising dentist, the main emphasis
in treatment planning for implantsupported dentures is placed on the
prosthetic specialist. If said specialist
is also trained in implants and surgery,
he will place the implant himself as a
support measure for his prosthetic
therapy, which results in great simplification with regard to planning
and the treatment process. As a rule,
however, a dentist who deals with
prosthetics will complete his implant
prosthesis in close collaboration with
an oral surgeon or oral-maxillofacial
surgeon.
Fig. 1
Fig. 2
While surgeons are concerned
with the best possible implant procedure or implant design, prosthetic
specialists bring us back to the starting point of implantology: the patient’s wishes. Patients do not want
implants; rather they want beautiful
new teeth with which they feel confident in day-to-day life.1
Fig. 3
22 I CAD/CAM
4_ 2012
Team-work is gaining increasing importance in
this regard, since, depending on the functional prosthetic objective, prosthetic specialists, dental technicians and implant surgeons might have to work together on the optimal implementation of the planned
results using navigation and CAD/CAM systems. In
the future, this method of integrating implantology
will be found in just about every practice. As the hardware for 3-D planning is currently very expensive,
dentists should seek suitable partners to support
them in the integration of current therapy options.
Furthermore, from a biological and an economic
perspective, production should rely on the most
biologically compatible material with sufficient mechanical stability, for example titanium and cobaltchromium alloys. Zirconium oxide is also an option.
However, in terms of casting engineering, the processing of these alternative materials does not offer
sufficient precision of fit. Cast implant structures
manufactured from non-precious metals have been
found to exhibit gaps with an average width of 200 to
230 µm between the superstructure and the implant
abutment.2 In contrast, cast structures manufactured from precious metal alloys have been found
to have gaps with an average width of 40 to 50 µm.3
The use of alternative materials thus requires the
use of alternative production technologies, if only to
obtain the required precision.
Ideally, a superstructure is milled from an industrially prefabricated solid material in order to eliminate inhomogeneities safely. Following this line of
thought, milling-based manufacture of superstructures using the CNC (computer numerical control)
procedure began more than ten years ago. Attempts
with this kind of CAD/CAM technology demonstrated
that the achievable precision of current constructions—between 20 and 30 µm—is better than the
precision of fit achieved with cast precious metal
structures.3
With modern scanning and software technology,
this production principle has been extended to the
area of virtual construction. Thus, the CNC milling
procedure, which has been used for years, is supplemented with the possibility of a purely virtual con-
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I
struction. This technology is now offered by various
manufacturers.
_Objective
Our objective as specialists must not only be the
replacement of a lost tooth as soon as possible after
extraction, but also be the satisfaction of our patients’
constantly increasing aesthetic demands—with regard to the anterior tooth area in particular—through
suitable bone and soft-tissue management.
Fig. 5
Fig. 4
Thus, even when the implant is being inserted,
preference must be given to keeping the crestal bone
structure as unchanged as possible because in this
way the interdental papilla and the peri-implant gingiva can be maintained in the long term.4
_Case presentation
Fig. 6
The realisation of the patient’s wish was facilitated in the following case in close collaboration with
Zahntechnik Zentrum Eisenach after the tooth replacement was firmly in place, despite alveolar bone
loss and difficult gingival conditions (Figs. 1 & 2). The
surgical procedure for this case is described in Liebaug
and Wu (2011).5
challenge for the treatment team. In addition to
successful osseointegration of the implant, particular
attention must be given to functional and aesthetic
parameters to achieve a restoration that perfectly
harmonises with natural teeth.8
Fig. 4_Condition
immediately
after the healing
Fig. 7
abutments were
placed (height of 2 mm).
Fig. 5_Three weeks of good
healing and moulding of the
peri-implant soft tissue.
Fig. 6_Schematic depiction
of the Conical Seal Design for
a custom-fitted conical connection
between the implant and abutment.
Fig. 7_Abutments on the master cast
with the gingival mask.
_Prior to surgery: Addressing the patient’s
The anatomically formed and bevelled OsseoSpeed
wishes and providing information
TX Profile implants (DENTSPLY Implants) were used in
regions #12, 11, 21 and 22. These implants are specially
designed to preserve the marginal bone in an alveolar
ridge with angular atrophy both vestibularly and orally,
that is, 360 degrees around the implant.6 Restoration
with patient-specific ATLANTIS abutments (DENTSPLY
Implants) was planned in order to complete prosthetic
restoration optimally after successful implantation
and osseointegration. As described in Noelken (2011),7
the marginal bone can be preserved cheaply by the
use of these implants, which are new to the dental
market. Optimal soft-tissue support can be achieved
with individualised manufactured abutments.
_Challenge in terms of maxillary
anterior tooth loss
While replacing a missing tooth with an implant
can now be considered routine, rehabilitation in the
maxillary anterior region still represents a particular
Fig. 8
The patient’s wishes must always be considered before treatment begins. The patient should be offered
clarification prior to treatment, particularly in difficult
initial situations with evident hard-tissue loss and unfavourable gingival conditions. For forensic reasons,
photographic documentation of the initial situation
is an indispensable aid in addition to diagnostic casts.
It should also be used as the basis for discussion with
the patient.
If bone on the labial side has already been lost and
the optimal bone contours have not been restored with
a bone transplant, achieving the desired aesthetic
result is nevertheless often not difficult.
In terms of this 67-year-old patient, the implants
were exposed by incision to the middle of the alveolar
ridge from regions #12, 11, 21 and 22 after a fourmonth healing phase (Fig. 3).
Fig. 8_Virtual 3-D model
for abutment planning below
the subsequent crowns.
Fig. 9_Virtual 3-D model for
patient-specific abutment planning.
Fig. 10_Occlusal view of the
abutment and adjustment thereof.
Fig. 9
Fig. 10
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I case report _ patient-specific abutments
Fig. 11
Fig. 13
Fig. 12
Fig. 11_Patient-specific abutment
prior to insertion.
Fig. 12_Complete individualised
crown restoration on master cast.
Fig. 13_Abutment insertion and
mounting with a torque wrench
at 25 Ncm.
It should be noted that, owing to the bevelled design of the implants used, an almost seamless insertion
into the natural osseous alveolar process is achieved,
and thus the plastic cover and the primary wound closure are simplified for the surgeon. This is also the basis for a quick and smooth healing process.
Three-dimensional bone structures can be preserved using the above-mentioned OsseoSpeed TX
Profile implant. Healthy bone is a prerequisite for optimal prosthetic restoration with regard to aesthetics.
The otherwise often necessary hard- and soft-tissue
transplants can now mostly be avoided.5
The extent to which a temporary restoration can be
screwed together after prosthetic pretreatment and
after the implant region has been moulded, or whether
a removable device can be used temporarily, depends
significantly on the patient’s financial resources. In
addition to the use of gingiva formers native to the
system, temporary restorations aid the moulding,
preparation and stabilisation of the peri-implant soft
tissue during and after the healing phase. As the interim prosthesis guaranteed functionality and aesthetics that satisfied the patient, additional moulding
of the soft tissue was achieved through special gingiva
formers or healing abutments (Figs. 4 & 5).
The results obtained in terms of preservation of the
marginal bone using the ASTRA TECH Implant System
(DENTSPLY Implants) are documented in Palmer et al.
(2000) and Wennström et al. (2005).9, 10 Preservation of
the marginal bone level and healthy soft tissue are
indispensable for the long-term success of implant
Fig. 14_Occlusal view of the
inserted abutment.
Fig. 15_Closing of the screw opening
with Cavit (3M ESPE) prior to
cementing the superstructure.
24 I CAD/CAM
4_ 2012
Fig. 14
treatment both clinically and aesthetically. The bone
provides the soft tissue with stability, while the soft
tissue protects the bone from micro-organisms.
A special feature of the implant system used is the
patented Conical Seal Design, which prevents micromovements and micro-gaps at the interface between
the implant and abutment, reliably protecting the implant and bone from bacteria. The clinical relevance
of the pump effect caused by micro-movement and
possible crestal bone resorption were experimentally
tested by Zipprich et al. (2007).11 Furthermore, arising
stress is distributed farther into the bone and peak
loads are simultaneously reduced.12, 13 In this regard,
the preference for preserving the marginal bone level
must be clarified as well. The implant–abutment connection is thus reliably sealed against bacteria and
the bone is thereby protected from external influences.
Maintenance of the superstructure is also made easier
for the patient.
The integration of the abutment is simplified by
the conical implant–abutment connection (Fig. 6).
However, with regard to the bevelled OsseoSpeed TX
Profile implants, particular attention must be given to
the precise transfer of the clinical situation to the
model being manufactured using moulding aids and
transfer posts during precision moulding, which requires specific experience and a good instinct.
The individualised ATLANTIS abutments are a good
solution for cemented crowns or bridges, as they
guarantee optimal functionality, are the basis for
sophisticated prostheses and are easy to use.
Fig. 15
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case report _ patient-specific abutments
ATLANTIS abutments fabricated from titanium,
titanium nitride-coated titanium (ATLANTIS GoldHue)
or zirconium oxide are available for all established implant systems. All abutments are supplied by the manufacturer with the corresponding abutment screws.
The ATLANTIS VAD (virtual abutment design) software
allows the production of abutments that are based on
the final tooth form and thus guarantees not only a
natural, aesthetic result but also optimal functionality.
A model was produced from the impression following
healing, implant exposure (Fig. 3) and insertion of
temporary gingiva formers (Fig. 4).
The patient’s wish for stable and natural-looking teeth
was fully satisfied, which was
ultimately the main criterion
and motivation for our efforts as the treating team.
Additional improvement of
the soft-tissue situation is expected if the patient adheres
to the appropriate cleaning
technique.
I
Fig. 16
_Conclusion
The master cast should have a stable removable
gingival mask made of silicone (Fig. 7). Casts should be
placed onto articulators before the dentist or dental
laboratory sends them in to Astra Tech so they can
subsequently be sent with the ATLANTIS CaseSafe
shipping box. The models can be converted into a
virtual image using a 3-D scanner after the model has
been produced in a high-tech dental laboratory or
after the model has been sent, should no scanner be
available immediately (Figs. 8–10).
After the specialist has confirmed the virtual abutment design, which is sent via e-mail, the ATLANTIS
abutment is manufactured, verified and sent to the
attending dentist (Figs. 7 & 11). Individualised prostheses can be manufactured in the dental laboratory
after the precision of fit and the position of the patientspecific abutment have been verified (Fig. 12).
It must always be ensured that the abutment screw
delivered with the abutment is used for the final insertion of the abutment in the mouth. The ATLANTIS abutments are designed to correspond to the form of the
dentine core of natural teeth. Of course, the ATLANTIS
VAD software allows for consideration of the specialist’s preferences, which should take the patient situation into account, with regard to the production of
the individualised abutment. The size of the abutment
is determined by the average profile created by the
form and size of the healing or temporary abutment.
The mucosa may be temporarily anaemic when
the abutment is inserted into the patient’s mouth
(Figs. 13–15). ATLANTIS abutments are manufactured
with standard gingival moulding if the specialist does
not select or provide any particular options when the
order is placed.
Considering the extremely unpromising initial situation (Figs. 1 & 2), a result that was satisfying in terms
of functionality and aesthetics for both the patient
and the dental/prosthetic specialist was achieved
after the individualised crown restoration had been
placed (Figs. 16 & 17).
Implantology is a central
component of modern therapy procedures in dentistry.
Continuous development of
materials, implant design and
the relevant technologies
seeks to obtain high reliability
with a good long-term prognosis for a wide range of
indications. Careful diagnosis and detailed planning
are indispensable if patients’ increasing demands are
to be satisfied. In particular, care in aesthetically demanding clinical situations requires interdisciplinary
treatment in many cases. The possibilities presented
by this case report for the production of patient-specific abutments on anatomically formed and bevelled
OsseoSpeed TX Profile implants constitute a gain and
are the basis for long-term success, even in the event
of reduced bone and difficult soft-tissue conditions.
Fig. 17
Fig. 16_Condition immediately
after placement of the individualised
crown restoration.
Fig. 17_Despite difficult soft-tissue
conditions, a good gingival stippling
effect was achieved in the cervical
area, which attests to sufficient
osseous support.
_Acknowledgement
The authors would like to thank Z.T.M. Blum from
the Zahntechnik Zentrum Eisenach for his collaboration and laboratory work, as well as Franzisko Fischer
from Astra Tech for his support during planning.
Finally, we would like to offer special thanks to my
father, Manfred Liebaug, who supported us throughout, from surgery to prosthetic placement, as well as
while exploring new methods._
_contact
CAD/CAM
Prof. Frank Liebaug
Praxis für Laserzahnheilkunde und Implantologie
Arzbergstr. 30
98587 Steinbach-Hallenberg
Germany
Tel.: +49 36847 31788
frankliebaug@hotmail.com
CAD/CAM
4_ 2012
I 25
[26] =>
CAD0412_01_Title
CAD0412_26-28_Bausch 12.12.12 16:40 Seite 1
I special _ occlusion
The importance of occlusion
Author_ Dr Peter Bausch, Germany
Fig. 1
Fig. 2
_The correct physiological restoration of occlusion poses a major challenge for every dentist
and technician. Even the smallest high spot, measuring just a few microns, can cause dysfunction in
a patient’s masticatory system. In restorative dentistry, occlusal proportions are constantly changing. It is therefore essential, for the benefit of the
patient, to understand and monitor the function of
teeth in static and dynamic occlusion. Functional
occlusion is important for the overall health of the
patient. The interdisciplinary verification of symptoms and treatment is an integral part of daily
practice. Therefore, checking the occlusion during
treatment is strongly encouraged.
_Occlusion and the potential effects
of occlusal interference on patients
26 I CAD/CAM
4_ 2012
dynamic occlusion. The smallest occlusal interference of just a few microns is disruptive to the
proprioceptors of the stomatological system. This
can cause bruxism (clenching or grinding), which
can result in functional disorder of the craniomandibular system. Overstraining teeth, periodontium, muscles and joints are the effects.
It is important not only to detect, but also to
avoid further functional disorder in the craniomandibular system. The smallest interference to
habitual occlusion can cause serious disturbances
for the patient. An acute functional disorder such
as clenching or grinding can become chronic in the
long term.
Every restoration, extraction, prosthetic device
and orthodontic treatment changes the static and
Patients with new fillings, crowns and bridges,
or who have undergone orthodontic treatment,
who complain of typical symptoms (craniomandibular dysfunction syndrome) should undergo
Fig. 3
Fig. 4
[27] =>
CAD0412_01_Title
CAD0412_26-28_Bausch 12.12.12 16:40 Seite 2
special _ occlusion
I
Figs. 5 & 6_The best physiological
position: the condyles are in centric
position with enough occlusal
contacts.
Figs. 7 & 8_The condyles are still in
centric position. An interfering initial
contact is evident on tooth #36.
Fig. 5
Fig. 6
Fig. 7
Fig. 8
examination of their occlusion specifically. Premature contacts are often uncomfortable, as
the proprioceptors are sensitive to pressure. The
patient will try to compensate for the occlusal
interference by adopting a new habitual position,
with consequences for the attached tissue structures.
mandible is essential. In most cases, centric occlusion is the new therapeutic position.
_Position for occlusal restoration
Essential to any kind of occlusal restoration is
the position of the mandible. Most patients are
treated in their habitual position of the mandible,
which is the correct position for most patients.
For patients with more complex restorations or
patients suffering from temporomandibular joint
disorders, a new physiological positioning of the
Fig. 9
Centric relation is the position of the mandible
relative to the maxilla, with the intra-articular
disc in place, when the heads of the mandibular
condyles are against the most superior part of
the distal-facing incline of the glenoid fossa (i.e.
the mandibular condyles are in their most superior
and anterior position).
For balanced occlusion in a static position, the
patient should have enough ABC contacts on each
quadrant in the intercuspal position. In this position, the teeth of the opposing jaws achieve
complete intercuspation and are in maximum
contact with each other.
Fig. 10
Figs. 9 & 10_Compensatory reaction
caused by the interfering contact
on tooth #36. The mandible has
shifted to a new position, which is out
of centric occlusion, to compensate
for the occlusal interference.
CAD/CAM
4_ 2012
I 27
[28] =>
CAD0412_01_Title
CAD0412_26-28_Bausch 12.12.12 16:40 Seite 3
I special _ occlusion
Fig. 11
of the contact point has
a lighter shade. The more
intense-coloured edge of
the contact point is not
part of the contact. Just the
lighter-coloured centre is
the real contact area. For
occlusal equilibration, only
these areas should be adjusted. For a balanced occlusion, the patient should
have enough ABC contacts
on each quadrant.
Fig. 12
Fig. 13
Fig. 14
_The physiological influence
of interfering initial contacts
For most of the patients, their habitual position
of the mandible in maximum occlusion is the preferred position for occlusal restoration. However,
even a tiny interfering prematurity contact of only
20 µ can trigger a compensatory reaction, placing
the mandible into a new physiological position. This
is a natural reaction of our biological system to avoid
higher forces focused only on one area.
For example, if you are eating something and you
chew on a little grain of sand, you automatically
shift your mandible to a different position to protect
your teeth. A permanent “grain of sand” (occlusal interference) can trigger an overload of the biological
system, in which case the patient will have reached
his or her maximum capacity for compensation.
Pain symptoms can then become chronic.
_Occlusal restoration
In order to reconstruct physiological occlusion,
correct visual identification of contact points is essential. Occlusion checking materials (articulating
papers) with the effect of progressive colour transfer are helpful in identifying occlusal forces in intercuspal habitual position. Areas with higher force
loads can be identified as darker-shaded markings
with higher contrast. These markings likely indicate
the initial contacts. Areas with less intense colour
markings indicate contacts with lower occlusal
forces or areas with no contact. Upon close examination, these markings look like a donut. The centre
28 I CAD/CAM
4_ 2012
Occlusal corrections can
be additive or subtractive.
If modification of the
occlusal relationship in
patients who have been
grinding their teeth over a
long period is needed, this
may be challenging, as
they would already have
lost a significant part of their hard tooth tissue.
A splint is indicated for treating such patients
(additive occlusion).
_Conclusion
The reconstruction of physiological occlusion is
essential for the complex functioning of the entire
stomatognathic system. There are various concepts
of occlusion. For recording and analysing the complex movement of the mandible, a wide range of
electronic devices are available.
Beside all these tools, a basic understanding of
the biomechanical design of an occlusal surface
is essential. Today, we have a wide selection of different occlusion indicators to visualise these biomechanical structures. Soft colour-impregnated
occlusion checking papers, in combination with thin
occlusion checking films, are optimised for visual
checking of the occlusal relationship between the
maxilla and mandible._
_contact
Dr Peter Bausch
Dr. Jean Bausch GmbH & Co. KG
Oskar-Schindler-Str. 4
50769 Cologne
Germany
pb@bauschdental.de
CAD/CAM
[29] =>
CAD0412_01_Title
FDI 2013 Istanbul
Annual World Dental Congress
28 to 31 August 2013 - Istanbul, Turkey
Bridging Continents for Global Oral Health
www.fdi2013istanbul.org
congress@fdi2013istanbul.org
[30] =>
CAD0412_01_Title
CAD0412_30-32_Bindl 12.12.12 16:40 Seite 1
I industry report _ CAD crown design
Computer-aided crown
design—Fabrication of
CAD/CAM crowns chairside
Author_ Dr Andreas Bindl, Switzerland
(for example with Syntac/Variolink II or Multilink
Automix, all Ivoclar Vivadent). This makes them
strong enough to withstand masticatory forces in
the long term.
Fig. 1
Fig. 1_Pre-op situation: the buccal
wall of tooth #25 was cracked
and featured a large, damaged
composite filling—a clear indication
for a crown.
Fig. 2_A digital impression was
taken of the preparation and the
antagonists and the situation in
centric occlusion (CEREC Bluecam)
from the buccal aspect (middle).
Fig. 3_Semi-automatic alignment
of the maxillary and mandibular
jaw models with the help
of the buccal image.
30 I CAD/CAM
4_ 2012
_CAD/CAM technology allows dental professionals to manufacture solid all-ceramic crowns
chairside. A digital image of the preparation is
captured with an intra-oral camera and the crown
is designed accordingly. A variety of ceramics are
available for the construction of the crown, for
example an aesthetic, easy-to-mill ceramic such as
IPS Empress CAD (Ivoclar Vivadent). As this leucite
glass-ceramic is weaker than zirconium oxide, these
crowns must be seated with the adhesive technique
Fig. 2
IPS e.max CAD (Ivoclar Vivadent), which has been
on the market for some time, is a lithium disilicate
glass-ceramic that demonstrates a flexural strength
of 360 MPa. This ceramic is machined to the desired
shape while it is still in its metasilicate or blue
state (approximately 130 MPa). Subsequently, the
ceramic is crystallised for 20 minutes. During this
process, the material attains its final state and obtains its excellent mechanical and aesthetic properties. IPS e.max CAD is available in a low translucency
(LT) version, which is suitable for the fabrication
of crowns and implant-retained crowns. The high
translucency form is intended for the construction
of inlays and partial crowns. The stains and glaze are
applied before the crystallisation process.
As a result, subsequent polishing is unnecessary.
Owing to the high strength of the restoration, adhesive cementation with a separate dentine conditioner is not indicated as long as the thickness of
the ceramic is not less than 1.5 mm. Self-adhesive
Fig. 3
[31] =>
CAD0412_01_Title
CAD0412_30-32_Bindl 12.12.12 16:40 Seite 2
industry report _ CAD crown design
Fig. 4
Fig. 5
Fig. 6
Fig. 7
cementation materials can be used. The new selfadhesive composite cement SpeedCEM (Ivoclar
Vivadent) is particularly suitable for this purpose.
(Ivoclar Vivadent) and a digital impression was
taken with the CEREC Bluecam camera (Sirona).
The Version 3.8 of the CEREC software generates a
visual image of the antagonists, which replaces the
centric bite record. In order to match the maxillary
and mandibular teeth, an image of the centric situation was captured from the buccal aspect (Fig. 2).
The maxillary and mandibular teeth were matched
semi-automatically (Fig. 3).
In this case report, the chairside creation of
a crown is described on the basis of a clinical case
using IPS e.max CAD LT and the new SpeedCEM
luting cement.
I
Fig. 4_The biogeneric crown
software designs an occlusal surface
according to the individual situation.
Fig. 5_Bucco-oral cross-section
of the restoration: the minimum
occlusal thickness of 1.5 mm
was checked.
Fig. 6_Occlusal view of the crown
in the blue state during try-in,
before crystallisation firing.
Fig. 7_Buccal view of the crown
in the blue state during try-in,
before crystallisation firing.
_Clinical case report
Tooth #25 of a 32-year-old female patient was
restored with a crown owing to extensive destruction of the dental hard tissue (Fig. 1). First, the tooth
was prepared with a shoulder of approximately
1 mm in width (epigingivally). Subsequently, the
preparation was dusted with IPS Contrast Spray
Fig. 8
The 3.8 version is capable of designing biogeneric
occlusal surfaces for full crowns. The software provides a design proposal for the tooth morphology,
which is based on the occlusal surface of the distal
neighbouring tooth and the antagonist (Fig. 4). The
image of the bucco-oral cross-section of the crown
allows the user to check the minimum occlusal
Fig. 9
Fig. 8_Occlusal view of the
crystallised and glazed crown
on tooth #25.
Fig. 9_Buccal view of the crystallised
and glazed crown on tooth #25.
CAD/CAM
4_ 2012
I 31
[32] =>
CAD0412_01_Title
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I industry report _ CAD crown design
Fig. 10_Cementation of the crown
with the dual-curing, self-adhesive
luting composite cement SpeedCEM.
Fig. 11_Buccal view of the crown
seated with a self-adhesive luting
cement after the removal of excess.
Fig. 12_Occlusal view of the crown
seated with a self-adhesive
luting cement.
Fig. 10
Fig. 11
Fig. 12
thickness of 1.5 mm (Fig. 5). The minimal densification of the ceramic (0.2 vol.%) during the crystallisation process is taken into account by the software
and adjusted accordingly.
After the crown had been milled, the proximal
and occlusal contacts were adjusted on the patient
(Figs. 6 & 7). In this case, the white and creme materials from the corresponding stain assortment
(IPS e.max CAD Crystall./Stains, Ivoclar Vivadent)
were sparingly applied to the cusp tips and the
sunset material to the tooth neck and in the fissures.
Immediately afterwards, a glaze in spray form
(IPS e.max CAD Crystall./Glaze Spray) was applied
to the outer surfaces of the crown. The spray was
applied several times. Once the restoration had
been fully coated with a white-opaque glaze layer,
the crown was fired in a combined crystallisation
and firing process in the Programat CS furnace
(Figs. 8 & 9).
Before the restoration was cemented in place,
the inner surface of the crown was etched with
4.9 per cent hydrofluoric acid (IPS Ceramic Etching
Gel, Ivoclar Vivadent) for 20 seconds. Subsequently
it was silanised for 60 seconds (Monobond Plus,
Ivoclar Vivadent). The crown lumen was filled with
the self-adhesive SpeedCEM. Next, the crown was
32 I CAD/CAM
4_ 2012
securely seated on the prepared tooth by applying
even pressure (Fig. 10).
The cement residue was polymerised for one
second per surface (mesio-oral, disto-oral, mesiobuccal, distobuccal) with a curing light (bluephase
in the low power mode, Ivoclar Vivadent) at a distance of about 5 mm. In this cured state, the cement
was removed with great care using a scaler and
a probe. The cement was fully cured with the bluephase in the high power mode. Subsequently, the
cement margin was polished. The final inspection
revealed the restoration to be in harmony with the
overall situation (Figs. 11 & 12).
_contact
CAD/CAM
Dr Andreas Bindl
Station für Zahnfarbene und
Computer-Restaurationen
Praxis am Zürichberg
Attenhoferstr. 8a
8032 Zurich
Switzerland
andreas.bindl@bluewin.ch
[33] =>
CAD0412_01_Title
[34] =>
CAD0412_01_Title
CAD0412_34_Planmeca 12.12.12 16:41 Seite 1
I industry news _ Planmeca
Planmeca ProMax 3D Mid—
An optimal volume size for every
3-D imaging application
ALARA (as low as reasonably achievable) principle
to minimise radiation.
Additionally, Planmeca ProMax 3D Mid offers
a new kind of panoramic imaging. The standard
panoramic imaging program is optimised to expose
only the teeth area to radiation, reducing patient
dose. Optionally, the temporomandibular (TMJ)
joints can be imaged with a program in which the
TMJ imaging angles can be adjusted, as with regular
TMJ programs.
“Planmeca ProMax 3D Mid clearly demonstrates
our best achievement in imaging. It provides the
most advanced visualisation of patient anatomies
for a variety of diagnostics needs—never compromising the important principle of minimising the
radiation dose when feasible,” explained Auvo
Asikainen, Vice President of the X-ray Division at
Planmeca.
Planmeca ProMax 3D Mid is based on Planmeca
ProMax technology. Planmeca’s existing 3-D imaging products in this range are Planmeca ProMax 3D s,
ideal for applications where a smaller field of view
is sufficient, Planmeca ProMax 3D for general 3-D
applications with a field size covering the mandible
and maxilla, and Planmeca ProMax 3D Max for a
variety of field sizes from a single tooth to the
entire maxillofacial area._
34 I CAD/CAM
4_ 2012
_Planmeca has introduceda new product to the
recognised Planmeca ProMax 3D range. Planmeca
ProMax 3D Mid provides an extended selection of
3-D volume sizes, combined with traditional 2-D
panoramic and cephalometric imaging.
_contact
Planmeca ProMax 3D Mid offers the user an
optimal volume size for every application requiring
3-D imaging. For example, for endodontics requiring high resolution, implantology requiring images
with a smaller field of view, and for orthodontics
requiring large image sizes. The volume sizes range
from 34 x 42 mm to 160 x 160 mm. This wide selection of volume sizes allows optimisation of the
imaging area according to the specific diagnostic
task—always complying with best practice and the
Planmeca Oy
Asentajankatu 6
00880 Helsinki
Finland
Auvo Asikainen
Vice-President of the X-ray Division
Tel.: +358 20 7795 502
auvo.asikainen@planmeca.com
www.planmeca.com
CAD/CAM
[35] =>
CAD0412_01_Title
CAD0412_35_Sirona 12.12.12 16:41 Seite 1
industry news _ Sirona
I
CEREC Omnicam: Powder-free
3-D scanning in full colour
_This autumn Sirona presented its new CEREC
camera in Europe. The CEREC Omnicam generates
full-colour scans of intra-oral surfaces without the
need for a powder coating on the teeth (Fig. 1). Operating the camera is simple and intuitive. Moreover,
the imaging functionality and camera dimensions
are ergonomically designed. Sirona, a technology and
market leader in the dental industry, launched its new
CEREC Omnicam camera in August at a special event
in Las Vegas, USA. This exciting new product was
recently unveiled to dental professionals in Europe
at an informative product presentation attended by
distributors and the media at the company’s new
headquarters in Salzburg. At the launch, the generation of precise whole-arch scans in the shortest
possible time using the camera was demonstrated.
Three features of the CEREC Omnicam stand out
in particular: it supports video streaming; it digitises
the structures of the jaw in their natural colour; and
it does not require powder coating of the tooth surfaces. Instead, the user moves the camera head over
the intra-oral surfaces with a smooth, flowing movement. The CEREC Omnicam is extremely resistant to
camera shake.
A virtual 3-D model is displayed in natural colour
on the monitor of the CEREC AC. Thanks to this lifelike visualisation, it is easy to distinguish between
different materials (enamel, dentine, metal or composite) and identify the palatinal and gingival contours. As a result, it is easy to navigate around the oral
cavity and determine the preparation margins—even
in subgingival areas. The extensive depth of field of
the CEREC Omnicam delivers high-precision images,
even in cases in which the camera has been placed
directly on the tooth.
The ergonomic, lightweight camera feels comfortable in the hand. Thanks to the slimline design and
the compact camera head, it is easy to scan inaccessible areas such as the distal surfaces of the posterior
molars (Fig. 2).
In addition, the CEREC Omnicam boasts a patientcounselling mode. The dentist can record short video
clips and present these to the patient via the CEREC
AC monitor. This promotes effective communication
and enables the patient to make important decisions
based on reliable information.
In future, CEREC AC will be available in combination with either the tried-and-tested CEREC Bluecam
or the new CEREC Omnicam. Both cameras are easy
to use and generate high-precision scans. The Bluecam and Omnicam differ in terms of technology and
field of application. Whereas the CEREC Omnicam
is particularly well suited to multiple restorations,
the strengths of the CEREC Bluecam lie in its proven
precision and extensive field of view, which makes it
ideal for single-tooth restorations. The Bluecam generates a series of 3-D images, which are subsequently
combined in order to create a panoramic image of
the teeth. The benefits of the CEREC Omnicam at
a glance:
The CEREC Omnicam generates
full-colour scans of intra-oral
surfaces and does not require
a powder coating on the
teeth surfaces.
Unrivalled handling:
_slim, lightweight casing and compact camera head;
_natural flowing movement of the camera over the
tooth surfaces;
_anti-vibration function;
_extensive depth of field.
Powder free:
_fewer processing steps;
_short learning curve;
_the digital impression-taking process
can be delegated to an assistant.
Colour visualisation:
_improved patient counselling;
_the natural colours of the virtual 3-D model enable
the dentist to identify the various tooth surfaces
clearly and determine the preparation margins.
Thanks to the slimline design and
the compact camera head, scanning
the posterior teeth is trouble-free.
Owing to the ongoing marketing authorisation
procedures, the CEREC Omnicam is not yet available
in China, Japan, South Korea, certain countries in the
CIS and South America._
_contact
CAD/CAM
Sirona Dental GmbH
Sirona Str. 1
5071 Wals bei Salzburg
Austria
contact@sirona.com
www.sirona.com
CAD/CAM
4_ 2012
I 35
[36] =>
CAD0412_01_Title
CAD0412_36_3shape 12.12.12 16:41 Seite 1
I industry news _ 3Shape
3Shape introduces CAD Points—
A unique pay-per-design service
that opens up new opportunities
for dental labs
_CAD Points gives easy access to designs
for advanced indications
Dental labs can purchase CAD Points through
3Shape’s Webshop or reselling partners and moments later can use their CAD Points to pay for
creating a new design, according to predetermined
CAD Point pricing. CAD Point functionality is integrated into 3Shape’s Dental System, and users of
the system can gain access to add-on modules for
advanced indications using CAD Points. Through
their status overview, users can easily keep track
of their CAD Points, and they receive notifications
when their CAD Points are about to run out.
_CAD Points opens up new business
opportunities
3Shape CAD Points represents an attractive and
safe start-up package for many labs because it is
cost-efficient and involves minimal investment risk.
It also allows labs to experiment with new business
models before investing in advanced indication
functionalities.
_3Shape CAD Points provides a new way for
medium-sized or smaller labs to offer a wider
range of services with a minimal upfront investment. CAD Points gives labs pay-per-design access
to 3Shape’s add-on modules for designing customised abutments, implant bars and bridges,
removable partial dentures and other advanced
indications.
With CAD Points, 3Shape, a technology leader
in 3-D scanning and CAD/CAM software for dental applications, is offering a unique business
opportunity to dental labs. 3Shape CAD Points is
a flexible getting-started package for labs that
want to offer services for a complete range of
dental indications, or test potential new business
models, without committing to a major upfront
investment.
36 I CAD/CAM
4_ 2012
_Versatile, durable, convenient
CAD Points are not limited to a specific 3Shape
add-on module and can be used with the various
advanced indications included in the program. The
points do not expire and users can purchase their
CAD Points whenever they need them._
_contact
3Shape A/S
Holmens Kanal 7
1060 Copenhagen K, Denmark
www.3shapedental.com
CAD/CAM
[37] =>
CAD0412_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] =>
CAD0412_01_Title
CAD0412_38_Straumann 12.12.12 16:42 Seite 1
I industry news _ Straumann
Straumann and Align discontinue
distribution agreements
for iTero intra-oral scanner
_Straumann and Align Technology announced
in October that they had decided to discontinue
their distribution agreements for the iTero intraoral scanner in Europe and North America with
effect from 31 December 2012.
Second, our core business is in tooth replacement and restoration. We now have the digital
workflow in place to enable us to produce highprecision prosthetics for dental implants, starting
from an intra-oral scan.
As a result, we no longer need to sell intra-oral
scanners directly and will focus our resources on
driving our CARES business. And lastly, we have
come to the conclusion that the business case for
distributing scanners is not economically viable for
us in the present economic environment.”
The agreement for exclusive distribution in Europe was signed in 2009 between Straumann and
Cadent, the developer of iTero, which was acquired
by Align Technology in April 2011. The agreement
awarding Straumann non-exclusive distribution
rights in North America was signed shortly before
the acquisition.
Beat Spalinger, Straumann’s president and CEO,
explained the rationale behind Straumann’s decision: “We are convinced that intra-oral scanning
will have a major role in daily dental practice thanks
to its superior accuracy, convenience and patient
comfort in comparison with conventional impression taking.
Furthermore, we are convinced that iTero is one
of the best intra-oral scanners available. However,
we have decided to step back from distributing this
hardware for three reasons.
First, our experience over the past three years
has shown that a single hardware brand limits
our addressable market. Moving ahead, our CARES
CAD/CAM system will be accessible to various intraoral scanning systems, including the iTero scanner.
38 I CAD/CAM
4_ 2012
Align and Straumann are fully committed to providing continued support and services to existing iTero
customers. The two companies are currently working
together on plans for a smooth transition and will
communicate details to customers once they are
finalised. In the meantime, Straumann will continue
to offer first-level equipment support in Europe for
at least the next 12 months, after which Align will assume full responsibility for regional customer service.
Straumann is strongly committed to digital
dentistry and the development of digital workflows
as part of its CARES platform and product offering.
The discontinuation of the distribution agreements
with Align will not affect the launch of new CARES
services and products.
However, it will have an impact on Straumann’s
intra-oral scanning staff and further details in this
respect will be communicated with the company’s
third-quarter results on 30 October. Sales of intraoral scanners constitute approximately one per cent
of the Straumann Group’s net revenue._
_contact
Institut Straumann AG
Peter Merian-Weg 12
4001 Basel, Switzerland
www.straumann.com
CAD/CAM
[39] =>
CAD0412_01_Title
CADCAM_Abo_A4_Implants_Abo_A4 12.12.12 15:05 Seite 1
CAD/CAM
digital dentistry
international magazine of
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[40] =>
CAD0412_01_Title
CAD0412_40_Camlog 12.12.12 16:42 Seite 1
I industry news _ Camlog
CAMLOG Foundation
calls for entries for its
2012/2013 research award
2012/2013 CAMLOG Foundation Research Award
will be given the opportunity to present his/her work
to a wider audience during the 2014 International
CAMLOG Congress. Furthermore, the authors of
the three best contributions will receive attractive
cash prizes of €10,000, €6,000 and €4,000, respectively.
The entry conditions and the mandatory registration form can be downloaded from the internet
at www.camlogfoundation.org/awards. The registration deadline is 30 November 2013.
Research award 2010/2011
ceremony: Prof. Jürgen Becker—
President CAMLOG Foundation,
Dr Sönke Harder—2nd prize winner,
PD DDr Arno Wutzl—1st prize winner
and Prof. Fernando Guerra—
Vice president CAMLOG Foundation.
_The CAMLOG Foundation is calling for submissions for its third CAMLOG Foundation Research
Award. The award is presented biennially at the
International CAMLOG Congress and is open to all
talented scientists/researchers and dedicated professionals at universities, hospitals and practices
under 40 years of age.
The submissions must have been published in an
accredited scientific journal and can be submitted
in either English or German. The articles must deal
with one of the following topics in implant dentistry
or a related discipline:
_diagnostics and planning;
_hard- and soft-tissue management;
_sustainability of implant-supported prostheses;
_physiological and pathophysiological aspects; and
_advances in digital procedures.
The contributions will be evaluated by the
CAMLOG Foundation Board. The winner of the
40 I CAD/CAM
4_ 2012
The CAMLOG Foundation is a foundation established under Swiss law. It engages in the targeted
support 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 better serve the
patient.
As part of its scientific mission, the CAMLOG
Foundation holds its international congress every
two years._
_contact
CAMLOG Foundation
Margarethenstr. 38
4053 Basel
Switzerland
info@camlogfoundation.org
www.camlogfoundation.org
CAD/CAM
[41] =>
CAD0412_01_Title
CAD0412_41_Platforms 12.12.12 16:43 Seite 1
digital platforms _ course calendar
I
Announce your courses
in CAD/CAM!
LIVE EDUCATION SYMPOSIUM AT FDI ANNUAL WORLD DENTAL CONGRESS
28–31 August 2013
Istanbul Congress Center, Istanbul, Turkey
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.
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
4_ 2012
I 41
[42] =>
CAD0412_01_Title
CAD0412_42-43_Capp 12.12.12 16:43 Seite 1
I meetings _ CAPP
Digital dentistry conference
draws over 500 to Singapore
Author_ Dental Tribune Asia Pacific
Top left_CDO Patrick Tseng (left)
getting hands-on with the latest
equipment. (Photos courtesy
of CAPP Asia, Singapore)
Top right_CAPP’s Business
Development manager Tzvetan
Deyanov and Managing Director
Dr Dobrina Mollova in talks with
DTI publisher and CEO
Torsten R. Oemus (from left to right).
(DTI/This Photo Daniel Zimmermann)
42 I CAD/CAM
4_ 2012
_Attendance figures for the first CAD/CAM
& Computerized Dentistry International Conference in the Asia-Pacific region have exceeded
original expectations, the Center for Advanced
Professional Practices (CAPP) has announced.
According to its figures, more than 520 dental
professionals took part in the event, which
was sponsored by major market players and
saw 14 lecturers from around the globe presenting in fields like computer-guided surgery and
3-D dental imaging.
Plans for a follow-up conference in the citystate are already being discussed and will be
announced in the coming weeks, CAPP officials
recently told Dental Tribune Asia Pacific. The
event will be held in autumn next year after the
organisation’s eighth Dubai congress scheduled
for May 2013.
CAPP has been organising congresses for
dental CAD/CAM and computerised dentistry in
the emirate since 2006. As a spin-off of its suc-
[43] =>
CAD0412_01_Title
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meetings _ CAPP
cessful annual series there, a conference was
organised for Asian dentists for the first time
this year. Besides a three-day scientific programme, it offered a theatre presentation on
chairside CAD/CAM-fabricated restorations, as
well as a parallel session that aimed to provide
dental technicians in the region with an overview
of the latest digital technology and guidelines
for its use in dental labs. In addition, renowned
orthodontist Dr Khaled Abouseada held a workshop on using ClearPath, a US-developed invisible aligner orthodontic therapy manufactured
and distributed by ClearPath Orthodontics in
Saudi Arabia, with dental CAD/CAM.
“We should all be open to learning about
the newest technologies,” Dr Kuan Chee Keong,
President of the Singapore Dental Association
(SDA), remarked. “CAD/CAM technology is inevitable and it is a very good idea to hold such a
conference here.”
Prof. Seung-Pyo Lee and Shin-Eun Nam from
South Korea won the poster presentation competition with their new method of measuring
interdental space using 3-D virtual models. They
competed against fellow researchers from South
Korea and Malaysia, who presented latest findings on digital restoration using implant prostheses, among other things.
The event also received support by Dental
Tribune’s flagship publication DT Asia Pacific, as
well as its CAD/CAM international magazine of
digital dentistry.
I
Keong added that his association will continue
to support CAPP’s efforts in Singapore in the
years to come. The SDA has worked with the company over the last 12 months to raise awareness
of the event among local dentists, who represented more than 40 per cent of the conference
attendees.
CAPP recently partnered with the international dental publisher, agreeing to manage it's
operations in the Middle East and Africa._
CAD/CAM
4_ 2012
I 43
[44] =>
CAD0412_01_Title
CAD0412_44-45_Eao 12.12.12 16:44 Seite 1
I meetings _ EAO
EAO celebrates successful
anniversary event in Copenhagen
20th congress of the European Association for Osseointegration presented
latest concepts and developments in implant dentistry
Author_ Dental Tribune International
Bottom left_A record number
of companies exhibited at the
20th EAO congress.
(DTI/Photo Daniel Zimmermann)
Bottom right_Members of the Tivoli
Boys Guard entertaining attendees
of the opening ceremony.
(DTI/Photo Yvonne Bachmann)
44 I CAD/CAM
4_ 2012
_Celebrating the achievements of implant
dentistry in the last 20 years, thousands of clinical specialists from Europe and around the globe
recently gathered at the Bella Center exhibition
and congress venue in the Danish capital for the
annual scientific congress of the European Association for Osseointegration (EAO). Following a
successful event in Athens last year, the congress
event more than 2,300 scientists and clinicians
involved in implant and restorative dentistry over
the course of four days.
Besides an extensive scientific programme
covering topics like imaging and factors of implant loss, the event saw a record number of companies exhibiting established clinical solutions
[45] =>
CAD0412_01_Title
CAD0412_44-45_Eao 12.12.12 16:44 Seite 2
meetings _ EAO
and a number of new products, including dental
implants and sophisticated surgical equipment.
Market leader Nobel Biocare, for example, had
its new OsseoCare Pro drill motor, which can
be operated entirely through Apple’s iPad tablet
computer, on display. Italian manufacturer mectron presented its multipiezo pro device, which
can be used for ultrasonic implant cleaning, in
Copenhagen.
New implant devices were exhibited by MIS
Implants, MegaGen and BioHorizons.
Held for the 20th time, the EAO’s latest annual
meeting looked back on various issues related
to implant dentistry from the last two decades.
Acknowledging the progress being achieved in
the field, a Saturday morning session titled
“Future perspectives of implant dentistry” dis-
I
cussed future prospects of bioactive implant surfaces and the use of computer-guided implant
planning, among other topics. For the first time,
a session organised by members of the EAO’s
Junior Committee also presented new revolutionary ideas that could shape implant dentistry
in the years to come.
Having originated from a clinical meeting by
implant specialists in the late 1980s, the EAO is
today an established authority and one of the
most important scientific and clinical forums for
implant dentistry in Europe. It is comprised of
renowned clinicians and researchers from around
the world.
With more than one third of visitors coming
from regions outside the continent, its annual
scientific congress has recently gained more relevance internationally._
(DTI/Photos Daniel Zimmermann)
CAD/CAM
4_ 2012
I 45
[46] =>
CAD0412_01_Title
CAD0412_46-47_IDS 12.12.12 16:45 Seite 1
I meetings _ IDS 2013
Digital developments on show
at IDS 2013—CAD/CAM
technology in the spotlight
_Since the 1980s, digital technology has increasingly been used in dentistry. Initially, CAD
methods were used in manufacturing glass-ceramic inlays and crowns. Later, stereolithography
was used to make guides for navigated implantation. Today, advances in the development of
CAD/CAM have reached just about every aspect of
dentistry and caused significant changes in some
cases. The state of the art in CAD/CAM will be on
display at the International Dental Show (IDS) in
Cologne from 12 to 16 March 2013.
While not everything is digital and conventional
techniques are certainly still necessary, progress
continues to advance at a rapid pace. It is a good
46 I CAD/CAM
4_ 2012
idea to become well informed about these latest
developments, as this is the only way to determine
which innovations are important for one’s own
work.
At IDS, dentists will discover how the possibilities
of CAD/CAM technologies can optimise daily work
in their practices, regardless of whether the practice
already uses integrated digital processes or plans
to do so in the future. In some cases, dental technicians have been benefiting from advancements in
CAD/CAM for years. As far as they are concerned, the
innovations that will be presented at IDS represent
an opportunity to expand the range of services they
offer at their own laboratories.
[47] =>
CAD0412_01_Title
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meetings _ IDS 2013
Regardless of whether the issue is CAD manufacturing processes, new materials or advanced
milling machines, high-tech is becoming increasingly important in laboratory work. Planning and
preparation processes are becoming more detailed
and goal oriented. The virtual process chain actually starts at the dentist’s chair. First, digital impressions of the patient’s teeth are made using an
oral scanner. The data is then transferred, a virtual
design is made using CAD planning software, and
finally a precise visualisation of the functional
and aesthetic results is displayed. And all this takes
place before treatment even begins!
“Developments in the CAD/CAM segment are
making great strides,” according to Dr Markus
Heibach, Executive Director of the Association of
German Dental Manufacturers (VDDI). “Whether
it’s materials, software, CAM modules or the
networking of the individual components and
processes, all of the relevant innovations will be
presented at IDS in Cologne.
These techniques not only affect collaboration
between the practice and the laboratory, but also
offer immediate benefits to the patient. Intra-oral
scanners, for example, are very popular because
they eliminate the need to take impressions using
a moulding compound—a process that is rather uncomfortable for some patients. For patients who are
especially anxious, this could be decisive in enabling
them to overcome their fear of a visit to the dentist.
The intra-oral scanner market is diverse. Thanks to
different functional principles and different ways
of handling the instrument, the no-contact impression technique appears to have enormous potential.
In addition to generating patient loyalty, it also
makes collaboration between dentists and dental
technicians particularly efficient.
IDS is held in Cologne every two years and is
organised by the Society for the Promotion of the
Dental Industry (Gesellschaft zur Förderung der
Dental-Industrie) and the commercial enterprise
of the VDDI, and staged by Koelnmesse._
I
In addition, visitors will have the opportunity to
go directly to trade fair stands, where they’ll get
first-hand information and be able to discuss important issues with manufacturers and experts.”
All images courtesy of
Koelnmesse GmbH.
The latest planning tools also contribute to successful dentist–technician cooperation. With these
tools, a virtual preview of the planned dental prosthetic can be created. In other words, an important
decision-making aid is now in the hands of the
patient. It is certainly easier to convince patients of
the benefits of a particular treatment when they
have the desired results before their eyes. The appropriate software can thus provide valuable assistance during consultations, which is an advantage
for both the dentist and the technician.
CAD/CAM
4_ 2012
I 47
[48] =>
CAD0412_01_Title
CAD0412_48_Events 12.12.12 16:46 Seite 1
I meetings _ events
International Events
2013
2nd BIOMET 3i European Symposium
11 & 12 January 2013
Madrid, Spain
www.biomet3ieuropeansymposium.com
International Dental Show
12–16 March 2013
Cologne, Germany
www.ids-cologne.de
ITI Congress North America
4–6 April 2013
Chicago, USA
www.iti.org
8th CAD/CAM & Digital Dentistry
International Conference
2 & 3 May 2013
Dubai, UAE
www.cappmea.com
International Symposium Osteology
2–4 May 2013
Monaco
www.osteology.org
ITI Congress South East Asia
16 & 17 May 2013
Bangkok, Thailand
www.iti.org
MIS’ 2nd Global Conference
6–9 June 2013
Cannes, France
www.mis-implants.com
Nobel Biocare Global Symposium
20–23 June 2013
New York, USA
www.nobelbiocare.com
FDI Annual World Dental Congress
28–31 August 2013
Istanbul, Turkey
www.fdiworldental.org
2nd Asia-Pacific Edition
9th CAD/CAM & Digital Dentistry
International Conference
5 & 6 October 2013
Singapore
www.cappmea.com
EAO 2013
16–19 October 2013
Dublin, Ireland
www.eao.org
AAID Annual Meeting
23–26 October 2013
Phoenix, AZ, USA
www.aaid-implant.org
48 I CAD/CAM
4_ 2012
[49] =>
CAD0412_01_Title
CAD0412_49_Submission 12.12.12 16:46 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
4_ 2012
I 49
[50] =>
CAD0412_01_Title
CAD0412_50_Impressum 12.12.12 16:46 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 Dehmel
n.dehmel@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 Dehmel
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
4_ 2012
[51] =>
CAD0412_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
®
en C oFa
xis D com
AD ce
e
3
m e
/CA ™
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
[52] =>
CAD0412_01_Title
3Shape Dental System
™
A timeless solution that grows stronger rather than growing old
Model Builder,
Create lab models directly from TRIOS ® and 3rd party intraoral scans. Design implant models and all types of sectioned models ready for output on model-making machines.
An impression & model scanner for every lab
The D800 scanner, with two 5.0 MP cameras, provides high accuracy and captures textures and pencil markings. The fast and
robust D700 is for productivity and the D500 for an easy entry into
CAD/CAM.
Implant Bar & Bridges and more
Coming
Soon!
Get a precise and productive tool for designing sophisticated imRNCPV DCTU CPF DTKFIGU HQT DQVJ TGOQXCDNG CPF ƂZGF RTQUVJGUKU
Enjoy also Dentures, New Abutment Designer™, Post & Core,
Orthodontic appliances and much more.
TRIOS® Inbox & 3Shape Communicate™
Dental System™ includes free connectivity to TRIOS ® systems in
dental clinics so labs can receive impression scans directly. Smart
communication tools enhance cooperation with the dentist.
Join 3Shape’s Webinars
3Shape’s new on-line learning channel
Follow us on:
Scan the QR code to sign up, its free!!
Or go to http://3shapedental.com/webinar
)
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/ Prevention of failures in oral implantology
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/ Traditional imaging will not disappear with CBCT
/ Early childhood anterior tooth trauma
/ CAD/CAMpatient-specific abutments and a new implant design
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