CAD/CAM international No. 2, 2014
Cover
/ Editorial: One step further with CAD/CAM
/ Content
/ The Virtual Facebow A digital companion to implantology
/ Aesthetic Digital Smile Design: Software-aided aesthetic dentistry—Part II
/ “The trend towards the medium-price range has accelerated”
/ A leading-edge implant- supported prosthetic concept for long-term success and tissue stability
/ Shortening guided surgical implant times based on a combination of CBCT and digital surface scanners
/ Maestro Scanner system
/ Planmeca makes CAD/CAM easier than ever
/ Inspired by nature: Zirconia Reinforced Composite
/ 3Shape launches Implant Studio for implant planning and surgical guide design
/ Straumann abutments now available to 3Shape software users
/ It is time to look at aesthetics from a new angle
/ “Clinician education is critical to success”
/ International Events
/ Submission guidelines
/ Imprint
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Standard_300dpi
CAD0214_01_Title 13.05.14 11:08 Seite 1
issn 1616-7390
Vol. 5 • Issue 2/2014
CAD/CAM
digital dentistr y
international magazine of
2
2014
| CE article
The Virtual Facebow
| special
Aesthetic Digital Smile Design – Part II
| case report
Implant-supported prosthetic concept
[2] =>
Standard_300dpi
GMT 32593 GB 1307 © Nobel Biocare Services AG, 2014. 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.
Product images are not necessarily to scale. 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.
Gain direct access to
unrivaled products.
Be more efficient in your work with the new
NobelProcera 2G Scanner. Ultimate precision
enables you to process even advanced cases
with confidence.
Learn more
nobelbiocare.com/2G
[3] =>
Standard_300dpi
CAD0214_03_Editorial 13.05.14 11:08 Seite 1
editorial _ CAD/CAM
I
One step further
with CAD/CAM
_My presentation at the Dental Tribune Study Club Symposium at IDEM Singapore 2014 highlighted
some of the advantages and disadvantages of the use of CAD/CAM in dentistry. My goal was to enable
clinicians to see how it might become more widely accepted in their daily practice and remove some of
their reservations. The next generation of dentists will hopefully come to view traditional methods of
manufacturing dental prostheses in the same way as we now view fixed partial dentures as a way to replace
missing teeth before implants.
Dr Steven Soo
CAD/CAM methods for conventional dental and implant-borne prostheses have gained popularity
for a variety of reasons. Despite many advantages in terms of cost and convenience, the uptake of this
relatively new technology is slow, hinting at a reluctance to try something new.
Many, if not most, clinicians still choose to have fixed implant-borne multi-unit prostheses fabricated
by traditional methods of casting and veneering precious metal alloys. However, the associated high
technical and material costs may be prohibitive to the group of patients who need this treatment modality
the most. To this end, more cost-effective alloys, including base metal alloys, have been cast and veneered
with a variety of tooth-coloured materials with good success. CAD/CAM takes this one step further. In fact,
materials such as zirconia, which has revolutionised dental prostheses, would not be in use were it not for
CAD/CAM.
There has been much discussion around the problem of achieving passivity of fit, the lack of which,
it has been postulated, can contribute to mechanical and biological complications. The multiple steps
and materials used in impression taking, casting a working model, producing a wax pattern, casting in metal
alloy then veneering in tooth coloured material all lead to a certain degree of misfit.
CAD/CAM can help to address this common problem. The use of digital dentistry is more common than
clinicians might think, as the laboratory processes involved have already been widely implemented and
dental technicians can take the credit for driving the use of the technology forwards. The next step is
to adopt digital technology to replace some of the clinical steps in fabricating a prosthesis, namely the
impression stage, which leads to production of a working cast.
These steps can introduce cumulative inaccuracies, as well as consume a variety of materials that are
then discarded. In addition, there are time-savings to be made, perhaps not in the initial stages of learning
and integrating new technology, but, once familiar with the systems involved, all will benefit from the
improved and efficient workflow.
I wish you a pleasant read of this CAD/CAM issue, and I hope you will find various interesting articles in it.
Dr Steven Soo
Dental specialist in prosthodontics at Specialist Dental Group® in Singapore
CAD/CAM
2_ 2014
I 03
[4] =>
Standard_300dpi
CAD0214_04_Content 13.05.14 11:12 Seite 1
I content _ CAD/CAM
page 06
page 12
I editorial
I industry report
03
32
One step further with CAD/CAM
I industry news
I CE article
36
The Virtual Facebow
38
Aesthetic Digital Smile Design:
Software-aided aesthetic dentistry—Part II
| Dr Valerio Bini
40
42
Straumann abutments now available to
3Shape software users
| Straumann
“The trend towards the medium-price range
has accelerated”
| An interview with Straumann executive board member Frank Hemm
about the company’s recent investment in MegaGen
44
A leading-edge implant- supported prosthetic concept
for long-term success and tissue stability
| Dr Fred Bergmann
It is time to look at aesthetics from a new angle
| Nobel Biocare
I meetings
46
I case report
26
3Shape launches Implant Studio for implant planning
and surgical guide design
| 3Shape
I feature
20
Inspired by nature: Zirconia Reinforced Composite
| Schütz Dental
I special
18
Planmeca makes CAD/CAM easier than ever
| Planmeca
| Dr Les Kalman
12
Maestro Scanner system
| Terence Whitty
| Dr Steven Soo
06
page 26
“Clinician education is critical to success”
| An interview with AO Annual Meeting chairman
Dr Lyndon Cooper
issn 1616-7390
Vol. 5 • Issue 2/2014
CAD/CAM
digital dentistry
international magazine of
2
2014
48
International Events
I about the publisher
| CE article
The Virtual Facebow
| special
Shortening guided surgical implant times based
on a combination of CBCT and digital surface scanners
49
| submission guidelines
| Drs Alejandro Lanis & Orlando Álvarez del Canto
50
| imprint
Cover image courtesy of
Schütz Dental GmbH (www.schuetz-dental.com).
page 44
page 48
Aesthetic Digital Smile Design – Part II
| case report
Implant-supported prosthetic concept
page 32
04 I CAD/CAM
2_ 2014
[5] =>
Standard_300dpi
The natural choice
ATLANTIS patient-specific abutments
™
DENTSPLY Implants does not waive any right to its trademarks by not using the symbols ® or ™. 32670183-USX-1312 © 2013 DENTSPLY Implants. All rights reserved
For all major
implant
systems
Give your patients excellent function and natural esthetics.
ATLANTIS patient-specific abutments go beyond CAD/CAM to deliver:
• Freedom of choice in implant system and material
• Optimal emergence profiles and soft tissue margins
• Anatomical support for the final restoration
• A simplified restorative procedure
To learn more about ATLANTIS patient-specific prosthetic solutions,
contact your local DENTSPLY Implants representative or visit our website.
We have you covered
ATLANTIS abutments are backed by a
comprehensive warranty program.
For full warranty terms and conditions,
visit www.atlantisdentsply.com.
ATLANTIS patient-specific abutment
Stock abutment
www.dentsplyimplants.com
32670183-USX-1311_ad_ATLANTIS Clinician_A4.indd 1
2014-01-08 13:55
[6] =>
Standard_300dpi
CAD0214_06-10_Kalman 13.05.14 11:13 Seite 1
I CE article _ Virtual Facebow
The Virtual Facebow
A digital companion
to implantology
Author_Dr Les Kalman, USA
Fig. 1
Fig. 1_Implant treatment planning.
Fig. 2_Analog facebow.
Fig. 2
_Abstract
The Virtual Facebow has been developed as an
open-source tablet app that provides an alternative to
the conventional facebow for the mounting of casts
to an articulator.
The Virtual Facebow implements several design features to prevent and minimize errors, provide accurate
mounting and reinforce the anatomical considerations
associated with articulators. The Virtual Facebow is an
effective, efficient and accessible digital companion to
dental implant diagnoses and treatment planning.
To support proper mounting of patient casts, a facebow, which aligns the maxilla to relative facial planes,
can be utilized. Errors in the utilization of the facebow,
or complete lack thereof, create critical errors in diagnoses and treatment planning that become magnified
in the design and delivery of implant prosthetics.
The Virtual Facebow has been developed as a digital
substitute to the analogue facebow to address the
shortcomings.
_Background
Analog facebow
_ce credit CAD/CAM
_Introduction
This article qualifies for CE
credit. To take the CE quiz, log
on to www.dtstudyclub.com.
Click on ‘CE articles’ and
search for this edition of
the magazine. If you are not
registered with the site,
you will be asked to do so
before taking the quiz.
Prior to the delivery of dental treatment, carefully
established diagnosis and treatment planning is required. This is particularly important with dental implant therapy.1
The facebow (Fig. 2) facilitates the mounting of the
maxillary cast to the articulator. The Whip Mix Quick
Mount facebow (Whip Mix, Louisville, KY) is composed
of a caliper-type instrument that anchors into the ear
canals and is balanced by the bridge of the nose.
To assist the process, the mounting of a patient’s diagnostic casts remains an important step, as it allows the
assessment of critical factors such as occlusion, implant
position and forces direction.2 It also allows exploration
into prosthetic options,2 such as angled abutments (Fig. 1).
A bite fork is utilized, embedded with polyvinylsolixane, to register the position of the maxillary teeth. The
bite fork is then transferred to an articulator, through
the use of a transfer jig. The maxillary cast is positioned
and mounted to the upper portion of the articulator.
06 I CAD/CAM
2_ 2014
[7] =>
Standard_300dpi
CAD0214_06-10_Kalman 13.05.14 11:13 Seite 2
CE article _ Virtual Facebow
Fig. 3
The facebow is a largely omitted during the diagnosis and treatment-planning phase due to its shortcomings. It can prove tedious and uncomfortable for the
patient, as the ear canal projections, bite fork and nose
bridge can apply pressure and pain. The facebow can
prove tedious and frustrating to the clinician, due to
the subjective positioning and multiple adjustments3, 4, 5
(Fig. 3).
If utilized incorrectly, the facebow can result in
errors, which include:
_facebow application;
_assembly;
_patient position;
_verification;
_in maxillary cast orientation;
_in mandibular cast orientation;
_occlusal relationship.
Errors have direct impact on the assessment of
inter-arch space, occlusal contacts and force direction
(Figs. 1-4). Errors will then affect the diagnosis, treatment plan, implant type, abutment angle and prosthesis. If inaccurate mounting errors are not recognized
early, the outcome may yield a compromised result,
poor prosthesis (form and function), timely adjustments and a remake.
As with any compromised result, the ultimate
consequence would include inefficient use of time,
unnecessary costs, patient unhappiness, stress on the
clinician and an unnecessary environmental impact.
Virtual Facebow
To rectify these compounded issues, the Virtual
Facebow app (VF) (Research Driven, Komoka, Ontario)
was developed as a digital substitute for the analog
facebow.
I
Fig. 4
Fig. 3_Facebow application.
Fig. 4_Incorrect mounting.
Several safeguards were incorporated to minimize
errors in positioning and orientation. The VF has
been developed as an app that incorporates patient
photos, alignment verification, anatomical relevance
and confirmation of occlusion. The open source tablet
app has been developed to be accessible through
affordable tablet cost, affordable app cost and unlimited use.
Data can be readily shared, used on various devices,
requires no specialized software, is simple to open
and read and provides an easy-to-email option. The VF
was designed to be efficient, effective, economical and
educational. The VF’s current requirements include:
any supported tablet device with an Android operating
system, a back-facing camera and a minimum system
update of 4.0.3. The VF is currently available on the
Google Play market.
Although the VF app has been designed to be used
as a standalone substitute for the analogue facebow,
several peripherals have been developed to offer even
more simplicity to the process. A patient positioner
verifies patient orientation, a vertical tablet stand simplifies operation and an articulator mount positions
the maxillary cast.
_Methodology: Case study
Clinical
The following is a step-by-step instruction on the
VF utilization. Properly position the patient and confirm
orientation. Place the tablet in the stand within 6 to
12 inches of the patient. Launch the VF app (Fig. 5).
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I CE article _ Virtual Facebow
Fig. 5_Tablet-patient position.
Fig. 6_Screenshot face-skull.
Fig. 7_Occlusal contacts.
Fig. 8_Screenshot tooth map.
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Position the skull and reference markers over the
patient’s image. Confirm alignment of tablet and markers and simply take a photo. Resize and reposition the
patient photo if required and save the image. Verify
orientation of midlines, incisal edges, occlusal planes
and anatomical references by altering the transparency
of either the skull or face image (Fig. 6). Clinically assess
occlusal contacts (Fig. 7) and input via the touch screen
(Fig. 8). Clinical component has been completed.
Laboratory
When the cast is correctly positioned, simply take
a photo. Resize and reposition the image if required
and save the image. Orientation can be confirmed
by altering the transparency of either the face or cast
image. Mount the maxillary cast to the upper articulator. The record of occlusal contacts (Fig. 8) will then be
displayed. Position the mandibular cast to the maxillary
cast, confirming contacts,and mount the mandibular
cast.
The VF will then generate a composite of the skull,
face and cast. The operator has the ability to alter the
If the clinician has delegated mounting to the lab - transparency of any image to reconfirm the position
oratory, then the records phase has been completed. of the skull to the patient’s face and, ultimately, to
The following applies to those who mount their own the cast (Fig. 11). The laboratory component has been
casts. Position the tablet in the stand 6 to 12 inches from completed (Fig. 12).
the cast and launch the VF app. Place the maxillary cast
The files are then saved on the hard drive as a series
on the articulator mount (Fig. 9). The patient image
of PDFs and JPGs, both of manageable size. The user has
will appear.
the option of emailing either the complete series or
Adjust orientation of cast (tilt) to confirm alignment individual images, in PDF or JPG, to any third party.
with the patient markers. Verify orientation of midline, The user has the ability to refer back to any image
incisal edges, occlusal plane and facial references but cannot modify any of the images. A series of six
screenshots document the VF process.
(Fig. 10).
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CE article _ Virtual Facebow
I
Fig. 9_Cast photo.
Fig. 10_Screenshot face-cast.
Fig. 11_Screenshot skull-face-cast.
Fig. 12_VF mounted casts.
Fig. 9
Fig. 11
_Discussion
The VF utilizes several proprietary design features
that enable a tablet device to have the ability to record,
confirm and reproduce the orientation of the maxilla
to relative facial landmarks. This enables a simple, efficient and effective technique in the mounting of the
maxillary cast to the articulator.
The VF also records the maxillo-mandibular relationship vital to correct mounting, enabling the accurate mounting of complex implant cases (Fig. 13). With
exact mounting, the proper position and angulation
of dental implants can be achieved (Fig. 14).
A pilot study was recently performed at the
Schulich School of Medicine & Dentistry at Western
University. Patients with restored dental implants
were selected. A practitioner assessed the occlusion.
Impressions and required records were taken, and casts
were mounted.
Fig. 10
Fig. 12
One dental student utilized the analogue facebow,
the other the virtual facebow. Mounting was assessed
in terms of: cast position (anteriorposterior and lateral),
quantity of occlusal contacts, required clinical, laboratory and total time and cost. Preliminary analysis
suggests that the VF is more accurate, efficient and
cost-effective. Data will presented in the near future.
The use of cone-beam computer tomography remains the gold standard of dental implant treatment
planning.6 However, many clinicians have barriers to the
technology either from limited finances, physical access
or intimidation. Many implant cases are planned and delivered with little to no clinical records, other than final
impressions. The Virtual Facebow provides a digital companion that is accessible, affordable and understandable.
_Conclusion
The Virtual Facebow is an open-source tablet app
that not only facilitates the mounting of the maxillary
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I CE article _ Virtual Facebow
Fig. 13
Fig. 14
Fig. 13_Implant case.
Fig. 14_Implant radiograph.
(Images provided by Dr Les Kalman)
cast but offers a record of occlusion. The VF also reinforces the anatomical basis of articulator mounting
and supports clinical records through patient photographs.
The VF provides the clinician with a digital alternative to the analog facebow. Although evaluated through
a pilot study, a larger research project would provide
further validation.
By reducing errors in the diagnosis and treatment
phases of implantology, the VF hopes to prevent and
minimize errors incurred through incorrect mounting.
Dental implant therapy can then be planned and
delivered with the affirmation that mounting has not
faulted the process of treatment delivery._
Editorial note: The Virtual Facebow has been acquired
by Whip Mix Corporation. Version 2.0 has been developed
to allow a simplified approach. The new version will be
available in early summer of 2014.
_References
1. Siadat H, Shahrokhi Rad A and Mirfazaelian A. A Simple
Method for Making Diagnostic Casts for Dental Implants
Using Acrylic Abutments. Journal of Dentistry: 2006; Vol.4,
No. 2: 89–121.
2. Misch CE and Dietch-Misch F. Diagnostic Casts, Preimplant
Prosthodontics, Treatment Prostheses and Surgical Templates. In Misch CE. Implant Dentistry (2nd ed.) p135–149,
St. Louis, 1999, Mosby.
3. Wilcox WW, Sheets JL & Wilwerding TM. Accuracy of
a Fixed Value Nasion Relator in Facebow Design. Journal
of Prosthodontics: 2008; 17:31–34.
4. Chow TW, Clark RKF & Cooke MS. Errors in Mounting
Maxillary Casts Using Face-Bow Records as a Result of
an Anatomical Variation. Journal of Dentistry: 1985; 13,
No. 4:277–282.
5. Palik JF. Accuracy of an Earpiece Face-Bow. Journal of
Prosthetic Dentistry: 1985; 53:800–804.
10 I CAD/CAM
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6. Benavides E, Rios HF, Ganz SD An CH, Resnik R, Reardon GT,
Feldman SJ, Mah JK, Hatcher D, Kim MJ, Sohn DS, Palti A,
Perel ML, Judy KW, Misch CE & Wang HL. Use of Cone-Beam
Computed Tomography in Implant Dentistry: The International Congress of Oral Implantologists Consensus
Report. Implant Dentistry: 2012;21(2): 78–86.
_about the author
CAD/CAM
Dr Les Kalman, DDS, graduated
from the University of Western
Ontario with a doctor of dental
surgery degree in 1999.
He then completed a GPR at the
London Health Sciences Centre.
He has been involved in general
dentistry within private practice
since 2000. He has served as the chief of dentistry
at the Strathroy-Middlesex General Hospital. In 2011,
he transitioned to full-time academics as an assistant
professor at the Schulich School of Medicine and
Dentistry. Kalman is also the coordinator of the Dental
Outreach Community Services (DOCS) program,
which provides free dentistry within the community.
Kalman has authored articles on subjects ranging
from paediatric Impression to immediate implant
surgery in both Canadian and US journals. He has
been a product evaluator for several companies,
including GC America and Clinician’s Choice.
Kalman is the co-owner of Research Driven Inc.,
a company that deals with intellectual property
development. His most recent dental product invention
has been featured on the W Network’s “Backyard
Inventors” television series. Kalman is a member of the
American Society for Forensic Odontology, International
Team for Implantology, Academy of Osseointegration,
American Academy of Implant Dentistry
and the International Congress of Oral Implantology.
He can be contacted at lkalman@uwo.ca.
[11] =>
Standard_300dpi
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I special _ digital smile design
Aesthetic Digital Smile
Design: Software-aided
aesthetic dentistry—Part II
Author_Dr Valerio Bini, Italy
Fig. 18a_Images orientation
and analytic focal length.
Fig. 18a
_Virtual planning and digital wax-up
Having introduced the fundamental tenets of
this method in Part I, I move on to a step-by-step
description of Aesthetic Digital Smile Design (ADSD)
in Part II.
_Import and adaptation of images: after having acquired the video frames that statistically capture
the dynamic phases of the smile and after having
imported all the intra- and extra-oral photographs
in the manner described in Part I, the smile designer, as if he or she were an architect, undertakes
true and accurate mapping of the face and the
smile, observing the peculiarities according to
focal length. The aesthetic analysis (macro, mini
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and micro) to which it makes reference is based
on values and parameters derived from Powell,
Goldstein, Rufenacht, Lombardi, Arnett and
Chiche, Pinault, Ricketts, Fradeani and others,
and the aesthetic dentist can use these values
and parameters with rulers, set squares and goniometers. The full face images of the patient also
involve an analytical observation of the portrait
and therefore hair and skin colour, make-up, pose,
etc. are important. After being imported, these
factors will be processed in the manner described
below.
_Verification of orientation and exposure of the
subject photographed (Fig. 18a): the imported
images must be verified on the basis of the quality
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special _ digital smile design
Fig. 18b
of the shot, exposure, sharpness, etc., technical
factors that most software packages can correct
and improve, and some of which the Digital
Firmware camera cauìn correct itself. Practice to
acquire greater familiarity and skill will prove
useful to the smile designer.
In addition to the qualitative factors, the correct
orientation of the patient’s face is absolutely essential. Some software on Mac operating systems
allows rotation of the image with a simple movement of the fingers. In general, however, it is possible to trace a bi-pupillary plane that the software
will recognise as the horizontal plane to which to
make reference for adapting the image.
Another efficient method, with a dual function,
is that of using the cropping grid. This offers the
possibility of cropping the photograph to centre the
image for use in ADSD. It permits us to align the bipupillary plane horizontally to check the symmetry
in relation to the sagittal plane.
There is another simple but efficient way: increasing the zoom on the photograph. The pupils
I
Fig. 18c
will be more detailed and thus, by rotating the
photograph, it will be possible to take as a reference
point the upper edge of the software window,
on which to verify the pupillary alignment. Later on,
it will be possible by scrolling the image towards
the top to examine the mouth and the teeth to
verify the occlusal plane.
_Mapping of the macro-aesthetics (face): having
decided on the correct position of the face for a
detailed aesthetic analysis and after a digital
analysis, it is indispensable to mark the face and
the smile with reference lines and areas, verifying
symmetries and asymmetries (Fig. 18b). The first
thing to do is to mark the reference points and
morphological determinants (face marker); these
should be saved in the project from the photograph because they are fixed anatomic topographical points in both the extra-oral and intraoral soft tissue, obviously bordering on the teeth
and gingivae. From now on, it is essential to save
the various ADSD projects. In this manner, we shall
have immediately at our disposal the cardinal
points of the topographic anatomy on which we
shall later base the proportions of the face in terms
Fig. 18b_Mapping of the
macro-aesthetics of the face.
Fig. 18c_Mapping of the
mini- and micro-aesthetics
of the mouth and smile.
Fig. 18d_Check of mini-aesthetic
virtual planning with opacity
and semi-transparency.
Fig. 18e_Comparison of the before
and after images in virtual planning.
Fig. 18d
Fig. 18e
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I special _ digital smile design
Fig. 19
Fig. 20a
Fig. 20b
Fig. 20c
Fig. 19_Dento-facial profile
with multidisciplinary ADSD
and Powell analysis.
Figs. 20a & b_Sublabial dental
profile with semi-transparent effect.
Fig. 20c_Virtual planning.
of vertical and horizontal dimensions and the
golden ratio analysis.
_Mapping of the mini-aesthetics (mouth and
smile): from the macro-aesthetic focal length, we
can come closer to select the perioral and intraoral zone where it is necessary to carry out
the virtual simulation after a careful dento-labial
analysis (Fig. 18c).
The photographs taken statically with closed lips
in relaxation, the lips spontaneously half-closed or
the lips in a smile while pronouncing the phonemes
“/m/” and “/i/” can be compared to video frames:
from the recording of this data, we can evaluate
movement, the dynamic curvature of the lower
lip in relation to the maxillary anterior teeth, the
position of the central incisors, their exposure and
the breadth of the smile well delimited by the width
of the labial corridors.
Often the multidisciplinary approach to a clinical
case entails a preliminary examination by the plastic surgeon to establish the aesthetics of the labial
profile. The plastic surgeon, who has to speak in
favour of possible plastic surgery to the profile or
the like, sends the patient to the dentist for a clinical evaluation of the dental–skeletal ratios, which
is comparable with the aesthetic analysis of the
entire profile of the face (Powell’s aesthetic triangle,
Ricketts’ aesthetic plane, etc.). A dento-facial aesthetic analysis thus becomes a fundamental pillar
for the co-operation between the specialists in the
facial aesthetics medical team (Fig. 1 in Part I) to
allow a predictable diagnosis and a treatment plan
based on a multidisciplinary vision, considering the
fact that the soft tissue of the lower third of the face
is supported by and moves by sliding on the hard
structures (bones and teeth).
In this regard, ADSD can be of help for analysing
the lateral thickness of the hard tissue, particAll of these factors are relevant to the smile ularly the position of the anterior teeth, their
design. It is also fundamental to verify the re - inclination and their emergence profile. Indeed,
lationship with closed lips between the labial it is possible to perform digital image editing
vermilion (analysed both frontally and in profile) analytically on a millimetre grid based on the
and the labial dimensions useful for defining and reference points from the mapping of the facial
comparing the vertical dimensions of the face, profile. The simple superimposition of the images
eventual losses or excesses of substance, brux- and the implementation of protocols or compleism, atrophic jaws, dental alignment, micro- or mentary examinations (virtual 3-D orthodontic
macrodontia, malocclusion or even simple loss simulations; vto; cephalometric analysis; dental
of lip fullness, which is currently of great aesthetic design related to the thickness of veneers, overinterest not only clinically, but also and above all lays, prosthetic crowns, recontouring, etc.) can
in the media.
process virtual plans, in which it is possible to pre-
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special _ digital smile design
Fig. 21a
dict the future position of the lips and vestibules
(Fig. 19).
_Mapping of the micro-aesthetics (intra-oral):
the iconography of the analysed face includes the
study of photographs taken with lip retractors in
place (micro-aesthetics). The focus of this type of
image is the close-up of the mouth, the details of
which are relative to and parameterised according
to the horizontal and vertical lines traced on the
patient’s face. Our virtual project will centre on the
occlusal plane ideally parallel to the bi-pupillary
plane, and the main vertical lines (i.e. the median of
the face, inter-incisal of the teeth, subnasal area,
etc.).
The intra-oral mapping is thus a simple magnification of what has already been traced on the face.
In practice, on our computer desktop, we will have
a map in which there are very distinct regions,
including outlines, ridges and depressions characteristic of the dento-facial morphology.
_At this point, all we have to do is to start tracing
lines (outlines; Figs. 11a & b in Part I) on the intraoral photographs, passing over the gingival margins, papillae, and interproximal margins of the
central incisors, lateral incisors and canines (Digital Dental Design). In order to achieve a symmetrical drawing, the lines and contours of the teeth can
be duplicated to create a mirror image. In this way,
I
Fig. 21b
Fig. 21c
Fig. 22a
Fig. 22b
it is possible to obtain the positioning of the forms
on the contralateral teeth. Among the lines used,
it is very important to insert a line corresponding
to the ideal aesthetic curve, which will have a
value directly proportional to the position of the
occlusal plane.
Figs. 21a–c_Close up
of the dental arches and ADSD.
Figs. 22a & b_Implementation
of ADSD CAD.
_Paste or overlay the images taken from the Dental
Digital Photo Database or model a filling of the
outlines. In many cases, it is not strictly necessary
to draw the teeth, since often the images of the
teeth are copied, shaped, moved and positioned
on the dental arch (Digital Dental Calibrated Transposition).
_Position the teeth by reducing the opacity to place
them with greater visibility in the desired positions. Opacity enables one to better visualise the
underlying images when using tools for the superimposition of images, is an option in all photograph-editing software and can easily be adjusted
in percentage.
_Adapt and proportion the teeth in space (dimension and alignment) by using the images rendered
semi-transparent by adjusting opacity comparable to the previous opacity (Fig. 18d).
_Save the images where the transparency level
enables us to calculate it as a superimposition
(Figs. 20a & b), where the points of departure and
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I special _ digital smile design
the data approximates the clinical reality of the
subject photographed.
_Verify and modify the gingival architecture concerning the aesthetic component and tissue ratios.
The positioning of the zenith, papillae and cervical
parabolas represents an absolute value in aesthetic analysis for planning. It is particularly sensitive data useful for deciding on therapy with
the periodontist.
_After finishing the positioning of the teeth and
gingivae, shape them morphologically according
to the customised aesthetic “plan”, bordering on
the aesthetic dental composition (Fig. 18e).
_Every image editing step relating to the simulation must be saved in the software format
so that no data is lost to allow modification at
a later date. The same must be done for JPG and
similar formats in the patient’s file, re-naming
them in a sequential manner, which permits
a more reliable and revisable back-up for the
smile designer and the aesthetic dental team,
and permits a better method of communicating
the various therapeutic possibilities to the
patient. It also provides essential information
for checking the positioning of the prototypes
(Figs. 20c & 21a-c).
Fig. 23a
Fig. 23b
Figs. 23a & b_Zirconia restorations
in situ showing harmony of forms
and biological integration.
16 I CAD/CAM
2_ 2014
arrival can be seen and where the sublabial dental
composition can be seen (i.e. superimposing the
micro-aesthetic images with the mini- and macroaesthetic ones, and being able to observe above
and below the labial and perilabial soft tissue).
Indicate and record on the photograph the unit
of measurement chosen for the conversion scale
of the software so that the data approximates clinical reality. If the measurements were previously
according to an analogue or digital scale, you will
be able to obtain optimal indications as regards
reference points. For example, the position of the
maxillary central incisors can provide information
about the distance between the incisal edge or
cervical margin and the subnasal or bi-pupillary
line. Therefore, remember to indicate and record
on the photograph the unit of measurement
chosen for the software conversion scale so that
_At this point, we have at our disposal the digital
wax-up, which we can transfer to the dental
technician so that he or she can create an actual
diagnostic wax-up, which once photographed
can be inserted into the oral cavity. Note that,
where it is already possible to transfer the ADSD
file into CAD, the CAM phase will produce a model
that is useful for reducing the time and synchronising the methods implementing the protocols.
By decreasing the opacity of the image and working on the transparency, we can check whether
the virtual records and indications conform to
the analogue model.
_If everything corresponds, it is possible to make
modifications then to continue with the direct or
indirect mock-up, which necessitates the preparation of a silicone key to accommodate provisional
material to be adapted to the teeth or a workpiece
produced by the dental technician without it being
necessary to adapt the material to the teeth, such
as composite veneer, resin and PMMA.
_Having positioned the aesthetic model in the
oral cavity, it is inspected and approved with
the patient, correcting any individual or functional
details from the point of view of occlusion, facial expressions and the dento-labial relationship,
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special _ digital smile design
which can easily be tested using phonetic tests.
In this phase, as well as giving the patient the
opportunity to look at himself or herself in a mirror, it is very useful to use the camera again, since
the recording of the physiology of the smile in
relation to the phonetics and facial expressions
may become the subject of further live 3-D analysis of the patient. The more information we send to
the dental technician, the more it will be possible
for him to observe the patient and update himself
or herself on the analysis being carried out. While
the dentist is in his or her surgery, the technician in
the laboratory can watch the video clips, analyse
the photographs and communicate via the telephone or video-conferencing on Skype. All this offers many advantages to this protocol. Being able
to dispel any doubts will give greater satisfaction
to the dental team and result in clinical success,
clearly demonstrated by the aesthetic harmony
in the smiles of our patients.
_Once the mock-up has been approved with the
consent of the patient, who will have been the
first critical spectator of and commentator on the
video clip, one can take another traditional dental
impression or take an impression using an interoral scanner (optical impression). During the video
playback, the patient is able to observe peculiarities about himself or herself that he or she would
not be able to see using only a mirror, the first being
seeing himself or herself in profile through images
that are not static and precisely because of their
dynamic nature correspond to spontaneity and
naturalness.
_Carry out digital smile morphing of the images step
by step to demonstrate and transmit the actual
simulation corresponding to virtual planning.
This phase is of great interest and effect for the patient because morphing, being shown sequentially,
appears to be like a film. This procedure is carried
out as far as the superimposition of the images
processed during the first analytical aesthetic
phase up to the related functional models inserted
into the oral cavity before the definitive restoration.
_From the analogue phase of the model, we move
on to the digital phase to produce the prosthesis
with CAD/CAM procedures (these images can be
further analysed in the virtual planning phase;
Figs. 22a & b).
_In the case of particular work procedures in which
software-assisted implantology techniques are
used, one may also have at one’s disposal a second model in PMMA, diagnostic or surgical guides
especially for implant structures, etc.
I
_The final step in the implementation of ADSD in
the CAD/CAM protocol is the placement of the definitive restoration in the oral cavity (Figs. 23a & b).
The outcome of the multidisciplinary approach
should confirm the predictability concerning the
aesthetic and bio-cosmetic integration of the
prosthesis.
_Conclusion
The detailed analysis of the smile and its project,
indispensable for the formulation of an aesthetic
clinical diagnosis, is a fundamental part of the delicate approach to the patient, the true protagonist
of aesthetic dentistry. Today, the operator has at
his or her disposal new non-invasive means of formulating the treatment plan; digital dentistry and
image-editing software are now part of a dentist’s
armamentarium. Furthermore, the entire treating
team being advanced in the use of instruments and
technologies for diagnosis and communication
makes an excellent marketing tool for dental
services. ADSD is a simple and economical way of
offering the patient a predictable plan that can be
visualised immediately or at least at the second
appointment to demonstrate the aesthetic and
functional changes possible with treatment with
the aid of corresponding models. It is also a tool
for transmitting all the information necessary to
the entire treating team in the multidisciplinary
approach. Let us hope that a new professional
figure may soon establish himself or herself in the
world of dentistry, the smile designer, a new way
to communicate._
Editorial note: This is the second of a two-part article
based on a paper presented by Dr Valerio Bini to the
15th International Congress of Aesthetic Medicine in
Milan in October 2013 during the session titled “Aesthetic
dental surgery of the lower third of the face”. Part I of the
article appeared in CAD/CAM 1/2014.
_about the author
CAD/CAM
Dr Valerio Bini, DDS, graduated from the University
of Genoa in Italy. He is a specialist in prosthodontics
and aesthetic dentistry. He has presented papers
at international conferences on aesthetic dentistry
and aesthetic medicine, and is the author of many
articles published in national and international
journals. Dr Bini is a member of the European
Society of Cosmetic Dentistry, a fellow of Società
Italiana di Estetica Dentale (Italian society of
aesthetic dentistry) and a fellow of the Italian Academy
of Esthetic Dentistry. He is Invisalign certified.
Dr Bini may be contacted at info@studio-bini.com.
CAD/CAM
2_ 2014
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I feature _ interview
“The trend towards
the medium-price range
has accelerated”
An interview with Straumann executive board member Frank Hemm
about the company’s recent investment in MegaGen
_Following previous investments in Brazil,
Germany and Spain, Straumann recently announced that it has bought convertible bonds
worth US$30 million from MegaGen, one of
the largest dental implant solution providers in
South Korea. At the recent World Symposium of
the International Team for Implantology in
Geneva in Switzerland, on behalf of CAD/CAM,
implants magazine Managing Editor Georg
Isbaner had the opportunity to talk with Frank
Hemm, a member of Straumann’s executive management board, about the investment and how
it will affect his company’s position in the Asia
Pacific region.
_CAD/CAM: According to analysts, South
Korean manufacturers are expected to dominate
the market for dental implants in Asia in the years
to come. Is this projected development the main
reason for your investment in MegaGen?
Frank Hemm: South Korea is one of the largest
markets for implants in terms of volume. More
than two million implants are placed every year
and local manufacturers are looking to expand
into other Asian markets with high potential.
China is a good example, where the market is
still comparatively small but under-penetrated
and growing quickly.
In these markets, the premium implant segment, where Straumann has been and still is very
active, is growing less dynamically than the
medium- and low-price segments are. We see
the same trend in other markets, like Brazil,
where companies like Neodent sell higher volumes than premium providers do. Two years
ago, we had to ask ourselves whether we could
18 I CAD/CAM
2_ 2014
address the non-premium segment with our
existing brand or whether we needed a second
brand. We decided on the latter and purchased
a 49 per cent stake in Neodent. As an established
brand in the region, MegaGen gives us a foothold
in the Asian “value” (medium-price) segment.
The convertible bond approach means that we
have the option to gain a majority stake in 2016
with a managed low risk.
Straumann has always provided premium
dental implants backed by solid scientific evidence and service excellence. These key differentiators make it necessary to use a separate brand
strategy to address customers who are willing
to accept lower standards and who want to pay
less for implants. The value segment is growing
exponentially and developing a new brand from
scratch would simply take too much time and too
many resources, which is the reason we chose to
invest in other established companies.
_Both companies have said that they will continue to operate separately. Still, do you expect
any synergies to arise from this partnership?
It is important to keep both businesses
completely separate to ensure that customers
do not think that Straumann is MegaGen and
vice versa. The only synergies we see are in
supporting the value brand companies to enter
selective markets, and in sharing back-office
functions, like infrastructure, information technology or accounting. Everything else is handled
by each company independently. Straumann
products are certainly produced in Straumann
facilities and this will continue to be the case
in the future.
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CAD0214_18-19_Hemm 13.05.14 12:36 Seite 2
feature _ interview
_Is there the risk that you might be creating
more competition for yourself with this investment?
We would not have taken this step if the
market situation had not required it. The trend
towards products in the medium-price range has
accelerated and there is already strong competition, even without MegaGen. We are not adding
more competition; rather, we are competing
where we could not compete as Straumann.
_What position is your company generally
aiming for in the Asia Pacific region?
We aspire to market leadership in the region.
We are not there yet, partly because our Roxolid
implants with the SLActive surface are not yet
available in the larger markets. We recently received
approval for SLActive Tissue Level implants in
Japan and the sales figures demonstrate the extent
of the potential of our innovative technologies.
Achieving a leading position in Asia will certainly have a positive influence on our global
position.
_What requirements will have to be fulfilled
for you to exercise the option to convert and
acquire a majority stake in MegaGen in 2016?
We are keeping a close eye on the company’s
development. MegaGen is a relatively new enterprise. It is growing dynamically and has many
ambitions that still have to be realised. We also
want to see how the market develops and the
extent to which MegaGen can penetrate certain
areas. The company’s valuation is another item
on our radar. If our expectations are met, we can
convert the bonds into shares in 2016 or require
repayment with interest. That is the flexibility
that this option allows us.
I
Georg Isbaner (left) in talks
with Stefan Hemm.
(DTI/Photo Henrik Schröder, Germany)
_Should you decide to convert the bonds into
stock, another large international implant conglomerate would be created. Is it only possible to
survive in the long run as a large market player?
The implant market is still very fragmented
and the market share of larger corporations is
actually declining. There are hundreds and hundreds of smaller providers, often founded by dental clinicians, that come and go because they do
not have the capability to expand internationally.
Few companies succeed in making this jump and
remaining in the market for a longer period.
Unlike in some industries, scale in the dental
implant industry does not have inherent returns.
What we are seeing is a consolidation in a larger
context, as many distributors have started to
include implants in their portfolios with the aim
of becoming one-stop shops. This development
needs careful scrutiny because implants involve
other factors that only we as specialists can
deliver.
_Thank you very much for the interview.
CAD/CAM
2_ 2014
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CAD0214_20-24_Bergmann 13.05.14 11:16 Seite 1
I case report _ dental implantology
A leading-edge
implant-supported prosthetic
concept for long-term
success and tissue stability
Author_Dr Fred Bergmann, Germany
Fig. 1
Fig. 2a
Fig. 1_The radiograph (OPG)
of the initial situation.
The gap in region 36 is to be closed
by means of an implant-supported
prosthetic solution.
Figs. 2a–c_The three-dimensional
image of the initial situation
confirmed the suspected
insufficient bone volume in the
buccal area of region 36. The ideal
implant location was determined
in the planning software.
Figs. 3a & b_Comparison of planning
and implementation. The implant
(XiVE) was inserted into
the bone as planned.
Fig. 4_The master cast with gingival
mask and desired emergence profile.
Fig. 5a_Virtual wax-up of the
abutment (ATLANTIS).
20 I CAD/CAM
2_ 2014
_Patient-specific restorations are the focus
of state-of-the-art dentistry. A treatment concept
tailored to the specific situation has also become
indispensable in implant dentistry. Based on the
case presented, this article describes how a custom abutment can be used to create an implantsupported crown very similar to the natural tooth
in shape and soft-tissue profile.
Fig. 2b
Fig. 2c
A leading-edge treatment protocol distinguishes
itself by a perfectly coordinated surgical-prosthetic
procedure with the goal of harmony and long-term
stability of peri-implant bone and keratinized mucosa. The key parameters of the concept are implant
positioning in the lingual or palatal third of the
alveolar ridge to ensure a buccal bone plate with
a minimum thickness of 1.5 mm.1, 2 In addition, a zone
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CAD0214_20-24_Bergmann 13.05.14 11:16 Seite 2
case report _ dental implantology
Fig. 3a
of keratinized mucosa of at least 3 mm must be
maintained or created. The surgical approach is minimally invasive based on advanced diagnostics with
three-dimensional DVT, imaging and virtual surgical
planning. Furthermore, the “oneabutment-one-time”
concept3 avoids frequent abutment changes with the
consequence of peri-implant tissue loss. Lastly, the
treatment concept includes a custom CAD/CAM fabricated abutment with anatomical contour, so that the
crown margin terminates at the same level as the gingiva. This serves to avoid excess cement subgingivally
and the occurrence of peri-implant inflammation.4
The importance of stable peri-implant soft tissue
for an implant-supported restoration is the topic
of numerous publications.5, 6 But how can the dentist achieve this goal in a safe and efficient manner?
A well-coordinated treatment concept and optimal interlocking product components are required.
The presented case report explains how the in-
I
Fig. 3b
Fig. 4
terdisciplinary treatment team can combine these
aspects. The case report shows how an implant
(XiVE) is used in region 36 with a custom abutment
(ATLANTIS) fabricated using CAD/CAM technology.
Years of research and development have been
invested in the implant design and surface, and the
best possible outcome has been achieved in this
Fig. 5b_Virtual wax-up
of the abutment (ATLANTIS).
Fig. 5c_View of the abutment design:
The profile of the crown margin
is exactly at gingival level.
Fig. 6_The fabrication of the
designed abutment in titanium was
carried out at the Fabrication Center.
Fig. 5a
Fig. 5b
Fig. 5c
Fig. 6
CAD/CAM
2_ 2014
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I case report _ dental implantology
Fig. 7a
Fig. 7b
The optimum result can be visualized in advance
and the treatment sequence precisely defined.
_Initial situation and planning
Fig. 7c
Figs. 7a–c_Delivery of abutment,
transfer guide and
a temporary crown.
Fig. 8_After the healing phase,
the conditions were stable
and the width of the alveolar
ridge was sufficient.
Fig. 9_Careful exposure
of the implant. The laser ensured
a minimally invasive procedure.
Fig. 8
area. Now attention is being focused on the implant
abutment. In addition to standardized abutments,
components customized to the patient are becoming increasingly important and promise highly
aesthetic results and long-term stability. State-ofthe-art restorations also focus on other factors such
as a minimally invasive procedure and a prognosisoriented approach, for instance the prevention of
peri-implantitis. Before the abutment is fabricated,
implant placement or planning of the optimal implant position must be taken into account. The
emergence of the implant platform or collar from
the soft tissue must be taken into consideration
at this stage, and the abutment must be designed
accordingly. Three-dimensional diagnostics provide the ideal basis for the conceptual planning.
Fig. 9
22 I CAD/CAM
2_ 2014
The patient approached the treatment team with
a wish for an implant-supported prosthetic restoration in region 36. The patient’s general medical
history revealed no anomalies. The oral situation
also indicated no significant need for treatment. The
maxilla was fully dentulous, but a radicular cyst on
tooth 12 was diagnosed radiographically. Surgical
treatment of this cyst is scheduled in the near future.
A similar picture emerged in the mandible. After
closing the gap in region 36 and restoring tooth 12,
the treatment will be completed. The initial radiograph (OPG) showed sufficient vertical bone (Fig. 1),
but a lack of buccal bone volume from a clinical perspective. This was confirmed in the three-dimensional view (DVT). The implant (XiVE, DENTSPLY Implants)
in region 36 was planned virtually in a slightly lingual
position using a planning and navigation software
and the need for augmentation in the buccal area
was evaluated (Figs. 2a–c). The concave profile of the
alveolar ridge would not allow for an aesthetically
satisfactory result without grafting. The goal was to
achieve a buccal plate of approximately 2 mm, and
thus a slightly convex ridge in this area. This required
systematic treatment planning. All natural structures of hard and soft tissue should be optimally
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CAD0214_20-24_Bergmann 13.05.14 11:16 Seite 4
case report _ dental implantology
Fig. 10
I
Fig. 11a
preserved and stabilized. This requirement was incorporated into the planning, and the emergence profile
of the implant from the soft tissue was considered
already at this early stage. The final implant location
was based on the existing anatomical parameters
and the desired prosthetic restoration (Fig. 3a).
_Initial surgical session
According to the plan and the drilling protocol,
the implant was inserted in region 36 and the bone
grafted in the buccal area (Fig. 3b). To fabricate the
abutment during the healing phase of the implant,
it was necessary to transfer the situation (implant
location) from the mouth to the cast model as
precisely as possible. The index registration proved
successful for this purpose. The implant impression
coping was screwed into place in the mouth and the
implant location fixed using a plastic index key. After
removing the central screw, the key was removed
from the mouth with the impression coping and
transferred to the dental laboratory with the impression for fabrication of the master cast. A cover
screw was used to enable a submerged healing.
_Fabrication of the abutment
The dental technician used the index key to transfer the exact location of the implant to the cast and
to mold a wax-up of the planned prosthetic restoration. Based on this specification, the ideal emergence
profile was defined (based on biological width) (Fig. 4).
A gingival mask provided the corresponding emergence profile of the basal abutment area. It was important to design the connection between the abutment and the later crown at gingival level to prevent
excess cement from compromising the long-term
result. A subgingival crown margin significantly
increases the risk of overlooked excess cement.2
ATLANTIS (DENTSPLY Implants) was chosen to
design and fabricate the abutment using CAD/CAM
technology. This concept allows custom abutments
for cement-retained prosthetic solutions to be cre-
Fig. 11b
ated in a simple and efficient manner. After scanning
the implant cast (with gingival mask), a detailed threedimensional image of the intra-oral situation emerged.
At the Design & Fabrication Center (ATLANTIS), a virtual abutment was fabricated based on the patient’s
specific situation and an image of the situation sent
to the treatment team via the web portal (Figs. 5a & b).
After assessing the templates and slightly adapting
the virtual wax-up in the 3-D editor, the design was
released and fabrication of the abutment ordered
(Fig. 5c). Zirconium oxide, titanium, and titaniumnitride-coated titanium (GoldHue) are available as
materials for implementation. In this case, titanium
was the material of choice for the abutment, for reasons of stability. The laboratory received the industrially fabricated abutment just a few days after receiving the ordering information. It fits perfectly on the
cast model and required no rework. The instructions
were to leave the basal area of the abutment untouched and not polish the abutment in any way.
The titanium surface has a certain roughness in the
area of the emergence profile, which optimally supports epithelial attachment of the soft tissue (Fig. 6).
However, the abutment was not the only component
to be fabricated in preparation for the next appointment (Figs. 7a & b). The temporary crown also had to
be cemented in the mouth at the appointment for
placing the abutment. Therefore, the dental technician fabricated a monolithic crown (CEREC, Sirona)
made of lithium disilicate based on the wax-up (Fig. 7c).
Fig. 10_The exposed implant
is ready to receive the abutment.
Figs. 11a & b_The transfer guide
supported accurate positioning
of the abutment in the mouth.
CAD/CAM
2_ 2014
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I case report _ dental implantology
Fig. 12
Fig. 13
months, shape the soft tissue profile accordingly
before the final restoration is inserted. This way, the
healing process and training of the peri-implant gingiva will run undisturbed (one-abutment-one-time).
_Conclusion
Fig. 14
Fig. 12_The abutment is screwed
on the implant in the exact position
and is not removed again.
Epithelial soft tissue apposition
is not threatened. The screw access
is sealed with composite.
Fig. 13_The radiographic check:
The designed “biological width”
allows optimal apposition
of the gingiva in the basal area.
Fig. 14_Inserted crown made
of lithium disilicate.
24 I CAD/CAM
2_ 2014
_Second surgical session
The closed healing phase was complication-free
and resulted in an osseointegrated implant 36 a few
weeks later, as well as a slightly convex profile of the
buccal alveolar ridge thanks to the grafting measures.
The goal of augmentation was achieved: a 3 mm thick
attached gingiva (Fig. 8). In a gentle laser procedure,
a small incision was made to expose the implant
(Fig. 9). This minimally invasive procedure made it
possible to avoid raising the periosteum of the buccal
mucosa, which is essential for preserving the grafted
bone. The cover screw was removed (Fig. 10) and the
abutment inserted. A plastic index key, created in
advance in the laboratory, was again used for accurate transfer from the cast to the patient’s mouth.
With the key attached over the adjacent teeth, the
abutment was accurately transferred and screwed
onto the implant in the mouth (Figs. 11a & b). A slight
anemia in the buccal area confirmed the accuracy
of the fit. The contour of the abutment emergence
profile blended in well with the intra-oral conditions
(Fig. 12). The “preparation margin” was at gingival
level as desired (Fig. 13). After ensuring that the abutment met the specifications exactly and that the surface will allow epithelial adhesion in the basal area,
the temporary crown fabricated in lithium disilicate
using CAD/CAM technology was cemented (Fig. 14).
The crown will “train” the bone, and over the coming
In just two surgical treatment sessions, the gap in
region 36 was treated using an implant-supported
prosthetic restoration. The restoration met all anatomical, prosthetic, functional and aesthetic requirements. With the CAD/CAM method of fabricating the
custom abutment (ATLANTIS), a restoration was realized in an efficient manner that meets the demands
of state-of-the-art dentistry. Based on the “one-abutment-one-time” concept, the titanium abutment will
not be removed again after insertion in the mouth.
Preservation of the bone and training of the periimplant soft tissue are thereby optimally supported.
Since the crown margin was precisely determined
during the virtual wax-up based on the emergence
profile, the risk of excess cement and any resulting
peri-implantitis was significantly reduced. The crown
margin was at gingival level, which greatly simplifies
removal of any excess cement. The procedure described allows long-term stable results and is ideal
for referring practices that can realize the prosthetic
restoration in a safe manner after implant placement._
Editorial note: A complete list of references is available
from the publisher.
_contact
CAD/CAM
Dr Fred Bergmann
Private practice
Dr Bergmann & Partner
Heidelbergerstr. 5–7
68519 Viernheim
Germany
www.oralchirurgie.com
[25] =>
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Maestro 3D DENTAL System
Innovative solutions for dental applications
www.maestro3d.com
OPEN 3D DENTAL SCANNER
Attachment designer
Models Builder module
Label designer
Brackets module
Clear aligner module
IPR
Interproximal reduction
Crown & Bridge
AGE SOLUTIONS SRL - www.age-solutions.com - www.maestro3d.com
Viale Rinaldo Piaggio, 32 56025 Pontedera - PI - ITALY
tel: 0039 0587274815 - fax: 0039 0587970038
info@age-solutions.com
[26] =>
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CAD0214_26-31_Lanis 13.05.14 11:18 Seite 1
I case report _ CBCT and digital surface scanner
Shortening guided surgical
implant times based on
a combination of CBCT
and digital surface scanners
Authors_Drs Alejandro Lanis & Orlando Álvarez del Canto, Chile
Fig. 1_ProMax 3D s CBCT
imaging unit.
(Source of the image:
www.planmeca.com)
Fig. 2_Digital surface scanner
(TRIOS Cart solution, 3Shape).
(Source of the image:
www.3Shape.com)
26 I CAD/CAM
2_ 2014
Fig. 1
Fig. 2
_The introduction of digital surface scanners
to the dental field and the simplicity of data transfer
are closing the gap in the creation of a completely
“virtual patient” with the optimisation of the digital
treatment workflow.1 Something that a few years
ago sounded like science fiction in dentistry, is possible today owing to the technological advances that
have been incorporated into our field. The prosthetic,
surgical, radiological and laboratory worlds are being
fused in sophisticated digital platforms, enabled by
the capacity to import the data obtained from digital
surface scanners and the DICOM files into surgical
and prosthetic planning software.2–4 The complete
digitalisation of patients’ information and the possibility to combine it offer several advantages to clinicians
and are changing the way in which patients perceive
invasive dental treatments. Because of their advantages in providing personalised treatment, intra-oral
scanners for digital impressions and surgical simulation software will be used as a fundamental technology
for diagnosis, planning, treatment and prevention.5
_Case report
A 55-year-old healthy female patient present ed to our practice desiring mandibular molar
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case report _ CBCT and digital surface scanner
I
Fig. 3a_A CBCT scan of the
mandibular left quadrant.
Fig. 3b_Surface scanning
of the edentulous zone.
Fig. 3c_Digital reconstruction
of the mandibular left quadrant
after the surface scanning process.
Fig. 3d_The digitally reconstructed
arches in maximum intercuspation.
Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3d
rehabilitation. She complained about the absence
of a mandibular left first molar (tooth 36) owing to
an extraction performed several years ago because
of failed endodontic treatment. After a complete
diagnostic evaluation, including clinical and
photographic analysis, a CBCT scan of the left
mandible was performed using ProMax 3D s
(Planmeca; Figs. 1 & 3a). At the same appointment,
Fig. 4a_A lateral view of the
initial digital crown design.
Fig. 4b_A lateral view of the maxillae
and the mandible in maximum
intercuspation with
the virtual crown design.
Fig. 4c_An occlusal view
of the final crown design.
Fig. 4d_A lateral view
of the final crown design.
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 4d
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2_ 2014
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I case report _ CBCT and digital surface scanner
Fig. 5
Fig. 6a
Fig. 5_Multiple views of the
3-D digital implant positioning.
Note how the designed virtual crown
was used as a digital
radiographic template.
Fig. 6a_Implant planning performed
using an intra-oral surface scan.
Fig. 6b_Implant planning
checked with the cone beam
3-D reconstruction.
Fig. 7a_A lateral view of the guide
design. The green line shows
the future guide margin.
Fig. 7b_The orange cylinder
showing the screw exit for
the future restoration.
Fig. 7c_Virtual 3-D reconstruction
of the surgical guide showing the
screw exit of the future restoration.
Fig. 7d_An angled view of the final
surgical guide design and the
insertion axis of the implant.
28 I CAD/CAM
2_ 2014
a digital surface scan of the left maxilla, left
mandible and of both arches in maximum intercuspation to establish interocclusal contact was
done with a TRIOS digital scanner (3Shape; Figs. 2
& 3b–d). Once all the diagnostic information had
been gathered, a treatment appointment was
made for the next day.
The digital scan files and the DICOM files
obtained from the CBCT were imported into the
Implant Studio software (3Shape), in which an innovative technique of spacial recognition allows
the creation of a 3-D superimposition of the real
intra-oral situation and the radiographic images.
A restorative design tool included in Implant
Studio was utilised to create a functional and
aesthetic virtual crown with the ideal prosthetic
position on the reconstructed surface image
(Figs. 4a–d). After the final crown evaluation, the
Fig. 6b
3-D digital implant position was defined to obtain
the most convenient prosthetic and surgical
result, respecting vital structures, such as the
inferior alveolar nerve and vascularity. Thus, the
designed virtual crown was used as a radiographic
template (Fig. 5).
The planning can be performed using an intraoral surface scan and can be checked with the
cone beam 3-D reconstruction at the same time,
assuring the optimum implant position and
avoiding any bone fenestration or dehiscence
(Figs. 6a & b).
The implant selected was a Tapered Internal
implant (BioHorizons; D 4.6 mm × L 10.5, platform
D 4.5 mm). Once the implant position had been
approved, a teeth-supported virtual surgical guide
was designed (Figs. 7a–d). The final guide design
Fig. 7a
Fig. 7b
Fig. 7c
Fig. 7d
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case report _ CBCT and digital surface scanner
I
Fig. 8a_A lateral view of
the final surgical guide design.
Fig. 8b_An occlusal view of
the final surgical guide design.
Fig. 8c_Processed images
(reconstructed STL files)
ready for the 3-D printing process.
Fig. 9_The Objet Eden260V
3-D printer.
(Source of the image:
www.stratasys.com)
Fig. 8a
Fig. 8b
Fig. 8c
Fig. 9
was sent as an STL file (Figs. 8a–c) to the 3-D print
manufacturer, where the surgical guide was fabricated in two hours (Objet Eden260V, Stratasys;
Fig. 9). Once the guide had been fabricated, a final
try-in was performed on the study model to assess
any fit inaccuracies or surgical access problems
before sterilising the guide and the BioHorizons
guided surgery kit (Fig. 10a).
Fig. 10a
Fig. 10b
Fig. 10c
Fig. 10d
Fig. 10a_Pre-op surgical guide
check on a study model.
Fig. 10b_Surgical guide positioned
in the surgical site.
Fig. 10c_A guided tissue punch was
utilised for the soft-tissue removal.
Fig. 10d_Removal of
the excised soft tissue.
CAD/CAM
2_ 2014
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I case report _ CBCT and digital surface scanner
Fig. 11a
Fig. 11b
Fig. 11c
Fig. 11d
Fig. 11e
Fig. 11f
Fig. 11a_The 2.0 mm guided key
in position in the master cylinder
in the surgical guide.
Fig. 11b_The 2.0 mm pilot
guided drill was used to begin
the osteotomy.
Fig. 11c_The 4.1 mm tapered
guided drill was used to widen
the osteotomy.
Fig. 11d_The surgical site showing
the osteotomy without the
surgical guide.
Fig. 11e_The guided implant driver
and drill stop key with the
Tapered Internal implant.
Fig. 11f_Guided implant placement.
Fig. 12a_The implant placed
in final position.
Fig. 12b_A healing abutment
was placed.
Fig. 12c_A small connective tissue
graft was placed in a buccal wedge
to create denser and thicker
keratinised tissue around the implant.
Fig. 12d_A post-op periapical
radiograph of the implant.
30 I CAD/CAM
2_ 2014
The next day, the patient returned to our practice for the surgical procedure. After a mouth rinse
with 0.12 % chlorhexidine gluconate (Oralgene,
Laboratorios Maver) for 2 minutes and the disinfection and preparation of the surgical field,
local anaesthetic was delivered to the edentulous
area (tooth 36 region) by buccal, crestal and lingual infiltrations (2 % lidocaine hydrochloride and
1:100,000 epinephrine). After a few minutes, the
surgical guide was placed in position and the
4.6 mm-diameter guided tissue punch was utilised
through the master cylinder placed in the surgical
guide at 1,200 rpm. The guide was then removed
and the sectioned soft tissue was removed with
a tissue elevator and kept in saline solution
(Figs. 10b–d).
Fig. 12a
Fig. 12b
Fig. 12c
Fig. 12d
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case report _ CBCT and digital surface scanner
The surgical guide was repositioned and a
2.0 mm diameter guided key was placed into the
master cylinder. A pilot guided drill of 21 mm in
length and 2.0 mm in diameter was utilised to start
the osteotomy at 1,200 rpm through the guided
key cylinder. The surgical guide system compensates 10 mm in actual drill depth so the final
osteotomy in this situation was performed at
11 mm depth (Figs. 11a & b). The procedure was
sequentially repeated with the 2.5 mm guided
key and tapered guided drill of 21 mm in length and
2.5 mm in diameter, the 3.2 mm guided key and
tapered guided drill of 21 mm in length and 3.2 mm
in diameter, the 3.7 mm guided key and tapered
guided drill of 21 mm in length and 3.7 mm in
diameter, and finally the 4.1 mm guided key and
tapered guided drill of 21 mm in length and 4.1 mm
in diameter (Fig. 11c).
The surgical guide was then removed to check
the osteotomy site (Fig. 11d). The guide was then
repositioned and the implant was mounted in
the 4.6 mm guided implant driver (Fig. 11e). The implant was placed through the master cylinder
at 15 rpm and 50 Ncm torque (Fig. 11f). Once the
implant was at the final depth position (Fig. 12a),
the guided implant driver was removed and a healing abutment (BioHorizons; D 4.5 mm × L 3 mm)
was screwed into the implant (Fig. 12b). A small
connective tissue graft taken from the soft tissue
removed by the tissue punch was then placed
in a buccal wedge to gain soft-tissue volume
and thickness in the remaining keratinised tissue
(Fig. 12c). No sutures were indicated. A postoperative radiograph was taken to evaluate the
final implant position.
_Conclusion
The combination of digital surface scans and
CBCT images for virtual planning for implant
surgery can be used for safe and effective noninvasive computer-guided implant placement.
Implant Studio is a user-friendly realisation of
this innovative technology and can significantly
reduce the preoperative preparation procedures
and treatment times while maintaining surgical
accuracy. In this specific clinical situation, the
computer-guided surgical preparation and surgery took no longer than two days, improving the
waiting times associated with conventional CBCT
guided surgical systems.
We invite anyone interested in this innovative technology to visit our clinic and specialist
CAD/CAM training centre in Santiago in Chile,
where participants will be involved in practical
clinical cases, be given live surgery demonstra-
I
tions, and attend lectures about guided surgery
procedures and CAD/CAM surgical and restorative
technologies._
Readers can find a video of the procedure at the
following link: https://www.youtube.com/watch?v=
2gNwAtWE0U&feature=youtu.be
Editorial note: A complete list of references is available
from the publisher.
_about the authors
CAD/CAM
Alejandro Lanis, DDS, MS,
received his DDS degree from
the University of Valparaíso
and performed his residency
program in Oral and
Maxillofacial Implantology
at the University of Chile.
The International Team for
Implantology (ITI) selected him as an ITI Scholar
for the University of Michigan in the US. He is member
of the AO, Constituent Member of the International
College of Prosthodontits, ITI Member and Fellow of
the Chilean Society of Oral Implantology. He practices
in Santiago, Chile, specifically dedicated to implant
dentistry, prosthodontics and aesthetic dentistry.
He can be contacted at alelanis@umich.edu.
Orlando Álvarez del Canto,
DDS, MS, received his DDS
degree from the University of Chile
and his MS degree in Implantology
and Oral Rehabilitation from the
Andrés Bello University in Chile.
He has a diplomate degree in
Health Institutions Management
from the University of Chile and a diplomate degree
in Executive and Marketing Management from
the Pontifical Catholic University of Chile. He is a
member of the Chilean Prosthodontics Society, Chilean
Society of Oral Implantology, ALAO, ITI and constituent
member of the International College of Prosthodontists.
He is an Associate Professor of Oral Implantology
at Universad del Desarrollo, Chile. He practices
in Santiago specialised in implant dentistry,
prosthodontics and aesthetic dentistry.
He can be contacted at dr.alvarez@oseintegration.cl.
Drs Alejandro Lanis & Orlando Álvarez del Canto
Office 601
Av. Presidente Kennedy 7100
7650618 Santiago de Chile
+56 2 2655 9080
CAD/CAM
2_ 2014
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CAD0214_32-34_Whitty 13.05.14 11:22 Seite 1
I industry report _ digital dental equipment & software
Maestro Scanner system
Author_Terence Whitty, Australia
Fig. 1
Fig. 2
Fig. 1_Maestro 3D Dental Scanner.
Fig. 2_An example of MMR
(Maxillary and Mandibular
relationship) scanning.
_The concept of digital study models has
often been talked about, particularly in orthodontic circles, as a solution to the considerable
physical space required to store plaster models.
If a model could be scanned in three dimensions
to a high degree of accuracy, stored electronically
and then reconstituted should the need arise
some time in the future, then the need for
physical storage of models could potentially be
eliminated.
While there has been talk of this, little in the
way of real solutions have been available. Study
model scanning services exist but often if you look
Fig. 3_An example
of impression scanning.
32 I CAD/CAM
2_ 2014
Fig. 3
at the fine print in their terms and conditions, you
may not even own the scans of your own models!
A more practical alternative is to be able to scan
study models in your own laboratory rather than
sending them out to be scanned by a third party.
Digital models have many advantages. They
are easy to make, inexpensive, very accurate, cost
very little to store and transportation is a breeze.
Amazingly, you can store over 800 sets of models
on one DVD-R disc or an average 500 GB hard
drive could hold a staggering 100,000 sets of
models! Much better than rooms and rooms full
of study models.
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I
I have been working with digital models for
some time and have examined several systems
on the market today. I have recently found a great
new digital study model system with a host of
very “useable” features and the best news of all is
that it is very affordable.
The Maestro Scanner system consists of a digital 3-D scanner and various software programs
so you can easily scan dental models, manipulate
the data in various ways and then easily share
this data so anyone anywhere with the viewing
software can visualise the digital models.
The Maestro Scanner is a smartly designed
state-of-the-art structured light 3-D scanner.
It uses patterns of light and two digital cameras
to measure the surface of the model in threedimensions. Projecting a narrow band of light
onto a three-dimensionally shaped surface
produces a line of illumination that appears
distorted from other perspectives than that of
the projector, and can be used for an exact
geometric reconstruction of the surface shape.
This is the basis of structured light scanning
and in this case, uses no lasers so it’s completely
safe for anyone to use. It also has great accuracy and is quite speedy in operation. This type
of scanning is used by many dental CAD/CAM
manufacturers so the technology is well proven
for our market.
The Maestro System comes with the Maestro
Easy Dental Scan program and I have to say, the
name says it all. Put your model into the scanner,
click a button or two and you are on your way
to a scanned model. However, diving deeper into
the program allows you to uncover more complex
features if you wish. It even allows you to scan
crown and bridge models and acquire multiple
dies (up to 8) in one scan. Some of the more
advanced C&B scanners are not able to do this.
Remember, digital study models are not just
for orthodontic purposes but can be used for
Fig. 4
all dental models. It’s a great way to diagnose,
discuss and store models.
Fig. 4_An example
of multi dies scanning.
The quality of the scans is more than impressive with a great amount of detail once the
scans are processed. Once you scan the upper
and lower models and do a quick occlusal scan,
the registering of the scanned models into the
correct bite relationship is completely automatic.
This is a feature I really like. You can also register
the models in various relationships—centric relation; centric occlusion; protrusive or construction bite to name a few. There are also various
editing and measuring tools provided and you
can do adjustments to the scans if need be.
You can save the finished files in industry standard STL or a proprietary ORTHO and ORTHO iPAD
file format. File sizes are quite small and easily
emailed to clients.
One of the additional notable features of
Easy Dental Scan is the option to batch scan.
Fig. 5_Maestro 3D iPad Viewer.
Fig. 6_Main screen
of Maestro 3D Ortho Studio.
Fig. 6
Fig. 5
CAD/CAM
2_ 2014
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I industry report _ digital dental equipment & software
Fig. 7
Fig. 8
Fig. 7_Brackets positioning
in Maestro 3D Ortho Studio.
Fig. 8_Attachments positioning
in Maestro 3D Ortho Studio.
In many systems, immediately after the scan is
completed, it is processed which can take quite
a bit of time. With the batch scan, you can quickly
scan several models and then complete the processing of the scans at a later time. You simply
walk away and the computer does all the work
while you get on with something else.
There is also an Ortho Studio program. This
starts with a powerful and cleverly thought out
database section. Sets of models are sorted by
Dental Practice–Dentist–Patient and this is great
because it’s very easy to find what you are looking
for. It only takes a few minutes to master this
section. It is just so easy to use.
When a set of models are loaded, all the information from the database accompanies it so
you know exactly what you are looking at. In this
section of the program, you will find tools for
adding virtual orthodontic bases using various
popular angles including ABO 2013, measuring
tooth and arch width, occlusal mapping, multiple
views, snapshot, printing and much more. It’s extremely easy to use and you are guided through
each step in a wizard-like interface. The latest
version of Ortho Studio has the ability to perform complex digital diagnostic set-ups and the
ability to create files ready for aligner therapy as
well as orthodontic bracket placement. This is
a powerful system and a valuable tool for any
practice or laboratory.
A real bonus of the package has to be the
free Ortho Studio Viewer. This program is a
cut down version of Ortho Studio but is still
34 I CAD/CAM
2_ 2014
feature rich enough for using digital models
for diagnosis on an everyday basis. The viewer
includes tools for measuring tooth and arch
width, occlusal mapping, multiple views, snapshot, printing and more. Of course it’s very
easy to use so people will actually use it! This is
a great program to give away to people you want
to share your digital files with. For example, you
may be a lab scanning models for various clients.
You can distribute the free viewer to these clients
so they can use it to view and diagnose direct
from the scans._
_about the author
CAD/CAM
Terry Whitty lectures nationally
and internationally on a variety
of dental technology and
material science subjects
and runs a busy laboratory
in Sydney’s Eastern Suburbs,
specialising in high tech dental
manufacturing. Using the latest
advances in intra- and extra oral scanning, CAD/CAM
and 3-D printing technologies, most specialties are
covered including fixed and removable prosthetics,
orthodontics and computer implant planning and
guidance. He also specialises in the latest injection
systems for traditional and CAD designed removable
prosthetics and various associated dental appliances.
His articles appear in various international journals.
He can be contacted at www.trulinedental.com.au
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P R O F E S S I O N A L
M E D I C A L
C O U T U R E
EXPERIENCE OUR ENTIRE COLLECTION ONLINE
WWW.CROIXTURE.COM
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CAD0214_36-37_Planmeca 13.05.14 11:22 Seite 1
I industry news _ Planmeca
Planmeca makes CAD/CAM
easier than ever
_Planmeca’s open-interface CAD/CAM solutions
introduce, above all, quality, cost efficiency and precision to the daily workflow at dental clinics or laboratories. Petri Kajander, product manager of Planmeca’s
CAD/CAM solutions, explains the revolutionary features of these new products in this article.
_State-of-the-art solutions for dentists:
Superfast Planmeca PlanScan
The new Planmeca PlanScan is a digital and powderfree intra-oral scanner that scans the patient’s dentition quickly and accurately. The scanner produces realtime digital impressions from one-tooth to full arch
scans. Thanks to the open STL data, the scanned files can
be sent to any dental laboratory for design work. This
is the world’s first dental unit-integrated intra-oral
scanner that can also be connected to a laptop.
Fig. 1
Fig. 1_Petri Kajander,
product manager of Planmeca’s
CAD/CAM solutions.
Fig. 2_Planmeca PlanScan.
Fig. 3_Planmeca PlanCAD Easy.
Fig. 2
“The scanner has only one cable, so it is extremely
easy to move from one place to another, for example
between different treatment rooms or clinics,” said
Kajander. “In addition, the scanner is delivered with
a laptop, so the device can be flexibly shared between
different users. In other words, Planmeca PlanScan
offers value for your investment: it is not a device for
just one dentist but can be used by the entire clinic.”
The scanner uses the blue-laser technique. It projects a pattern on the surface of the teeth and then
analyses it from different directions to calculate distances. In this way, the device is able to calculate a model
that is extremely accurate. “You can view the result as
a real-time video image. The video recording and the
dental surface identification algorithm make the device
extremely flexible to use. Thanks to these features, you
can pause the scanning at any time and continue later
on at any point from where data is already available.”
Fig. 3
36 I CAD/CAM
2_ 2014
The scanner includes a range of exchangeable tips
in various sizes, the smallest of which facilitates access
to the posterior areas, particularly in small children
and trauma patients. The tips can be autoclaved for
efficient infection control. In addition, the scanner is
extremely durable, since it has no internal moving parts
other than a fan that removes warm air. “Thus, the
device stays calibrated and is not subject to mechanical wear,” explained Kajander.
_Planmeca PlanCAD Easy,
an efficient design tool for prostheses
Planmeca also offers dentists a new kind of open
software solution for 3-D design. Planmeca PlanCAD
Easy is seamlessly integrated into Planmeca Romexis
software, and it is a user-friendly design tool for the
design of inlays, onlays, veneers, crowns and bridges.
“The software runs on a floating licence basis. This
means that it is not tied to just one computer or workstation, but the work is saved on the Planmeca Romexis
server. In this way, the scanning station can be used
only for scanning, while another workstation is used
for the actual design work. This is a truly unique feature, which allows work to be continued straight away
on another computer, while the scanner is freed for
more productive operation,” said Kajander.
Every dentist who designs his or her own prostheses
will also face cases that require assistance from a dental
laboratory. For this reason, Planmeca’s system utilises
an open STL file format that allows the work to be sent
immediately to a partner via the Planmeca Romexis
Cloud service.
Since Planmeca PlanCAD Easy is integrated into
Planmeca Romexis software, soft-tissue scans can also
be conveniently paired with CBCT scans of the patient.
This combined data provides valuable information for
implant planning, for example, because it visualises
the soft tissue and the crown that is designed for the
occlusion. This facilitates the planning of the implant
screw’s location.
The Planmeca PlanCAD Easy workflow, from preparation to the finished result, includes just five easy
stages: work description, scanning, marking of the
margin line, automatic design, and sending the work
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industry news _ Planmeca
I
to the mill. “Once the work has been sent to the mill, it is
transferred there in its entirety and the mill’s computer
finishes the work. In this way, the software and scanner
are immediately freed for a new assignment.”
The software is very user-friendly. All design phases
are saved automatically and previous phases can be returned to flexibly if further impressions are needed. The
design software automatically takes into account the
cusps and marginal ridges of the adjacent teeth, in addition to the contact strengths defined by the user. This
creates a design that blends into its surroundings well.
Fig. 4
Fig. 5
_Planmeca PlanMill 40, a fast and
precise milling unit for dental clinics
Planmeca PlanMill 40 is an extremely precise fouraxis milling unit controlled by its own computer. The
device is suitable for all single-tooth indications, in
other words for the milling of crowns, inlays, onlays and
veneers. The mill can manage bridges of up to five units
in the posterior area and three units in the anterior area.
Fig. 6
Fig. 7
Since the mill handles the milled pieces completely
independently, as many as several dozen pieces can
be sent to the mill at a time. In addition, the device
determines which block size, colour and material should
be used, so any member of the staff can place the block
in the mill. “This saves everyone working time. The
dentist does not need to put the block in himself,” said
Kajander.
Design takes place in the open Planmeca PlanCAD
Premium laboratory software, which can be used for
the design of all prostheses, ranging from one-tooth
units to full arch structures. The software can also be
used to design for example individual abutments, night
and sports guards, different crown and bridge work
and implant bridges and bars for cement-retained and
screw-retained solutions.
Planmeca PlanMill 40 has a six-tool exchange mechanism, and it changes tools independently according to
different job requirements. In addition, the device mills
different materials according to their properties. For
example, it knows how to handle delicate ceramics gently in work phases that require precision. “If you force
the material, it may break prematurely. Even the smallest hairline crack in the material can lead to a cemented
piece breaking when pressure is applied to it.”
The software has an order manager page that lends
efficiency to the workflow by reporting each stage of
work. In this way, several work orders can be entered
into the software in one go. The last phase is always
saved in the memory so that work can be continued
freely at the most convenient time. In addition, precise
values can be set for each workpiece to allow for
cement space and the milling unit’s blade.
Also, the maintenance of the device is easy. The mill’s
computer calculates the service life of the tools, monitors wear and reports on these via the user interface.
It also calculates the time that milling will take and
lets the user know when the tools or water should be
replaced. “Similar to a car, a mill requires maintenance
at certain intervals and notifies the user of this.”
An open STL file is created from the design, and the
design can be manufactured with any milling unit that
supports the open file format, including Planmeca
PlanMill 50. This milling unit can mill any soft, wet
and dry materials and for example glass ceramics.
In addition, the file can be sent to a milling centre, such
as Planmeca’s own PlanEasyMill milling centre, for
manufacture._
_An ideal solution for laboratories too
_contact
For dental laboratories, Planmeca offers a comprehensive solution that utilises the open STL file format.
Planmeca PlanScan Lab is an accurate desktop scanner
that uses blue light for scanning gypsum models and
impressions. The device scans gypsum models quickly
and effortlessly with an accuracy of 15 µm.
Planmeca Oy
Asentajankatu 6
00880 Helsinki, Finland
Fig. 4_Planmeca PlanMill 40.
Fig. 5_Planmeca PlanScan Lab.
Fig. 6_Planmeca PlanMill 50.
Fig. 7_Planmeca PlanCAD Premium.
CAD/CAM
www.planmeca.com
CAD/CAM
2_ 2014
I 37
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CAD0214_38_Schuetz 13.05.14 11:28 Seite 1
I industry news _ Schütz Dental
Inspired by nature:
Zirconia Reinforced
Composite
fully anatomical crowns, inlays, onlays and veneers.
This material can also be used for long-term temporaries for up to a whole arch and lasting for up to
two years of wear.
Fig. 1
Fig. 2
The Tizian Zirconia Reinforced Composite is
slightly elastic like the natural tooth and adopts
a kind of “buffer function”. Chewing forces are
spread out in the jaw which reduces the selective
stress on the bone. The bone remain intact. Thanks
to the excellent physical properties, this material is
ideal for implant restorations (Fig. 3) and for use on
patients with CMD or Bruxism.
In combination with the veneering composite
dialog Occlusal, you can rebuild the physics of the
natural tooth as authentically as possible (Fig. 4).
Fig. 3
Fig. 4
Fig. 1_Milling blank.
Fig. 2_Final treatment.
Fig. 3_The system is perfectly
suited for the treatment
of implant-supported cases.
Fig. 4_Rebuild the physics
of the natural tooth as
authentically as possible.
_Schütz Dental presents a new material combining high performance acrylics and zirconium
dioxide. Tizian Zirconia Reinforced Composite
blanks enables you to produce final restorations
of up to 3 units and temporary restorations of up
to 16 units.
These restorations stand out thanks to their
outstanding antagonist and TMJ friendly properties. These bionic qualities derive from the moderate Vickers hardness and corresponding elasticity
module. Chipping and breakage is reduced. Milling
blanks (available in two heights) fit in the 98 millimetre open system holder (Fig. 1) and are suited
to dry-milling.
This material is suitable to produce final restorations up to three-unit bridges (Fig. 2). This bridges
might even expand to the posterior region. This adds
to its suitability for final crown structures as well as
38 I CAD/CAM
2_ 2014
Due to its hardness, the dialog Occlusal applied
to the framework of Tizian Zirconia Reinforced
Composite creates an accurate likeness to the natural enamel. Together, the two materials recreate
the physics of the natural tooth. This is also referred
to as the “bionic principle”. The system is wearresistant and abrasion-resistant whilst being gentle
on the jaw joint and the antagonists.
Tizian Zirconia Reinforced Composite blanks
come in a range of five tooth colours.
Find more information here: http://sdent.eu/
bionicprinciple_
_contact
Schütz Dental GmbH
Dieselstr. 5–6
61191 Rosbach
Germany
www.schuetz-dental.com
CAD/CAM
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Tel: +1 424 744 0608 / email: c.ferret@tribunecme.com / www.TribuneCME.com
[40] =>
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CAD0214_40_3shape 13.05.14 11:29 Seite 1
I industry news _ 3Shape
3Shape launches Implant
Studio for implant planning
and surgical guide design
_3Shape, a leading innovation company for
3-D scanners and CAD/CAM software solutions,
has released its new Implant Studio software to the
European market. The solution
is designed for
use in both clinics and laboratories, and 3Shape
is offering Implant Studio in
various configuration packages
to match the
different needs
of both.
_All-in-one solution
A solution that finally brings together the latest
technologies in implant planning into a single
smooth workflow is now available to the market.
3Shape’s solution offers the following:
_a complete digital workflow for dentists and for
laboratories;
_all the restorative components provided to the
dentist before surgery;
_easy implant planning with intuitive tools that merge
the benefits of planning in both 3-D and 2-D;
_virtual crown functionality, offering optimal implant placement in combination with the intended
prosthetic design;
_the design of cost-efficient surgical guides ready
for local manufacture;
_3Shape Communicate integration, which makes it
easy to receive 3-D surface scans from TRIOS and
from 3Shape desktop scanners, and to send approved implant positions for designing abutments
and crowns in Dental System; and
_an open software platform: Implant Studio supports open DICOM CT scans and STL surface scans,
as well as implant systems (libraries) from major
implant manufacturers.
40 I CAD/CAM
2_ 2014
“Implant Studio represents the accumulation
of our dental technology expertise and industry
knowledge, and that is what makes it stand out
among existing solutions,” said Flemming Thorup,
President and CEO of 3Shape . “We have brought
together digital impressions, CBCT scans, and intuitive CAD workflows to form a unique solution.
Implant Studio provides optimal results for implant
placement and prostheses with high aesthetics,
while opening new service options for both clinics
and labs that include the provision of full treatment
packages to patients.”
_3Shape Dental System integration
After planning has been completed, laboratories
can directly manufacture restorations and implant
components (temporaries, crowns, abutments, and
more) in a smooth and integrated workflow, providing dentists with a complete treatment package.
_Released to the European market
Implant Studio has recently passed the strict regulatory process required for market launch in Europe.
3Shape expects to obtain regulatory clearance in
the US and other selected markets during 2014.
Implant Studio will be available through 3Shape
resellers. Actual availability to end-users will
depend on the specific system configuration.
Please contact your local 3Shape supplier, or visit
www.3shapedental.com regarding reseller information._
_contact
3Shape A/S
Holmens Kanal 7
1060 Copenhagen K, Denmark
www.3shapedental.com
CAD/CAM
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DTSC_A4_EN_Layout 1 04.02.14 14:23 Seite 1
www.DTStudyClub.com
Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
Y free membership
Y no travel costs
Y no time away from the practice
Y interaction with colleagues and
experts across the globe
Y a growing database of
scientific articles and case reports
Y ADA CERP-recognized
credit administration
Register for
FREE!
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
[42] =>
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CAD0214_42_Straumann 13.05.14 11:29 Seite 1
I industry news _ Straumann
Straumann abutments
now available to
3Shape software users
Fig. 1
Fig. 2
Figs. 1 & 2_Straumann CARES
Abutments.
_Global implant manufacturer Straumann and
CAD/CAM software provider 3Shape have been
working together to integrate Straumann CARES
libraries into 3Shape’s software. Recently, the new
software function was made available to 3Shape
software users, enabling them to design and order
customised zirconia or titanium abutments with
Straumann original implant connections.
Using the new software capabilities, dental technicians who use the 3Shape Dental System software
can design abutments and a range of customised
prosthetics, including cobalt–chromium alloy, zirconium dioxide, and various full contour materials.
These can be ordered with an original Straumann
connection.
“Many laboratories are steadfast users of both
the 3Shape Dental System and Straumann abutments. Now, they can design highly aesthetic and
functional customised abutments and send them
directly for manufacturing at Straumann—thereby
introducing a wider range of choices for dentists
and their patients,” explained Flemming Thorup,
President and CEO of 3Shape.
42 I CAD/CAM
2_ 2014
“In addition, 3Shape customers are now able to
connect with Straumann dentists and, thus expand
their business opportunities,” Frank Hemm, Executive Vice-President of Customer Solutions and
Education at Straumann, added.
3Shape users who wish to benefit from this
opportunity may contact Straumann for information on obtaining the libraries. However, availability
will depend on the specific system configurations,
the companies stated._
_contact
Institut Straumann AG
Peter Merian-Weg 12
4052 Basel
Switzerland
www.straumann.com
CAD/CAM
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CAD0214_44-45_Nobel 13.05.14 11:29 Seite 1
I industry news _ Nobel Biocare
It is time to look at aesthetics
from a new angle
Fig. 1
Fig. 2
Fig. 1_A new angle for aesthetics:
the ASC abutment from NobelProcera
allows the screw channel to be set at
an angle between 0 and 25 degrees
within a full 360-degree radius.
In the anterior region, this makes
screw-retained restorations possible
where aesthetic considerations
would previously have ruled
them out. In the posterior region,
it offers greater accessibility
and retrievability.
Fig. 2_The unique pick-up function
of the Omnigrip screwdriver must be
experienced to be fully appreciated.
The extraordinary level of grip
improves handling and is designed
to reduce the risk of the screw
detaching in the patient’s mouth.
Fig. 3_The Omnigrip system
is instantly distinguishable
from other tooling by blue markings
on both the screwdriver and screws.
44 I CAD/CAM
2_ 2014
_True innovation is about finding new and
improved ways to do things. At Nobel Biocare, this
means developing new products and solutions to
help dental professionals treat more patients better.
“Innovation” is a term that is used often, but at
Nobel Biocare it is much more than just a word; it is
a mission. The company’s Designing for Life strategy
has innovation at its heart.
With the new NobelProcera Angulated Screw
Channel (ASC) abutment and Nobel Biocare’s
unique new Omnigrip tooling, true innovation has
been achieved. These products allow clinicians to
offer screw-retained restorations in a practical and
aesthetic way that would previously have been
impossible in some cases.
_Increased restorative flexibility with
no cement: It is as easy as A-S-C
With the NobelProcera ASC abutment, the
screw channel can be placed with an angle of up to
25 degrees from the axis of the implant anywhere
within a 360-degree radius. In the anterior aesthetic
region, this makes it possible to use screw-retained
restorations where a buccal screw access hole
would previously have ruled them out. When designing the ASC abutment in the NobelProcera
Software, the screw access hole can instead be
positioned on the lingual side of the restoration.
The patient therefore benefits from an optimally
Fig. 3
aesthetic result without any risk of the issues
that can arise with excess cement. Using a screwretained rather than a cement-retained solution
also makes the restoration easier to retrieve.
_Leading restorations now available
for a leading implant connection
In the posterior region, the NobelProcera ASC
comes into its own. When used for molars or
premolars, the ability to tilt the screw channel
into the most convenient position makes it
easier for the clinician to place, and access, the
restoration.
As a one-piece restoration, the NobelProcera
ASC abutment requires less labour from the dental
laboratory and so is produced more quickly, reducing costs. This, together with benefits such as
improved aesthetics and easier maintenance, can
increase the likelihood of patient acceptance.
Moreover, once the patient is in the chair, placing
just a single piece makes for a more comfortable
experience.
The ASC option is available for zirconia abutments on narrow-platform and regular-platform
implants with Nobel Biocare’s internal conical
connection. This advanced connection is available
for Nobel Biocare’s award-winning1 NobelActive
family, as well as on NobelReplace Conical Connec-
[45] =>
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CAD0214_44-45_Nobel 13.05.14 11:30 Seite 2
industry news _ Nobel Biocare
I
Fig. 5
Fig. 4
tion and NobelReplace Conical Connection PMC
(partially machined collar) implants. The conical
connection offers a hexagonal internal locking
mechanism for a tight seal and high mechanical
strength.2
It also allows for platform shifting. This shift
moves the implant–abutment junction on to the
implant platform, thereby making room for the
maximum volume of soft tissue to come up on to
the platform edge safely. Platform shifting therefore encourages more natural-looking gingivae for
an even better aesthetic result. Moving the junction
further away from the bone has also been shown
to reduce radiographically detectable crestal bone
loss.3–5
Given that individualised abutments from
NobelProcera allow the optimal emergence profile
to be defined, the combined effect is designed
to give an unrivalled soft-tissue result. Owing to
a titanium adapter, this zirconia option can also
be utilised in the posterior region, providing the
clinician with an entirely new option for delivering
the best possible restoration.
_Come to grips with better handling:
Introducing Omnigrip tooling
The benefits of the ASC abutment are only pos sible owing to the introduction of the associated
Omnigrip tooling. Designed in-house by Nobel
Biocare’s product development team, it is more than
just a screwdriver; it is a driver of increased clinical
success.
The unique tip of the Omnigrip screwdriver allows the screw to be tightened and loosened within
the angulated channel with the same accessibility
and torque as if the channel were straight. It allows
easy handling from multiple angles, even in the
posterior region.
The pick-up feature of the special tip is an outstanding feature. The Omnigrip screwdriver grips
and holds the screw equally tightly at any angle
within the available range. Clinicians will not have
experienced tooling like this before. Such is the
level of grip that it has to be experienced to be
believed. This capability offers convenience and,
most importantly, safety. The Omnigrip screwdriver is designed to hold the screw firmly when
it matters most: when the clinician is working in
the patient’s mouth.
Fig. 4 & 5_Angulation in action:
Using a screw-retained restoration
in the anterior remains an aesthetic
option as the screw access hole
is pointed in the palatal direction.
(Case courtesy of Dr Juan Zufía,
Sr. Santiago Dalmau)
_A new channel of opportunity
Together, the NobelProcera ASC abutment and
the Omnigrip tooling offer clinicians not just new
treatment possibilities, but opportunities to increase the number of screw-retained restorations
they place. Being just one piece, the abutment
represents an option that is efficient to produce,
but with unique features and benefits that increase
patient acceptance. Additionally, overcoming barriers to optimal aesthetics is also likely to improve
patient satisfaction. Nobel Biocare innovates to
help its customers treat more patients and to treat
them better. These new products do just that._
Editorial note: A complete list of references is available
from the publisher.
_contact
CAD/CAM
Nobel Biocare
Balsberg
Balz-Zimmermann-Str. 7
8302 Kloten
Switzerland
www.nobelbiocare.com/nobelprocera
CAD/CAM
2_ 2014
I 45
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CAD0214_46-47_AO 13.05.14 11:30 Seite 1
I meetings _ AO Annual Meeting
“Clinician education
is critical to success”
Interview with AO Annual Meeting chairman Dr Lyndon Cooper
Author_Sierra Rendon, DT America
_The Academy of Osseointegration is recognized as the premier association for professionals
interested in implant dentistry. It has always been
at the forefront of scientific advances in dental
implant and tissue replacement therapy. In an interview, Annual Meeting chairmen Lyndon Cooper,
DDS, PhD, and Donald Clem III, DDS, discuss this
year’s meeting, which was held recently, and plans
for the 2015 event.
Dr Lyndon Cooper
_Sierra Rendon: How many people attended
AO Annual Meeting 2014?
Dr Lyndon Cooper: More than 2,000 clinicians
joined us for the 29th annual meeting of the Academy of Osseointegration (6–8 March 2014, Seattle,
USA), which recorded the fourth largest attendance
in its history. We had 624 international attendees
representing 45 countries and more than 1,100 exhibitors who showcased products and services to
support implant dentistry.
_Why did AO choose the theme “Real Problems,
Real Solutions”?
We have seen that implants are widely applicable
and generally successful, and we recognize that
clinician education is critical to success among our
patients. This year, we sought to inform clinicians
that a segment of our population will experience
implant complications and failure, but emerging
strategies can help them recover success. We
encouraged the clinical team to examine implants
carefully, address issues promptly and recognize
when—and learn how to—intervene to preserve
dental implant and patient health.
_What were some highlights of the clinical
sessions?
Leading experts led the program with insights
on who experiences complications, why they occur
and what evidence says about how well we address
these complications. Consistent with the plan,
46 I CAD/CAM
2_ 2014
a broad range of data was presented. The early
focus on periimplantitis opened the minds of the
audience, while the closing futuristic presentations
certainly left everyone feeling inspired. Our clinical
presentations anchored the meeting by demonstrating what good science offers great clinicians
who adopt an evidence-based approach to caring
for people.
_Was research a big focus of the meeting?
Yes, presentations ranged from digital planning,
new aesthetic techniques and prevention strategies to molecular strategies and stem cell biology.
Abstract presentations explored original scientific
and clinical research, clinical innovations and case
presentations that could help shape the future of
implant dentistry. We had a record number of more
than 250 Scientific Posters as well.
_The new board of directors was also announced
in Seattle. How does the AO enjoy such a seamless
transition in leadership?
Approaching its 30th year, the AO is fortunate
to have organization leadership and leadership
development that are very carefully managed. We
are all very excited to announce that Dr. Joseph
Gian-Grasso, a periodontist from Philadelphia, was
elected to serve as the 2014–2015 president of AO.
He will follow in the footsteps of a very successful
president, Stephen Wheeler, DDS. Dr. Gian-Grasso—
along with the rest of us—will remain committed
to establishing a nexus where specialists and generalists from around the world can come together
to learn and stay up-to-date on the rapidly advancing clinical research and innovations in the dental
implant and tissue engineering industries.
_Have you already started planning for AO 2015?
Yes, because it’s AO’s 30th anniversary, we’re
all very excited about it. Mark the calendar now to
join us in San Francisco from 12 to 14 March 2015,
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CAD0214_46-47_AO 13.05.14 11:30 Seite 2
meetings _ AO Annual Meeting
where we plan to on the power of collaboration to
advance the art and science of dental implant therapy.
_Can you give us a few glimpses at what’s in
store for next year?
The opening symposium will feature teams of
doctors presenting on how they manage patients
together for optimal results. The keynote speaker
will be Dr Daniel Alam, who was a member of the
multi-disciplinary team of doctors and surgeons
at Cleveland Clinic who performed the first neartotal face transplant in the United States. He will
speak to the critical importance of different disciplines coming together to support a patient’s medical, surgical and emotional needs to make them
whole again.
AO also will take a look at what the academy
has learned throughout its 30-year history and
summarize current recommendations to address
the most challenging conditions in implant dentistry. AO has enlisted some of the foremost authorities in both surgical and restorative dentistry
to share their knowledge and views to support this
initiative.
I
Keeping with AO tradition, we also want to
ensure the closing symposium doesn’t disappoint.
It will be an interactive session where attendees can vote on keypads to give their opinion
on various treatment options for presented cases.
A panel of experts will also discuss and debate
the options.
_What are you most excited about for the
meeting?
At the annual meeting, we are excited to build
on AO’s past and chart the way for its future.
This will be done via top-notch surgical and
restorative tracks, as well as a “Morning with
the Masters,” for which AO has put together
an outstanding group of experts to a give attendees pearls that can be used in the office
on Monday morning. Ultimately, patient safety
and benefit must be based on sound evidence
—that’s what the academy is all about and our
annual meetings are as well. To learn more
about AO membership, please visit our website
(www.osseo.org/NEWmembership.html).
_Thank you very much for the interview._
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CAD/CAM
2_ 2014
I 47
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CAD0214_48_Events 13.05.14 11:30 Seite 1
I meetings _ events
International Events
2014
ISRRT World Congress
12–15 June 2014
Helsinki, Finland
www.isrrt2014.fi
APDC 36th Asia Pacific Dental Congress
17–19 June 2014
Dubai, UAE
www.apdentalcongress.org
18th World Congress on Dental Traumatology
19–21 June 2014
Istanbul, Turkey
www.iadt-dentaltrauma.org
IACA 2014 Annual Meeting
24–26 July 2014
Bahamas
www.theiaca.com
AAED 39th Annual Meeting
5–8 August 2014
Santa Barbara, CA, USA
www.estheticacademy.org
ICOI Summer Implant Prosthetic Symposium
21–23 August 2014
Chicago, USA
www.icoichicago2014.org
FDI Annual World Dental Congress
11–14 September 2014
New Delhi, India
www.fdi2014.org.in
EAO 2014
25–27 September 2014
Rome, Italy
www.eao.org
EPA Annual Conference
25–27 September 2014
Istanbul, Turkey
www.epa2014.org
ICOI World Congress
3–5 October 2014
Tokyo, Japan
www.icoi.org
ESCD Annual Meeting
9–11 October 2014
Rome, Italy
www.escdonline.eu
155th ADA Annual Session
9–12 October 2014
San Antonio, USA
www.ada.org
Digital Dentistry Show
16–18 October 2014
At the International Expodental Milano, Italy
www.digitaldentistryshow.com
ADF Meeting
25–29 November 2014
Paris, France
www.adf.asso.fr
Great New York Dental Meeting
28 November–3 December 2014
New York, USA
www.gnydm.com
Helsinki. Photo: Oleksiy Mark
48 I CAD/CAM
2_ 2014
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CAD0214_49_Submission 13.05.14 11:31 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
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_the complete article;
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address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
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Please place image references in your article wherever they
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If you do not directly refer to the image, place the reference
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In addition, please note:
In addition, images must not be embedded into the MS Word
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Article lengths can vary greatly—from 1,500 to 5,500 words—
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We can run an unusually long article in multiple parts, but this
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In short, we do not want to limit you in terms of article length,
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Larger image files are always better, and those approximately
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Also, please remember that images must not be embedded into
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You may submit images via e-mail, via our FTP server or post
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Any formatting contrary to stated above will require us to remove
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Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
CAD/CAM
2_ 2014
I 49
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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
Melissa Brown
m.brown@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
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f.dachsel@dental-tribune.com
Copy Editors
Sabrina Raaff
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International Administration
Marketing & Sales
Esther Wodarski
e.wodarski@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: Esther Wodarski
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
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
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Löhnert Druck
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Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
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 2014 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
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check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
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by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I CAD/CAM
2_ 2014
[51] =>
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Planmeca’s open CAD/CAM solutions
Your ideal combination
Scan.
• Open solutions for digital dentistry
• High precision for prosthetic works
• Integrated workflows for dentists and dental labs
Planmeca PlanScan™
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Planmeca PlanCAD™ Easy
Planmeca PlanCAD™ Premium
Manufacture.
Planmeca PlanMill™ 40
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Find more info and your local dealer:
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Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com
[52] =>
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More than efficiency.
Cost-effective
workflow solutions.
What does efficiency mean to your business?
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Straumann® CARES® X-Stream™’s 1 scan, 1 design and 1 delivery
ѹѹ Directly veneerable TAN Abutment for a quick path to your
final restoration
ѹѹ New CARES® Screw-retained Bridges and Bars increase
treatment flexibility
ѹѹ Ability to connect your CADCAM system to Straumann®
CARES® Prosthetics – no additional investment or training
required, visit: www.straumann.com
Ad_Cares 8.8_A4_Vorlage.indd 1
01.04.14 10:26
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/ Editorial: One step further with CAD/CAM
/ Content
/ The Virtual Facebow A digital companion to implantology
/ Aesthetic Digital Smile Design: Software-aided aesthetic dentistry—Part II
/ “The trend towards the medium-price range has accelerated”
/ A leading-edge implant- supported prosthetic concept for long-term success and tissue stability
/ Shortening guided surgical implant times based on a combination of CBCT and digital surface scanners
/ Maestro Scanner system
/ Planmeca makes CAD/CAM easier than ever
/ Inspired by nature: Zirconia Reinforced Composite
/ 3Shape launches Implant Studio for implant planning and surgical guide design
/ Straumann abutments now available to 3Shape software users
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