CAD/CAM international No. 1, 2015

Cover / Editorial / Content / The importance of brand and own reputation—from real daily life to the web / A minimally invasive approach according to biomechanical principles of teeth / CAD/CAM Technology: a review / Latest trends in prosthetics - Total maxillary rehabilitation with a Toronto Bridge using digital technologies / Digital possibilities for making implant prosthetics / Periodontal and peri-implant tissue management in the aesthetic zone / Digital impression taking helps me be a better dentist / Value chains being transformed by new digital dental technologies / Going (unintentionally) green: The unexpected bonus of switching to CAD/CAM and same-day dentistry / Industry News / International Events / Submission guidelines / Imprint

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CAD0115_01_Title 02.03.15 12:30 Seite 1

issn 1616-7390

Vol. 6 • Issue 1/2015

CAD/CAM
digital dentistr y

international magazine of

1

2015

| CE article
Biomechanical principles

| industry report
Latest trends in prosthetics

| special
Value chains being transformed
by digital dental technologies

[2] => Standard_300dpi

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[3] => Standard_300dpi

CAD0115_03_Editorial 02.03.15 12:31 Seite 1

editorial _ CAD/CAM

Dear Reader,
_This year, in addition to the International Dental Show, significant for the entire global
dental industry, another important event in digital dentistry is taking place: the CAD/CAM
and Digital Dentistry International Conference—celebrating its tenth anniversary—which is
to be held in May at the Jumeirah Beach Hotel in Dubai.
Almost 20 years after the first CAD/CAM system was presented on the market, with
great enthusiasm and a belief in digitalizing dentistry, the Centre for Advanced Professional
Practices (CAPP) held its first CAD/CAM and computerized dentistry conference in the
Middle East. CAPP, with a group of passionate leaders, such as Drs Munir Silwadi, Aisha Sultan
and Omar Adeeb, supported by 3M ESPE, Sirona, KaVo, etkon and the MOH, UAE, has made
possible what we have today, the fruit of ten years of continuous dedication to digital dentistry
education. To date, more than 15,000 dentists and dental technicians have been educated
in digital dentistry by CAPP.

Dr Dobrina Mollova

Our journey over the last decade has been fraught with the many challenges of keeping
pace with the incredibly fast growth of the industry and new technologies. Ten years ago, we
could not even have imagined the opportunities to change dentistry and improve patient care,
covering everything from diagnosis to treatment in terms of precise, improved efficiency,
and changing outcomes and aesthetic needs.
What has been accomplished in the past ten years has been significant, and we would like
to acknowledge our business partners, industry, sponsors and supporters for helping us make
CAPP the success it is today. Thank you to all who have worked with CAPP during this period
and who share the challenges and passion. We are grateful to all of the dentists and dental
technicians who have followed us in this decade of rapid development in the dental industry
and technologies.
In 2015, there is one more anniversary to celebrate: CAD/CAM magazine is now
6 years old! Since 2010, CAD/CAM has served as a platform for education and information
exchange, and we all hope it will continue. Inside this issue, you will find clinical articles,
as well as reviews of CAD/CAM technology, and industry news.
Yours faithfully,

Dr Dobrina Mollova
Managing Director of CAPP
Dubai, UAE

CAD/CAM
1_ 2015

I 03

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CAD0115_04_Content 03.03.15 10:29 Seite 1

I content _ CAD/CAM

I editorial

I special

03

42

Dear Reader
| Dr Dobrina Mollova

I practice management
06

The importance of brand and own reputation—
from real daily life to the web

| Friedhelm Klingenburg

I opinion
50

| Prof. Antonio Pelliccia

I CE article
12

I industry news

A minimally invasive approach
according to biomechanical principles of teeth

I review

54

CAD/CAM Technology: a review
58

MIS Implants Technologies launches
MCENTER Europe, new digital dentistry hub in Berlin
| MIS

Latest trends in prosthetics
| Massimiliano Rossi, Fabrizio Molinelli & Dr Ilaria Caviggioli

60

EGS at IDS 2015: Discover the ultimate
CAD/CAM upgrades in digital dentistry
| EGS

I overview

61

Adentatec Competence in Dental
| Adentatec

Digital possibilities for making implant prosthetics
| Dr Joannis Katsoulis

62

I case report
36

Planmeca PlanScan is the world’s first
dental unit integrated intraoral scanner
| Planmeca

I industry report

32

Bringing innovation back:
Introducing a complete posterior solution
| Nobel Biocare

56

| Drs Cynthia Kassis, Pierre Khoury, Tatiana Zogheib,
Louis Hardan & Prof. Mehanna Carina

28

Going (unintentionally) green: The unexpected bonus of
switching to CAD/CAM and same-day dentistry
| Dr Joel Strom

| Dr Michael L. Young

22

Value chains being transformed
by new digital dental technologies

Eisenbacher Dentalwaren ED,
your specialist for NEM dental alloys
| Eisenbacher

I meetings

| Dr Riccardo Verdecchia

64

I about the publisher

40

65
66

04 I CAD/CAM
1_ 2015

CAD/CAM
digital dentistry
1

2015

International Events

I feature
| Interview with Dr Simon Kold, owner of Herning Implant Center in Denmark

Vol. 6 • Issue 1/2015

international magazine of

Periodontal and peri-implant tissue management
in the aesthetic zone

Digital impression taking helps me be a better dentist

issn 1616-7390

| submission guidelines
| imprint

| CE article
Biomechanical principles

| industry report
Latest trends in prosthetics

| special
Value chains being transformed
by digital dental technologies

Cover image courtesy of
EGS (www.egsolutions.com).

[5] => Standard_300dpi

© MIS Corporation. All rights reserved.

MCENTER

Open w
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irrigationtemplate allows ted
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guidanc inate the need and
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Learn more at: www.mis-implants.com

[6] => Standard_300dpi

CAD0115_06-10_Pelliccia 02.03.15 12:32 Seite 1

I practice management _ brand building

The importance of brand
and own reputation—from
real daily life to the web
Author_Prof. Antonio Pelliccia, Italy

_We usually associate the term ‘brand’ with
a product that has a unique, consistent and wellrecognised character (i.e. Coca-Cola, BMW). These
brands conjure up images in the minds of consumers. Large organisations work hard to raise the
power and status of their brands and guard them
carefully against unlicensed use or unfair imitation.
The American Marketing Association (AMA)
defines a brand as a ‘name, term, sign, symbol or
design, or a combination of them intended to identify the goods and services of one seller or group
of sellers and to differentiate them from those of
other sellers’.
Therefore, it makes sense to understand that
branding is not about getting your target market
to choose you over the competition, but it is about
getting your prospects to see you as the only one
that provides a solution to their problem. Looking
out into the world today, it is easy to see why brands
are more important now than at any time in the
past 100 years. Brands are psychology and science

06 I CAD/CAM
1_ 2015

brought together as a promise mark, as opposed
to a trademark. Products have life cycles. Brands
outlive products. Brands convey a uniform quality,
credibility and experience. Brands are valuable.
Many companies put the value of their brand on
their balance sheet.
Why? Well you do not have to look very far. In today’s world, branding is more important than ever.
But you cannot simply build a brand like they did
in the old days. You need a cultural movement
strategy to achieve kinetic growth for your brand.
With that, only the sky’s the limit. What sells Chanel
when it produces a cosmetic? A cream or a dream
of beauty? What does the Perugina brand sell when
it produces the ‘Bacio’? A chocolate or a feeling?
What sells Ferrari when it produces the 458: car or
social status? What sells Starbucks when opening
its stores? A coffee or a third place between home
and work? The list goes on with many examples.
Branding is fundamental. Branding is basic. Branding is essential. Building brands builds incredible
value for companies and corporations.

[7] => Standard_300dpi

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At Straumann we are fully committed to taking care of you and the success
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for you!
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[8] => Standard_300dpi

CAD0115_06-10_Pelliccia 02.03.15 13:16 Seite 2

I practice management _ brand building
If you are still not convinced, let me give you another example. The dollar is a world brand. In essence
it is simply a piece of paper. But branding has made
it valuable. All the tools of marketing and brand
building have been used to create its value. On
the front you will find the owner of the brand: the
Federal Reserve. There is a testimonial from the first
President of the United States, George Washington.
There is a simple user’s guide: ‘This note is legal
tender for debts public and private’. And if you are
still not convinced, the owner has added the allimportant emotional message: ‘In God We Trust’. The
dollar is a world brand. It confers a uniform value
globally. But, as I said, it is really just a piece of paper.
Branding has made it worth something.
I mentioned earlier that brands are more important today than in the past. There are a few reasons
for this. Firstly, the world has come online and there
are many new markets and a growing middle class
in places such as India, China, Brazil, Russia, South
Africa, Nigeria, Indonesia and in many more places.
These consumers buy brands. They buy premium
brands. The best branding today is based on a strong
idea. The best brands have remarkable creativity in
advertising to help them break through people’s
wall of indifference to create brand heat and product lust. A case in point is the recent turnaround
of Chrysler and its reliance on marketing and advertising. Or look at the reinvention of Levis. A final
example is a campaign by my own agency, which
has helped reenergise one of America’s great iconic
brands—Jim Beam.
Developing a corporate brand is important because a positive brand image will give consumers,
and other interested stakeholders, confidence
about the full range of products and activities
associated with a particular company.
_Essence: A single, energising central idea; it is the
heartbeat of the organisation.
_Values: What the organisation believes in and
stands for.
_Personality: The traits and qualities that distinguish your organisation as being different.
_Behaviour: The actions associated with values and
personality.
_Relationships: The internal and external rules of
engagement.
_Value Proposition: The offer that is made to customers, the point of difference and why it matters.
The sophisticated strategy is a cultural movement strategy. I believe that building brands now
requires a cultural movement strategy as opposed
to simply a brand building strategy. A cultural
movement strategy can accelerate your brand’s rise

08 I CAD/CAM
1_ 2015

to dominance. Once you have cultural movement,
you can do anything in a fragmenting media environment, maximising the power of social media
and technology. The world has changed. We are now
living in the age of uprisings and movements. I have
written about how to build a brand in this new age
in my new book Uprising. These days, building
brands has become a lot less expensive and smart
brands can take advantage of new tools and rocket
up there globally, very fast. A common interpretation is that a brand is the promise that is made
to customers. Or, the brand is not what you say it
is, but what your customers say it is. While these
views are legitimate ways of helping to understand
a brand, an-actively-managed approach makes a
brand more tangible and provides it with structure.
Company branding is the most efficient way to
show potential customers what your business is
about. It is reflected visually via the logo and company design elements, as well as through verbiage in
marketing materials, slogans and informational
copy. According to Fast Company magazine, ‘The
brand is a promise of the value you'll receive’.
In the face of the current economic challenges, it
is worth noting that brands do better in tough times
compared to unbranded products. Brands outlive
product cycles. And in these challenging times,
there are still great brands being built. Brand owners still recognise opportunity and their brands will
thrive in the years ahead.
No branding, no differentiation. No differentiation, no long-term profitability. People do not have
relationships with products, they are loyal to brands.
In a movement strategy, brands have a purpose that
people can get behind. Brands can inspire millions of
people to join a community. Brands can rally people
for or against something. Products are one dimensional in a social media enabled world, brands are
Russian dolls, with many layers, tenents and beliefs
that can create great followings of people who find
them relevant. Brands can activate a passionate
group of people to do something like changing the
world. Products cannot really do that.
Brands have to contain:
_Uniqueness: utilise your branding to set yourself
apart from your competitors. To do this, analyse
what you do best and consider you target demographic. Use graphics and word choices that
clearly reflect your business to your target audience, hence your brand. Use your branding to
deliver clear messages.
_Target Audience: done correctly, your brand can
assist you in getting a stronger foothold in your

[9] => Standard_300dpi

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32670693-USX-1502_ad infographic_Restoring happiness_IDS 2015.indd 1

2015-02-18 15:37

[10] => Standard_300dpi

CAD0115_06-11_Pelliccia 03.03.15 11:04 Seite 3

I practice management _ brand building

niche market. Define your unique selling position
and consider methods to communicate key messages to your desired audience. Use specific images or phrases to encourage the feel of inclusivity. Let them know the reason your company exists
and how it can fulfil their needs. This can connect
you to your target audience, engage them and
motivate them to buy.
_Emotional Connections: according to a 2010 study
conducted by the world’s largest public relations
firm, Edelman, the Y Generation, also known as the
Millennials, consider brand identification almost
as important as religious preference and ethnic
background when defining themselves online.
The power of branding has successfully melded
into that of personal identification and emotional
connection.
_Message Delivery: having strong branding can
evoke trust from your niche market. This can
translate to your newsletters, emails and advertisements garnering a greater response, hence
increasing sales. As people will already be vested
in your brand, they will be confident that they will
receive value for time spent reading your messages
or researching your product.

10 I CAD/CAM
1_ 2015

_Consistency: focus on your long-term branding
efforts to keep your business consistent. This
consistency should transcend messages, product
lines and audience appeal. It should enhance your
business, adding depth to your company’s presence. This should allow you to grow and keep
a loyal following.
Many small organisations and start-ups neglect
spending necessary time thinking about their brand
in this broad sense and the impact it has on their
business. Let’s look at 10 reasons why digging into
your brand is important:
_Branding promotes recognition. People tend to
do business with companies they are familiar with.
If your branding is consistent and easy to recognise, it can help people feel more at east purchasing
your products or services.
_Your brand helps set you apart from the competition. In today’s global market, it is critical to
stand apart from the crowd. You are no longer
competing on a local stage, your organisation
now competes in the global economy. How do
you stand out from the thousands or millions of
similar organisations around the world?

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CAD0115_06-11_Pelliccia 03.03.15 11:04 Seite 4

practice management _ brand building

_Your brand tells people about your business DNA.
Your full brand experience, from the visual elements like the logo to the way that your phones
are answered, tell your customer about the kind
of company that you are. Are all of these points of
entry telling the right story?

Wrangler, Apple, Perugina, Ferrari)—are these
companies really worth their equipment, their
products, their warehouses, or factories? No, these
companies are worth much more than their physical assets; their brand has created a value that far
exceeds their physical value.

_Your brand provides motivation and direction for
your staff. A clear brand strategy provides the
clarity that your staff needs to be successful.
It tells them how to act, how to win, and how to
meet the organisation's goals.

_Wrapping it up. The best branding is built on a
strong idea, an idea that you and your staff can
hold on to, can commit to, and can deliver upon.
Your brand needs to permeate your entire organisation. When your organisation is clear on the
brand and can deliver on the promise of the brand,
you will see tremendous fruit while building brand
loyalty among your customer base.

_A strong brand generates referrals. People love to
tell others about the brands they like. People wear
brands, eat brands, listen to brands, and they are
constantly telling others about the brands they
love. On the flip side, you cannot tell someone
about a brand you cannot remember. A strong
brand is critical to generating referrals or viral
traffic.
_A strong brand helps customers know what to
expect. A brand that is consistent and clear puts
the customer at ease, because they know exactly
what to expect each and every time they experience
the brand.
_Your brand represents you and your promise to
your customer. It is important to remember that
your brand represents you: you are the brand, your
staff is the brand, your marketing materials are
the brand. What do they say about you, and what
do they say about what you are going to deliver
(promise) to the customer?
_Your brand helps you create clarity and stay
focused. It is very easy to wonder around from
idea to idea with nothing to guide you—it does not
take long to be a long way from your original goals
or plans. A clear brand strategy helps you stay
focused on your mission and vision as an organisation. Your brand can help you be strategic and
will guide your marketing efforts saving time and
money.
_Your brand helps you connect with your customers
emotionally. A good brand connects with people at
an emotional level, they feel good when they buy
the brand. Purchasing is an emotional experience
and having a strong brand helps people feel good
at an emotional level when they engage with the
company.
_A strong brand provides your business value.
A strong brand will provide value to your organisation well beyond your physical assets. Think about
the brands that you purchase from (Coca-Cola,

But what does a dentist actually sell? Therapies
or trust? Improve the management of the dental
office by increasing the management control, the
Perceived Quality and Value Added, optimising
costs, acquiring new patients and increasing the
strategic positioning of professional success. Particular attention was dedicated to finding value
in being able to offer new therapeutic solutions,
especially in this economic, social and cultural ‘time
of crisis’.
There are opportunities for growth in the dental
business through increased perception of quality
in presenting and managing the range of services
in the sphere of performance, even aesthetic, not
to mention the more traditional therapies. The
professionalism of the team of front office and back
office generate word of mouth and optimise all
investments in communication. To transfer the
Perceived Quality, needs new tools of communication personal and professional. Climate Analysis,
Applied neuroscience, Web-Marketing and motivational communication, are just some of the
methods..._
Editorial note: This article is the first one from the four
parts series. Part II will appear in CAD/CAM 2/2015.

_about the author

CAD/CAM

Prof. Antonio Pelliccia
Economy,Marketing & Management
Università Cattolica del Sacro Cuore in Rome,
Agostino Gemelli Polyclinic
Università Vita-Salute in Milan,
San Raffaele Hospital.
Management Consultant for Corporate Strategies
and the Strategic Management of Human Resources
ap@arianto.it // www.arianto.it

CAD/CAM
1_ 2015

I 11

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CAD0115_12-21_Young 02.03.15 12:37 Seite 1

I CE article _ biomechanical principles

A minimally invasive approach
according to biomechanical
principles of teeth
Author_Dr Michael L. Young, USA

Fig. 1a

Fig. 1b

Fig. 1a_Pre-operative photo:
Diagnosis of structurally
compromised teeth.
Fig. 1b_Pre-op: Measuring
intercuspal distance of filling #3.
Fig. 1c_Pre-op: Measuring
intercuspal distance of filling #4.
(Photos/Provided by
Michael L. Young, DDS)

_Introduction
Traditionally, the practice of dentistry has been
a reparative model. We have waited for disease to
express itself, and then repaired it. What if we could
predict who would express a disease and prevent
it from happening in the first place? How would
this approach affect the long-term oral and overall
health of the dental patient?
Many of our patients tell us, “If it’s not broken,
don’t fix it.” Patients are often unaware of the
conditions in their mouths because there isn’t an
associated disability, and they won’t accept a solution to a problem they don’t have. Thus teeth at risk
may remain untreated until a quality of life issue has
occurred, such as pain, infection or a fractured
tooth.

_ce credit CAD/CAM
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.

12 I CAD/CAM
1_ 2015

Fig. 1c

This may be avoidable with a paradigm shift
to a wellness model of practice. A wellness model
is proactive and preventative. If we can identify
a dental condition that increases risk to the tooth
and patient, and treat the condition prior to
its consequence, we’re effectively reducing risk.
The effect is an improved prognosis. Subsequently,
health-care costs will be reduced and quality of
life improved.
We can do better.

_Biomechanical principles
Tidmarsh said in 1979 that teeth are like prestressed laminates. They flex but can return to their
natural state. However, under prolonged loading,
teeth can permanently deform.

According to Geurtsen, Schwarze, & Gunay
(2003), root fractures are the third leading cause of
tooth loss.

Grimaldi said in 1979 that there is a relationship
between how much tooth structure has been lost
and deformation.

Tooth loss is a quality of life issue. Loss of a tooth
ideally requires replacement, which necessitates
further expenditures and procedures.

Cavity preparation or endodontic access destroys the pre-stress state. Teeth can then deform
greater and are more susceptible to fracture. Too
much flexing makes them crack.

Failure to replace the tooth has consequences,
which may lead to further cost and need for treatment
or loss of additional teeth. The consequence of the
reactive approach to dental care is, at best, a lesser
prognosis for the tooth and, at worst, loss of the tooth.

Larson, Douglas and Geistfield (1981) showed
that a restoration that takes up just one-third of
the intercuspal distance is less than one-half of the
strength of an unrestored tooth. The load required

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CAD0115_12-21_Young 02.03.15 12:38 Seite 2

CE article _ biomechanical principles

Fig. 2a

Fig. 2b

Fig. 2c

Fig. 3a

Fig. 3b

Fig. 4

Fig. 5

Fig. 6

Fig. 7

to fracture a tooth was the same if the restoration
involved only the occlusal surface or included the
mesial and distal surfaces as well.
Geurtsen, Schwarze and Gunay (2003) agreed
that the risk of cuspal fracture increases considerably when the isthmus width of a restoration is 50 per cent of the intercuspal distance.
They stated that amalgam or resin composite
restorations should not exceed one-fourth to
one-third of the intercuspal distance. The more
tooth structure that is removed in cavity preparations, the more the tooth flexes under increasing
loads.1

Teeth with cuspal fractures may still be restored;
however, the prognosis will be lower and less than
ideal because there is less remaining natural structure to retain a crown and withstand the flexing
from functional and non-functional forces. These
teeth may last for years. However, they may eventually fracture at the gingival crest or below, because
of further cracks and propagation of those cracks.

Figs. 2a–c_Depth cut bur #3.
Fig. 3a_Final depth cuts.
Fig. 3b_Final depth cuts,
occlusal view.
Figs. 4 & 5_Gross occlusal
reduction with KS7 #3.
Figs. 6 & 7_Gross occlusal
reduction with KS7 #4.

Teeth with history of endodontic treatment are
at an increased risk of subgingival fracture, rendering the tooth non-restorable or with a poor prognosis.2 Therefore, it’s important to prevent these cracks
from forming at all.

Fig. 8a_Final occlusal
reduction frontal view.
Fig. 8b_Final occlusal
reduction occlusal view.

Fig. 8a

Fig. 8b

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Fig. 9a

Fig. 9b

Fig. 9c

Fig. 10

Fig. 11

Fig. 12

Fig. 9a_Measuring remaining enamel
ring after occlusal reduction #4.
Fig. 9b_Measuring remaining
enamel ring after occlusal reduction #3.
Fig. 9c_Occlusal reduction
lateral view.
Figs. 10–12_Breaking contacts and
removing remainder of existing filling.
Fig. 13_Blending occlusal
and interproximal #4.
Figs. 14a & b_Blending occlusal
and interproximal #3.
Figs. 15a & b_Final preparations
occlusal views.
Fig. 15c_Final preparations
lateral view.

How do we prevent too much flexing in these
teeth and prevent cracking? Some have wondered whether a bonded inlay restoration would
strengthen the tooth and prevent cuspal fracture.

possibility of limited or no removal of tooth structure on the axial wall, while covering the cusps.
The result is a tooth with more remaining original
structure, less flexure under force and thus less risk
of permanent deformation and fracture.

A study of bonded inlay restorations under static
load testing in maxillary premolars with large MOD
preparations concluded that bonding ceramic or
composite will not strengthen the tooth.3 A bonded
resin or ceramic inlay will not prevent cuspal deformation and fracture. However, bonded ceramic
onlays have been shown to be an effective answer
in restoring posterior teeth.4,5

It is important to preserve as much enamel as
possible, as failure rates of adhesively retained
restorations increase the more the tooth preparation involves the dentin.6 In addition, the size of the
remaining enamel ring after occlusal reduction is
an important determinant between an adhesively or
cohesively retained approach in tooth preparation.

Bakeman and Kois (2009) stated that all porcelain, adhesively retained restorations offered the

Increased occlusal reduction, or occlusal reduction on a worn tooth, results in a preparation with

Fig. 13

Fig. 14a

Fig. 14b

Fig. 15a

Fig. 15b

Fig. 15c

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Fig. 16

Fig. 18

a reduced enamel ring width. A decrease in the size
of the enamel ring thickness from 1.5 mm to 1 mm
increased the failure rate dramatically. An enamel
ring of less than 1 mm in width would be a contraindication for an adhesively retained restoration,
and a cohesively retained restoration would then be
required.7 A restoration bonded to enamel also provides a margin with reduced or no microleakage.8

I

Fig. 17

Fig. 19

_Summary
Aminian and Brunton (2003) stated: “The
removal of sound tooth structure is an unfortunate biological compromise. The conservation
of sound tooth structure, therefore, represents
an appropriate strategy to minimize biologic
risk.”

Fig. 20

Figs. 16 & 17_Tissue
management with Viscostat.
Figs. 18–21a_Gingival retraction.
Fig. 21b_Final gingival retraction,
occlusal view.
Fig. 22a_Scanning preparations.
Fig. 22b_PlanScan screenshot
of scanning preparations.

Fig. 21a

Fig. 21b

Fig. 22a

Fig. 22b

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Fig. 23_Scanning preparations.
Fig. 24a_Scanning opposing teeth.
Fig. 24b_PlanScan screenshot
of scanning opposing teeth.
Fig. 24c_Opposing model screenshot.

Fig. 25a_Scanning buccal bite.
Fig. 25b_Screenshot
of scanning buccal bite.
Fig. 26a_Screenshot of buccal bite.
Fig. 26b_Screenshot of occluded models.
Fig. 26c_Screenshot
of preparations in density view.
Fig. 26d_Screenshot of orientation
of preparation model.
Fig. 26e_Tracing margins.
Fig. 26f_Tracing margins in ice view.
Fig. 26g_Initial proposal
of restoration for #4.
Figs. 26h & i_Initial proposal
of restorations for #3 and #4.
Fig. 26j_Restorations #3 and #4,
checking material thickness
in occlusal view.

Fig. 23

Fig. 24a

Fig. 24b

Fig. 24c

Adhesively retained restorations offer the possibility to be more minimally invasive while restoring
a tooth to natural appearance and function. More
conservative removal of tooth structure also means
there is less risk to the pulp.

Tooth preparation is also more important as
retention and resistance form is essential to retain
the crown.

The converse is true in that cohesively retained
restorations are more invasive. Removal of more
structure increases pulpal risk, decreases strength and
increases tooth flexure, which may lead to fracture.

A laboratory can fabricate minimally invasive, adhesively retained restorations. However,
chairside CAD/CAM technology can fabricate
excellent restorations of the same quality in the
same visit. This means the challenge of fabricating a provisional for a tooth preparation that

Fig. 25a

Fig. 25b

Fig. 26a

Fig. 26b

Fig. 26c

Fig. 26d

Fig. 26e

Fig. 26f

Fig. 26g

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Fig. 26h

Fig. 26i

Fig. 26j

Fig. 26k

Fig. 26l

Fig. 26m

lacks retention and resistance form is eliminated.

as structurally compromised (Figs. 1b, c). The prognosis without treatment was fair.

In addition, it has been shown that patients
prefer a digital impression technique in lieu of the
traditional impression method.9–13

The restorations were to be completed with
PlanScan chairside CAD/CAM technology in the
same visit.

Yuzbasioglu, et al (2014), also determined that
the digital impression method was faster than
the traditional method. This finding was also
verified by Patzelt, Lamprinos, Stampft and Att
(2014), who indicated that workflow efficiency
was improved using a digital impression technique.

Local anesthesia was achieved with 1.7 cc
2 per cent Lidocaine with 1:100,000 epi, buffered
with Onset sodium bicarbonate inj., 8.4 per cent,
USP neutralizing additive solution.

_Case report
This patient presented for restorations of teeth
#3 and #4 (Fig. 1a). Because of the size of the
existing restorations, these teeth were diagnosed

Depth guide cuts were made using a 330 bur,
which has a 2 mm cutting surface (Figs. 2a–3b).
This ensures 2 mm of occlusal reduction to accommodate 2 mm of material thickness on the occlusal
surface of the restoration.
Gross occlusal reduction was completed using a
KS7 bur to the depth cuts (Figs. 4–8b, 9c). Adequate

Fig. 26k_Checking material
thickness of #4 in facial view.
Fig. 26l_Using rubber tooth tool
to adjust the anatomy of #4.
Fig. 26m_Using rubber tooth
to adjust the distofacial
cusp height of #3.
Fig. 26n_Using rubber tooth tool
to adjust the distal
marginal ridge height of #4.
Fig. 26o_Using smooth tool
to smooth the facial of #3.
Fig. 26p_Using smooth tool
to smooth the facial of #3.
Fig. 26q_Checking occlusal
contacts, location and strength, #3.
Fig. 26r_Checking interproximal
contact strength #4.
Fig. 26s_Final restorations,
occlusal view in PlanScan.

Fig. 26n

Fig. 26o

Fig. 26p

Fig. 26q

Fig. 26r

Fig. 26s

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Fig. 26t

Fig. 26u

Fig. 26w

Fig. 26v

Fig. 26x

Fig. 26t_Final restorations,
lateral view in PlanScan.
Fig. 26u_Final restorations #3,
slice view facial to lingual.
Fig. 26v_Final restoration #4,
slice view facial to lingual.
Fig. 26w_Final restorations,
lingual view.
Fig. 26x_Milling preview.

Fig. 26y_Try-in of restorations,
occlusal view.
Fig. 26z_Try-in of restorations
lateral view.

Fig. 26y

clearance was verified with a 2 mm prep check from
Common Sense Dental Products.
After gross occlusal reduction was completed,
the remaining enamel ring was measured (Figs. 9a, b).
The enamel rings were noted to be 1.5 mm, and
the teeth were prepared for adhesively retained
restorations. If the enamel rings were less than 1 mm,
the teeth would have been prepared on the axial walls
to create retention for cohesively retained crowns.
The remainder of the existing composite resin
in #3 and the amalgam in #4 were removed.
The occlusal surfaces of the preparations were
blended into the interproximal areas using a KS2
bur to create smooth preparations (Figs. 10–15c).
There was no retention or resistance form prepared
to retain the restorations.

Fig. 26z

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Tissue management was obtained with ViscoStat
Clear, gingival haemostatic gel, 25 percent (m/m)
aluminum chloride (Figs. 16 & 17). Gingival retraction was obtained using a two-cord system.
First, a #00 size cord from Ultradent was placed
on the mesial and distal of both preparations (Figs.
18 & 19).
Additional haemostatic gel was used prior to the
second cord. The second cord was #2 size cord from
Ultradent (Figs. 20 & 21a). A minimum of four minutes with both cords in place is needed for adequate
retraction of the soft tissue (Fig. 21b).
While waiting four minutes for gingival retraction, the opposing teeth were scanned with the
PlanScan wand to create a digital model (Figs.
22a–24c). The buccal surfaces were then scanned

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with the teeth fully occluded in maximum intercuspal position. This scan was used along with
the scan of the preparations and the opposing
teeth to create a model for the occlusion (Figs.
25a–26c).
Prior to scanning the prepared teeth, the second
cords were rinsed and removed. The cords were left
wet to lower the risk of disturbing the tissue upon
removal.

Fig. 27

Fig. 28

Fig. 29

Fig. 30

The #00 cords were left in place during the
scanning of the preparations, and the teeth were
dried to allow accurate scanning.
The preparation model was examined in data
density view to verify adequate data was obtained
during the scanning of the preparations (Fig. 26c).
Any areas lacking adequate data were scanned
further until adequate data was obtained. Next,

Fig. 27_Isolation for seating
of restorations using Isolite.
Figs. 28 & 29_Application
of Mulitlink Automix Primer.
Figs. 30 & 31_Application
of Liquid Strip.

Fig. 32_Curing restorations.
Figs. 33a–c_Checking occlusion.

Fig. 31

Fig. 33a

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Fig. 32

Fig. 33b

Fig. 33c

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Fig. 34

Fig. 35a

Fig. 34_Polishing.
Figs. 35a & b_Final restorations
occlusal view.

orientation of the preparation model was performed (Fig. 26d). Orientation is for optimal design,
not path of insertion. The margins were then traced
and viewed in ICE mode, which provides a rendering
of the scanned images for a clear view of the
margins, teeth and tissues (Figs. 26e, f).
The initial proposals for the restorations were
made using Library A and autogenesis, which is
morphogenesis of the library tooth with the neighbouring teeth (Figs. 26g–i).
Material thickness of the proposed restorations
was checked (Fig. 26j, k). Tools were then utilized
to improve the initial proposal to the desired result.
The rubber tooth tool was used to make minor adjustments to the anatomy (Figs. 26l–n). The smooth
surface tool was used to smooth the surfaces (Figs.
26o, p).
The location and strength of the occlusal contacts were checked and adjusted (Fig. 26q). Interproximal contact strength and location was then
verified and adjusted as needed (Fig. 26r).
The final proposals were then verified prior to
milling (Figs. 26s, t, w). The slice plane view was used
to check the space between the tooth preparation
and the restoration (Figs. 26u, v).
This is done to check for possible areas that may
prevent the final restoration from completely seating on the preparation or for areas that may be over
milled. Over-milling reduces the thickness of the
material. This view also illustrates the lack of preparation on the axial wall and the minimally invasive
approach taken. The location of the sprues were
noted and adjusted as needed in the milling preview
(Fig. 26x).
The fit of the restorations was then verified
intraorally prior to final seating (Figs. 26y, z). Occlusion can be verified intraorally with e.Max CAD
prior to crystallization and any staining and glazing.

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Fig. 35b

Checking occlusion with Empress CAD blocks prior
to bonding in place is not recommended.
The restoration for #3 was then glazed and
crystallized in a Programmat CS2 furnace (Ivoclar
Vivadent). The restoration was allowed to cool to
room temperature upon completion of glazing and
crystallization. The restoration was then cleaned
with a steam cleaner. Five percent hydrofluoric
acid was used to etch the e.max restoration for
60 seconds. The Empress restoration was etched for
20 seconds.
The etchant was rinsed with a steam cleaner.
Ivoclean (Ivoclar Vivadent) was applied for 20 seconds
on both restorations to clean their internal surfaces.
Monobond Plus primer (Ivoclar Vivadent) was applied to the internal surface of the restorations for
60 seconds. The primer was lightly air dried after
60 seconds, taking extra care not to allow primer on
the outside surfaces of the restorations.

The teeth were isolated using Isolite (Fig. 27).
Multilink Primer A/B was scrubbed onto the entire
bonding surfaces using a microbrush for 30 seconds. Excess material was dispersed with blown air
until the mobile liquid film was no longer visible,
leaving a glossy appearing surface (Figs. 28 & 29).
An OptraStick Application Aid (Ivoclar Vivadent)
was used to seat the restorations on the teeth
because onlays and partial crowns can be difficult
to handle. Initial tack curing was completed using
a Bluephase curing light (Ivoclar Vivadent) for three
seconds at each interproximal area. The resin was
then removed easily using a 36/37 scaler from
Brasseler. Liquid Strip (Ivoclar Vivadent), a glycerine
gel that prevents an oxygen-inhibited layer of the
resin cement, was applied to the margins prior to
final curing (Figs. 30 & 31).
Final curing of the restorations was then completed (Fig. 32). The initial #00 cords were removed

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Fig. 36a

after final curing so proper tissue management
could be maintained until curing was completed.
Occlusion was checked with the patient chair
at a 45-degree angle. Bausch articulating paper,
horseshoe shape, 200 microns thick, was used first,
and the patient was instructed to chew on the paper
as if chewing gum. Next, the patient was instructed
to tap straight up and down on red Troll Foil articulating foil. Any marks from the chewing strokes
that weren’t covered by the red paper were removed
to eliminate interferences and reduce the risk of
material fracture (Figs. 33a–c).
The restorations were then polished (Fig. 34).
For #3 e.max restoration, the burs were NTI Cera
Glaze — green, blue and yellow, in order. The green
prepolisher was not used on the Empress restoration for #4.
The final result was minimally invasive restorations that appear and function naturally, while
decreasing risk of tooth fracture, and minimize
further risk to the teeth. (Figs. 35a–36b)._
Editorial note: This article was published in CAD/CAM
C.E. Magazine No. 01/2014.

_References
1. Gonzalez-Lopez S, DeHaro-Gasquet F, Vilchez-Diaz MA,
Ceballos L, Bravo M. Oper Dent. 2006; 31(1):33–38.
2. Fennis WM, Kuijs RH, Kreulen CM, Roeters FJ,
Creugers NH, Burgersdijk RC. Int J Prosthodont. 2002;
15(6):559–563.
3. St-Georges AJ, Sturdevant JR, Swift EJ Jr, Thompson JY.
J Prosthet Dent. 2003; 89:551–557.
4. Magne P, Belser UC. Porcelain Versus Composite
Inlays/Onlays; Effects of Mechanical Loads on Stress
Distribution, Adhesion, and Crown Flexure. Int J Periodontics Restorative Dent. 2003; 23:543–555.
5. Bakeman E, Kois J, Posterior, All-Porcelain, Adhesively
Retained Restorations. Inside Dentistry. 2009: 20–33.
6. Dumfahrt H, Schaffer H. Porcelain Laminate Veneers.

Fig. 36b

A Retrospective Evaluation After 1 to 10 Years of
Service: Part II—Clinical Results. Int J Prosthodont.
2000; 13(1):9–18.
7. Kois DE, Chaiyabutr Y, Kois JC. Comparison of LoadFatigue Performance of Posterior Ceramic Onlay
Restorations Under Different Preparation Designs.
Compendium Contin Educ Dent. 2012; 33(3):2 –9.
8. Tjan AH, Dunn JR, Sanderson IR. Microleakage Patterns
of Porcelain and Castable Ceramic Laminate Veneers.
J Prosthet Dent. 1989;61(3):276–282.
9. Yuzbasioglu E, Kurt H, Turunc R, Bilir H. Comparison
of Digital and Conventional Impression Techniques:
Evaluation of Patient’s Perception, Treatment Comfort, Effectiveness and Clinical Outcomes. BMC Oral
Health. 2014. 30;14:10.
10. Patzelt SB, Lamprinos C, Stampf S, Att W. The Time Efficiency of Intraoral Scanners: An In Vitro Comparative
Study. J Am Dent Assoc. 2014; 145(6):542–551.
11. Geurtsen W, Schwarze T, Gunay H. Diagnosis, Therapy,
and Prevention of the Cracked Tooth Syndrome.
Quintessence Int. 2003;34(6):409–417.
12. Aminian A, Brunton PA. A Comparison of the Depths
Produced Using Three Different Tooth Preparation
Techniques. J Prosthet Dent. 2003;89(1):19–22.
13. Larson TD, Douglas WH, Geistfeld RE. Effect of
Prepared Cavities on the Strength of Teeth. Oper
Dent. 1981;6(1):2–5.

_about the author

Figs. 36a & b_Final restorations,
lateral view.

CAD/CAM

Dr. Michael L. Young
graduated from the University
of Michigan School of
Dentistry in 1994. He has
a private general dentistry
practice in Sterling Heights,
Mich. He has been practicing
chairside CAD/CAM dentistry
since 2004. Young is a mentor for the Kois Center
for Advanced Dental Learning. He is a member of
the American Dental Association, Michigan Dental
Association and the Detroit District Dental Society.

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CAD/CAM Technology:
a review
Authors_Drs Cynthia Kassis, Pierre Khoury, Tatiana Zogheib, Louis Hardan & Prof. Mehanna Carina, Lebanon

Fig. 1

Fig. 2

Fig. 1_Scanning the preparation.
Fig. 2_Drawing the limit line.

_CAD/CAM technology and materials are currently used in a number of clinical applications,
including the fabrication of indirect restorations.
CAD/CAM gives both the dentist and the laboratory
an opportunity to automate fixed restoration fabrication. Both chairside and chairside–laboratory integrated procedures are available. The properties of
these restorative materials and their indications and
appropriate use must be understood in order to
enable the achievement of predictable and aesthetic
results for patients.

engineer, Marco Brandestini, that developed the concept for what was to be introduced in 1987 as CEREC
by Sirona Dental Systems LLC, the first commercially
CAD/CAM system for dental restorations.4,5 Ever since
research and development sectors at a lot of companies have improved the technologies and created
in-office intraoral scanners.
All the existing intraoral scanners try to face with
problems and disadvantages of traditional impression
fabrication process and are driven by several noncontact optical technologies and principles.

_Introduction
In the past decade, the demand for all-ceramic
restorations has increased in both anterior and posterior teeth and the search for materials with improved
properties has expanded.1 The need for a uniform
material quality, reduction in production cost, and
standardisation of manufacturing process has encouraged researches to seek to automate the manual
process via the use of CAD/CAM technology since
1980.2
Computer-aided design (CAD) and computeraided manufacturing (CAM) technology systems use
computers to collect information and design, and
to manufacture a wide range of products.3 The introduction of the first digital intraoral scanner for
restorative dentistry was in the 1980s by a Swiss
dentist, Dr Werner Mörmann, and an Italian electrical

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The purpose of this present publication is to provide
an extensive review on the CAD/CAM technology and
to emphasise the application of this technology in
restorative dentistry.

_CAD/CAM techniques
The major goals of the impression-taking process
in restorative dentistry are obtaining a copy of one
or several prepared teeth, healthy adjacent and antagonist teeth, establishing a proper interocclusal
relationship and then converting this information into
accurate replicas of the dentition on which indirect
restorations can be performed.6
Traditional restorative techniques for fixed restorations require the use of impression materials to record
the contours and dimensions of the preparation. This

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is followed by the pouring of stone models and dies
prior to laboratory fabrication of the definitive fixed
restoration. Taking an accurate impression is one of the
most difficult procedures in dentistry, requiring careful
retraction or removal of soft tissue around preparation
margins, haemostasis, and selection of an appropriate
impression material and tray for the technique used.
By using a CAD/CAM restorative technique, a
number of steps can be simplified or eliminated.7
Digital systems now offer the opportunity to avoid
traditional, analogue impressions, including the usual
impression materials, time, and handling limitations
associated with them. Intraoral scanners have the
potential to offer excellent accuracy with a more comfortable experience for the patient and more efficient
workflow for the office. But care must be taken to
ensure that the whole preparation is scanned, to avoid
introducing errors.
Two techniques can be used for CAD/CAM restorations: the chairside technique or the integrated chairside-laboratory procedure.

_Chairside technique
The development of CAD/CAM technologies for
dental applications has enabled clinicians to prepare
and indirectly restore tooth tissue with an aesthetic
all-ceramic restoration, manufactured at the chairside
in a single patient visit.
Chairside CAD/CAM techniques offer advantages
to the patient, including eliminating the laboratory
procedure and the requirement for intra-visit temporisation of the prepared tooth structure.8
It eliminates several cumbersome dental office
tasks, such as selecting trays, preparing and using
materials, disinfecting and sending impressions to
the laboratory. It also removes a source of discomfort
and gagging. Moreover, it enables the clinician to take

a digital impression, design and mill the restoration
in-office, and fabricate cosmetic crowns, onlays and
veneers, with full management over contours and
tooth shade. Finally, it enhances the accuracy of
adaptation of the restoration to the preparation.9
In summary, with these systems, final restorations
are produced in models created from digitally scanned
data instead of plaster models made from physical
impressions.
There are three main sequences to this workflow.
The first sequence is to capture or record the intraoral
condition to the computer. This involves the use of
a scanner or intraoral camera.
During scanning, the clinician must ensure that all
margins of the cavity are captured by the scan and
visualised. The accuracy of CAD/CAM restorations
depends on the scanner’s ability to visualise the margin. A true laser scanner/digitiser takes precise digital
images of the preparation, including the margin, the
undercuts, the contours, the adjacent dentition, and
the gingiva. It captures hundreds of thousands of
points of reference with each image, and then utilises
a million data points to create an exact replica of the
prepared tooth and neighbouring dentition.
Depending on the system, a light and rapid dusting
of an opacifier may be required prior to capturing the
digital scans of the preparation arch, opposing arch,
and buccal bite registration. Once the data has been
recorded to the computer, a software programme is
used to complete the custom design of the restoration.
The preparation is shown on the monitor and can be
viewed from every angle to focus or magnify areas of
the preparation. Inadequate images are automatically
detected.
The “die” is virtually cut on the virtual model, and
the finish line is delineated by the dentist directly
on the image of the die on the monitor screen. Then,
a CAD system, called “biogeneric”, provides a proposal

Fig. 3_Designed molar restorations
using dental designer software.
Lingual view.
Fig. 4_Designed molar restorations
using dental designer software.
Occlusal view.

Fig. 3

Fig. 4

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Fig. 5

Fig. 6

Fig. 5_CAD/CAM milling machine.
Fig. 6_Milling machine.

of an idealised restoration and the dentist can make
adjustments to the proposed design using a number
of simple and intuitive on-screen tools.
The software identifies matching morphological
characteristics (fissures, cusps, marginal ridges, gliding contact angle) and then inserts corresponding
cusps, fossae, fissures, contacts surface into the virtual
model of the restoration. On the basis of the contact
point distribution, the cusp apexes and the proximal
contacts, the software is capable of creating a wellmatched tooth and detecting possible collisions with
the bite registration.
This biogeneric modelling process creates natural,
individual and functional occlusal surfaces.
A pre-manufactured block is inserted into the
machine and is milled using diamond burs. The final
sequence requires a milling device to fabricate the
actual restoration from the design data in the CAD
programme.

_Digital systems
The CEREC Bluecam (Sirona), E4D intraoral digitizer
(Planmeca), and iTero scanner (iTero) are considered
single-image cameras. They capture a series of individual digital images that overlap one another.
The overlapping images are “stitched” together by the
computer software programme to process a single
three-dimensional (3-D) virtual model.
The CEREC AC system powered by Bluecam is
a light-emitting diodes (LEDs) camera that projects
a changing pattern of blue light onto the object using
projection grids that have a transmittance random
distribution and which are formed by sub-regions
containing transparent and opaque structures.
Thus, the intensity of light detected by each sensor
element is a direct measure of the distance between
the scan head and a corresponding point on the target

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object. As a disadvantage of the system, the triangulation technique requires a uniform reflective surface
since different materials (such as dentin, amalgam,
resins, gums) reflect light differently. It means that it is
necessary to coat the teeth with opportune powders
before the scanning stage to provide uniformity in the
reflectivity of the surfaces to be modelled.
The earlier versions of CEREC employed an acquisition camera with an infrared laser light source. The
latest version employs blue LEDs; the shorter-wavelength intense blue light projected by the blue LEDs allows for greater precision of the output virtual model.
The E4D Dentist system was introduced in early
2008. It consists of a cart containing the design centre
(computer and monitor) and laser scanner head,
and a separate milling unit. The IntraOral Digitizer is
a single image camera with red laser light. It also works
by recording reflected data from the hard and soft
tissues.10
The Cadent iTero digital impression system by
Cadent LTD, came into the market in early 2007. The
iTero system employs a parallel confocal white and
red laser light camera to record series of single images
to create a 3-D model. The scanner emits a beam of
light that is reflected off the tooth surface. Only data
reflected back through the filtering device at the
correct focal distance is recorded.11
Using this technique, the iTero captures all structures and materials found in the mouth without the
need to apply any reflective coating to the patient’s
teeth.

_Integrated chairside-laboratory procedure
An integrated chairside–laboratory technique requires two visits.
The clinician can either scan the preparation directly and then send the scan to the laboratory, or can

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review _ CAD/CAM

take a traditional impression, after which a stone
model is poured and the laboratory scans the stone
model. The digitalisation of the dies was performed
by a laser scanner (Cercon eye, DeguDent) and the
substructures were designed on the CAD programme
of the system. Digital impression systems are designed
to electronically transmit the recorded data file to
the dental laboratory for restoration fabrication.
Efficient chairside assistants will increase the overall
production of dental practices by aiding dentists in
completing their procedures more quickly and more
effectively.

For chairside CAD/CAM restorations, an aesthetic,
strong material requiring minimal post-milling
aesthetic adjustment to minimise chairside time is
needed.17–19 Leucite-reinforced glass ceramics (IPS
Empress CAD, Ivoclar Vivadent; Paradigm C, 3M ESPE)
and lithium disilicate glass ceramics (IPS e.max,
Ivoclar Vivadent) can be used for chairside and
laboratory CAD/CAM single restorations. Leucitereinforced material is designed to match the dentition for strength and surface smoothness and to
offer aesthetic results by scattering light in a manner
similar to enamel.20

Other systems are also used by laboratories to
create copings, substructures, and abutments by CAM,
after which hand fabrication of any required ceramics
and finishing is conducted either by the same laboratory or by the laboratory that scanned and referred
the case for milling of the substructure. Ceramic blocks
for laboratory-milled restorations are available as
zirconia (zirconium oxide) and lithium disilicate glass
blocks. Zirconium oxide can be used to create accurate
and strong copings and bridge substructures. After
milling, the unit can be adjusted using an external liner
(Zirliner, Ivoclar Vivadent) that enables characterisation before the outer ceramic suprastructure is
created. The external ceramic layer can be created
either using press ceramics (in the same manner as for
a traditional bridge) or layering ceramic material onto
the substructure using a fine brush and powder/liquid.

A study has been done to evaluate and compare
the marginal gap, internal fit, and fracture load of
resin-bonded, leucite-reinforced glass ceramic mesioocclusal-distal (MOD) inlays fabricated by computeraided design/manufacturing (CAD/CAM) or hot pressing: as a result, they provided clinically acceptable
marginal and internal fit with comparable fracture
loads after luting.21

Advantages of a laboratory CAD/CAM milled
restoration include reduced chairside time and increased accuracy. Since a stone model is not used,
stone pouring errors are eliminated as well as errors
associated with abrasion of the adjacent and opposing
teeth due to manipulation of the models during fabrication that could result in overcontouring, tight
contacts, and excessive occlusal height. In addition,
reduced time is required for fabrication of the substructure.

_Materials
CAD/CAM restorative materials are currently
available in number of sizes in many shades and
translucencies, including multiple shades within
one dense gradated restorative block. The material
used depends on functional and aesthetic demands
and on whether a chairside or laboratory CAD/CAM
restoration is fabricated.13
A range of dental ceramic substrates have been
developed for chairside machining and are represented as prefabricated blocks, manufactured
using processing routes identified to reproducibly
control the resultant ceramic composition and
microstructure.14–16

I

Ceramic blocks for laboratory-milled restorations
are available as zirconia (zirconium oxide) and
lithium disilicate glass blocks. Zirconium oxide
(IPS e.max ZirCAD, Ivoclar Vivadent; Cercon, DENTSPLY
Ceramco) can be used to create accurate and strong
copings and bridge substructures. Zirconia offers
some significant physical properties that are advantageous for dental restorations besides its high
strength. It has a similar colour to natural teeth,
which reduces the need to opaque it or mask it as
would be done for a metal substructure. Zirconia
also has good opacity. This may be an advantage
when trying to block out underlying discolored
teeth or restorative materials. It may also be a
disadvantage when trying to develop a more translucent appearance to the crown. Some manufacturers can colour the zirconia substructure to simulate
dentine shades to improve the desired aesthetic
result.22
After milling, the unit can be adjusted using an
external liner (Zirliner, Ivoclar Vivadent) that enables
characterisation before the outer ceramic suprastructure is created. The external ceramic layer can
be created either using press ceramics (in the same
manner as for a traditional bridge) or layering ceramic
material onto the substructure using a fine brush
and powder/liquid.
Composite resin blocks are also available for CAD/
CAM restorations.23 Another option is the use of
a new resin nanoceramic block that consists of
ceramic clusters within a highly cross-linked resin
matrix. The resulting block is homogenous, and the
restoration can be CAD/CAM-milled chairside or in
the laboratory.

CAD/CAM
1_ 2015

I 25

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I review _ CAD/CAM
_Discussion
Marginal adaptation is an important factor affecting the longevity of all-ceramic restorations.24 Considerable research has been invested in the marginal fit
and internal adaptation of CAD/CAM restorations.25–28
Software limitations, as well as accuracy of milling
devices, may affect the fit of CAD/CAM restorations.
Most clinicians agreed that marginal gap should not
be greater than 100 μm. It has been reported in the
literature that restorations produced by CAD/CAM
systems can have marginal gaps of 10-50 μm which
is considered to be within the acceptable range.29

_authors CAD/CAM
Dr Kassis Cynthia,
DDS, MSc
Dr Khoury Pierre,
DDS, DESS
Dr Tatiana Zogheib, DDS
Dr Hardan Louis, DDS
CES PhD head of Esthetic
and Restorative Dentistry
department, USJ
Prof. Mehanna Carina,
DDS CES PhD FICD Director
of Esthetic and Restorative
Dentistry Postgraduate
Program USJ, President of
the Continuing Education
committee, Lebanese Dental Association
_contact:
Dr Cynthia Kassis
cynthiakassis@yahoo.com

26 I CAD/CAM
1_ 2015

Giannetopoulos and Al investigated and compared
the marginal integrity of ceramic copings constructed
with the CEREC3 and the EVEREST system, employing
three different margin angle designs. They explored to
what extent these CAD/CAM machines can produce
acute marginal angles, creating restorations with acceptable margins. They found that the average chipping factor (CF) of the CEREC copings was: 2.8 per cent
for the 0° bevel angle, 3.5 per cent for the 30° bevel angle and 10% for the 60° bevel angle. For the EVEREST
copings, the average CF was: 0.6 per cent for the
0° bevel angle, 3.2% for the 30° bevel angle and 2.0 per
cent for the 60° bevel angle. Univariate Analysis of
Variance and multiple comparisons showed that there
was a statistically significant difference in the quality
of margins between the two systems for the 0° and
60° bevel finishing line.30
Mjör and Al have evaluated CAD/CAM restorations
and found that they have a marginal fit as good as or
superior to that of traditional impressions. A further
benefit found with CAD/CAM restorations has been
the reduced incidence of secondary caries (the leading
cause of direct restoration failure with both amalgam
and composite materials), attributed to the high accuracy of the approximal fit and the ability to ascertain
that this is accurate prior to completion of the restoration and cementation.31
Another study evaluated the accuracy of marginal
and internal fit between the all-ceramic crowns manufactured by a conventional double-layer CAD/CAM
system and a single-layer system. Ten standardised
crowns were fabricated from each of these two systems: conventional double-layer CAD/CAM system
(Procera) and a single-layer system (CEREC 3D). Marginal discrepancies of Procera copings were significantly smaller than those of Procera crowns and CEREC
3D crowns (P > 0.05). On internal gaps, CEREC 3D
crowns showed significantly larger internal gaps than
Procera copings and crowns (P < 0.05). Within the limitations of this study, the single-layer system demonstrated an acceptable marginal and internal fit.32

On the other hand, depending on the preparation
design, either an adhesive or a non-adhesive luting
cement can be used with these materials.
CAD/CAM restorative materials can be cemented
with either traditional luting cements such as zinc
phosphate, polycarboxylate cement, glass ionomers,
or resin-modified glass ionomers. Materials that
can be sealed with these include zirconia, lithium
disilicate, alumina, and resin nanoceramics.33,34
With regards to resin adhesive cements, they offer superior aesthetics and low viscosity. They chemically bond to the restoration surface and the tooth
surface, either providing all of the retention or, for
retentive preparations, improved retentive strength.
They also have greater compressive strength.35
Meanwhile zirconia fixed partial dentures showed
good to sufficient marginal integrity in combination with Panavia/ED, Compolute/EBS and RelyX
Unicem.36
When evaluating the initial and the artificially
aged push-out bond strength (PBS) between ceramic
and dentine produced by one of five resin cements,
there was a significant effect of resin cement
(P < 0.0001): RelyX Unicem showed significantly
higher PBS than the other cements. Syntac/Variolink
II showed significantly higher PBS than SmartCEM2
(P < 0.001). No significant differences were found
between SpeedCEM, SmartCEM2, and iCEM. The
predominant failure mode was adhesive failure of
cements at the dentine interface except for RelyX
Unicem, which, in most cases, showed cohesive
failure in ceramic.37

_Conclusion
Digital impressions tend to reduce repeat visits and
retreatment while increasing treatment effectiveness.
Patients will benefit from more comfort and a much
more pleasant experience in the dentist’s chair.38
The quality of adaptation of CAD/CAM-generated
restorations is an area of current interest. Studies
demonstrate the clinically acceptable durability of
CAD/CAM restorations for colour matching, interfacial
staining, secondary caries, anatomic contour, marginal adaptation, surface texture, and postoperative
sensitivity.39–43
Adhesive cementation seems to be the key for the
long-term clinical success of CAD/CAM inlays and
onlays.44_
Editorial note: A complete list of references is available
from the publisher.

[27] => Standard_300dpi

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INTERDENT d.o.o. · Opekarniška cesta 26 · 3000 CELJE · SLOVENIJA
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E-mail: info@interdent.cc · www.interdent.cc

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CAD0115_28-31_Rossi 02.03.15 12:48 Seite 1

I industry report _ digital technologies

Latest trends in prosthetics
Total maxillary rehabilitation with a
Toronto Bridge using digital technologies
Authors_Massimiliano Rossi, Fabrizio Molinelli & Dr Ilaria Caviggioli, Italy
illary rehabilitation with a Toronto Bridge will be
presented, giving attention to 3-D scanning technologies, smile design software and CAD system.
The article concludes that digital technologies
are being increasingly implemented in the everyday work of both dentists and dental technicians
because they provide more precise working protocols.

_Total maxillary rehabilitation
with a Toronto Bridge
New technologies allow conventional steps to
be performed digitally. In this way, we can achieve
a more efficient workflow, which saves time and
costs.

Fig. 1

_Introduction
This article presents a clear example of the increasing importance of new technologies and,
more specifically, digital technologies in dental
prosthesis planning and fabrication. By presenting
a real case, this article aims to provide an overview
of the benefits arising from the use of a new protocol in this field. The entire process of total max-

The first step of the digital dentistry workflow is
evaluation of the clinical situation. In particular,
for relevant rehabilitations, our protocol starts
with patient image management. With just two
photographs of the patient, a photograph of his or
her smiling face and an intra-oral photograph, we
can easily create a clinical, functional and aesthetic
design of the smile using an innovative software
program called Digital Smile System (DSS).

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

28 I CAD/CAM
1_ 2015

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industry report _ digital technologies

Fig. 8

Fig. 10

Through a guided workflow, the software allows
the user to quickly create a custom aesthetic test
of the virtual smile, contextualizing it against the
entire face of the patient, with a self-managed
digital elaboration.
Owing to the eyewear marker, DSS is able to
automatically align the two images and to guide
the design. This particular calibration system permits users to study the morphology of the patient’s
face and to acquire very reliable measures in order
to facilitate the work of both the dentist and the
technician (Figs. 1–3).
The mathematically controlled algorithms of
the prosthetic tool for edentulous patients allow
DSS to suggest the most suitable commercial
dental library to be used (Figs. 4–7).

Fig. 9a

Fig. 9b

Fig. 11

Fig. 12

In this first phase, digital dentistry and, more
specifically, the clinical use of DSS represents an
incredible advantage for the planning of both the
work and the information flow. Indeed, it will be
easier for the dentist to present the final prosthetic
result to the patient (Figs. 8 & 9a & b) and to provide
the necessary information to the dental technician
for fabrication of the prosthesis.
After completing the pre-visualization, the
dental arch was prepared for transfer to the CAD
system. Owing to direct integration with DentalCAD (EGS), DSS can automatically export compatible 3-D output to support modelling in the CAD
environment (Figs. 10–13).
Once the aesthetics have been defined, the
workflow moves to acquisition of the 3-D data

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

CAD/CAM
1_ 2015

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I industry report _ digital technologies

Fig. 19

Fig. 20

Fig. 22

Fig. 21

Fig. 23

Fig. 24

(second step of the digital dentistry workflow).
First, we used a desk scanner with blue structured
light technology (DScan3 Blue Light, EGS) to
acquire data from the model. This provided very
accurate data (up to 15 μ) to the laboratory for an
effective and efficient result (Fig. 14).
We then used a body scanner to acquire the
facial data with great precision (Fig. 15). This
scanning step was fundamental for the volume
construction and for the consequent fabrication of
the underlying framework (Fig. 16).
At this point, all of the data collected was
transferred to DentalCAD, now in Version 4.2. We
then created the framework using its simple 3-D
modelling tools and by importing the volumes
studied in DSS (third step of the digital dentistry
workflow). Using the 3-D data of both the face
and the mouth, we were able to study the occlusal
aspects, as well as the relationship between the

Fig. 25a

Fig. 25b

30 I CAD/CAM
1_ 2015

teeth and lips. It was possible to align the 3-D scan
of the face with the 3-D scan of the mouth owing
to an additional scan taken with an extra-oral
landmark (Figs. 17–22).
The very high quality of the mesh created with
DentalCAD allows 3-D printing of the framework
in PMMA in order to try it on the patient. In accordance with the procedure, all of the customizations necessary for the fabrication of the final
prosthesis were performed in a very short period by
screwing the prototype directly into the oral cavity
of the patient (Fig. 23).
The use of these technologies offers several
benefits, in particular, the repeatability of the
shapes designed and the prototype creation. The
prototype obtained can be considered definitive
and fabrication of the definitive prosthesis will be
simplified, since the project files will be stored digitally. In addition, the patient is shown a concrete

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industry report _ digital technologies

Fig. 26

pre-visualization using the prototype (Fig. 24). The
prototype is also very important for the dentist
in order to check the relationship between the
teeth and lips (in terms of aesthetics, phonetics and
support of the soft tissue).
After this step, according to the volumes
obtained, the framework to support
the acrylic teeth was constructed in
DentalCAD (Figs. 25a & b). Our goal
was to create a framework in titanium
by reducing the prototype on which
the teeth were to be placed—exactly
as planned in DSS. We created and
submitted the CAM file for order processing through software integrated
into DentalCAD.
After the milling cycle (fourth step
of the digital dentistry workflow), the
product was carefully adapted to the
model in order to finalize the work. In particular, the titanium framework was prepared and
the acrylic teeth positioned using a verticulator
(Fig. 26).
By means of these new digital technologies,
the dental technician is given the opportunity to
express and enhance his or her skills and creativity
by focusing on finalization of the aesthetics and
functionality.
As can be seen, the final result is perfectly in
accordance with the schedule established with the
patient during the first step of the digital dentistry
workflow (Figs. 27 & 28).
Following a precise workflow, the protocol
covers all stages of the project, from the material
choice to the production and finalization, aiding
the work of both the dentist and dental technician
and providing several new benefits to the patient
too.

Fig. 27

_Conclusion
This article clearly demonstrates the precise
working protocols provided by digital technologies
and the reason they are being increasingly implemented in daily work in dental practices and
laboratories. In particular, it has shown how the use

Fig. 28

of 3-D scanners and dedicated software is becoming part of the digital workflow in dentistry. It allows
a complete aesthetic and functional preview of
the final result and facilitates working in CAD with
very accurate data. The digital dentistry workflow
presented with this particular example has shown
that the benefits arising are not limited to the work
(a time and cost saving, as well as more accurate
results), but also extend to the patient, who is given
a reliable preview of the treatment outcome._

_about the authors

CAD/CAM

Massimiliano Rossi is a CAD/CAM specialist
and dental technician working for EGS.

_contact CAD/CAM

Fabrizio Molinelli is a CAD/CAM specialist
and dental technician working for DSS.

EGS
Via Speranza 19/4
40068 Bologna, Italy

Dr Ilaria Caviggioli, DDS works in a private
practice in Novara, Italy.

egs-info@egsolutions.com
www.egsolutions.com

CAD/CAM
1_ 2015

I 31

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CAD0115_32-34_Katsoulis 02.03.15 12:51 Seite 1

I overview _ implant prosthetics

Digital possibilities
for making implant
prosthetics
Author_Dr Joannis Katsoulis, Switzerland

_Introduction
In contemporary dental medicine, computers
and implants are closely linked. By dealing with

Fig. 1_Virtual 3-D implant-planning
based on volume tomography.

Fig. 1

this topic, the question arises whether one can
speak about a(n) (r)evolution in planning and
manufacturing of tooth- and implant-supported
reconstructions in the field of implant prosthetics.
Dental prosthetics are concerned with the
restoration of lost teeth and tooth-bearing
tissues in the oral cavity. Loss of teeth and
edentulism are quite frequent in old age and
often the main reasons to visit a dentist. Hence,

32 I CAD/CAM
1_ 2015

dental implants have become important means
of therapy, whereby computer-assisted procedures play an increasing role in the daily routine of the dental practice. Thus, it is no contra-

diction to use modern computer technology
and new materials equally for young and old
people.
The continuous advancement of specialised
fields in radiological imaging, manufacturing
methods in the engineering industry und dental
implantology have extended the possibilities of
decision making, planning and surgical as well
as prosthetic realisation of a therapeutic plan.

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overview _ implant prosthetics

Fig. 2_Digital design
of CAD/CAM-FDP framework.
Fig. 3_Full-ceramic reconstructions.

Fig. 2

Actually, this proceeding of dental medicine
only has been made possible by bringing together
these formerly independent disciplines, which
basically depend on the increased performance of
digital data processors.

Fig. 3

Additionally, the digitalised anatomical and
prosthetic conditions can be analysed virtually
and with the help of clearly-formulated criteria
contribute to the decision making in case of either
fixed or removable implant-borne reconstructions.5 It has turned out that the proportion of

_Revolution or evolution?
AD

Despite these developments, many colleagues
do not consider a computer a helping advice in
their daily routine. Any digitalisation of a certain
practice area needs a modification and adaption
of the whole team’s workflow, depending on the
scope of digitalisation. This requires a large effort
of all employees involved, the willingness to learn
from earlier mistakes and to keep pace with the
progressing digital technologies. One thing is
certain: Innovations in dental medicine do occur
more often and faster nowadays. Therefore, evolution or revolution does not depend on the given
digital possibilities but rather on the individual
experience and know-how.
In dental medicine, computer technology is
no more a real technological revolution. Virtual
implant-planning based on volume tomography
has facilitated the decision making and information for a patient for quite some time now (Fig. 1).
Computer-assisted implant placing occurs with
high precision in partially or fully edentulous
patients.1 Here, the so-called backward planning
ensures a high level of predictability of the surgical and prosthetic result. The surgical realisation
of the 3-D planning with stereolithographic
splints is an important advancement in complex
cases and can contribute to less invasive and
rapid proceedings in selected cases. By this, one
can precisely determine whether a completely
“flapless” procedure is possible for single or all
planned implants in the jaw and which augmentative technique is indicated.2 Especially for
older patients with relatively more risks when
implanting, a well-planned, minimally-invasive
proceeding with a shortened operation time is
of advantage.3, 4

• Non-precious dental alloys on nickel-chrome
base System KN and System NH
• Non-precious dental alloys on cobalt-chrome
base System NE and System Duro
• Partial alloy System MG
• CAD/CAM discs on cobalt-chrome
base System NE-Blank and System Soft-Blank
• CAD/CAM disc on titanium base System Ti5-Blank

Konrad-Adenauer-Str. 13 50996 Koeln-GERMANY
Phone + 49 2 21 - 35 96 - 100 Fax + 49 2 21 - 35 96 - 170 info@adentatec.com
www.adentatec.com

CAD/CAM
1_ 2015

I 33

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I overview _ implant prosthetics
Figs. 4 & 5_Fitting accuracy below
50 μm is possible for CAD/CAM
full-arch reconstructions providing
passive fit with minimal stress.

Fig. 4

Fig. 5

bone in the upper jaw is clinically often overestimated.6 According to the characteristics of
an atrophy of the alveolar ridge, the prostheticoriented planning will control the implant positioning and type of reconstruction of the operation virtually in advance.

The CAD/CAM production is specific for metals
like titanium and ceramics, as for example zirconia. For milling with CNC-machines, especially
suited milling cutters are used. After the milling of
zirconia in the overdimensioned green-/whitebody, the final crystallisation (sintering and HIP)
of the work piece is made. Despite of automated
and mechanical processes, the CAM step requires
the experience of specialised engineers who
are able to oversee the processes and step in if
problems occur.

_CAD/CAM technologies in
implant prosthetics
Closely connected to computer-assisted implant
planning is the CAD/CAM technology (ComputerAided Designing/Computer-Assisted Manufacturing), which has significantly changed the dental
medicine in the course of the past twenty years.7
The more parallel dental implants can be planned
and clinically placed, the easier and more stable
the design (Fig. 2) of CAD/CAM frameworks/FDPs
(Fixed Dental Prostheses) and bars made of titanium
or zirconia can be kept. These materials are also
characterised by improved technical and biological
features. Consequently, technical and biological
complications are to be expected less often.8, 9
Depending on the connection type of implant
systems, also full-ceramic reconstructions can
be screwed together directly on the implant’s
level (Fig. 3).
The fitting accuracy of implant-borne CAD/
CAM-titanium and -zirconia reconstructions are
significantly higher than the conventionally
produced bridges with cast alloys.10 By now, most
of the major manufacturers offer their own
CAD/CAM systems and have centralised production facilities for manufacture of frameworks and
bridges at their disposal. Thus, a fitting accuracy
below 50 μm (Fig. 4 & 5) seems routinely possible
for full-arch reconstructions with the required
care and know-how of the production process.11-13

34 I CAD/CAM
1_ 2015

The current development efforts and advancements take place in the area of software possibilities and the connection of individual digital
subareas. Thereby, a universal data format (STL)
enables the forwarding of data by intra- or extraoral scanners via CAD- and CAM software. However, it probably might take some time until the
various providers will open their systems completely and thus enable users to freely choose
between the digital work steps._
Editorial note: A list of references is available from the
publisher.

_contact

CAD/CAM

PD Dr med. dent. Joannis Katsoulis, MAS
Department of Reconstructive Dentistry and
Gerodontology
School of Dental Medicine
University of Bern
Freiburgstrasse 7
3010 Bern
Switzerland
joannis.katsoulis@zmk.unibe.ch

[35] => Standard_300dpi

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

www.maestro3d.com

[36] => Standard_300dpi

CAD0115_36-39_Verdecchia 02.03.15 12:54 Seite 1

I case report _ tissue management and CAD/CAM restoration

Periodontal and peri-implant
tissue management
in the aesthetic zone
Author_Dr Riccardo Verdecchia, Italy

Fig. 1

Fig. 2

_Initial situation

_Treatment plan

A 38-year-old male patient with a non-contributory medical history presented owing to a
vertical fracture of the maxillary left central incisor (tooth #21). The patient showed a combination
of risk factors that together had led to the fracture:
the absence of the ferrule effect, short posts, bruxism,
and occlusal overload due to premature contacts
during protrusive movements (Figs. 1–3).

Based on the clinical and radiographic examination, the aesthetic risk profile was determined to
range from moderate to high on the International
Team for Implantology’s aesthetic risk assessment
guidelines. Horizontal and vertical bone defects
were detected, with a distance of 6 mm from bone
level to the contact points (Fig. 4). A delayed implant placement (Type 2) was planned in order to

Fig. 3

Fig. 4

Fig. 6

Fig. 7

36 I CAD/CAM
1_ 2015

Fig. 5

Fig. 8

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case report _ tissue management and CAD/CAM restoration

Fig. 9

Fig. 11

Fig. 10

Fig. 12

achieve complete healing of the soft tissue before
the guided bone regeneration procedures and implant placement. In order to minimize the number
of surgical appointments and reduce the overall
morbidity, a simultaneous approach of periodontal and implant surgery was preferred. The periodontal tissue of tooth #11 was modified along with
implant surgery on region #21 with two different
objectives: (a) to increase the ferrule effect and
move the mid-facial soft-tissue margin slightly
upwards to improve the harmony of the scalloped

I

Fig. 13

mucosal line (Fig. 5); and (b) to hide the dark underlying appearance of the root with a connective
tissue graft (Fig. 2).
The initial phase involved the removal of the
fractured tooth #21 utilizing a periotome. The extraction socket was filled with a collagen plug to
achieve stabilization of the blood clot during the initial healing of the soft tissue. A Maryland bridge was
cemented on the same day and modified to avoid
interferences during protrusive movements (Fig. 6).

Fig. 14

Fig. 15

Fig. 16

Fig.17

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1_ 2015

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I case report _ tissue management and CAD/CAM restoration

Fig. 18

Fig. 19

Fig. 20

Fig. 21

_Procedure
First surgical procedure
Six weeks later, periodontal and implant surgery
were performed. A mid-crestal incision was executed
on the implant site. At this stage, scalloped incisions
were applied on the palatal and buccal sides of tooth
#11. Afterwards, bucco-oral ostectomies on the root
were performed for the previously described goals.
The tiny interproximal bone peak was treated with
due respect and left untouched (Fig. 7). Subsequently,

a Straumann Bone Level implant (ø 4.1 mm, SLActive
12 mm) was inserted in the correct 3-D position to
replace tooth #21 (Fig. 8). Shortly afterwards, autogenous bone chips were harvested locally and applied to cover the dehiscence-type defect. A layer of
Straumann BoneCeramic (400–700 μm) was placed
to overcontour the external surface of the facial bone.
The grafting material was covered with a non-crosslinked collagen membrane in accordance with guided
bone regeneration principles (Fig. 9). A double-layer
technique was used to improve the stability of the
membrane. Once perfused with blood, the membrane
could be easily adapted to the alveolar bone crest and
did not require any additional fixation. Tension-free
primary wound closure was achieved with horizontal
mattress sutures after splitting the periosteum at the
base of the flap (Fig. 10). The ovate pontic was ground
to avoid pressure on the tissue below. The provisional
bridge was then recemented (Fig. 11).
Second surgical procedure

Fig. 22

38 I CAD/CAM
1_ 2015

The stability of the provisional bridge allowed
an extended interval (four months) for the final
flattening of the ridge contour due to remodelling
of the alveolar bone. A roll flap technique was then
regarded as adequate to compensate for a mild
horizontal discrepancy at region #21 (Figs. 12 & 13).
Meanwhile, a very thin (≤ 1 mm) connective tissue
graft was harvested from the premolar area of the
palate and inserted with a tunnel technique in a
supra-periosteal pouch, with the purpose of hiding

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case report _ tissue management and CAD/CAM restoration

the dark aspect of the nearby root of tooth #11
(Figs. 14 & 15). In both surgical appointments, vertical papillary incisions, which had been deemed
not necessary, could be avoided.

(Figs. 20 & 21). The periapical radiograph (two-year
follow-up) shows the stable crestal bone levels
around the implant (Fig. 22)._

Prosthetic procedures

_about the author

A screw-retained provisional crown remained in
situ for six months on the implant while maturation
and stabilization of the peri-implant soft-tissue
contours were established. During this period, modifications in form, contour and outline were effected
to improve the aesthetic outcome using a lightcuring composite material (Fig. 16). Proper implant
placement allowed the establishment of an optimal
final subgingival contour (Fig. 17). A customized impression coping was then fabricated to capture the
transition zone contour created by the provisional
restoration. For the final restoration, a CAD/CAM
zirconia abutment was selected and Straumann
CARES CADCAM was used to fabricate the frameworks
(Figs. 18 & 19). The screw access position allowed
the use of a one-piece restoration. The abutment was
veneered using a pressable ceramic system. After
the try-in and colour correction by the laboratory,
the final crown was delivered to the patient and
tightened at 35 N cm. The access hole was sealed with
gutta-percha and a light-curing composite resin.

Riccardo Verdecchia, DMD,
maintains a private practice in
Rome (Italy) specializing in
periodontology, implant dentistry
and fixed prosthodontics. He is
a member of the International
Team for Implantology and
the Società Italiana di
Parodontologia e Implantologia (Italian society
of periodontology and implantology). He can be
contacted at riccardoverdecchia@hotmail.com.

CAD/CAM

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20 y
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20
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S e i t s tab l i s
E

The prosthetic procedures on the root of tooth
#11 involved the delivery of a longer golden post
in order to reduce the risk of root fracture. For the
same purpose, it was essential to perform prosthetic
preparation of the palatal aspect of the gold abutment to create 1.5–2.0 mm of space for the zirconia
framework and pressable ceramic. The final goal was
to avoid interference during protrusive movements.

_Conclusion
The surgical and prosthetic challenge in this clinical case was to develop a natural scalloped mucosal
line on the maxillary central incisors and to obtain a
good aesthetic outcome with the prosthetic crowns,
despite the various existing dental and skeletal asymmetries and the bone defects at the implant site.
Of utmost importance was knowledge of the
hard- and soft-tissue remodelling around the implant in region #21 and around the root of tooth #11
after the surgical steps.
A benefit resulting from the conservation of the
root of tooth #11 was the maintenance of the interproximal height of the tiny bone peak, which provided support to the papilla mesial to the implant.
Furthermore, this approach was highly beneficial
to the natural appearance of the prosthetic crowns

Wir freuen uns auf Ihren Besuch!
We are looking forward to your visit!

Halle/Hall 3.2
Stand/Booth A30/C39
Eisenbacher Dentalwaren ED GmbH
Dr.-Konrad-Wiegand Straße 9
63939 Woerth am Main

Tel.: +49 (0)9372 9404-0
Fax: +49 (0)9372 9404-29
info@eisenbacher.de

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I feature _ interview

Digital impression taking
helps me be a better dentist
TRIOS allows you to move more naturally. You can
stop and then start up scanning again from the
same place, and you can even rescan selected areas
and merge them into a complete impression. All of
this makes it much easier and faster to obtain good
impressions every time.
_What about digital impressions in terms of
accuracy?
Shortly after we started using the TRIOS system,
I successfully completed a maxillary reconstruction
with 14 new teeth, all based on digital impressions.
Both scanning and the whole workflow with the
laboratory went smoothly and all 14 teeth were
seated without making any adjustments.
Dr Simon Kold, owner of
Herning Implant Center in Denmark.
Dr Kold studied at the Department
of Dentistry at Aarhus University with
his wife, Louise. In 2006, they started
Herning Implant Center, a referral
clinic for surgery, implantology and
major prosthetic reconstruction.
The centre currently has a dental
laboratory and 18 employees,
including a permanent anaesthetist
and anaesthetic nurse.
It has provided implant treatments
for more than 20 years.
Dr Kold is a popular and active
lecturer, delivering seminars
at leading dental industry events
around the world.

_Dr Simon Kold from Herning Implant Center
in Denmark has worked with the TRIOS scanner
since 2011. For him, there is no going back to traditional impression taking. Dr Kold believes that his
preparations and final results have improved significantly since he started working with TRIOS. The
technology has taken his business to new heights.
According to him, “Intra-oral scanning helps me
give patients better dental treatment”.
_What initially made you move from traditional
impression taking to digital impressions?
Dr Kold: Our clinic has been working with guided
implant surgery since 2005. With the emergence
of new technologies, we saw huge potential in
combining digital impressions with CBCT scans to
ensure both accurate and aesthetic implant treatment. After trying various intra-oral scanners on the
market, we finally found the best choice in terms
consistent accuracy and adequate detail in the scan.
Today, we use the 3Shape TRIOS digital impression
solution for most types of cases.

To be on the safe side, I also took a traditional impression during the process. Later, out of curiosity,
I sent the physical impression to the laboratory
and asked them to assess its precision in relation to
the scan. The laboratory estimated that the sources
of error had been reduced by up to 70 per cent.
Even half of that would have impressed me.
_Was it as easy for your clinic to adapt to the
new technology?
One thing that surprised me was how excited
everybody was about working with the new technology. It clearly boosted the staff’s professional
self-esteem. Today, I can really see how the change
has made a difference for our clinic. Installing and
using the digital impression system has developed
us, made us better, and is still moving our business
and careers in new directions. The technology has
caught the attention of patients as well: they ask
questions and seem impressed. I think that they like
the idea of being treated by a top modern facility
with the best equipment.

_What made TRIOS stand out for you?
_What was the learning curve like?
It was mainly because it was so easy to use. With
the many other intra-oral scanners I tried, I needed
to keep my hand completely steady while scanning.
The slightest movement, of the patient or my hand,
was enough to make the scan useless for clinical
work. I would have to start over from the beginning.

40 I CAD/CAM
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Naturally, our staff had to learn how to scan
optimally for specific cases. Like any new tool, the
more you work with it, the better you get. The first
day we received the system, we scanned six patients
in a row with 3Shape experts giving instructions.

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feature _ interview

After that, we were ready to work on our own. Here
at our clinic, assistants scan as often as dentists
because the TRIOS system is so intuitive.
_As an experienced user of intra-oral scanning,
what do you see as the key advantages?
Digital impression taking offers many advantages, and some systems include a few benefits
that go beyond just taking an impression. In general, digital impression taking avoids the uncertainties and potential errors that can come with
traditional impression taking and casting in plaster. Precision becomes significantly higher. There
are other advantages that come with the technology, including the things that can be done while
taking the impression rather than as extra steps.
For example, with TRIOS, I can take shade measurements as I scan and snap high-definition photographs for capturing important details that help
the laboratory fabricate a better restoration for my
patients. The impression’s colours are amazingly
lifelike and I thus use the 3-D image to discuss
treatment with patients.
_Does digital impression taking make you a
better dentist?
It has always been challenging to define an
adequately precise margin and this places demands
on the dentist’s preparation skills. Now I find it
easier to assess the quality of my impression because I can see the preparation right away in 3-D
and in the high-definition photographs that I take
with the scanner while scanning.
The complete digital workflow that TRIOS enables makes us a better provider of implant treatment, which represents our core business. The digital impression merged with CBCT scans is used to
virtually plan implant positions, model the restoration, and design low-cost surgical guides that can
be produced by a 3-D printer. The digital method enables us to offer patients guided surgical treatment
that is faster and cheaper so that more patients can
afford implant solutions.
_Does the technology have any cost benefits
for patients?
One great option with TRIOS is that we can make
model-free crowns in full zirconium dioxide and
IPS e.max (Ivoclar Vivadent). Skipping the physical
model makes the whole workflow faster and cheaper,
giving us an alternative to conventional crown
treatment. This allows a large number of patients,
who would otherwise have chosen composite treatment to save money, to have this treatment.

_Do you have any advice for dentists still considering digital technologies?
Yes. Don’t wait! Start now so that you are ahead
of the game. Yes, it is a significant investment, but
one that saves time, costs and most significantly will
help develop your clinic’s reputation, dental skills
and business success. That is how it worked for us.
Laboratories and dental schools all over are starting
to train technicians to give preference to CAD/CAM
and workflows using digital impressions. Soon,
all laboratories and clinics will be working digitally
because the technology offers so many benefits.
You do not want to be left behind._
Editorial note: This interview first appeared in 3Shape News.

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I special _ digital technologies

Value chains being transformed
by new digital dental technologies
Innovative digital solution for dentures
Author_Friedhelm Klingenburg, CEO Merz Dental GmbH, Germany

Supporting
activities

fit m
Pro

Corporate infrastructure
Human resources

in
arg

Technology development

Outbound
logistics

Customer
service

fit m

Operations Marketing
and sales

Pro

Inbound
logistics

arg

Procurement

Fig. 1_Basic model of
Porter’s value chain.
(All images courtesy of
Merz Dental GmbH.)

Fig. 1

Primary activities

_The definition of ‘value chain’ depicts the
stages of production as an ordered series of
activities. These activities create values, consume
resources and are linked to one another in
Processes. According to the approach taken by
Michael E. Porter¹, ‘Every firm is a collection of
activities that are performed to design, produce,
market, deliver, and support its product. All of
these activities can be represented using a value
chain’. Another definition describes the value
(adding) chain as ‘the stages of the transformation process that a product or service passes
through, from starting materials to final use’.²
Value added is the difference between the income
that the product generates and the resources
employed.
To be specific, this means that the value chain
is represented by the sum of all values added
(margin) of each individual market participant.
All market participants who wish to participate
in a value chain together make up the value chain
system of an industry. If this is applied to our
industry, we must consider the specific situation
of the market participants, ‘industry, dental lab,
dental practice and patient’. All those involved
are part of the value chain. In the past, industry
generated its value added by manufacturing

42 I CAD/CAM
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consumables or equipment for the dental technician or dentist, the dental technician generated
his value added by making traditional dental
restorations and the dentist generated his value
added by rendering services for patients. The
chain has changed more and more over the past
20–30 years, mainly due to the introduction of
digital technologies. The following outline presents selected developments based on use of digital technologies, plus a future-oriented project
for the integration of total prosthetics into digital technology.

_Analogue meets digital
(change in occupation profiles)
The whole field of digital technologies in
dentistry has now become so extensive that
not all aspects can be covered in this article. For
example, digital technology has an impact on the
following.
_The profile of a dental technician's occupation,
which is no longer a ‘plaster room’ job but rather
a computer workstation position. As a result,
however, the requirements change for candidates because the modern-day ‘skilled trade’
calls for future applicants to be interested in

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special _ digital technologies

computer aided design (CAD) for crowns,
bridges, telescopes, abutments, etc and the programming of milling strategies for transforming
the CAD design into an end product that is made
by subtractive or additive processes. It is advisable and essential to integrate such requirements into dental technician training at an early
stage.

dental lab were facilitated, speeded up and thus
made more efficient in implementation at the
beginning of this digital evolution, by using scanners and CAD/CAM milling machines. Only in a
subsequent step were other market participants
included, e.g. milling centres in Germany and
abroad or also industrial companies that want to
participate in the value added (Figs. 2 & 3).

_The rendering of dentistry services is calling for
increasing use of state-of-the-art digital instruments and methods. In future, a dentist will not
only make a diagnosis but chiefly focus on treatment preparation, surgery and the insertion of
a dental restoration (conservative or prosthetic).
The other activities will be replaced by digital
work processes.

_Digitisation—
an opportunity for the dental lab?

There would probably have not been any
change in the value chain that had applied for
decades (see Fig. 1) if companies like Sirona had
not introduced the first digital technologies to
dental practices and dental labs in the 1980s. And
even though the concept of the shift in value
added was already an integral part of the system,
initially only work steps and work processes in the

For a long time now, innovative and marketing-oriented dental labs have recognised the
advantages of digitisation and been benefiting
from their timely entry to the world of CAD/CAM.
Their wide range of services covers the entire
dental technology portfolio with modern, stateof-the-art framework materials and veneering
materials. Standard restorations in particular,
such as crowns and bridges are made by CAD/
CAM—nowadays that is already state of the art.
But what impact have these change processes
had in the dental lab? The fact is that there has
been a shift in the focuses of activity in in-house
production towards more services in the digital

Fig. 2_Basic model of market
participants in the value adding
process, not including
digital dental technology.

Role of market participants in the value adding process, NOT INCLUDING digital steps
taking a precious metal-based crown as an example

INDUSTRY

DENTAL LAB

Manufacture and supply
of precious metal alloy

DENTIST

Plaster model
Jaw relation recording
(articulator)
Modelling: wax sprue
Investment
Processing: metal
framework
Veneering/polishing

Diagnosis
Preparation
Shade taking
Impression
taking
Temporary
restoration

Fig. 2

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Role of market participants in the value adding process, INCLUDING digital technology
taking a ceramic crown as an example

DENTIST

DENTAL LAB

Diagnosis
Preparation
Shade taking
Impression taking

Scan of conventional
impression
Design preparation
limits
Milling
Veneering/finishing

INDUSTRY

Digital scan
Data transmission

Manufacture/
supply of materials

Milling centre
Range of services
identical to those
of an external
milling centre

MILLING
CENTRE
Checking the dataset
Design preparation
limits
Milling
Dispatch to dental lab

Optional:
Purchasing from
milling
centre/industry

Optional:
Completion and
dispatch to dentist

Fig. 3
Fig. 3_Basic model of market
participants in the value
adding process, including
digital dental technology.

Fig. 4_Mandibular BD Load,
after milling process.

planning and coordination process and the
process chain has been minimised. In terms of
quality not much has changed, even though it
may have been expected. Without doubt, material
quality is perceived by the patient only in terms
of shade (from gold to white) and the fit/security
of a dental restoration is still dependent on the
job instructions that have been received from
the dental practice. Process quantity has seen a

major change—nowadays only half of the original
dental lab processes are necessary in the lab in
order to produce a functional, highly aesthetic
dental restoration. Although in economic terms
it means high capital investment costs for the
dental lab owner, it also means that, depending on
the amortisation period and the quantities to be
made, he is able to make competitive prices when
faced with market participants who attempt to
penetrate the market by price dumping.
These days, the dental lab is—more than ever—a
service provider for the dental practice and less and
less a skilled trade. That naturally involves risks for
the skilled occupation, but it also offers substantial
opportunities. A dental lab owner can highlight his
locational advantage and provide his special services and cooperation in a spirit of partnership.
What type of dental lab are you? Do you rank
among the dental labs that are still highly characterised by craftsmanship? Are you extremely
uncertain and waiting to see what happens or do
you lack the required knowledge of economics or
marketing to also embark on the path of digitisation? The fact is that anyone who fails to have an
open mind about digital technology will no longer
have a major player role among the dental labs.

Fig. 4

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special _ digital technologies

Fig. 5

The more dental practices invest in digital workflow and exchange relevant data, the more dental
labs have to adapt and serve it technologically. It
is still the responsibility of dental labs to support
the dentist, and hence the patient, by providing
optimal process chains. That is why dental labs
should regard digitisation as an opportunity.

_From stand-alone solutions
to value chains
At the beginning of the digital dental world
there were stand-alone solutions, single work
steps, but nowadays there is more and more consideration of complex dental lab processes that
can be implemented on a totally digital basis. It all
started with implant navigation, digital function
diagnostics, and the production of aesthetic dental restorations in the form of crowns and bridges,
and nowadays these have already become main-

stream, so to speak, in an innovative, modern-day
dental lab. The next step in a dental world that
is becoming increasingly digital is advancement
towards the consideration of entire value chains
—including the process of making full dentures.

Fig. 5_Illustration of the conventional
method of production and treatment.

_Backward planning for full dentures—
the digital value adding process
in reverse!
While in the past the introduction of digital
technologies chiefly aimed at indication-related
solutions for individual work steps, the focus of
digital dental technologies is now on entire value
adding processes. One of the last groups of topics
and areas of indications, which, in digital terms,
has so far only been dealt with in passing, is total
prosthetics. Here in particular, though, there are
innovative digital approaches that will simplify
and speed up production. This is where pioneer-

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Fig. 6
Fig. 6_Innovative digital method
of treatment and production.

ing digital revolutions are accounting for yet
another milestone in digital dental technology.
The future scenario is depicted in Fig. 6.

that only applies to Germany. Consequently, total
prosthetics still ranks as one of the most important areas of prosthetics.

After all, total prosthetics does not merit the
reputation of being an ‘unloved child’. For dentists
and dental technicians it still does not have the
same level of importance as other prosthetic
restorations. But why? It is certainly not due to the
fact that patients are so difficult, or total prosthetics generally is so unattractive to dentists and
dental technicians. On the contrary. Production of
a precision-fit, functional and aesthetic prosthesis is often a major challenge to dentists and dental technicians. Especially because with edentulous patients important information is frequently
missing to be able to achieve an optimal reconstruction of the jaw and mouth. The main reason
is rather that the dentist’s and dental technician’s
services to be rendered for a full denture are both
extensive and elaborate and the fee chargeable
for the service cannot cover the costs incurred.
In Germany, between 300,000 and 400,000 full
dentures are still being made every year.

The complexity of today's production process
for a full denture is illustrated by the following
flow chart.

And according to expert opinion, the figure will
tend to remain constant in years to come owing
to a longer life expectancy and sociodemographic
change. With an average total fee rate of approx.
€ 1,000–€ 1,400 per full denture this market
segment has a volume of over €300 million—and

46 I CAD/CAM
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Production of a conventional prosthesis is
currently based on complex interaction between
the dentist, dental technician and patient. In an
idealised process flow, there are at least five appointments for the patient and dentist, which can
take several days or even a few weeks. From the
very first appointment the work starts to be dispatched, from the first impression, functional
impression and occlusal record to the first wax
model, until, after much to and fro between the
dental practice and the dental lab, the final denture can be fitted in the last appointment. The
dentist's net treatment time in the chair can then
total about 2.5 hours. Quite often another one
to two more appointments are required. Per appointment there is a calculated preparation and
follow-up time of at least 5 minutes so if there
are five appointments another 25 minutes have to
be added on. Consequently, dental practice time
soon totals 3 hours or more for a full denture.
At the dental lab end, the level of complexity is
even higher. From initial model impression taking

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special _ digital technologies

Fig. 7

to final completion the dental lab can expect to
have dental lab work amounting to 6–8 hours.
This does not include pick-up and delivery times
for commuting between the dental lab and the
dental practice. Even after denture incorporation
there is often rework, which is time-consuming
and not included in the service fee.
The conventional workflow (Fig. 5) for making
a full denture therefore positively cries out for an
approach to address the last bulwark of the conventional dental process chain and make a digital
solution available.

_The future of the full denture is digital
That is definite. Although nowadays there are
ways of simplifying individual work steps with a
scanner and a CAD/CAM milling machine (prosthesis baseplate or basing arches made from industrially prefabricated blanks), consideration of
the process chain as a whole has so far been missing. This is the approach adopted in the following
illustrated solution with a full denture based on
completely digital development and production.
The entire solution concept is based on the prin-

ciple of backward planning. In real terms this
means that a full denture completed by a master
craftsman is customised to suit the patient's oral
situation, with just one appointment! Very soon
the production of a full denture will take place
in a fully digital process—from digital impression
taking to production, completely devoid of dust
and plaster. Unfortunately the digital scanning
systems available at present are not yet able to
provide the option of comprehensive collection
of oral situation information in a single appointment, but it is definitely only a matter of time. Until then the jaw relation, palate, centric relation
and aesthetics will be recorded by analogue
means and then transferred to the digital system.
By this method, all the data for making the prosthesis later is collected in just one appointment.
The process is followed by comparing the digital data with a prosthesis database, selecting the
appropriate milling blanks with previously polymerised dental arches, and the modelling of the
gums, which vary from patient to patient. After
transferring it to the CAM module all that has to be
done is mill the respective maxillary/mandibular
pair. That is followed by finalisation in the dental

Fig. 8

Figs. 7 & 8_BD Load
(maxillary and mandibular milling
blank in occlusion,
available in various sizes)
before milling process.

Figs. 9_Process-integrated
Creator CAD Software.
Fig. 10_BD Load,
during milling process.
BD

Fig. 9

Fig. 10

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Fig. 11

Fig. 12

Figs. 11 &12_BD Load,
after milling process.

lab and a second appointment at the dentist's
for the purpose of incorporation. The finished
product is a functional, precision-fit, highly aesthetic dental restoration of master craftsmanship
quality, made in Germany!
This new future-oriented method called Baltic
Denture System uses digital technologies to make
the production of a full denture economically
profitable again for the dental practice and the
dental lab, for the first time in years. Despite digitisation, market participants remain the same and
the value adding process takes place within the
familiar, implemented structures.

_Digital technology as an option
for additional business
With the aforementioned method of production and by focusing on a small number of analogue processes in the dental lab there is more
scope for new lines of business for dental labs.
The dental lab of the future will no doubt regard
itself increasingly as a partner and service unit for
its dentist and be capable of taking ‘troublesome’
issues off his hands. In addition, the dental lab
can manage the data stream for its client to
ensure optimal results. Another field of activity
that presents itself as a result of digital techniques is that of dental aesthetics! One example
is the concept of lächeln2go (smile to go), which,
with its volunteers, first developed the concept of
dental aesthetics as a new line of business. What
is impressive is the use of a two-dimensional
aesthetics check that makes it easy to record
dental status and aesthetic deficits.

_Conclusion
It remains to be seen who the winners and
losers of increasing digitisation will be. The fact
is that we are not yet at the end of optimal digital
workflow. It is still important to modernise and
develop digital processes. However, the opportu-

48 I CAD/CAM
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nities are quite clearly in the majority, and due to
optimisation in the process chain the resulting
work has a higher level of precision achieved in a
shorter amount of time. This means firstly that
thanks to the declining proportion of expenditure
accounted for by staff costs per prosthesis it
is also becoming possible to increasingly internationalise German dental restoration work.
Secondly, scope is being created for new lines of
business such as dental aesthetics. The patient too
benefits from digital production, which also saves
time for him or her. Owing to the use of digital
technologies and optimisation of value chains the
profitability of hitherto unattractive work is increasing again for the dentist and dental technician. What is more, in this way scope is created for
additional service offerings, which in turn creates
potential for additional business and income.
In spite of all the digitisation and value chain optimisation one must not forget that, despite everything, direct contact between the dentist, dental
technician and patient is still crucial and important
for the outcome: aesthetic and functional dental
restoration about which the patient is not only
satisfied but also enthusiastic in everyday life._
_References
1. Porter ME. The Competitve Advantage: Creating and
Sustaining Superior Performance. NY: Free Press 1985
2. Harting D. Wertschöpfung auf neuen Wegen. Beschaffung Aktuell 1994; 7:20-22

_contact

CAD/CAM

Merz Dental GmbH
Eetzweg 20
24321 Lütjenburg, Germany
info@merz-dental.de / www.merz-dental.de
www.baltic-denture-system.de

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Digital solution for dentures

Ideas become reality!

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www.baltic-denture-system.de

Merz Dental GmbH Eetzweg 20 · 24321 Luetjenburg, Germany · Tel +49 (0) 4381 /403-0 · www.merz-dental.de · ISO 13485

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I opinion _ ecological advantages of CAD/CAM

Going (unintentionally) green:

The unexpected bonus of
switching to CAD/CAM
and same-day dentistry
Author_Dr Joel Strom, USA

_Introduction
With dentistry as innovative and dynamic as it is,
the progress made and the exciting new trends that
result are often judged in terms of the technological
or financial: We can update our equipment to have
a purely digital office, or we can adopt new practices
and offer new procedures to our patients that bring
in extra revenue.
While these accomplishments are certainly
laudable, it is time for dentistry to measure its
progress by different standards, ones that affect
the profession and the world as a whole. In short,
we can examine how our practices and procedures
influence the environment and what dentistry as a
profession can do to ensure this influence remains
positive.
Fortunately, dental professionals no longer have
to choose between advances in technology and
what is considered “eco-friendly.” In fact, practice
owners can assure themselves of the best of both
worlds by adopting digital technology, such as
in-office CAD/CAM systems such as the Planmeca
PlanScan System (E4D Technologies). While the
practical and financial benefits of CAD/CAM technology are well established, the environmental
benefits—though discussed less often and perhaps
not as well understood—abound.

_CAD/CAM: Why dive into digital?
Though not ubiquitous, digital technologies,
particularly in-office CAD/CAM systems, are making their presence known. Dental professionals
who integrate these advanced technologies can
offer sameday dentistry to their patients; that is,

50 I CAD/CAM
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they condense the restorative process of multiple
appointments over several weeks down to one
appointment lasting a few short hours. Clinicians
can digitally scan the patient’s teeth and design the
restoration(s) right then and there. Once approved,
the restoration(s) can be milled and seated immediately. Essentially, in-office CAD/CAM systems
are revolutionizing how restorative dentistry is
practiced.
This CAD/CAM revolution provides almost innumerable benefits to patients. Multiple appointments for one restoration become non-existent, so
patients no longer need to make multiple trips to
the dental office. Digital scans eliminate the need
for messy, uncomfortable impressions that make
patients gag and are prone to errors. Temporary
restorations are no longer necessary, removing that
extra step from the restorative process and ensuring
that patients are not at risk for increased sensitivity or leakage while wearing sometimes uncomfortable provisionals for weeks. Finally, definitive
restorations are fabricated and placed within hours
of scanning and can be adjusted immediately, so
patients no longer have to wait for that perfect
laboratory restoration.
Clinicians, too, reap several benefits. Digital scans
equal easier “impressions” that enable accurate
reproductions of patients’ dentition. Restorations
can be designed in the office without communication or transfer to a dental laboratory, eliminating
back-and-forth exchanges that cause delays or less
than optimal results. In fact, restorations can now
be fabricated with more patient input, since intuitive CAD software enables dentists to easily design
restorations on-screen while remaining chairside,
providing patients with that “wow” factor as they

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opinion _ ecological advantages of CAD/CAM

see what digital technology is allowing dentists to
do. Once designed, the restorations can be immediately milled in the office and tried in the patient’s
mouth, so a perfect fit and high-quality aesthetics
are affirmed at the same appointment.

_Digital practice equal green practices
Since CAD/CAM technology was first introduced
decades ago, early adopters and technology enthusiasts have encouraged integration of these
systems for various practical and financial reasons.
Though generally a substantial initial investment,
practices that upgrade to digital technology find
that streamlined procedures and happier patients
lead to a significant return on investment.
But switching to a CAD/CAM system provides an
unanticipated bonus, one with a far broader impact.
Using an in-office CAD/CAM system is one of the
most environmentally conscious upgrades a practice can make, offering both concrete and intangible benefits for dental practices, their patients and
the greater community.
CAD/CAM systems add to a practice’s green image with the many small changes they allow the
office to implement. For example, now that impressions are taken with a digital scanner (PlanScan),
traditional impressions—and all their associated

materials, such as disposable impression trays,
impression material and the water with which it
is mixed—are no longer necessary. Clinicians who
thought they were only saving money (and storage
space) can rest easy at night knowing they’re no
longer contributing to the throwaway, disposable
culture in many health-care offices.

Switching to digital systems
is beneficial not only to clinicians
and patients but to
the environment as well.

Additionally, because digital impressions can be
viewed instantly with software that allows users
to see potential errors, any mistakes are quickly
averted with a second digital scan that requires
no extra materials or waste. It is not uncommon
for dentists to take a second traditional impression
because of errors caused by saliva or air pockets in
the impression material or to have a backup on hand
in case there are problems down the road. Over time,
material waste created using traditional impression
methods adds up. Using digital technology not only
streamlines the process but ensures that materials,
time and money aren’t wasted.
Moreover, because traditional impressions aren’t
needed with a digital workflow, equipment previously used to perform these procedures, such as
a mixing gun for impression material, are also no
longer necessary. While clinicians may think they
are only saving themselves hassle or time by
purchasing an easier-to-use piece of equipment,
they’re also saving energy—literally. With digital

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I opinion _ ecological advantages of CAD/CAM

An average dental practice uses
360 gallons of water per day.
Think how much you can save by
getting rid of extra washing cycles.

technology, impression-taking instruments no longer
need to be run through a wash cycle and sterilized.
This saves time, energy and water.
While it seems like saving resources, particularly
water, isn’t possible in dental practices, small steps
such as these really add up. The Eco-Dentistry Association (EDA) (www.ecodentistry.org) estimates that
dental practices use 360 gallons of water per day.
This totals 57,000 gallons of water per year, per
practice. In the United States alone, dental practice
water usage totals approximately 9 billion gallons
of water per year. This does not even include dental
laboratories, which must use substantial amounts
of water when mixing and pouring models in stone
and cleaning their equipment.
In addition to the above in-office water issues,
along with laboratories and their respective procedures that will always require water, these staggering statistics spell out the clear need for water
conservation whenever possible, and in-office
CAD/CAM supports this effort.

_Greener materials:
Using all ceramics instead of amalgam
Amalgam restorations had been the standard
of care in restorative dentistry for decades. With
material science advancements, however, there
are new contenders for that title. In particular, the
use of all-ceramic materials has significantly increased in recent years, and when coupled with
in-office CAD/CAM systems, their advantages are
economical and ecological, in addition to aesthetic,
biocompatible and functional.

52 I CAD/CAM
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The majority of the materials for same day
CAD/CAM dental procedures are generally composite or all-ceramic blocks, so there is no metal
involved. These metal-free restorations can often
be used without reservation for various indications,
including single-unit restorations, inlays and onlays.1 While the benefits of these materials have
been expounded upon (e.g., aesthetics, ease of use,
wear, optical properties.), they provide tangible
environmental benefits as well.
For example, the longevity of all-ceramic restorations such as in-office CAD/CAM designed
inlays is well documented.2 In addition to a highly
aesthetic restoration, patients receive restorations
that will last for many years, without the concerns
associated with amalgam, such as cracks, failures
or potential mercury toxicity. This potentially saves
patients and clinicians time, money and wasted
resources that would be spent traveling to and
from the dental practice, taking more impressions
and fabricating new restorations.
Perhaps of greater consequence is removing
toxic metal from this equation. All-ceramic and
metal-free restorations mean that dental practices
no longer have to worry about amalgam disposal
and its accompanying mercury toxicity.
The Environmental Protection Agency (EPA) estimates that nearly 50 per cent of all mercury entering
local wastewater treatment facilities originates in
dental offices.
Using CAD/CAM compatible materials such as
all-ceramics lessens or eliminates the contribution

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opinion _ ecological advantages of CAD/CAM

of your dental office to environmental mercury.
It also means that dental practices needn’t worry
about using an amalgam separator.
Currently, the American Dental Association (ADA)
does not have national regulations in place for
amalgam separators, so many dental practices and
laboratories aren’t compelled to use them. Although
designing and milling all-ceramic materials still requires energy and results in some waste materials,
can they really compare with the toxic by products
of metal-based restorations?

_Crunching the numbers:
CAD/CAM math
In-office CAD/CAM systems provide more than
just a clear conscience about saving the environment. There are real, tangible benefits and savings
that can easily be estimated to demonstrate the
immense value of this digital technology.
Because same-day in-office CAD/CAM dentistry
reduces the number of appointments from two (or
possibly more, if the restoration does not fit) to one,
it stands to reason that every dentist who incorporates these procedures would positively impact
the environment by reducing the number of automobile trips patients make to the practice. This
would result in a 50 per cent reduction in gasoline
and oil product use.
With a carbon content of 2,421 grams, one gallon
of gasoline produces approximately 19.4 pounds
per gallon of carbon dioxide emissions. This is calculated by multiplying the carbon content (2,241)
by the amount of carbon that remains unoxidized
(0.99) by the ratio of the molecular weight of CO2 (44)
to the molecular weight of carbon (12).
Using the state of California as an example,
where approximately 10 per cent of the 100 million
laboratory dental restorations are completed in
the United States every year, we can calculate an
approximate savings. If four gallons of gasoline are
used for a round trip to the dentist, a restoration
needing two appointments to complete would require eight gallons of gasoline. But if these dental
practices adopted same-day in-office CAD/CAM
dentistry, that number could be cut in half, saving
four gallons of gasoline per restoration. Four gallons
of gasoline multiplied by 10 million restorations
would equal a savings of 40 million gallons of
gasoline for restorative procedures in the state of
California alone. This, in turn, would equal a reduction
of carbon dioxide emissions by 776 million pounds
per gallon each year (assuming the previously calculated 19.4 pounds per gallon measurement).

If we extrapolate to the United States as a whole,
we can calculate that this would equal 400 million
gallons of gasoline saved and 7,760 million pounds
per gallon of carbon dioxide emissions eliminated,
per year. This would all be due solely to a reduction
in patient automobile trips to and from the dentist
for restorative procedures. While same-day dental
procedures may not save the world, their potential
impact, even estimated, is undeniable.

_Conclusion
In-office CAD/CAM systems’ advantages are
limitless. In addition to the clear financial and practical benefits they bring, their positive impact on the
environment makes the decision to upgrade even
better. They remove toxic, wasteful and disposable
materials and practices from the equation, replacing them with greener practices that have a tangible influence. While the clinical advantages of
CAD/CAM systems and same-day dentistry continue to be rightfully celebrated, their ecological
advantages should not be overlooked._
Editorial note: This article was published in CAD/CAM
C.E. Magazine No. 01/2014.

_References
1. Della Bona A, Kelly JR. The clinical success of
all-ceramic restorations. J Am Dent Assoc. 2008;
139:8S-13S.
2. Sjogren G, Molin M, van Dijken JW. A 10-year
prospective evaluation of CAD/CAM-manufactured (CEREC) ceramic inlays cemented with a
chemically cured or dual-cured resin composite.
Int J Prosthodont. 2004;17(2):241–246.

_about the author

CAD/CAM

Dr Joel Strom is a former
president of the California
State Dental Board and former
course director of “Ethics
in the Practice of Dentistry”
at USC School of Dentistry.
He graduated from UOP
School of Dentistry in 1979
and completed an NIH post-doctoral fellowship
at Columbia University in 1983. He has owned
an E4D milling machine and camera for five years
and practices general dentistry in Beverly Hills
and provides consultation and litigation support in
the dental health area, including corporate clients,
governmental agencies and individual dentists.

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CAD0115_54-55_Nobel 02.03.15 13:04 Seite 1

I industry news _ Nobel Biocare

Bringing innovation back:
Introducing a complete posterior solution
dation for treatment success is the implant itself.
Nobel Biocare offers several implant options, each engineered to the specific demands of the posterior region.
All are intended to shorten time-to-teeth for the patient
by enabling immediate loading whenever possible.
One option is NobelActive. Many clinicians are
already familiar with this award-winning* implant.
Its distinctive design and the surgical protocol form
a unique combination that can enable Immediate
Function in cases in which it might otherwise not be
achieveable.1–3
Fig. 1

Fig. 1_Multiple innovations
combine to create
one complete posterior solution.
Figs. 2a & b_Both NobelActive (left)
and NobelParallel Conical Connection
(right) are available in wide-platform
variants that are designed
to provide optimized results
in the posterior region.
Anatomically shaped, the PEEK
Temporary Abutments (a) and PEEK
Healing Abutments (b) match the
contours of the molars. In addition
to supporting an improved
emergence profile, this can help
reduce chair time by reducing the
number of adjustments needed.

_Large extraction sockets, limited accessibility, excess cement that is difficult to remove and high occlusal
forces—these are just some of the challenges a clinician
faces when restoring a single tooth in the posterior
region. With molar replacement being among the most
common indications, these challenges are encountered
repeatedly. A solution that addresses all these problems
in an efficient and predictable way would be beneficial to
both dental professionals and patients. That is precisely
why Nobel Biocare is bringing innovation back to the posterior region with its new complete posterior solution: an
original combination of new wide-platform implants and
restorative options, all specially designed for molar sites.

In order to condense bone gradually, its tapered
body features threads that narrow towards the apex,
while the apex itself features drilling blades to preserve
bone by allowing a smaller osteotomy. These features
are all designed for high primary stability, even in soft
bone and extraction sockets.
Now, a new variant offers the benefits of the
NobelActive family but with dimensions ideal for the
molar region. NobelActive wide platform (WP) possesses a wider diameter implant body (5.5 mm) to better fit the large extraction sites in the molar region and
a wider implant platform for an optimal emergence
profile. NobelActive WP also comes in a shorter body
(7 mm) to avoid critical anatomical structures such as
nerves.

_An implant like no other

_Stability and flexibility in parallel

Multiple Nobel Biocare innovations have been
combined to offer a complete solution, and the foun-

Alternatively, clinicians can opt for NobelParallel
Conical Connection (CC). Combining a parallel-walled
implant body that is well documented with an advanced internal connection, NobelParallel CC offers
extraordinary flexibility. It is engineered for use in all
bone qualities and for a wide range of indications.
The 5.5 mm WP option is designed for an optimized
emergence profile for large molar sites.
Both experienced clinicians and those new to implantology will appreciate NobelParallel CC’s straightforward surgical protocol. It offers flexibility and
shortens treatment time, benefitting the patient too.

Fig. 2a

Fig. 2b

54 I CAD/CAM
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Together, the surgical protocol and implant design
form a unique combination that is intended to allow
Immediate Function in more cases by providing high
primary stability. The thread design and tapered apex

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industry news _ Nobel Biocare

of NobelParallel CC are designed for under-preparation of the surgical site and bicortical anchorage—
techniques that support immediate loading.4, 5
High stability during the initial healing phase is
then maintained by Nobel Biocare’s unique TiUnite
surface.6 In addition, patented grooves enhance
osseointegration7 for a predictable end-result.

_Connecting strength and flexibility
Both new implants benefit from Nobel Biocare’s internal conical connection. This advanced connection’s
conical seal and hexagonal interlocking mechanism
provide high mechanical strength.8 The connection
offers restorative flexibility too, being compatible with
Nobel Biocare’s most innovative restorative solutions,
including those designed specifically for the posterior
region.
These include the new PEEK Healing and PEEK
Temporary Abutments, which are anatomically shaped
to match the molar contours. As the PEEK Abutments
come ready-shaped for an optimized emergence profile, fewer adjustments are needed. This can simplify
treatment and reduce costly chair time.

_The crown that rules them all
When it comes to the final restoration, the FCZ
(full-contour zirconia) Implant Crown is designed
for strength and predictability even under the high
occlusal forces of the posterior region. There is no
worrying about chipping either, as the full contour of
the NobelProcera FCZ Implant Crown removes the
need for veneering.
The biocompatibility of the materials used contributes to biological stability in the areas in which
it matters most. Plus, being screw retained, the FCZ
Implant Crown is completely cement free, avoiding
the risks associated with cement excess entirely. Even
the titanium adapter is mechanically retained.
The ability to use an angulated screw channel allows the screw access hole on the FCZ Implant Crown to
be placed anywhere between 0 degrees and 25 degrees
in a 360-degree radius. This means it can be angled
towards the front of the mouth for easy access, even
in the posterior region. It also helps avoid placing the
access channel on the cusp of a tooth, where it could
affect occlusion. The associated Omnigrip Screwdriver
further simplifies work on the restoration. Its effective
pick-up function and secure grip on the screw help the
clinician to work safely and efficiently.
Natural-looking tooth colour is another benefit
offered by the FCZ Implant Crown. Whichever of the

Fig. 3a

Fig. 3b

eight available shades is used, the colour is applied
throughout the material. This means discoloration is
not a concern when making adjustments. Cut-backs
and staining can also be used to achieve the desired
aesthetic effect.

_Several components;
one complete solution

Figs. 3a & b_The advanced internal
conical connection is compatible
with innovative restorative solutions
such as the FCZ Implant Crown.
This can incorporate an angulated
screw channel, which allows
the screw access hole
to be positioned for easier access
and better aesthetics.

While each product within Nobel Biocare’s complete posterior solution stands out on its own, together
they are a powerful combination. Like all Nobel Biocare
innovations, they are tested as one system in the
patient’s mouth.
Combining Nobel Biocare components means all
elements are designed to work in synergy for the
optimal treatment outcome. Restoring single molars
represents a clinical challenge for many reasons, but
now, by uniting new and proven innovations, Nobel
Biocare has the answer._
*Details of awards can be found at www.nobelbiocare.com.
Editorial note: GMT 38231 GB© 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. A list of references is available from the publisher.

_contact

CAD/CAM

Nobel Biocare
Balsberg, Balz-Zimmermann-Str. 7
8302 Kloten, Switzerland
www.nobelbiocare.com/bringinginnovationback

CAD/CAM
1_ 2015

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CAD0115_56_Planmeca 02.03.15 13:05 Seite 1

I industry news _ Planmeca

Planmeca PlanScan is the
world’s first dental unit
integrated intraoral scanner
_Unique foot controlled scanning
What also sets Planmeca PlanScan apart from
other scanners is that it can be conveniently controlled from the dental unit’s wireless foot control,
leaving the user’s hands free for scanning and patient
treatment at all times. The foot control allows easy
toggling between prep, opposing and buccal views,
so that the dentist can focus on scanning without
interruptions. Hands-free operation also guarantees
impeccable infection control.

_Easy and ﬂexible use
Planmeca PlanScan has been designed for an
efﬁcient workﬂow—it is used just like any other
dental instrument and shared effortlessly between
different users. The plug-and-play scanner can also
be easily installed in different dental units and different rooms. The ﬂexible licensing system enables different CAD/CAM work phases (scanning, designing
and manufacturing) to be performed simultaneously
by different users.
_Planmeca’s full range of open CAD/CAM solutions for dentists and dental technicians includes
the world’s first dental unit integrated intraoral
scanner—Planmeca PlanScan. The scanner’s unique
integration with Planmeca dental units guarantees
a smooth workflow, as real-time scanning data is
now immediately available from the chairside tablet
device. Scanning can also be controlled from the
dental unit’s wireless foot control for hands-free
operation.

_A smooth scanning workflow
The ultra-fast and accurate Planmeca PlanScan
can now be easily integrated with any digital Planmeca dental unit. Thanks to the dental unit’s Full HD
tablet device, the dental team has constant and
optimal access to live scanning data. This allows
them to focus on the treatment area without any
distractions. The scanner also provides practical
sound guidance to ensure optimal data capture.

56 I CAD/CAM
1_ 2015

‘This is a truly innovative product that guarantees
a smooth and effortless chairside workflow and lets
dentists concentrate on their patients. The system is
built on our Planmeca Romexis software platform—
the first software in the world combining CAD/CAM
and X-ray imaging. This means that all images and
scans are conveniently available through one user
interface’, says Mr. Jukka Kanerva, Vice President
for Planmeca’s Dental Care Units and CAD/CAM.
‘Together with our other Planmeca CAD/CAM™ solutions, Planmeca PlanScan contributes to better patient
care and helps to increase the clinic’s productivity.’_

_contact

CAD/CAM

Planmeca Oy
Asentajankatu 6, 00880 Helsinki, Finland
www.planmeca.com

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CAD0115_58_Mis 02.03.15 13:05 Seite 1

I industry news _ MIS

MIS Implants Technologies
launches MCENTER Europe,
new digital dentistry hub in Berlin
“MCENTER products represent some very
exciting and innovative advances in digital dentistry technology exclusive to MIS Implants,”
continued Hebbecker. “The MGUIDE surgical
template or guide is a lightweight, open wireframe design that allows delivery of irrigation
and anaesthesia through the template. Special
slots built in to the drill permit irrigation to
penetrate even while the drill is fully inserted
in the sleeve. Also no drill guidance keys are
needed, freeing up dentists’ hands for a quicker
and more accurate procedure.”
_As a dentist, what are your goals? Most likely,
to provide the best possible treatment for your
patients while developing your professional reputation for a successful practice. These objectives
are mutually beneficial to both patient and dentist:
patient satisfaction directly affects profit. Achieving
your goals can be greatly accelerated using digital
dentistry technology.
“Success has never been more attainable and
the MIS MCENTER truly makes it simple,” according
to Christian Hebbecker, MCENTER Europe Manager.
“We provide doctors with optimum support for
quicker, more accurate surgical procedures, reduced
chair-time, less patient visits, plus beautiful and
predictable outcomes.”
Hebbecker explained that the new MCENTER
offers expert digital dentistry capabilities in support of the fast-growing MIS customer base in the
region by concentrating all MIS digital dentistry
products and services (from the initial treatment
plan to temporary restoration) in one convenient,
well-equipped location.
The MCENTER provides a comprehensive range
of services covering three main products: (a) MSOFT,
3-D and 2-D virtual implant planning software
for prosthetic-driven planning; (b) MGUIDE, an
exclusively designed 3-D printed template and
dedicated surgical kit; and (c) MLAB (CAD/CAM),
for the fabrication of customized abutments and
temporary crowns.

58 I CAD/CAM
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Hebbecker explained additional features of the
MCENTER guided surgical system, including the
MGUIDE Surgical Kit (patent pending), in which all
of the drills can be used as final drills and actually
help collect bone during the drilling process. The
proprietary MSOFT planning software, which offers
a top-down planning approach, assists clinicians
in creating the ideal treatment plan according to
depth, position and angulation of the desired endresult. All components used in the MCENTER process
are precision engineered for use with MIS implants
and prosthetic parts to ensure component compatibility for optimum accuracy, reliability and fit.
“I’m extremely excited to officially open the
doors of the new MCENTER Europe facility, and
especially proud to be able to offer MIS quality
and simplicity in providing our customers, doctors
throughout the region, with highly accurate and
efficient guided implant placement procedures
and CAD/CAM solutions,” concluded Hebbecker.
To learn more about MIS Implants and the MCENTER,
please visit the MIS website._

_contact
MIS Implants Technologies
P.O. Box 7, Bar Lev Industrial Park
20156 Israel
www.mis-implants.com

CAD/CAM

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CAD0115_60_Egs 02.03.15 13:05 Seite 1

I industry news _ EGS

EGS at IDS 2015: Discover
the ultimate CAD/CAM
upgrades in digital dentistry
experience simple and interactive up to 3-D printing:
touch it to believe it! This new version presents complete functional coverage (with just one licence),
powerful wax-up functions and angled implant
support and social integration to share cases and
experiences on Facebook.
Moreover, EGS will be introducing the 2.0 version of
Digital Smile System, the first software for designing
the aesthetic and functional reconstruction of the
smile. By means of simple and automatic tools, it allows users to project the final result and to export it in
3-D directly to DentalCAD. It also offers a prosthetic
tool with automatic face shape detection and a complete commercial library for use in edentulous patients.
This allows the user to study the patient’s morphology
and determine the suitable dental library to use.

_During this year’s IDS exhibition, EGS will be presenting a wide range of products that cover the entire
digital dentistry workflow, from digital smile design to
3-D scanning and modelling. During the show, EGS is
launching the new DScan 3.2 with verticulator integration and it will be wearing an innovative outfit certain
to set a trend for the whole year, the ghost cover.
But do not let the name fool you. The attribute
“ghost” is not always equivalent to “scary”. EGS’s
Ghost Scanner immediately grabs attention with its
elegant and finished look. DScan 3.2 is a new-generation dental scanner that uses structured blue light
technology, which allows faster and more accurate
3-D scanning of both the model and verticulators.
Specifically designed to accommodate the verticulator (which is also shown digitally in the program), it
allows automatic pairing of the models in occlusion.
DentalCAD 4.0, which now boasts a touch screen,
will also be showcased at IDS. The newest software
version, which offers a complete solution for the dental laboratory and supports users’ experience in dental design and modelling, allows technicians to work
with their own hands but in digital mode, making the

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As is the case every year, EGS’s new products
and solutions will be revealed through live demonstrations and presentations. Prospective partners,
members of the press and anyone else interested
are invited to book individual meetings for further
information. Send your meeting request to Serena
Santoro at marketing@egsolutions.com._

_about the company

CAD/CAM

EGS is an Italian company with more than 15 years
of experience in the CAD/CAM industry and is
recognized worldwide for its expertise in
3-D technology. Based on its substantial knowledge
in this regard, EGS is at the forefront in offering
innovative solutions targeted at the original
equipment manufacturer market. EGS technology
is fully developed in-house to ensure maximum
control, safety and quality. EGS works directly with
its partners and offers full customization possibilities
for both hardware and software to fulfil any specific
technical requests or design adaptation.
Via Speranza 19/4, 40068 Bologna, Italy
www.egsolutions.com

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CAD0115_61_Adentatec 02.03.15 13:06 Seite 1

industry news _ Adentatec

Adentatec
Competence in Dental

_Adentatec, based in Cologne in Germany,
is a global dental company specialising in the
production and distribution of non-precious
dental alloys on a cobalt–chromium and a
nickel–chromium base, as well as CAD/CAM
discs on a cobalt–chromium and a titanium base.
The medical devices distributed by Adentatec are
exclusively produced in Germany and are certified to the highest standards (CE marking and
US Food and Drug Administration). Adentatec
is committed to the strict implementation of
the quality and process requirements of DIN EN
ISO 13485 and DIN EN ISO 9001 in relation to the
entire manufacturing process.
The company was established in 1997 and
its focus at that time was the distribution of
sand-blasting material and plaster to dental laboratories all over Germany. In 2003, Adentatec
started production of high-quality dental alloys,
for which it implemented a quality management
system. Its products undergo biocompatibility and
corrosion resistance tests, among others, and
are manufactured from high-quality raw materials to ensure consistent quality. Adentatec
has always given priority to patient health.
Since 2005, the company’s export business has
increased steadily. Adentatec now has more than
20 agents worldwide who represent its product
range.
The company’s brand-name products, such
as System KN, System MG and System NE, have

long been widely used by dental technicians.
Its product range includes plaster, investment
material and sand-blasting material. In 2009,
Adentatec expanded the range to CAD/CAM discs
on a cobalt–chromium base (System NE-Blank
and System Soft-Blank). The high-quality discs
are available in different diameters and heights,
and can be used for all open milling systems.
The discs are soft, homogeneous and easily
milled. The strong oxide provides excellent metal
to ceramic bonding. Importantly, the discs have
high corrosion resistance and biocompatibility.
In 2012, the company’s CAD/CAM disc on a
titanium base, System Ti 5-Blank (Grade IV),
was launched.
The Adentatec team would be pleased to
welcome you at their booth at the IDS in Cologne.
Please stop by at hall 10.2., booth V029 to
learn more about the Adentatec products and
services._

_contact CAD/CAM
Adentatec GmbH
Konrad-Adenauer-Str. 13
50996 Cologne
Germany
info@adentatec.com
www.adentatec.com

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CAD0115_62-63_Eisenbacher 02.03.15 13:06 Seite 1

I industry news _ Eisenbacher

Eisenbacher Dentalwaren ED,
your specialist for NEM dental alloys

Fig. 1

Fig. 2

_German manufacturer and supplier of NEM
dental alloys Eisenbacher Dentalwaren ED offers
a range of well-designed products for casting,
milling (CAD/CAM) and laser sintering technologies
(selective laser melting). It also manufactures highquality consumer products for daily use in dental
laboratories, such as all types of dental stone and
phosphate investment materials for crowns and
bridges and for model-casting processes.
With over 20 years of experience, the highly
motivated Eisenbacher team produces dental and
medical products of the highest quality. The company’s key strengths are its reliability, materials
expertise and fully comprehensive service for customers, with quick and simple processing at reasonable prices. Eisenbacher Dentalwaren has DIN EN
ISO 9001:2008 and DIN EN ISO 13485 certification,
and meets the standards of the US Food and Drug

Fig. 3

Fig. 4

62 I CAD/CAM
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Administration. It distributes its tried-and-tested
products to over 75 countries.
The new cobalt–chromium sintering powder
Kera S-Powder has been designed for use in the
production of crowns and bridges, for ceramic
veneering and for removable dentures (combined
model casting) in laser sintering processes (selective
laser melting). The powder has a very high degree of
pourability and can be processed using common
laser sintering systems. Owing to the selected composition and grain distribution, very delicate framework structures can be produced economically, with
homogeneous material structures and good surface
qualities.
The tried-and-tested Kera-Disc CAD/CAM milling alloy is a cobalt–chromium ceramic alloy for
the CNC production of dental crown and bridge

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CAD0115_62-63_Eisenbacher 02.03.15 13:06 Seite 2

industry news _ Eisenbacher

Fig. 5

restorations. The circular blank alloy stands out
owing to its very good machining properties and
protects the milling tools for economic and effective
processing. The special manufacturing method with
subsequent heating process under high
pressure gives the disc complete homogeneity and a very delicate grain structure, which explains its good corrosion resistance and biocompatibility. The blanks
are available in different thicknesses, from
8 mm to 24.5 mm, either with or without
a step, and with a diameter of 98.3 mm or
99.5 mm, and are suitable for the most
commonly used milling machines. The
frameworks produced using Kera-Disc
can of course be veneered with all standard refractory dental ceramics.
The Kera Line milling alloy has been
available for some time as a material- and
time-saving alternative for the millingbased CNC production of crowns and
bridges or single-piece abutments. This
dosage form is available in Grade 5 titanium and as a bonding cobalt–chromium
alloy in the proven composition of universal casting alloy Keragen in different diameters.
The Kera Ti 5-Disc Grade 5 titanium milling alloy
is particularly suitable for the production of implant-supported dentures. The biocompatible material is available in thicknesses of 8–25 mm, with or
without a step, and in diameters of 98.5 mm and
99.5 mm. It can be used in common milling machines. With a thermal expansion of 10 × 10–6 K–1,
the alloy can be used with titanium ceramics.
For the conventional segment in crown/bridge
technology and for model-casting processes, Eisenbacher Dentalwaren ED offers its customers a wide
range of bonding/casting alloys with excellent material and processing properties. The Main Metall
casting alloy, for example, has specially configured

Fig. 6

strength properties that allow it to be used for
delicate and long-span bridges, as well as for implant-supported treatments with multiple pontics.
The Robur 400 model-casting alloy is the perfect

Fig. 7

product for partial dentures with clips. The aboveaverage tensile strength of the alloy ensures good
strength with enough elasticity leeway for delicate
and stable removable dentures.
Visit us at IDS 2015 in Hall 3.2, Booth A30/C39;
we look forward to seeing you!_

_contact

CAD/CAM

Eisenbacher Dentalwaren ED GmbH
Dr.-Konrad-Wiegand-Str. 9
63939 Wörth am Main, Germany
www.eisenbacher.de

CAD/CAM
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CAD0115_64_Events 02.03.15 13:07 Seite 1

I meetings _ events

International Events
2015
36th International Dental Show
10–14 March 2015
Cologne, Germany
www.ids-cologne.de

9th International Congress
on 3D Dental Imagining
17–18 April 2015
Dallas, USA
www.i-cat.com/events/congress/

Academy of Osseointegration
30th Annual Meeting
14–12 March 2015
San Francisco, USA
www.osseo.org

97th Annual Meeting of the Academy
of Prosthodontics
28 April–2 May 2015
Austin, USA
www.academyofprosthodontics.org/
2015_Austin_Texas.html

IMAGINA DENTAL
4th 3D & CAD/CAM Digital Dentistry Congress
1–3 April 2015
Monaco
www.imaginadental.org

10th CAD/CAM & Digital Dentistry
International Conference
8–9 May 2015
Dubai, UAE
www.cappmea.com/cadcam10/

BIOHORIZONS Global Symposium
16–18 April 2015
Los Angeles, USA
www.biohorizons.com/globalsymposium2015.aspx

Perspectives in Perio-Implantology
and Comprehensive Dentistry
8–9 May 2015
Szeged, Hungary
www.symposiumszeged.com
EuroPerio 8
3–6 June 2015
London, UK
www.efp.org/europerio/
ICOI Summer Implant Symposium
14–16 August 2015
San Francisco, USA
www.icoi.org
EAO
24–26 September 2015
Stockholm, Sweden
www.eao-congress.com
12th International CAD/CAM Expo & Symposium
20–22 November 2015
Los Angeles, USA
www.dloac.org/symposium
CAD/CAM International Conference 2015
4–5 December 2015
Suntec, Singapore
www.capp-asia.com

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CAD0115_65_Submission 02.03.15 13:07 Seite 1

about the publisher _ submission guidelines

submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).

I

Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:

In addition, images must not be embedded into the MS Word
document. All images must be submitted separately, and details
about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from 1,500 to 5,500 words—
depending on the subject matter. Our approach is that if you
need more or less words to do the topic justice, then please make
the article as long or as short as necessary.
We can run an unusually long article in multiple parts, but this
usually entails a topic for which each part can stand alone because it contains so much information.
In short, we do not want to limit you in terms of article length,
so please use the word count above as a general guideline and if
you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
use of italics and boldface. If you would like to emphasise certain
words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers.
Please do not use underlining.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line between paragraphs. Please do
not add tab stops.

_We require images in TIF or JPEG format.
_These images must be no smaller than 6 x 6 cm in size at 300 DPI.
_These image files must be no smaller than 80 KB in size (or they
will print the size of a postage stamp!).
Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available.)
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
your article.
Abstracts
An abstract of your article is not required.

Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.

Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
or less).

Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.

Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com

CAD/CAM
1_ 2015

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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

Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com

Melissa Brown (International)
m.brown@dental-tribune.com

Designer
Franziska Dachsel
Copy Editors
Sabrina Raaff
Hans Motschmann

Matthias Diessner (Key Accounts)
m.diessner@dental-tribune.com

Peter Witteczek (Asia Pacific)
p.witteczek@dental-tribune.com
Weridiana Mageswki (Latin America)
w.mageswki@dental-tribune.com
Hélène Carpentier (Europe)
h.carpentier@dental-tribune.com

International Administration

Barbora Solarova (Eastern Europe)
b.solarova@dental-tribune.com

Chief Financial Officer
Dan Wunderlich

International Offices

Business Development Manager
Claudia Salwiczek
Event Manager
Lars Hoffmann
Event Services
Esther Wodarski
Marketing Services
Nadine Dehmel
Sales Services
Nicole Andrä
Executive Producer
Gernot Meyer

Editorial Board
Prof. Albert Mehl, Switzerland
Prof. Gerwin Arnetzl, Austria
Dr Stefan Holst, Germany
Hans Geiselhöringer, Germany
Dr Ansgar Cheng, Singapore

Dental Tribune International
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
info@dental-tribune.com
www.dental-tribune.com
Dental Tribune Asia Pacific Ltd.
Room A, 20/F, Harvard Commercial Building,
105–111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
Tribune America, LLC
116 West 23rd Street, Ste. 500,
New York, N.Y. 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185

Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany

Copyright Regulations
_CAD/CAM international magazine of digital dentistryis published by Dental Tribune International (DTI) and appears in 2015 with four issues. The magazine
and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable
to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author,
represent the opinion of the afore-mentioned, and do not have to comply with the views of DTI. Responsibility for such articles shall be borne by the author.
Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed
for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty
representation are excluded. General terms and conditions apply. Legal venue is Leipzig, Germany.

66 I CAD/CAM
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Planmeca PlanScan

®

The ultimate
scanning experience

• 7Ke ZorldȇV ȴrVW denWal uniW
inWeJraWed inWraoral Vcanner

• &onVWanW cKairVide acceVV
Wo liYe VcanninJ daWa from
Full +' WaEleW deYice

• :ireleVV fooW conWrol for
KandVfree oSeraWion

Planmeca CAD/CAM™ Chairside

Ζntegrated ZRrNȵRZ

Scan.

Design. Manufacture.

Find more info and your local dealer
www.planmeca.com

Planmeca Oy Asentajankatu 6, 00880 Helsinki, Finland
Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com

6ee you aW IDS 2015 in &oloJne
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[68] => Standard_300dpi

A complete
posterior solution

Bringing innovation back
To keep pushing forward, we’re bringing innovation to the back. Connect with
your entire treatment team and achieve shorter time to teeth with Nobel Biocare’s
complete posterior solution. It offers new ways to overcome the challenges of
working in the posterior region while reducing complexity and risks.

nobelbiocare.com/bringinginnovationback
© Nobel Biocare Services AG, 2015. 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. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale.
&KUENCKOGT5QOGRTQFWEVUOC[PQVDGTGIWNCVQT[ENGCTGFTGNGCUGFHQTUCNGKPCNNOCTMGVU2NGCUGEQPVCEVVJGNQECN0QDGN$KQECTGUCNGUQHƂEGHQTEWTTGPVRTQFWEVCUUQTVOGPVCPFCXCKNCDKNKV[

PS a complete posterior solution A4 CADCAM rev.indd 1

2015-02-03 09.57

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[cover] => CAD/CAM international No. 1, 2015

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