CAD/CAM international No. 1, 2023
Cover
/ Editorial
/ Content
/ IDS is back: 120,000 attend centenary of the world’s leading dental show
/ Academic review of CAD/CAM applications within dentistry
/ Industry news
/ 3D fabrication workflow - Solid and lattice-structured titanium alloy dental implant overdenture bars
/ Digitally planned highly aesthetic restorations
/ Guided maxillary arch implant restoration: Language and cross-border collaboration are no barrier with hybrid workflow
/ A clinical case report on maxillary compromised dentition treated with Straumann Pro Arch in a digital workflow
/ Individual PEEK healing abutments and impression copings
/ Realising optimal integration of function and aesthetics - An interview with Dr Marco Tudts, edelweiss dentistry
/ Digital workflow for dental offices and laboratories—where are we now? - An interview with Niels Plate from Dentsply Sirona
/ Successful use of KATANA Zirconia Block in single-visit dentistry - An interview with Dr Karim Nasr
/ Manufacturer news
/ Meetings
/ Submission guidelines
/ Imprint
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[1] =>
issn 1616-7390 • Vol. 14 • Issue 1/2023
international magazine of dental laboratories
study
3D fabrication workflow
case report
Digitally planned
highly aesthetic restorations
interview
Digital workflow for dental offices
and laboratories—where are we now?
1/23
[2] =>
Anatomically shaped ,
individualised PEEK gingiva
formers and impression posts
Do you want to reduce patient times and increase patient comfort?
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The individual DEDICAM PEEK gingiva formers and impression posts are offered for the
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in all countries. Please ask your local Camlog / BioHorizons® representative if you have
access to our CAD/CAM services.
DEDICAM®, CAMLOG®, CONELOG®, iSy® and CERALOG® are registered trademarks of
CAMLOG Biotechnologies GmbH. BioHorizons is a registered trademark of BioHorizons.
All rights reserved. Not all products are available in all countries.
[3] =>
editorial
|
Magda Wojtkiewicz
Managing Editor
CAD/CAM in dentistry—
the present and the future
CAD/CAM technology has been used in dentistry since
the 1970s and over the years has gained popularity
and the confidence of dental professionals as well as
patients. Dental restorations made with CAD/CAM are
durable, precise and highly aesthetic, because of the
significant improvements in the technology and materials.
It is still quite expensive technology, but is becoming
increasingly affordable for both dental professionals and
patients owing to the rapid development of this segment
of the dental industry.
The use of CAD/CAM was widely presented during the
2023 International Dental Show (IDS), where two topics
stood out: completely digital workflows and sustainability. Whether in the laboratory or in the dental office,
CAD/CAM—which includes the rapidly developing
3D-printing technologies—plays an important role in the
digital workflow, ensuring fast, safe and precise production of restorations of all kinds, as well as surgical guides.
The innovations presented at IDS showed that the
greatest advances in CAD/CAM are in software, chairside devices and materials with high physical and
aesthetic properties.
Although interest in CAD/CAM continues to grow, undergraduate education on CAD/CAM has not kept pace.
The majority of currently practising clinicians did not
receive any formal education on this topic and gained
their knowledge through postgraduate educational
programmes. However, the importance of integration of
CAD/CAM into dental schools’ curricula has been
recognised and the number of universities offering
CAD/CAM education is thus increasing.
One of the pioneers among dental schools incorporating
CAD/CAM into its undergraduate curriculum was the
College of Dentistry at the University of Tennessee Health
Science Center in the US. The school invested in a CEREC 3
unit already in 2001—having tested five CEREC 2 units the
summer before—and students can experience at first
hand the potential of this digital technology. The college
was followed by others, among them Heidelberg University Hospital in Germany, Queen Mary University of
London in the UK and RMIT University in Australia. These
are only a few examples of those already offering courses
centred on dental CAD/CAM technologies.
It is clear that the integration of CAD/CAM into dental
school curricula throughout the world is increasing, but
the level of access to such technology is not guaranteed
everywhere. It is hoped that today’s dental students,
who are already well acquainted with digital technologies
and using computers every day by the time they reach
university, have an increased affinity for the incorporation
of CAD/CAM into their learning experiences.
Sincerely,
Magda Wojtkiewicz
Managing Editor
CAD/CAM
1 2023
03
[4] =>
| content
editorial
CAD/CAM in dentistry—the present and the future
03
Magda Wojtkiewicz
news
IDS is back: 120,000 attend centenary of the world’s leading dental show 06
Academic review of CAD/CAM applications within dentistry
10
page 18
industry news
“The edelweiss CAD/CAM BLOCK certainly created a buzz”
12
Franziska Beier
Amann Girrbach offers complete digital workflow
14
Jeremy Booth
ClearCorrect expands into international markets
and new manufacturing lines
page 32
15
study
3D fabrication workflow
16
Dr Les Kalman
case report
Digitally planned highly aesthetic restorations
18
Atsushi Hasegawa & Dr Yusuke Takayama
Guided maxillary arch implant restoration: Language and
cross-border collaboration are no barrier with hybrid workflow
24
Dr Florian Obădan & Jorge Reyes Minguillán
page 48
A clinical case report on maxillary compromised dentition
treated with Straumann Pro Arch in a digital workflow
32
Dr Tran Thanh Phong
industry report
Individual PEEK healing abutments and impression copings
38
CAMLOG Biotechnologies
interview
Realising optimal integration of function and aesthetics
42
An interview with Dr Marco Tudts
Digital workflow for dental offices and laboratories—
where are we now?
Cover image courtesy of
Microgen/Shutterstock.com
1/23
issn 1616-7390 • Vol. 14 • Issue 1/2023
44
An interview with Niels Plate
Successful use of KATANA Zirconia Block in single-visit dentistry
48
An interview with Dr Karim Nasr
manufacturer news
51
international magazine of dental laboratories
meetings
Implant Solutions World Summit 2023
International events
about the publisher
study
3D fabrication workflow
case report
submission guidelines
international imprint
Digitally planned
highly aesthetic restorations
interview
Digital workflow for dental offices
and laboratories—where are we now?
04
54
56
CAD/CAM
1 2023
57
58
[5] =>
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ONE-TIME
SOLUTION
TISSUE-LEVEL SCREW-RETAINED SYSTEM
MAKE IT SIMPLE
CO
ECT
The MIS CONNECT is a stay-in abutment system which enables avoiding interference
with the peri-implant gingival seal. It offers doctors the ability to maximize the
tissue-level restoration concept, enabling the entire prosthetic procedure and
restoration to occur far from the bone, and at any level of the connective tissue.
Learn more about MIS at: www.mis-implants.com
[6] =>
| news
IDS is back:
120,000 attend centenary of
the world’s leading dental show
By Dental Tribune International
from 60 countries exhibited at the show, including over
1,300 from abroad.
Mark Stephen Pace, chairman of the executive board of
the Association of the German Dental Industry, commented: “IDS 2023 was a success across the board and,
at the same time, it proved that even after 100 years it
is still reinventing itself and developing further. IDS has
once again confirmed that it is a world leading trade fair.
The quality of the visitors was sensational. Together with
Koelnmesse, we will successfully lead IDS into the second century of the event’s history with energy, ambition,
creativity and vision. This year’s claim ‘100 years IDS—
shaping the dental future’ reflects the outstanding importance of the trade fair today and in the future.”
The International Dental Show (IDS), which celebrated
its 100th anniversary this year, provided the perfect
opportunity for thousands of companies to showcase
their latest product releases to an interested audience of
dental professionals. According to organiser Koelnmesse,
120,000 visitors from 162 countries attended, 60% of
them coming from abroad. In total, 1,788 companies
06
CAD/CAM
1 2023
Chief Operating Officer of Koelnmesse Oliver Frese
added: “Over five days, we experienced an IDS that more
than lived up to its claim as a leading international hub.
This gives the global dental industry the necessary impetus for the coming months and, at the same time, underlines the global appeal that emanates from the IDS. The
result of the event is all the more remarkable as the geopolitical framework conditions are currently a challenge.”
Two topics stood out at this year’s IDS: complete digital
workflows and sustainability. Furthermore, a consider-
[7] =>
news
able number of companies showcased artificial intelligence applications.
The overall feedback from the exhibitors was very positive. Fred Freedman, vice president of member services
at Dental Trade Alliance and president of International
Dental Manufacturers, stated: “IDS is the largest and best
international dental meeting in the world. The 2023 IDS
can be summed up in one sound bite: IDS is back.
With the enormous crowds and thousands of international distributors and visitors, this is a must for all
US manufacturers and companies looking for new international business.”
|
Simon Campion, president and CEO of Dentsply Sirona,
concluded: “It was important for us as a company to be
back on-site and meet our customers in person because
that makes a difference. Under the motto ‘United for
better dentistry’, we offered our visitors a programme
with 40 hours of live demonstrations and hands-on training.
In addition, we made clear statements on the topics of
digitalisation and sustainability with our panel discussions.
We can positively impact the lives of millions of patients.
We can only do this through mutual exchange and closer
collaboration.”
(All images © Koelnmesse)
CAD/CAM
1 2023
07
[8] =>
[9] =>
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Provide a completerange of quality
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[10] =>
| news
Academic review of CAD/CAM
applications within dentistry
By Dental Tribune International
One thing is certain: technology is always changing.
Whether a dental clinician is experienced in CAD/CAM or
is a novice in digital dentistry, it is important to stay abreast
of new developments. To help dental practitioners navigate
the myriad of ever-evolving terms developed to describe
CAD/CAM, including 3D printing, within dentistry, researchers at the Department of Oral Medicine and Radiology
at the Datta Meghe Institute of Higher Education and
Research in the Indian state of Maharashtra have released
a helpful reference guide.
Understanding innovation within CAD/CAM is only possible
with an overview of the fundamentals. This is particularly relevant because the majority of currently practising clinicians
did not receive any formal education on CAD/CAM, 3D printing,
materials science or engineering, all of which are now fundamental areas of knowledge in the practice of dentistry.
The authors ease clinicians into the technologies with an
overview of the three broader approaches to CAD/CAM.
Direct CAD/CAM enables restoration in a single visit, and
all processing stages occur on-site. For semi-direct
CAD/CAM, a least one step has to be performed externally.
The practitioner obtains the data for the CAD, CAD is performed either in-house or by an outside laboratory, and the
requisite prosthesis is manufactured externally. In indirect
CAD/CAM, the clinician creates a physical impression that
is sent to an external production facility, leaving no stage
of design or production in-house.
There are possibilities for application in all dental specialties,
including restorative dentistry, prosthodontics, oral surgery
and orthodontics. For example, CAD/CAM can be used for
the design and fabrication of inlays; onlays; prostheses;
prosthetic bases; frameworks and bars; veneers; surgical guides;
indirect bonding trays; and models for various uses, including
for fabrication of clear aligners. In fact, there are increasingly
fewer procedures that cannot be carried out with the aid of
some form of digital technology.
The benefits of choosing to learn more about and invest
in CAD/CAM processes are significant, according to the
researchers. Aside from increased profitability and productivity, a clinician has access to a much broader range of
treatment options, improving the patient experience and
saving chair time. Additionally, for patients, involving them
in their treatment through computer-generated visualisations of their treatment plan and envisaged outcome—as
opposed to being passive recipients of treatment—boosts
treatment acceptance.
The reference guide, titled “Application of CAD/CAM technology
in dentistry”, was published in the October 2022 issue of the
Journal of Research in Medical and Dental Science.
© Vasyl Rohan/Shutterstock.com
Though daunting from the outside, it is not difficult to learn the basics of CAD/CAM applications for dentistry, and with these technologies, clinicians can
advance the care they provide and grow their practices.
10
CAD/CAM
1 2023
[11] =>
register at www.roots-summit.com
ROOTS SUMMIT IS
COMING TO ATHENS
THE GLOBAL DENTAL CE COMMUNITY
Tribune Group GmbH is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or
endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Tribune Group GmbH designates this activity for 18.5 continuing education credits. This continuing education activity has been planned
and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group GmbH and Dental Tribune International GmbH.
[12] =>
| industry news
“The edelweiss CAD/CAM BLOCK
certainly created a buzz”
By Franziska Beier, Dental Tribune International
The edelweiss CAD/CAM BLOCK is a unique block that is
created through a patented laser sintering and vitrification
process to produce a single glass phase. The block has the
aesthetics of pure glass ceramics, the strength of particle-filled
ceramics and the resilience of natural dentine.
The edelweiss CAD/CAM BLOCK has several advantages compared with other blocks on the market. Owing to the material’s
glass-like property, the final restoration only needs to be polished
with a linen buff, significantly speeding up finishing and polishing.
No additional firing or glazing is needed, saving time and money.
The edelweiss i-BLOCK with integrated screw channel.
Pioneering Austrian manufacturer edelweiss dentistry
presented its aesthetic solutions at this year’s IDS and had a
successful and interactive time at the trade fair. The company
boasts the only biomechanical direct veneer system that
overcomes the disadvantages of the organic fillers normally
used in composite veneers and at IDS presented its newest
development: the edelweiss CAD/CAM BLOCK, particularly
its unique i-BLOCK for implant restorations. In addition,
edelweiss dentistry showcased the edelweiss PEDIATRIC
CROWN, the only natural-looking and minimal preparation
crown on the market for use in children.
The edelweiss DIRECT VENEERs and OCCLUSIONVD system.
12 CAD/CAM
1 2023
“This newest block from edelweiss dentistry was one of the highlights of IDS 2023. Many industry representatives, dentists and
dental technicians milled the edelweiss CAD/CAM BLOCK on-site
and couldn’t believe the ease with which it can be milled. Manufacturers of milling units were amazed by the ease of polishing and
the strength of the product. The edelweiss CAD/CAM BLOCK
certainly created a buzz and was a talking point at IDS 2023,” said
Dr Stephan Lampl, CEO and founder of edelweiss dentistry.
He added: “Its outstanding, long-lasting shine and strength make
it currently the best option for both anterior and posterior CAD/
CAM restorations. This block is setting a new trend in the dental
industry and is certainly changing the future of CAD/CAM blocks.”
The i-BLOCK ensures high aesthetics
and exceptional strength
The edelweiss i-BLOCK has a screw channel built into it that fits
into the titanium base over the implant. This allows for perfect
design of the abutment with a perfect emergence profile,
[13] =>
industry news
|
The newly launched edelweiss CAD/CAM BLOCK showcased at IDS.
making it easy to restore implants especially in the case of
immediate loading or custom abutments. The block has a unique
shock-absorbing effect. Resin within the material gives the
restoration the resilience to withstand any occlusal force. This is
particularly important to avoid transmission of forces to the periodontal tissue and the implant, making the edelweiss i-BLOCK
a safe option for long-lasting protection of the implant.
The PEDIATRIC CROWN mimics
the p
roperties of natural teeth
Another highlight at this year’s IDS was the edelweiss
PEDIATRIC CROWN, the only crown for children that mimics
the properties of natural teeth, is highly aesthetic and
requires minimal tooth preparation, since stainless-steel
crowns are less aesthetically pleasing and zirconia crowns
require excessive removal of tooth structure. "It is also easy
to use and reduces chair time for the child", said Dr Desigar
Moodley, chief scientific officer at edelweiss dentistry. The
edelweiss PEDIATRIC CROWN contains zinc oxide nano
particles and fluoride for antibacterial properties. It is also free
of bisphenol A, making it very safe for young patients.
IDS 2023 participation
was a valuable experience
The company works with several key opinion leaders, some of
whom attended the fair to support edelweiss dentistry with
their expertise. They were very pleased with the positive response to the products. Dr Nikola Podolesov, a dentist from
North Macedonia and one of the company’s key opinion leaders
for Europe, commented: “It was fantastic to demonstrate the
edelweiss products live in front of so many dentists.” German
dentist Dr Vesna Jelic, who is also a key opinion leader for
Europe, said: “Being able to communicate with so many dentists, resulting in them learning from us, was very exciting.”
“Attending IDS 2023 after years of the pandemic provided a
valuable experience for the entire edelweiss team. The atmosphere of the event was busy and bustling with excitement,
and the show gave us the opportunity to network with industry
professionals from all over the world,” concluded Dr Lampl.
Editorial note: More information on the edelweiss dentistry
products can be found at www.edelweissdentistry.com.
IDS 2023 offered the edelweiss dentistry team the opportunity to network with industry professionals from all over the world. (All images: © e delweiss)
CAD/CAM
1 2023
13
[14] =>
| industry news
Amann Girrbach offers
complete digital workflow
By Jeremy Booth, Dental Tribune International
1
2
Fig. 1: Dr Wolfgang Reim, CEO Amann Girrbach. Fig. 2: From left: Falko Noack, Christian Ermer, Sina Moghadam, Dr Cyrus Alamouti, Dr Caroline Gommel.
Dental CAD/CAM technology specialist Amann Girrbach
held its IDS 2023 press conference in the form of an expert panel discussion and was moderated by Dr Caroline
Gommel. The panel consisted of Amann Girrbach’s own
experts and long-time users of its products in both clinical
and laboratory settings.
Dr Wolfgang Reim, CEO of Amann Girrbach, explained to
international media representatives that the company’s
special offering for dental teams covers the entire dental
prosthetics chain and that it includes digital workflows that
break down the long-standing interdisciplinary boundaries
between dentists and dental technicians. “This enhances
communication and collaboration between the two with
validated digital workflows that ensure high process safety
and reproducibility,” Dr Reim said, adding that the ultimate
result was a more economical way of working.
Christian Ermer, vice president of marketing and digital at
the company, and Falko Noack, vice president of research
and development, gave the audience a behind-the-scenes
look at product development at the Austrian company and
provided updates on the suite of products and solutions
that combine under the company’s motto “Connect To The
(Work-)Flow”. When asked what dental practice could look
like 20 years from now, Ermer said the answer could be
seen on-stage during the panel discussion: networked,
collaborative, intuitive digital solutions that enhance collaboration and break down disciplinary divides.
3
Fig. 3: “Connect To The (Work-)Flow” was Amann Girrbach’s motto for IDS.
14
CAD/CAM
1 2023
Complimenting the speaker panel was Dr Cyrus Alamouti,
a Cologne dentist and industry mentor, and dental technician
and musician Sina Moghadam. According to Moghadam,
Amann Girrbach has succeeded in connecting laboratory and
practice within a functioning digital workflow: “Mission completed,”
he said. Dr Alamouti and Moghadam made it clear that the
company’s cloud platform, AG.Live, is extremely beneficial for
the collaboration between dental practices and laboratories.
[15] =>
industry news
|
ClearCorrect expands into international
markets and new manufacturing lines
By Dental Tribune International
ClearCorrect, a pioneering provider of orthodontic solutions, has pressed ahead with its global growth strategy,
driven by several new market entries and manufacturing
line activations achieved during 2022. The company,
which was acquired by the Straumann Group in 2017,
has launched new and updated products and added
new features to its premier aligner and associated digital
portals, applications, software, service and educational
programmes in eight additional countries.
Engineered for precision, comfort and aesthetics,
ClearCorrect’s aligners represent the ultimate orthodontic tool for practising orthodontists. Created and evolved
from decades of material science research and innovation, these aligners retain ten times more of their initial
force than do the aligners of competitors and have four
times more proven tear resistance. This is achieved by
combining proprietary ClearQuartz tri-layer material, a high
and flat trim line and scientifically proven clinical features.
The physical product range is backed by a powerful
digital ecosystem designed to offer control and flexibility
over treatments while maximising productivity.
Furthermore, ClearCorrect has recently received approval
to commercialise its aligner system in China—an activity
which will be supported by in-country manufacturing and
treatment planning sites. Additional manufacturing lines
have been brought on stream in the US and Germany,
and with the Brazilian manufacturing already in place,
the company is primed for global production across four
different continents. ClearCorrect also operates three
treatment planning centres.
“The past year has been a continuation of the momentum
we have built up since ClearCorrect joined the Straumann
Group in 2017,” commented Camila Finzi, head of the
orthodontic business unit at Straumann. “With eight new
markets and two new manufacturing lines being activated,
we are now very well positioned to bring ClearCorrect to
clinicians and their practices all around the world. This latest
expansion drive is a signal of confidence in our product and
our ability to scale,” she continued.
“Across almost two decades, we have been able to
transform over a million smiles for people in more than
50 countries,” Finzi noted.
The company’s solutions are now available in 56 countries,
and at least three new markets will be coming on stream
during the rest of 2023.
ClearCorrect will be entering eight new markets and activating two new manufacturing lines as part of its global expansion strategy. (Image: © ClearCorrect)
CAD/CAM
1 2023
15
[16] =>
| study
3D fabrication workflow
Solid and lattice-structured titanium alloy dental
implant overdenture bars
Dr Les Kalman, Canada
1
2
Fig. 1: Patient soft-tissue model with implants and milled dental implant bar. Fig. 2: Implant bar model with internal lattice pattern. (Image courtesy of © ADEISS)
Figs. 3a–c: Implant bar design with circular cross-section internal lattice pattern. Frontal view (a). Top view (b). Cross-sectional view (c). (Image courtesy of © ADEISS)
Introduction
Dental implants remain the gold standard for the replacement of one or more missing teeth.1, 2 In an edentulous arch,
rehabilitation with implants provides the patient a significant
improvement in function, aesthetics and quality of life.3 Implant bars, where a bone-affixed bar supports and retains
the denture instead of it resting on the patient’s soft tissue,4
are predictable and cost-effective options. Implant bars
are fabricated through subtractive manufacturing, or milling,5
and delivered to patients through a complex clinical workflow.6 The milling process has numerous disadvantages in
terms of cost, efficiency and environmental footprint.7, 8
As metal additive manufacturing (AM) matures, it presents
a novel opportunity for the fabrication of implant bars, offer3a
3b
16
ing a process that promises to reduce both the time and
the cost,9, 10 ultimately improving treatment accessibility.
Moreover, AM provides a more sustainable approach,
specifically through a more conservative lattice-structured
design, reducing dentistry’s environmental footprint.11, 12
This report explains the workflow developed for the
fabrication of additively manufactured solid and latticestructured titanium alloy dental implant overdenture bars.
Methods and materials
Milled bar
A dental implant metal bar was sourced from Panthera Dental.
This bar was part of a patient education model, consisting
of the implant bar, a model of the patient’s lower jaw and the
simulated soft tissue (Fig. 1). The implant bar was milled from
3c
[17] =>
study
4
|
5
Fig. 4: Final additively manufactured latticed-structured dental implant bar. Fig. 5: Additively manufactured implant bar screwed to the dental implants
supporting a complete denture.
medical-grade titanium alloy (Ti-6Al-4V) on a fully robotic CNC
machine at an Industry 4.0 manufacturing facility. The bar was
monobloc, having no welded areas or porosity, and had a very
accurate and passive fit with the implants on the model. The
STL file of the bar design was provided by Panthera Dental.
Design
The implant bar design file was reviewed by ADEISS to evaluate the design for AM. Review for AM determined that the
design required modifications to incorporate through-holes
of 2 mm in diameter for implant placement, and the overall
implant bar structure needed to be thickened to account for
AM post-processing where surface finishing was required.
Two implant bar designs were generated for AM; the first
design was a solid structure to replicate a standard implant bar, and the second design incorporated an internal
latticed pattern within the bar component. The lattice design was created using standard CAD software functions
with circular cross-sectional geometry (Ansys Spaceclaim
3D modelling software, Ansys; Figs. 2 & 3). Additionally,
for the lattice-designed bars, drainage holes of 0.75 mm
in diameter were incorporated into the anterior walls, such
that non-consolidated powder from the AM process could
be cleaned from the samples in post-processing. The final
designs for AM were confirmed to match the dimensions
of a comparative milled bar sample.
Selective laser melting (3D printing) and post-processing
The designs for AM were prepared for printing in medicalgrade titanium alloy (Ti-6Al-4V). Printing was done using
selective laser melting technology with the Renishaw AM
400 system (Renishaw). The 3D printer utilises alloy powder
within the range of 30–50 µm in diameter and a 400 W laser
of 70 µm in diameter in a 250 × 250 × 250 mm build volume.
Eighteen implant bars (12 solid and six internal lattices) were
fabricated in a machine print time of 7 hours and 6 minutes.
After the printing process, the implant bars on the build
plate were cleaned using compressed air. Air was cycled
across the build plate and through drainage holes until no
loose powder was expelled. After powder clearance, the
implant bars were exposed to standard heat treatment in
a vacuum furnace, removed from the build plate and their
surfaces finished. All implant bars were processed to a
polished mirror finish (< 1 µm Ra ) using hand tooling (Fig. 4).
The final processing step included cleaning of all the implant bars using ADEISS’s ultrasonic cleaning methods to
remove any remaining alloy powder and polishing agents.
Discussion
The AM-fabricated implant bars were all evaluated to be clinically acceptable, based on the fit with the original patient
model and subsequently the fit of a denture (Fig. 5). Based on
the number of implant bars that can be fabricated on a single
build plate and the total time of fabrication and cost, the AM
fabrication workflow suggests meaningful advantages over
conventional milling of implant bars. Further research is being
conducted through four-point testing and will be released shortly.
Conclusion
The AM workflow for both solid and latticed-structured
dental implant bars indicated that AM is a suitable, and perhaps a superior, fabrication workflow for implant bars. Further
research and metrics are needed. Workflows that provide
improved cost-savings, efficiency and sustainability should
be explored, not only to improve the patient experience, but
also to enhance the sustainability of the profession.
Acknowledgements
Panthera Dental in Canada provided the milled implant
bars and models. All design, manufacturing and postprocessing for AM were completed by ADEISS in Canada.
Alien Milling Technologies in the US provided the Ivotion
(Ivoclar) denture. This research was funded by an International Congress of Oral Implantologists’ Implant Dentistry
Research and Education Foundation grant. Special thanks
to Dr Yara Hosein for her superlative assistance.
Editorial note: Please scan this QR code for the list of references. This
article originally appeared in Oral Health Magazine, and an edited
version is provided here with permission from Newcom Media.
about
Dr Les Kalman is an educator and
medical device researcher focusing on
additive manufacturing and software.
He is a fellow of the Academy of
Osseointegration, American College
of Dentists and Academy for Dental
Facial Esthetics and a diplomate
of the International Congress of
Oral Implantologists. He is the recipient
of an Alumni of Distinction Award from the Schulich School
of Medicine and Dentistry at Western University in London
in Ontario in Canada and a CES Innovation Awards honouree.
CAD/CAM
1 2023
17
[18] =>
| case report
Digitally planned
highly aesthetic restorations
Atsushi Hasegawa & Dr Yusuke Takayama, Japan
and aesthetically convincing if essential components of
modern dental technology are combined with the expertise
and experience of both the dentist and dental technician.
Case presentation
A 37-year-old female patient presented to Dr Takayama’s
dental practice requesting correction of the colour and
shape of her anterior teeth and treatment of her gingivitis.
Her tooth #23 had been extracted when she was at
school, and gingival recession was visible in this region.
When she first came to us, she had already received a
bridge from tooth #21 to tooth #24 and crowns in regions
#11 and 12. Especially the shape of the bridge did not
meet her aesthetic demands (Figs. 1 & 2).
Planning and pretreatment
The given circumstances meant that no labial space
was available for layering porcelain. It was thus decided
to treat the patient with monolithic restorations made of
the highly translucent and polychromatic zirconia Zolid
Gen-X Multilayer (Amann Girrbach) and to undertake
partial orthodontic treatment of the labially inclined and
crowded mandibular anterior teeth.
1
Aesthetic intuition, creativity and technical expertise—
these are just a few relevant factors for implementing
high-quality restorations. Choosing the right material is
also of key importance for accurate fitting. This patient case
illustrates how restorations can be functionally effective
2
3
In addition, correction of the gingival margin was to be carried out before starting the restorative treatment. Owing to
the gingivitis and missing tooth #23, the gingiva in the region
had receded considerably. This was corrected by surgery
in order to later achieve a natural gingival margin (Figs. 3 & 4).
4
Figs. 1 & 2: Initial situation. Bridge from tooth #21 to tooth #24 with a pontic in region #23 and crowns on teeth #11 and 12. Figs. 3 & 4: Soft- and hard-tissue
management with soft- and hard-tissue grafting.
18
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Fig. 5: Orthodontic treatment of the mandibular anterior teeth. Fig. 6:
Situation after surgery for gingival margin correction. Fig. 7: Teeth #12, 11,
21, 22 and 24 prepared for restoration. Fig. 8: Artex facebow transfer.
After these pretreatments (Figs. 5 & 6), the teeth were
prepared for restoration by the dentist (Fig. 7).
The perfect fit right from the start
The use of a facebow (Fig. 8) is considered essential to
show the individual relationship of the patient’s condyles
and occlusal plane. This ensures subsequent realisation
of patient-friendly occlusal concepts on the Artex articulator (both virtual and physical, Amann Girrbach).
The classic model work used the Model Management
System workflow (Amann Girrbach). Afterwards, the
models were mounted on the Artex CR articulator using
the Artex facebow record (Fig. 9) and digitalised using the
Ceramill Map 600 scanner (Amann Girrbach). The CAD
was done using the Ceramill Mind CAD software. One of
the major advantages of the Ceramill system is that both
analogue and digital workflows can be employed using
the same concept (Figs. 10 & 11).
The setting of the Artex articulator (condylar inclination
and Bennett angle) was average (sagittal condylar inclination of 35° and transversal condylar inclination of 10°).
For incisal inclination, a custom incisal guide table was
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chosen to set at 35°, the left wing at 0° and right wing at
30°, owing to the shallow anterior overbite and the right
canine being natural dentition (Fig. 12).
When designing anterior restorations, it is necessary to
consider not only aesthetics but also occlusion. The goal
is to achieve an occlusal scheme in which the posterior
teeth prevent excessive contact of the anterior teeth in
the maximal intercuspal position and the anterior teeth
disengage the posterior teeth in all mandibular excursive
movements. For this reason, when the anterior region is
in occlusion, it is an important area that guides the mandible and controls both protrusive and lateral movements.
In this case, since one canine was a pontic, tooth #24 was
also involved to reduce the load on the pontic and to control
the lateral movement (Figs. 13 & 14).
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Fig. 9: Mounting the model using the Artex facebow. Fig. 10: Ceramill Artex virtual articulator. Fig. 11: Ceramill Artex physical articulator. Fig. 12: Setting of
all function parameters on the Ceramill Artex. Fig. 13: Static occlusion registration. Fig. 14: Dynamic occlusion registration.
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Fig. 15: Smile design with Ceramill M-Smile. Fig. 16: Ceramill M-Smile, oblique view. Fig. 17: CAD-design based on pre-op data.
Virtual reality—Ceramill M-Smile brings
restorations to life
Designing a restoration with the Ceramill M‐Smile module
creates possibilities not available to technicians in the
analogue workflow. References, such as the pupillary
line and midline, previously difficult to make out with an
analogue articulator and models are now easy to see, and
it is even possible to use the patient’s smile for the design
(Fig. 15).
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Fig. 18: Observation of the centreline without facial orientation. Fig. 19: The balance between the shape and size of the tooth is important to achieve a good aesthetic result. Fig. 20: Matching
the midline of the facial profile. Fig. 21: Matching the midline and the lip line. Fig. 22: Design of the crown for tooth #12. Fig. 23: Design of the dental bridge for tooth #21 to tooth #24.
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It has to be considered that Ceramill M-Smile uses
2D images. Therefore, it is not advisable to use it for determining the crown labial contour or for the lip support
design. In order to sufficiently design these aspects,
designs from provisional restorations (preoperative scan
data) are useful, as the position of the incisal edges and
the contour of the labial aspect can be adjusted with reference to the provisional restorations (Figs. 16 & 17).
When considering the centreline based on the models,
the axial direction of teeth #11 and 12 suggests setting the
midline along the red dotted line (Fig. 18). With digital design, the feeling for shape and tooth size is lost because,
unlike when looking at a physical model, it is easy to zoom
in and out and rotate. The size of the physical model and
digital model is not the same. This is an important consideration in digital design of anterior teeth (Fig. 19).
The centreline can be determined from the orientation of
the patient’s face. Also, the smile line, which cannot be
referenced in the analogue process, is described by overlapping 2D images (Fig. 16). However, because the centrelines based on the model and on the facial features were
different, design of the individual teeth was very difficult,
especially in the area of the tooth #11 mesial interproximal
emergence profile (green arrow on Fig. 19) as an example.
To improve aesthetics, it was necessary to reduce the
bulk on the labial surface and tilt the tooth axis towards
the lingual side. In such cases, the wall thickness of the
crown must be controlled to ensure strength (Figs. 20–23),
following the manufacturer’s instructions for use.
If there is little space, the preferred restorative material
should always be monolithic. The high strength of zirconia
provides safety and longevity for the restoration. Zolid
Gen-X gives restorations a high level of aesthetics owing
to its natural colour gradient and high translucency.
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Fig. 24: Milling the restorations with Ceramill Matik.
Virtual becomes reality
Once the design process was completed, the restorations
were milled with the Ceramill Matik milling unit (Fig. 24).
As the patient preferred a slightly lighter shade, Zolid Gen-X
in Shade A1 was selected (Figs. 25 & 26).
After milling, the crowns and bridges were reworked with
suitable tools to individualise them (Fig. 27). The Zolid
Green‐State Finishing Kit was used to correct the morphology
of the approximal surface areas (connector areas) and of
26
Fig. 25: Ceramill Zolid Gen-X Multilayer blank discs. Fig. 26: Shade selection according to the patient’s natural teeth in the mandible.
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Blue-grey
Thin layer of Shade A
Shade A
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30
Transparent glaze paste
Transparent glaze paste and
a small amount of white
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Fig. 27: Milled restorations. Fig. 28: Sintering process with the Ceramill Therm 3. Fig. 29: Sintered and polished restorations. Figs. 30 & 31: Aesthetic
finishing with ready-to-use Vintage Art Universal paste stains and glazes. Fig. 32: Final restorations on the model. Fig. 33: Cleaning with KATANA Cleaner.
Fig. 34: Cementation of the restorations under the microscope.
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35
Fig. 35: Zolid Gen‐X monolithic crowns after cementation in the patient’s
mouth. Fig. 36: Final result in the patient’s natural smile.
the occlusal surface, which were difficult to correct after
sintering. The sintering process was then started (Fig. 28).
After sintering, slight adjustment of the morphology was undertaken using the Zolid Sinter‐State Polishing Kit, including
medium-grade polishing at the end (Fig. 29).
Zolid Gen‐X has a beautiful multilayer graduation and a very
natural look, so it is possible to produce restorations that require
minimal staining. In this case, Vintage Art Universal stains and
glazes (SHOFU) were used. The incisal area was coloured blue‐
grey for transparency. During application, care must be taken
not to make the incisal area too blue. A very thin layer of Shade A
was added over the body area (for colour supplementation),
and the cervical area was coloured darker than the body area
(Fig. 30). At the end, a thin layer of glaze paste was applied over
the surface. As a second layer, glaze paste was mixed with
a small amount of white and layered on the mesial and distal
marginal ridges (Fig. 31). By using Zolid Gen‐X, aesthetic and
functional restorations were produced (Fig. 32).
The typical cementation protocol was followed, but retraction
cord was used and extra care regarding moisture and contamination was taken. Especially the fitting surfaces of restorations can be contaminated by salivary protein during
the try‐in stage and have to be cleaned, for example with
KATANA Cleaner (Kuraray Noritake Dental; Fig. 33). PANAVIA V5
(Kuraray Noritake Dental) resin cement was used. To control
the value, bleach shade cement was chosen. Cementation
was performed under the dental microscope (Fig. 34).
Result
In this case, the position of the teeth limited the thickness of the
crowns and there was no space for ceramic layering. Anterior
bridges involving canines must be strong and aesthetic. In such
cases, Zolid Gen-X is the best material because it offers strength
and aesthetics. In addition, the use of Zolid Gen-X in combination with Ceramill M-Smile in the fabrication of the anterior
monolithic crowns produced a highly aesthetic result (Fig. 35).
The patient had a beautiful smile after cementation of the anterior
monolithic zirconia restorations in her mouth (Fig. 36).
36
about
Atsushi Hasegawa gained his licence
to practise as a dental technician in
1996 and completed postgraduate
studies at Kanagawa Dental University
in Yokosuka in Japan in 1998.
He then worked for 11 years in a dental
laboratory in Tokyo in Japan,
where he acquired specific knowledge
and skills in the field of occlusal concepts.
In 2008, he opened his own laboratory, Organ Dental Lab,
in Chigasaki in Japan. Today, Hasegawa transfers his
knowledge through lectures in Japan and worldwide.
He can be reached through his website, www.organdental.jp.
Dr Yusuke Takayama graduated
from Nihon University in Tokyo
in Japan in 2004. He has been in
private practice since then and opened
his own dental office, Shinyurigaoka
Minami Dental Clinic, in Kawasaki
in Japan in 2016. Since 2019,
he has been a lecturer at
the Dental Arts Academy in Tokyo.
He is a member of the Society of Japan Clinical Dentistry
and Japan Association of Microscopic Dentistry.
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Guided maxillary arch implant
restoration: Language and
cross-border collaboration are
no barrier with hybrid workflow
Dr Florian Obadan & Jorge Reyes Minguillán, Romania & Spain
1
The rehabilitation of a failing maxillary dentition requires comprehensive planning and appropriate tools to
execute a treatment which will meet the patient’s expectations and accomplish the biological principles for longterm successful restoration. Nowadays, digital workflows
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aid clinicians in achieving this accuracy with holistic treatment planning. Digitisation in implant dentistry has ensured that the dental technician and the clinician are in
sync at every step of planning and execution, as the exchange of data between them can be done remotely with
the click of a button. Guided implant placement ascertains
the precise transfer of the virtually planned implant positions to the surgical site. This pre-planned implant positioning facilitates immediate loading, as the provisional
prosthesis can be milled and kept ready prior to the surgery, requiring only minor relining and adjustments after
the surgery. Guided implant placement with immediate
loading not only restores function, aesthetics and the patient’s confidence instantly, but also has high patient acceptability owing to the minimised surgical trauma, postoperative discomfort and reduced treatment duration.
The following case report showcases the planning and execution of the SKY fast & fixed full-arch protocol (bredent
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laboratory 3D scanner, and the STL files, radiographs
and images were transferred to the dental technician in
Madrid in Spain.
Case presentation
The dental technician used exocad for the digital mock-up
and e-mailed it to the clinic. The CAD was printed (the
model without the teeth, the model with the new tooth
set-up and the teeth detached from the model) using a 3D
printer. The STL files were used for planning the ideal prosthetic positions of the implants (six 4 × 14 mm copaSKY
implants, bredent medical). CoDiagnostiX (Dental Wings)
was used for planning the implant positions, as well as the
appropriate abutments (Figs. 6–8). The surgical guide was
fabricated based on the virtually planned ideal positions of
the six implants (Figs. 9 & 10). The provisional prosthesis
was designed in Madrid by the dental technician, but
milled and kept ready prior to surgery in Romania.
Preoperative phase
High-resolution intra-oral images and profile pictures
were taken (Figs. 3–5). Preliminary impressions were
made with irreversible hydrocolloid (alginate), as there
was a possibility of tooth loss (owing to severe tooth mobility) with the use of silicone-based materials for impression taking. The resulting models were scanned using the
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medical) with synchronisation of a complete digital workflow between a dental technician in Spain and a clinician
in Romania who do not speak a common language.
A middle-aged woman presented to the dentist’s clinic in
Alexandria in Romania with a mobile central incisor, seeking a long-term highly aesthetic solution. A full-mouth
clinical assessment and radiographic examination with a
dental panoramic tomogram and CBCT scan (Figs. 1 & 2)
were carried out. Based on the severity, complexity of
management and extent of distribution, a diagnosis of
generalised severe periodontitis with potential loss of
dentition was made, and the patient was advised to undergo total extraction of the maxillary teeth (other than the
terminal molars) and immediate placement of implants
and their immediate loading using the SKY fast & fixed
treatment protocol.1–4
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Surgical phase
The procedure was done under local anaesthesia with articaine with 1:100,000 adrenaline. Atraumatic extraction of
all the maxillary teeth except the terminal second molars
(as they served as a vertical stop for maintaining occlusal
height) was done, and the extraction sockets were thoroughly curetted to remove the granulation tissue. After
mechanical debridement, to ensure complete disinfection
of the site, antimicrobial photodynamic therapy was per-
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formed. A blue photosensitiser (methylene blue) was applied inside each socket and left in situ for 60 seconds to
stain the bacteria. After rinsing off of the liquid, each
socket was then exposed to the diode laser for 1 minute.
This ensures focused antibacterial action by destruction
of the bacteria in the biofilm by singlet oxygen molecules.
The procedure was completely flapless to minimise surgical trauma, and it facilitated seamless seating of the surgical guide. The surgical guide was stabilised intra-orally
with four fixation pins placed buccally (Fig. 11). The surgical kit was used for fully shaft-guided implant placement,
which is more convenient than the sleeve-in-sleeve and
spoon systems. It is based on the principle of maximum
safety when reaching the drilling depth and angulation by
guiding the drills through the high-precision drill sleeve
(Fig. 12). Sequential drilling was done, and primary stability of more than 40 Ncm was obtained for all six implants,
facilitating predictable immediate loading. Titanium abutments were installed on all six implants, and a closed-tray
impression was taken (Fig. 13). The milled provisional
prosthesis was placed on the quickly poured model to
make the holes in the prosthesis to facilitate intra-oral relining with Qu-Resin and Qu-Connector (bredent medical)
to ensure a passive fit of the screw-retained prosthesis
(Figs. 14 & 15). The titanium copings were picked up in the
provisional prosthesis after relining, finished and polished
extra-orally, and inserted on to the implants to a torque of
18 Ncm (Figs. 16 & 17). The provisional prosthesis was
kept out of all eccentric contact, and light centric contacts
were maintained. Biomechanical principles were applied
by preventing cantilevers which could weaken and fracture the provisional prosthesis.
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The patient was instructed to avoid hard food, and oral
hygiene instructions were reinforced. She was extremely
satisfied with her new smile and regained her confidence.
Prosthetic phase
The patient was recalled after eight months for the final
prosthetic phase. Intra-oral scans were taken for fabrication of the final prosthesis (Fig. 18), the intention being to
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plan, start and finish the case completely digitally. This,
however, was not possible because there was a mismatch in fitting the components which the laboratory had
milled for verification on the printed models. The decision
was made to go the analogue route.
for the patient, and the final outcome was extremely gratifying for the surgical and prosthetic team (Figs. 25 & 26).
Titanium copings were inserted, and after confirmation of
proper seating with a panoramic radiograph, intra-oral
splinting of the copings was done to ensure accurate impression taking. Putty and light-bodied wash impressions were taken, carefully packed and sent to Madrid for
fabrication of the final prosthesis (Figs. 19a & b).
|
Discussion
Chronic generalised periodontitis can result in insidious
loss of periodontal attachment, tooth mobility and poor
prognosis of teeth. The SKY fast & fixed treatment protocol aims for immediate restoration of function and aesthetics for management of failing dentition. A recent study
by Slutzkey et al. concluded that, if the prerequisites
After obtaining the master model, the dental technician
made the design of the framework, milled it in PMMA and
sent it to the clinic. The provisional prosthesis, having a
passive fit, because it was fixed intra-orally, was used as a
verification key for the master model. Because there was
a passive fit, the framework was cemented on to the prefabricated copings with DTK-Adhesive (bredent medical)
on the model by the dental technician (Figs. 20 & 21).
The solution for the long-term restoration was determined based on the inter-arch distance and passivity of
fit, as well as protection of the implants. The choice of
material for the definitive prosthesis framework was
laser-sintered titanium with composite build-up teeth
(Figs. 22–24). The laser-sintered titanium, being produced
with an additive method, did not have undercut areas,
and it was fabricated by the dental technician in Spain.
Canine-guided occlusion was established without difficulty. Function and aesthetics were restored satisfactorily
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19b
19a
for immediate loading, such as high primary stability of
≥ 30Ncm, splinting of the implants via a provisional prosthesis and the use of bone-level implants with a sandblasted and acid-etched surface, are fulfilled, then fullarch fixed restorations supported by a combination of
axial and tilted implants can be a viable treatment option
to rehabilitate the terminal dentition of patients suffering
from severe generalised periodontitis.5
Immediate implant placement with the application of antimicrobial photodynamic therapy has made the procedure
more predictable. Antimicrobial photodynamic therapy
was used in the current case at the point of extraction of
the diseased and compromised teeth to ensure disinfec-
20
tion and better osseointegration of the implants. Antimicrobial photodynamic therapy has gained much attention as
a non-invasive and biocompatible approach that can be
employed to prevent biological complications associated
with implants.6 Histological and histo-morphometric analyses have demonstrated significantly better results for immediate implant placement in sockets decontaminated by
mechanical debridement with the adjunctive use of antimicrobial photodynamic therapy.7 The sites which received
this combined therapy led to osseointegration of the implants without evidence of inflammation; conversely, evidence of peri-implantitis was observed where antimicrobial photodynamic therapy was not used.7
The purpose of using implant software is to plan the
placement of the implants in prosthodontically driven positions.8 The advantages of guided surgery are that the
patient’s chair time is decreased, the surgery is more predictable and less stressful, the implants are placed in a
restoratively driven manner, and the case difficulty is
learned ahead of time.9–11 In other words, guided surgery
in full-mouth implant rehabilitation has also made immediate restoration of function and aesthetics easier and
more precise and has improved treatment acceptability
by the patient. However, in full-arch rehabilitation, the provisional restorations cannot be cemented to abutments
before surgery owing to passivity concerns, as seen in
the current case report.12 The pre-milled breCAM.multiCOM prosthesis (bredent medical) was relined intra-orally
to ensure passivity of the prosthesis.
21
Full-arch fixed rehabilitation by means of guided surgery
and immediate loading of implants placed in fresh extraction sockets appears to be a reliable and successful
procedure.13 Selection of the final prosthesis material was
done based on the inter-arch distance (from implant platform/ridge crest to incisal edge/occlusal plane of opposing dentition).14 Various materials were considered before
making the final choice.
High-impact polymer composite teeth with a BioHPP
(ceramic-reinforced PEEK) framework was considered;
however, the amount of inter-arch space necessary to
achieve mechanical stability and fracture resistance of
the framework was not available. Porcelain Fused to
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Metal was also excluded, because of the lack of adequate rigidity of the metal framework. The modulus of
elasticity of the ceramic is not optimal in this case. To protect both the implants and the antagonist arch, a titanium
framework was selected, on which the technician set up
the teeth from composite, a well-established soft-bite restorative material. The framework was made by laser sintering because of the improved qualities of the surface of
the metal compared with those of milled titanium. Cobalt–chromium was not considered because of evidence
of reactivity of this alloy in the oral environment.15 For longterm success, a passive and perfect fit was achieved using prefabricated prosthetic components.
Conclusion
Advances in materials science and the boom of digitisation and digital workflows in dentistry have provided an
array of options for tackling the same clinical situation.
This means that there are more treatment options for the
various clinical indications. In addition, the interoperability
of devices and software systems, the possibility of connecting over video calls and the ease of transferring a large
number of data sets over the internet make cross-border
collaboration a reality even in cases such as this one, where
the clinician and dental technician did not speak a common language, except for the language of digital dentistry.
It is clear that clinical decisions should not be solely based
on trends, but supported by thorough treatment planning
with the technical, surgical and restorative teams, based
on expertise, comfort and confidence of the clinician in
synchronisation with the dental technician to convert the
virtual planning into reality for long-term success. The comfort and safety of the patient should be in focus if increased
patient satisfaction at affordable cost is to be achieved.
|
Acknowledgements
We would like to acknowledge dental technician Vasile
Bacila from Slatina in Romania and dentist Dr Magdalena
Eugenia Obadan of Implant Consult in Alexandria in
Romania.
Editorial note: Please scan this QR code for the list of references.
about
Dr Florian Obadan has attended numerous courses to
specialise in his techniques, practising in countries such as
Romania, India, Georgia, and Armenia. In 2015, he founded
the Implant Consult clinic in the city of Alexandria, which
offered a different perspective and approach to the idea
of a dental clinic. He graduated from university in Craiova
in 2001, and since then he has been practising in the field
of dentistry. Supported by his family, he attended
advanced training c ourses, and through his perseverance
and desire, Dr Obadan realised in 2009 the first
Fast and Fixed implant in Romania, thus contributing
to the innovation of a difficult field by applying a safe,
predictable treatment, which offers the possibility
of recovering teeth in a single day, by implant.
contact
Dr Florian Obadan
+40 75 2733368
florian.obadan@gmail.com
Jorge Reyes Minguillán
+34 914 609708
dentalreyes@dentalreyes.es
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A clinical case report on
maxillary compromised dentition
treated with Straumann Pro Arch
in a digital workflow
Dr Tran Thanh Phong, Vietnam
1
2
Introduction
Successful immediate implant placement associated
with immediate loading remains a major clinical challenge. In addition to the placement of an implant immediately into the socket, the creation of an immediately
3
4
loaded screw-retained CAD/CAM provisional restoration
is critical for an optimal aesthetic outcome. When using
a conventional approach, the procedures require an
extensive number of patient appointments and chair time.
Fortunately, nowadays digital workflows can be implemented in our practice, and with this, our treatments can
be considerably shortened.
In the following case report, a digital workflow involving
Straumann Guided Surgery allowed us to have an efficient and predictable full-arch treatment protocol for immediate implant placement and the prosthetic restoration
design, including the individual emergence profiles,
prior to the surgery. This also led to an excellent patient
experience and satisfaction. The goal of this clinical
report is therefore to introduce an innovative one-stage
surgical approach for CAD/CAM provisionalisation with a
screw-retained restoration using the latest technological
improvements in prosthetic and surgical planning software (coDiagnostiX, Version 9.14; Dental Wings) and
seamlessly integrating the dental technician into the development of the digital treatment planning and new
prosthetic options.
Initial situation
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A 51-year-old male patient, smoker (less than ten cigarettes
per day), in good general health presented to the clinic
with missing molars in the second and fourth quadrants,
[33] =>
case report
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Class III mobility of teeth #17 and 24, root caries and gingival inflammation, and no abscess or sinusitis at tooth #16.
The anterior zone showed differing levels of gingival
recession, bone resorption and deep periodontal
pockets around teeth #12 and 22, leading to the patient’s
complaint of an aesthetically unsatisfying restoration
(Figs. 1 & 2).
Treatment planning
After the clinical and radiographic assessments, the
patient was introduced to two different treatment options.
The first one would involve the maintenance of the
canines by treating their recession and bone resorption,
|
13
which had exposed more than half of the roots, implant
placement in the incisal regions with soft-tissue grafting,
and extractions of the remaining posterior teeth and
implant treatment after guided bone regeneration and
sinus lift. For this option, the final restoration would
involve implant-supported bridges for regions #16–14,
#12–22 and #24–26 and crowns on teeth #13 and 23
after three months.
The second treatment option would consist of extraction
of all the remaining maxillary teeth and restoration of
the full arch with the Straumann Pro Arch concept.
This would involve the placement of four Straumann BLX
implants immediately after extraction in regions #15, 12,
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16
17
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21
22
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24
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26
27
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Table 1
Table 2
22 and 25 in a fully digitalised approach, using guided
surgery, a preoperatively fabricated screw-retained
CAD/CAM restoration for immediate function and aesthetics after surgery and a final restoration placed six to
12 months later.
(STL file) were matched in coDiagnostiX (Figs. 7–9).
The anchor pin guide, bone reduction guide, surgical
guide and bite registration guide were designed with
coDiagnostiX (Figs. 10–13) and produced using
3D-printing technology.
The total treatment time of the first option would be one
year and eight months, resulting in a higher number of
visits, longer chair time and higher costs in comparison
with the second option. Because of the reliable and short
treatment protocol and the patient’s inability to visit the
clinic for an extensive period, he chose the second
option. The patient was to receive a holistic treatment
approach for the mandibular teeth too; however, the
COVID-19 pandemic delayed the treatment.
Prosthetic design planning
Implant placement planning
An intra-oral scan was taken to record the patient’s
current oral situation, and the future prosthetic design
was created with software using the digital smile design
(DSD file) for the laboratory (Figs. 3–6). The 3D radiographic data (DICOM file) and the prosthetic design project
34
To design the restoration digitally, we selected the screwretained abutment (SRA) angle and gingival height (Fig. 14),
and then we created the patient model on which we could
connect the BLX implant with the SRA selected from the
Straumann library (Fig. 15). The surgical guide was placed
on the model to leverage the high stability that we could
gain from palatal support (Figs. 16 & 17). After printing of the
model, the BLX implant analogues were positioned using
the surgical guide. The digital planning using coDiagnostiX
allowed the dental technician to identify all the necessary
parameters related to implant position (Figs. 18–22).
Emergence profiles were set up on the model (Fig. 23).
The model was scanned using the scan bodies, and a
CAD/CAM provisional restoration was designed and milled
from a PMMA-based restorative material (Figs. 24–29).
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33
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35
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case report
36
37
38
39
40
41
42
43
44
Guided surgery
On the day of surgery, we followed the surgical protocol
provided by the implant planning software, which guided
us on the drilling sequence and the use of the appropriate
instruments for the implant bed preparation (Tables 1 & 2).
After the position of the anchor pins had been marked,
teeth #17–15, 13, 12 and 22–24 were atraumatically
extracted, and alveolectomy was performed using the
bone reduction guide (Figs. 30–35). Four implants (diameter:
4.5 mm; length: 12.0 mm; regular base; SLActive; Roxolid)
|
were placed, two straight implants in the anterior zone
and two tilted implants in the posterior zone. All the implants were stabilised to a torque of 50 Ncm (Figs. 36–42),
and the SRAs were placed on top, those on the posterior
implants having an angulation of 30° (diameter: 4.6 mm;
gingival height: 3.5 mm) and those on the anterior
implants having an angulation of 17° (diameter: 4.6 mm;
gingival height: 3.5 mm; Figs. 43 & 44).
The bite registration guide was fixed with the pins, and
the open-tray impression copings were placed on the
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48
49
50
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51
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55
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57
SRAs of the anterior implants and fixed with the guide using flowable composite (Figs. 45–49).
Impression taking for a
provisional zirconia restoration
Afterwards, we checked the provisional CAD/CAM restoration designed before the surgery (Fig. 50) and placed
protective caps on the SRAs, followed by bone grafting
using cerabone granules (botiss biomaterials) with a
1–2 mm grain size in the extraction sockets and suturing
(Figs. 51–53).
Because the patient was not able to visit the clinic periodically for follow-ups, we had decided to have him wear the
immediate PMMA restoration for a short time and to fabricate a provisional zirconia restoration thereafter to optimise
the condition and patient experience while he was not able
to visit our clinic. For the impressions, we used open-tray
58
59
60
61
36
54
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[37] =>
case report
62
64
|
63
65
impression copings (Fig. 54), and the impressions, together
with the bite registration, were transferred to the laboratory
(Figs. 55 & 56). The PMMA restoration was screwed on to
the SRAs, and the DSD image was taken (Fig. 57).
Laboratory procedures for the provisional
zirconia restoration
After creating the master cast, we were able to scan and
design the zirconia restoration (Figs. 58–61). The design of the
zirconia restoration was done by obtaining the information
from the bite registration, the image of the provisional prosthetic design (Fig. 6) and the mock-up with the provisional
PMMA restoration in the DSD. We then made a few modifications to the zirconia restoration. The design of the provisional zirconia restoration was sent to the milling unit and
produced from a full-contour zirconia disc. The final zirconia
restoration was then cemented on Variobase copings as an
interface to be screwed on to the SRAs (Figs. 62 & 63).
Treatment outcomes
Immediate implant placement associated with immediate
loading is a predictable protocol with some variables. The
digital tooth extraction was integrated with the production
66
Five-day follow-up
After five days, the patient returned to the clinic, the fixed
provisional PMMA restoration was removed and the
provisional CAD/CAM zirconia restoration was placed,
achieving a passive fit on the abutments with initial hand
tightening of each SRA up to 5 Ncm. After the seating had
been checked, the torque of each SRA was increased up
to 35 Ncm, and the restoration was screwed in at a torque
of 15 Ncm (Fig. 64). The occlusion was checked and contacts inspected. The screw access holes were sealed
with PTFE and a temporary filling material. A panoramic
radiograph was recorded, and the SRA screw positions
were evaluated to confirm the perfect fit of the provisional
restoration (Fig. 65). Oral hygiene and dietary instructions
were given to the patient, and a one-week follow-up
appointment was scheduled (Fig. 66).
of a screw-retained CAD/CAM provisional restoration
prior to the surgery and was successfully achieved.
The entire treatment workflow was done fully digitally.
Only a single surgical step was required to provide an
entire individualised prosthetic rehabilitation.
about
Dr Tran Thanh Phong is oral surgeon
from Ho Chi Minh City in Vietnam.
He runs a private practice exclusively
for oral implantology. Dr Phong is an
International Team for Implantology
speaker in Vietnam and an expert in
digital implant dentistry and merging
CAD/CAM processes with digital workflows.
CAD/CAM
1 2023
37
[38] =>
| industry report
Individual PEEK healing abutments
and impression copings
Nature-conforming emergence profiles in implant therapy
By CAMLOG Biotechnologies
PEEK has been in clinical use in implant dentistry for
many years and is predominantly used to fabricate
provisional restorations. The tissue-friendly PEEK material
and the optimisation of the anatomical emergence profiles offer clinical benefits in that no additional soft-tissue
manipulation is required and the shaped profile can be
transferred to the master cast in a precise manner (Figs. 1 & 2).
A stable soft-tissue cuff protects and nourishes the
peri-implant bone and creates the basis for a predictable
aesthetic outcome for the definitive restoration.
Customised PEEK healing abutments and
impression copings for Camlog implants
1
Fig. 1: Design of a customised healing abutment based on a virtual wax-up.
(All images © Dr Steffen Herzberg, Witten, Germany)
The replacement of missing teeth with dental implants
is an established therapeutic approach that allows
predictable results if correctly indicated. In the past, the
focus was on osseointegration of dental implants. Today,
the primary focus is on preserving the peri-implant tissue
structures and increasing patient comfort while reducing
morbidity and treatment time as far as possible.
In July 2021, CAMLOG Biotechnologies established a
new workflow in implant therapy with DEDICAM services
for its new customised anti-rotation PEEK healing abutments and PEEK impression copings, which are designed on the basis of patient-specific emergence profiles and manufactured from the same data set as part of
the CAD/CAM process. The individually tailored healing
abutments and impression copings, which are identical in
subgingival design, enable preoperative, intra-operative
and postoperative procedures for the shaping and
transfer of peri-implant soft tissue—for which intensive
interdisciplinary exchange between the treating teams is
an advantage.
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CAD/CAM
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The individualised PEEK healing abutments and impression copings are available with the connection for
CAMLOG SCREW-LINE and CAMLOG PROGRESSIVELINE implants (Figs. 3 & 4). They are milled in a CAD/CAM
procedure from solid PEEK rod material with a diameter
of 10 mm. Milling PEEK requires comprehensive knowledge of material processing and quality assurance, since
the patient-specific products demand the highest precision in manufacture.
The PEEK healing abutments are approved for use in
the oral cavity for a duration of 180 days. They can be
ordered individually or as a set consisting of a healing
abutment and an impression coping. The copings are
available for use with either the open- or closed-tray technique. For easy orientation of the individual products
in the oral cavity, it is recommended to apply a visual
marking in the form of a small indentation on the healing
abutment and impression coping.
“The PEEK healing abutments
can be ordered individually
or as a set consisting
of a healing abutment
and an impression coping.”
[39] =>
industry report
|
2
Fig. 2: Anatomical design of the healing abutment and definition of the emergence profile.
Utilising the libraries provided for the CAD software
from 3Shape, exocad and Dental Wings, registered
DEDICAM customers can design the healing abutments
themselves and submit an order for their subsequent
manufacture (Fig. 5). Based on the same data set, the
impression copings can be manufactured upon request
as well.
planning, intra-oral scanning and guided implant
placement, individually created implant components
achieve the optimal conditions for a customised
prosthetic restoration. Besides individual planning,
customisation extends to every prosthetic component, which can be manufactured in an individualised and precise way by means of CAD/CAM
technology.
By integration of the digital process chain and
the multifaceted workflow possibilities in the dental
practice and laboratory, patient-friendly treatment
concepts can be realised in a cost-efficient manner
and are easily adapted to the individual infrastructure
and requirements of the treating team. In addition
to 3D radiographic diagnostics, virtual 3D implant
4
Workflow possibilities
The use of the customised PEEK healing abutments is
characterised by great flexibility of the workflow. In the
following sections, three possible workflow options are
shown.
4
Fig. 3: Customised PEEK healing abutments inserted immediately after implant exposure. Fig. 4: Customised PEEK healing abutments supporting the
soft tissue for healing of the mucosa in an anatomical form.
CAD/CAM
1 2023
39
[40] =>
| industry report
5
Fig. 5: Using 3Shape Inbox for easy ordering of customised impression copings, which are of a subgingival design identical to that of the healing abutments.
The digital way
Based on the implant planning, which employs backward
planning, the anatomical emergence profile is established, the subgingival area is designed to support the
tissue and the height of the healing abutment is determined. An order for the design and manufacture of a surgical guide, a healing abutment and, if desired, an impression coping is submitted to Camlog (Figs. 6 & 7).
Alternatively, the design can be done in the laboratory
using the DEDICAM CAD library.
6
After guided surgery, owing to the exact positioning
and alignment of the implant’s internal configuration,
the healing abutment can be placed as part of a onestage immediate restoration procedure. The inserted
healing abutment heals uncovered, and the soft tissue
forms anatomically based on the abutment’s emergence
profile. If covered healing is preferred, the healing
abutment is inserted after exposure, in conjunction
with soft-tissue thickening in the form of a roll flap if
necessary.
7
Fig. 6: Using the customised impression copings for exact transfer of the soft-tissue situation and the implant position to the model after healing of the
soft tissue in a complex case. Fig. 7: Anti-rotation impression copings in situ, enabling accurate transfer to the master cast.
40 CAD/CAM
1 2023
[41] =>
industry report
|
If the healing abutment has shaped the soft tissue such
that it is adequately supportive, the design can additionally be used without modification to design the definitive
abutment. If changes are required, the soft-tissue situation can be recorded using an intra-oral scan taken from
the implant shoulder. However, for complex rehabilitations with bridge restorations on the implants, analogue
impression taking with the PEEK impression copings has
been proved to be advantageous.
The partially digital way
The partially digital way is characterised by collaboration
between the surgeon, referring dentist and dental technician. In coordination with the dentist, the surgeon places
the implants and scans them prior to covered healing.
When the implants are exposed, the customised healing
abutments are employed to anatomically shape the
peri-implant soft tissue.
After tissue healing, the prosthetic restoration commences
in the practice of the referring dentist. At this point, the
mucosa is already perfectly shaped and is transferred
to the laboratory for the fabrication of a master cast by
means of the individual impression copings in an analogue procedure without any additional effort. Based
on the preferences of the dental technician, the implant
restoration is then fabricated in either analogue or digital
fashion.
Outsourcing to the production centre—
a mix of analogue and digital
The surgeon takes an implant impression or scans
the implant position intra-operatively. He sends either
the physical models or the scan data together with
the situation scan and opposing arch scan to Camlog.
The skilled dental technicians at the DEDICAM service
centre design the patient-specific healing abutment in
consultation with the treating clinician and submit a
manufacturing order for the healing abutment and impression coping to the production centre. There, both
are manufactured with high precision and are available
in the practice when the implant is exposed in order to
obtain the best clinical conditions for anatomically
shaped mucosa (Fig. 8).
Conclusion
With the individual PEEK healing abutments and impression copings, the workflow is flexible and convenient for
everyone involved. The virtually designed patient-specific
emergence profile can be safely controlled from the time
of implant placement until the realisation of the definitive
restoration. There is no need to manipulate the soft tissue
as would be the case after removing a standardised
healing abutment. An impression coping with the same
emergence profile, since it is created from the same data
set, prevents the mucosa from collapsing and transfers
8
Fig. 8: Definitive restoration with stable and anatomically formed
peri-implant mucosa.
the shaped soft-tissue profile for the fabrication of a
form-congruent abutment. The easy handling, predictable result and reduced treatment appointments, pain
and work steps distinguish this patient-friendly treatment
concept. The work required for crafting a model or a
silicone key for analogue fabrication of individualised
impression copings with composite is eliminated. With
this treatment concept, surgeon and prosthodontist work
closely together with the laboratory and Camlog for the
ultimate benefit of the patient.
PEEK has been established in implant therapy as a
tissue-friendly material for provisional restorations. In addition to optimising the mucosa and preserving the alveolar bone, an anatomically designed emergence profile
creates the basis for the natural red–white aesthetics of
the implant restoration. The use of customised healing
abutments and impression copings is time- and costefficient and a valuable part of a patient-friendly treatment
concept.
Editorial note: DEDICAM services are not available in all
countries. Please contact the local BioHorizons Camlog
sales representative for further information.
“With the individual
PEEK healing abutments
and impression copings,
the workflow is flexible
and convenient.”
CAD/CAM
1 2023
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[42] =>
| interview
Realising optimal integration of
function and aesthetics
An interview with Dr Marco Tudts, edelweiss dentistry
By Dental Tribune International
Austria-based company edelweiss dentistry showcased its innovative aesthetic solutions at this year’s
IDS. In this interview, Dr Marco Tudts, one of the
company’s key opinion leaders, explains the newest
additions to the edelweiss dentistry product portfolio
and the benefits of the company’s unique hybrid glass
material.
Dr Tudts, at this year’s IDS, edelweiss dentistry
presented the new edelweiss CAD/CAM BLOCK.
Could you tell us more about this product?
The edelweiss CAD/CAM BLOCK is our newest product
and a true breakthrough in CAD/CAM technology. The
uniqueness of the edelweiss CAD/CAM BLOCKs lies
in the patented manufacturing process that uses laser
sintering and vitrification to produce a state-of-the-art
hybrid glass block. As a result of this process, the material
properties are greatly enhanced.
Fig. 1: Dr Marco Tudts is a senior lecturer at Ghent University in Belgium
and maintains a private clinic with a focus on aesthetics and complex
rehabilitation. Fig. 2: The new edelweiss i-BLOCK.
1
2
42 CAD/CAM
1 2023
[43] =>
interview
|
3
Fig. 3: The edelweiss DIRECT VENEERs and OCCLUSIONVD system. (All images: © edelweiss dentistry)
The block has the aesthetics of feldspathic or pure glass,
the strength of particle-infiltrated ceramics and the resilience
of hybrid composite blocks. Its versatile application, in
combination with its time- and cost-saving procedures,
makes the edelweiss CAD/CAM BLOCK a real asset for
dental professionals who have their patients’ best interests
at heart.
The edelweiss CAD/CAM BLOCK has several advantages
compared with other blocks currently on the market.
Owing to the material’s glass-like property, the final restoration only needs to be polished with a linen buff, which
significantly speeds up finishing and polishing, and does
not require additional firing and glazing equipment.
As part of the digital workflow, edelweiss dentistry
offers an implant CAD/CAM block. What are its
advantages?
The edelweiss i-BLOCK is unique because for the first
time we have a hybrid glass CAD/CAM block that can be
used to create customised directly screw-retained implant crowns. The new edelweiss i-BLOCK fits precisely
on a titanium base (or similar attachments) so that the
final restoration can be placed in the same appointment,
reducing treatment sessions and improving the patient
experience.
In addition, it has a unique shock-absorbing effect. Resin
within the material provides resilience to the restoration
to withstand any occlusal force. This is particularly important to avoid transmission of force to the periodontal
tissue, the implant, the opposing tooth or the temporomandibular joint.
The unique properties of the i-BLOCK ensure high aesthetics and exceptional strength with long-lasting polish
and wear resistance. The modulus of elasticity is similar
to that of dentine, making these blocks the best choice
for immediate loading procedures on implants, and the
i-BLOCK can easily be integrated into the practice’s
digital workflow.
What is unique about edelweiss dentistry’s restorative systems?
As mentioned before, through our patented manufacturing
process, we produce a unique hybrid glass material.
Being in a solid glass phase, this material stands out from
other materials on the market, as it has the optical properties of natural enamel, giving the restorations made from
it a lifelike appearance.
“The edelweiss CAD/CAM
BLOCK is our newest product
and a true breakthrough
in CAD/CAM technology.”
The physical and mechanical properties are also improved. Its strength is now similar to that of lithium disilicate ceramics. This benefits the clinician in that the material has properties similar to those of ceramics and
does not require extensive tooth preparation.
Making use of its excellent adhesion to the tooth structure,
minimal or non-preparation designs are used following
biomimetic principles of replacing only lost tooth structure and preserving the healthy tooth structure. This is
what edelweiss dentistry stands for: the optimal integration
of function and aesthetics.
CAD/CAM
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[44] =>
| interview
Digital workflow for dental
offices and laboratories—
where are we now?
An interview with Niels Plate from Dentsply Sirona
© Dentsply Sirona
By Magda Wojtkiewicz, Dental Tribune International
In an interview with Dental Tribune International at IDS, Niels Plate spoke about the present and the future of digital technologies in dentistry.
During the 2023 International Dental Show (IDS),
Dental Tribune International talked to Niels Plate, group
vice president of digital devices and equipment at
Dentsply Sirona, about the present and the future of
digital technologies in dentistry.
Why should dental professionals go digital—and why
would you recommend it?
I think that many dental professionals are already digital to
some extent, whether they know it or not, because
often they have very simple intra-oral cameras, which just
44 CAD/CAM
1 2023
take photos of the teeth, integrated into their treatment
centres that take digital images. Many dental professionals have digital radiographic units too, and now many
dentists also have 3D scanners, which are all digital.
Why should they go digital? Generally, this improves the
treatment outcome and increases the efficiency of the
practice. At the moment, in dentistry particularly, but also
in many other industries, the key bottleneck is labour:
we don’t have enough dentists or assistants or receptionists or lab technicians. So all over the industry, there is a
[45] =>
|
© Koelnmesse
interview
Dentsply Sirona presented interactive events, exciting digital experiences and live demonstrations at IDS.
severe shortage of qualified people. Digital helps people
to become more efficient, to produce reproducible results and to get better clinical outcomes, but also to focus
on the core of the job, and this means the patient and
the clinical result.
I can give one very simple example, the documentation
of our new Primeprint Solution. It automatically documents each print and allows the dentist to simplify data
storage in one PDF file. All necessary data can be summarised in one PDF file, which the dentist can then use
to fulfil his legal obligations, eliminating the need to take
any notes, to have any records and to do anything manually; all the work is done automatically. This is exactly
what I mean. This is work which is a waste of qualified
time for the dentist or assistant. This is where we can
help.
What are the latest digital devices and equipment
Dentsply Sirona is showcasing at IDS 2023?
Dentsply Sirona is showcasing many new products at
IDS, but let’s go through them in the sequence they were
introduced. The first one is the Axano. It’s a dental chair,
but of course, it’s much, much more, because it is built
to ideally support the individual way of working of each
dental professional. What does that mean? It means that
as a dentist you can use three settings, but you can
basically individualise the whole workflow according to
your requirements, working style, training and working
preferences. This helps to save time. By presetting the
dental chair regarding how you do an endodontic treatment or how you do a restoration, you don’t need to set
the value each time, allowing you to work fluently without
taking your hands off the patient because all the functions of the dental chair can be controlled by foot. This
allows you to switch smoothly through your preset
menus. Of course, Axano has many other excellent
features, like a massage function for the patient, but the
most important is that it combines an efficient workflow
with ergonomics.
The next product Dentsply Sirona is showcasing at IDS
is the Primeprint 3D-printing system. This is our first
“Digital helps people
to become more efficient,
to produce reproducible
results and to get
better clinical
outcomes (...).”
CAD/CAM
1 2023
45
[46] =>
© Koelnmesse
| interview
Trade show attendees experienced the digital universe at Dentsply Sirona’s booth.
3D printer, and it was very important for us to have a fully
digitalised workflow offering a complete solution for the
dentist.
Primeprint Solution runs mostly automatically, employing
a robotic arm that handles the printed object. It uses the
patented cartridge system to keep the printed object enclosed so that no chemical fumes reach the user. The
user then switches over to the post-processing unit by
pressing a button, and that again proceeds fully enclosed
and completely automated, producing the final washed
object. Primeprint Solution is designed for all the common dental applications, which start with models, then
also night guards, splints, surgical guides, temporary
restorations and mock-ups.
But there is another product I’d like to mention, Primescan
Connect, which is a version of Primescan, our highperforming intra-oral scanner now available in a laptop
configuration. The laptop version was requested by many
markets. This feature makes the workflow easier and
more ergonomic.
Primeprint Solution and Primescan Connect—are connected to DS Core, our cloud-based solution that provides up to 15 TB of cloud storage. Of course, DS Core
can connect all services and data, including radiographs,
clinical photographs and case files, and dentists can
46
CAD/CAM
1 2023
share all the data with some clicks or access it from
wherever they are. This data can be safely shared with
partners, with labs and with the patient. In the future, DS
Core will provide further solutions, because the possibilities of its use will continue to evolve.
Here at Dentsply Sirona’s IDS booth all presented devices are connected to DS Core.
Is Primeprint Solution designed exclusively for dental offices, or can it also be used in dental labs?
Our first intention with Primeprint was to have a chairside solution, but it is designed for both dentists and
dental technicians, depending on the size and set-up
of the dental lab. For a very big lab, then I would say
that a more industrial type of product would be needed,
but for the typical family-owned dental lab in Germany,
Primeprint is a very good solution. The biggest advantage of Primeprint is that it is fully automatised, so it
can run the entire printing process, including postprocessing, and safely deliver the final printed product,
providing a chairside solution. This device meets so
many high standards that you could even put it in your
living room.
What role does education play in transitioning dentistry to digital, and how is Dentsply Sirona fulfilling
this role?
[47] =>
interview
Education is very important to Dentsply Sirona and I think
we have all learned during the COVID-19 pandemic
that we can also digitalise education a little bit more.
Dentsply Sirona offers education programmes through
the Dentsply Sirona Academy. In our many international
education centres around the world, the largest being in
Charlotte in North Carolina in the US and in Bensheim in
Germany, we provide the knowledge, skills and inspiration. Among the clinical educational material available
on our academy platform, we have just published
on-demand curricula.
We also offer more and more digital content on various
platforms, like YouTube, where dental practitioners can
get quick training on subjects of interest, especially on
topics related to digital, or when they just want to get instructions on how to do something, how to maintain a
device or how to use certain functions. All this information
is available online.
I believe that this is the way forward, because that is
exactly how we behave in our non-professional lives.
When I needed to change the battery in my car key, what
did I do? I opened YouTube and searched for a video on
how to do that. I didn’t open the instruction manual;
I found the information online.
Dental professionals also search for information in this
way, and Dentsply Sirona is ready to provide them with
the answers they are looking for where they are looking
for it. Apart from that, we are putting a huge focus on user
experience.
The use of digital technology is a growing trend.
What do you think the next five to ten years will bring
in terms of new products or workflows?
Yes, I think that in the coming years the use of digital technology will still be a growing trend.
What we are now seeing is that digitalisation is moving
quicker and quicker, producing a huge amount of data,
and this will make it mandatory to move things into the
cloud, same as we saw with office software or in many
other industries. Moving to the cloud will give us not only
unlimited storage but also unlimited computing power,
which then, of course, will enable things like artificial intelligence in support of the dentist. I would expect then
bigger breakthroughs in diagnostics to help the dentist
to do an initial diagnosis and create a treatment plan to
solve the problem identified.
I think that design of dental restorations will be much
more automised and that these services which are still
done manually will become more and more generic.
This technology, called biogeneric, is already known to
CEREC users, but will evolve and become define a new
standard way of working. Today, you can imagine that
|
automation will move further and further and reduce the
need for the dentist to amend the final design, making
results reproducible.
I believe that another important area is outcome simulation. A very important part of dentists’ work is communicating with their patients about the outcome of the treatment planned. We can see that very well at the moment
for aligner treatments. A number of companies offer an
outcome simulator, which shows patients how their teeth
will look after aligner treatment. Of course, this has to
be transferred to other treatments to enable dentists to
show patients’ their smiles after treatment and give them
a treatment choice.
“Moving to the cloud
will give us not only
unlimited storage but also
unlimited computing power,
which then, will enable things
like AI support (...).”
The last area I would like to mention is equipment
efficiency to keep everything well maintained and to
increase uptime and reduce downtime. Treatment
management and remote servicing are other areas which
we are actively working on. We can see the first results in
DC Core already today, and this will reduce service costs
significantly. We will increase the number of cases for
which we can fix any issue remotely, without sending a
service engineer to the dental practice, which means that
the dentist can continue working. We will enable bigger
structures, like dental service organisations, to manage
their fleet and make sure that all their facilities are running
and service their dentists well.
That is in a nutshell what I expect, but of course, there
is much more. But there is also a natural limit to what
can be done in a certain amount of time.
Editorial note: More information about the products can
be found at dentsplysirona.com.
CAD/CAM
1 2023
47
[48] =>
| interview
Successful use of KATANA Zirconia
Block in single-visit dentistry
An interview with Dr Karim Nasr
By Kuraray Noritake Dental Europe
Dr Nasr, what chairside CAD/CAM system do you
currently use?
I am currently using a chairside CEREC Primescan AC
system (Dentsply Sirona), combined with an MC XL milling machine (Dentsply Sirona), in my private practice.
In my hospital practice and in the specialist aesthetic dentistry practice that I manage, we use a CEREC Primescan
AC system, combined with a CEREC Primemill milling
machine (Dentsply Sirona).
48
Dr Karim Nasr
Why did you opt for those components?
The choice of this entire system was guided by several
criteria. Working in a proprietary ecosystem certainly
locks the possibilities of mixing the equipment, but brings
real simplicity and fluidity of use. Moreover, the CEREC
software is certainly the most successful CAD software
for chairside use. It offers personalised and easily modifiable restorations in just a few steps. The simultaneous
milling of the top (extrados) and bottom (intrados) surfaces without changing the burs ensures a very short
milling time. Finally, a large number of materials are
available and can be used with this system.
Zirconia is a popular restorative material with highly
beneficial mechanical and optical properties. Owing to
long processing times, especially sintering, the material
was initially not suitable for single-visit dentistry. This
changed with the availability of zirconia variants with
shortened sintering times and special high-speed sintering furnaces. Among these variants is KATANA Zirconia
Block.
When did you start working with a chairside CAD/
CAM system?
I discovered and started working with my first chairside
system, CEREC 3, in 2005, shortly after graduating.
At that time, everything was new in this field. The intraoral scanner, CAD software, milling unit and ceramic materials had just been introduced. All those components
allowed us to deliver aesthetic dental treatments within a
single treatment session for the first time.
Kuraray Europe discussed these developments with
Dr Karim Nasr, a senior lecturer and head of CAD/CAM
postgraduate training at the Université Toulouse III—
Paul Sabatier in France. Having a passion for CAD/CAM,
he has used CEREC since 2005, was a CEREC trainer
and founded the iAcademy for digital dentistry training.
In this interview, he shares his experience of chairside
CAD/CAM, as well as his workflow and indication-specific
material preferences, and gives specific recommendations
regarding the use of KATANA Zirconia Block in single-visit
dentistry.
How have the chairside CAD/CAM systems evolved
over time?
Of course, with the advances in computer technology,
the systems have become more efficient. While it was still
necessary to powder the surfaces and possible to record
one or two teeth in 2005, now powder is no longer required
and full arches can be scanned in less than 2 minutes
with an accuracy of less than 20 μm. The design process is highly automated and very well supported—
artificial intelligence is used at all stages, making the
work easier.
CAD/CAM
1 2023
[49] =>
interview
For what purposes do you use your system today?
Over more than 15 years, the use of my system has
evolved. Nowadays, I reserve it for procedures that can
be performed in a single session. This is of the greatest
utility for my patients, and it allows me to optimise my
treatment time. For this reason, both the milling time and
the time needed for post-processing are crucial for the
decision of whether to use my chairside CAD/CAM
system or to collaborate with a dental laboratory.
What kinds of materials do you process chairside?
I think I have tested all the materials available, at least
in France, to be able to select the most suitable ones
for daily procedures. Currently, I use different kinds of
materials depending on the indication: PMMA for temporary restorations, composites for inlays and onlays, glass-
ceramics for onlays, overlays and crowns, and zirconia
for crowns and bridges.
How do chairside CAD/CAM and zirconia go together?
Quite simply! For me, chairside equipment must be able
to produce restorations in the same treatment session.
Otherwise, it is a labside workflow. Thus, to use zirconia
in chairside systems, the milling procedure must be fast
and efficient and, above all, the post-processing, especially sintering, must be fast. For short processing times,
dry milling is recommended, as well as the use of a
fast-sintering furnace, such as the CEREC SpeedFire
from Dentsply Sirona.
|
What are the benefits of zirconia compared with
other ceramic materials?
There are many of them. From a biomechanical point of
view, the high mechanical strength of zirconia allows us
to work with reduced wall thickness, which enables
us to be more conservative of dental tissue or to choose
any placement method, cementation or bonding.
From a biological point of view, perfectly polished
zirconia is the most tolerant ceramic, as it is kind to
antagonistic teeth and incredibly well tolerated by
periodontal tissue. I prefer zirconia for my crowns on
implants for this reason.
What was your first impression of KATANA Zirconia
Block?
I caught a first glimpse of the new material during an
event in 2018. KATANA Zirconia STML already existed in
discs for laboratories and was well known for its aesthetic
qualities. Its block version was highly anticipated, but
the most amazing feature was the short sintering
times announced—when using the CEREC SpeedFire
in particular.
Testing it, I was amazed by the quality of the ceramic and
impressed that it was possible to obtain such an aesthetic result in terms of translucency and shade gradation
within such a short time. This is aesthetic zirconia for
everyone!
49
[50] =>
| interview
For which indications do you employ KATANA
Zirconia Block?
I reserve the use of KATANA Zirconia Block for crowns
and for three-unit bridges. In some cases, I also use it to
produce cantilever bridges with a single-retainer design
to replace missing incisors, as described by M. Kern.
I particularly like it in cases where I employ a biologically
oriented preparation technique or vertical preparation.
Are there any features of the material which are
particularly interesting for you?
Its biomechanical qualities—which are those of zirconia—allow me to extend the indications of my chairside
restorations, but, in my opinion, the most interesting
property is the degree of translucency. Although it is
translucent, KATANA Zirconia Block is slightly more
opaque than glass-ceramics of the lowest degree of
translucency. This allows me to use it on discoloured
substrates with higher confidence and to avoid the grey
effect without having to use an opaque resin cement.
Do you have any recommendations for ideal processing of KATANA Zirconia Block?
The use of zirconia in chairside procedures requires
certain precautions to be taken in order to achieve the
expected results. I have carried out many tests to identify
the mistakes not to be made.
First, dry milling is strongly recommended. Nevertheless, it is
quite possible to mill in a wet environment. However, in that
case, it is fundamental to reserve a tank only for the milling of
zirconia, to never use any lubricant in the water—which should
ideally be demineralised water—and to ensure that the filters
are always clean, which means that they need to be cleaned
50
CAD/CAM
1 2023
after each milling procedure. After milling, it is important to
remove all the zirconia powder that may have remained on the
surface. After dry milling, the restoration must be sprayed
with air. The same applies after the use of burs or polishers to
finish the surface. After wet milling, a demineralised water and
ultrasonic bath may be indicated, but is not mandatory.
Very fast sintering with the CEREC SpeedFire, for example,
gives very satisfactory results, comparable with those of conventional slow sintering. This has also been confirmed by scientific literature. Without an appropriate furnace, it is impossible
to perform restorations in the same treatment session. However,
I do not use the CEREC SpeedFire for staining, glazing or microlayering but rather a furnace that can be parameterised.
Finally, I advise users to finish and glaze only what is necessary, such as occlusal grooves and vestibular surfaces
if visible, and to polish the rest.
Do you have any tips on how to achieve optimal
outcomes with KATANA Zirconia Block?
In anterior cases, I always recommend performing
shading and staining steps in the mouth because there is
no better model than patients themselves. Micro-layering
in anterior cases makes it possible to improve the aesthetic result with few steps. The 4.4.1 system, which has
been specifically developed for KATANA Zirconia, makes
micro-layering easy to achieve.
For polishing, the use of twist polishers is recommended.
They make it easier to polish all surfaces, especially the
occlusal surfaces, both extra-orally and in the mouth.
Just like their counterparts for composite, TWIST DIA for
Zirconia polishers are very effective.
[51] =>
manufacturer news
|
Grandio disc multicolor
Aesthetically pleasing restorations at the push of a button
Long-term restorations should be reliably stable and satisfy
patients’ high aesthetic requirements for a natural look. Digital
prostheses impress with first-class results, as even the minutest
of details can be processed with the assistance of computers.
For particularly aesthetically pleasing restorations, VOCO is offering
Grandio disc multicolor, a new product complementing the existing
shades of the Grandio disc nano-ceramic hybrid material. The
multicolor version imitates the colour gradient of natural teeth from
the incisal edge to the tooth neck—with just three layers—even
without individualisation.
The special composition of the material reflects and absorbs light
to create a particularly intense chameleon effect, allowing the
individual layers of the restoration to transition into each other and
producing a highly natural-looking colour gradient. This benefits
the restoration’s optical adaption to the neighbouring teeth and
overall aesthetics.
Invisible layer technology
The restorative material is divided into three layers: one for the
incisal area, one for the dentine layer—the basic tooth colour—
and one for the cervical area. The colouring of Grandio disc multicolor
makes the restoration appear vital, achieved with just these three
layers owing to the material properties.
When developing Grandio disc multicolor, special importance
was attached to remaining in the original shade family (e.g. A1 in
high translucency and A2 in high translucency) of the monocolour
Grandio disc to ensure that all the products could be combined.
The VITA shade system was chosen for selection of the correct
shade. Grandio disc multicolor is available in six shades: A1, A2,
A3, A3.5, B1 and C2. The designated shade is that of the middle
layer. The disc is processed in the milling device in the same way
as the Grandio disc in the monochromatic low translucency and
high translucency shades.
The material can be milled very finely and is easy to polish, allowing
the restoration both to fit perfectly and to meet high aesthetic
demands. With Grandio blocs and Grandio disc, it is possible to
manufacture restorations such as veneers which have very thin
walls and yet are stable, preserving the dental hard tissue.
Furthermore, using these nano-ceramic hybrid materials avoids
the need for time-consuming firing processes.
An overview of our numerous trusted partners can be found on our
website.
www.voco.dental
Indications
Just like the monochromatic version, Grandio disc multicolor has
a thickness of 15 mm and a diameter of 98 mm. It is indicated
for the manufacture of single-tooth restorations such as crowns,
inlays, onlays, veneers and implant-supported crowns.
About Grandio blocs and Grandio disc
The completely polymerised Grandio blocs and Grandio disc set
new standards with their far superior material strength: with a filler
content of 86%, the material is the most highly filled in its class.
The biaxial flexural strength also achieves values which are normally only associated with silicate ceramics, but Grandio blocs and
Grandio disc are significantly less abrasive on antagonists.
CAD/CAM
1 2023
51
[52] =>
| manufacturer news
3Shape innovative software
Do more digitally as a dental laboratory with 3Shape solutions
3Shape enables a laboratory to do more digitally. The company
delivers versatile solutions that optimise the laboratory’s daily
tasks and communication. It streamlines digital workflows to help
build strong relationships and repeat business with dentist
customers. Whether dental professionals take analogue or digital
impressions, 3Shape’s award-winning solutions will help to
manage their caseload more productively.
3Shape software for laboratories
3Shape offers innovative software solutions to optimise the everyday workflow efficiency for laboratories. 3Shape Dental System
is a dental CAD software program that provides a wide range of
in-demand indications, enabling dental technicians to design with
ease. 3Shape laboratory management software provides workflow management for all types of cases, enabling better customer
communication and improved tracking of orders, cases and
invoices.
3Shape dental laboratory scanners
Fast and accurate, 3Shape’s award-winning scanners enable
laboratories to efficiently connect analogue cases to digital workflows.* With four models in its portfolio, 3Shape offers laboratory
scanners for every budget.
52
CAD/CAM
1 2023
The dual-model F8 scanner is the newest addition to the scanner
portfolio and enables laboratories to do more in less time and
with fewer steps. The efficient dual-model scanning workflows
allow technicians to fast-forward to the design steps.
3Shape Design Service for laboratories
3Shape Design Service brings laboratories both the speed of
artificial intelligence and the design expertise of dental professionals to support all design needs. With turnaround times as fast
as 5 minutes, 3Shape Design Service is easy to use and is perfect
for when the laboratory is very busy.
3Shape LabCare
3Shape LabCare is a support package that enables laboratories
to keep up to date. Through customer support, regular updates
and training, LabCare provides peace of mind for a dental laboratory
business.
* Accuracy assessed according to the ISO 5725-1 standard.
www.3shape.com
[53] =>
manufacturer news
|
Workflow and printing solutions
Stratasys and 3Shape team up to develop powerful scan
and print workflow
Scaling production has never been more possible for clinicians,
thanks to the Stratasys J5 DentaJet 3D printer. An ingenious
pairing of the Stratasys J5 DentaJet 3D printer with 3Shape’s
robust software now makes it possible for practitioners to harness the printer’s array of capabilities more easily. Colour and
geometric features of a patient’s mouth can be transformed into
full-colour models with simplicity.
The companies announced that, by using an intra-oral scanner
along with 3Shape software, dentists can add further automation to their workflow, saving valuable time. 3Shape Senior Vice
President for Product Strategy Dr Rune Fisker explained that
time is often lost in trying to accurately match tooth colour;
however, attention to aesthetics is still vital.
developed and published by the 3MF Consortium and is
revolutionary because of the high level of information contained within the file, including model metadata and voxellevel control.
The format’s capability for detail makes it the perfect fit for
the Stratasys J5 DentaJet 3D printer, which is the only one on
the market that is PANTONE Validated for producing full-colour,
multi-material prints, thereby unlocking the capabilities of 3MF.
The success of this open-source project is likely to continue
long into the future, as Stratasys is a key member of the
3MF Consortium.
“For the first time, we’re automating that entire workflow for
customers using 3Shape and the J5 DentaJet printer. Dental
labs will be able to easily harness the full capabilities of the
only dental printer able to create highly realistic replicas of the
patient’s mouth from a TRIOS scan,” he said.
Whether printing is done in-house or in a laboratory, the
3Shape software provides a top-of-the-line workflow and
enables connection to external dental laboratories. The workflow, combined with the state-of-the-art capabilities of the
Stratasys printer, ensures a long-lasting solution for clinicians
who want to offer their patients cutting-edge treatment options
that are continually improving.
Now that support is offered for the open 3D manufacturing
format (3MF) file standard, clinicians can take their scans to
the next level with intra-oral scans that capture both colour
data and geometry. Using an open-source file format such
as 3MF broadens accessibility across dentistry. The format is
www.3shape.com
CAD/CAM
1 2023
53
[54] =>
| meetings
Implant Solutions World Summit 2023
Cutting-edge implant science and innovation
By Dentsply Sirona
Dental professionals are invited to join world-leading
experts in implant dentistry in an exclusive state-of-theart congress, the Implant Solutions World Summit, in
Athens in Greece from 8 to 10 June. Here, they will discover cutting-edge science and be able to explore the
latest innovations in digital dentistry, bone regeneration
and optimised implant treatment solutions, including the
EV implant family—all while enjoying the company of their
peers and friends from around the world.
“Peer-to-peer education is vitally important for our implant solutions community and we are thrilled to bring
implant professionals together from around the world to
explore the latest innovations and science transforming
implant dentistry,” said Tony Susino, group vice president
of global implant solutions at Dentsply Sirona. “The event
promises to be an inspirational opportunity for learning
and networking as we glimpse into the future of implant
dentistry and optimised patient care,” he continued.
The Implant Solutions World Summit will bring together
professionals who are passionate about elevating the
dental industry and improving the quality of implant treatment and care for patients. The congress will take place
at the InterContinental Athenaeum Athens hotel, close to
Greece’s famous Acropolis.
Innovative implant solutions
and digital workflows
Scientific programme
The Implant Solutions World Summit will feature presentations by more than 40 world-renowned experts in implant dentistry, who will share best practices, expertise and
insights. Dental professionals will learn about managing
implant complications, the connection between systemic and
oral health, maximising aesthetics, controlling risk factors,
maintaining peri-implant health and more.
The programme has been developed with the scientific
chairs, Prof. Tara Aghaloo from the US and Dr Michael
Norton from the UK. The programme chairs are Steve
Campbell from the UK, Dr Malene Hallund from Denmark,
Dr Mark Ludlow from the US, Dr Stijn Vervaeke from
Belgium and Dr Martin Wanendeya from the UK.
54
CAD/CAM
1 2023
The Implant Solutions World Summit will also feature
an interactive exhibition and exciting master class
workshops that will allow attendees to learn more about
Dentsply Sirona’s products, solutions and workflows,
including the company’s premium implant portfolio—
DS PrimeTaper implant system, DS OmniTaper implant
system and Astra Tech Implant System. They will also
receive information about OSSIX regenerative solutions,
DS Signature Workflows for single-tooth and partial- and
full-arch restorations, and the cloud-based DS Core platform
for building a successful and efficient dental practice.
The innovative and comprehensive implant solutions
portfolio from Dentsply Sirona has been developed to
help practices grow their implant dentistry business and
achieve the best results for their patients.
Editorial note: More information about the event can be
found at dentsplysirona.com/worldsummit.
[55] =>
THE GLOBAL DENTAL CE COMMUNITY
REGISTER FOR FREE
DT Study Club – e-learning community
www.dtstudyclub.com
@DTStudyClub
Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in
accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.
[56] =>
| meetings
International events
FDI World Dental Congress
4–7 May 2022
Antalya, Turkey
https://cnridentex.com
24–27 September 2023
Sydney, Australia
www.fdiworlddental.org/
world-dental-congress-2023
4th EAS Congress
36th Int’l Dental ConfEx
CAD/CAM Digital &
Oral Facial Aesthetics
11–13 May 2023
Torino, Italy
www.eas-aligners.com
27–28 October 2023
Dubai, UAE
https://cappmea.com
The British Dental C
onference &
Dentistry Show
GNYDM 2023
12–13 May 2023
Birmingham, UK
https://birmingham.dentistryshow.co.uk
24–29 November 2023
New York, USA
www.gnydm.com
56 CAD/CAM
1 2023
Expodental Meeting
ADF 2023
18–20 May 2023
Rimini, Italy
https://www.expodental.it/en
28 November–2 December 2023
Paris, France
https://adfcongres.com
Implant Solutions
World Summit
ROOTS SUMMIT
8–10 June 2023
Athens, Greece
www.dentsplysirona.com/
worldsummit
9–12 May 2024
Athens, Greece
www.roots-summit.com/
rootssummit/2024-athens/
© 06photo/Shutterstock.com
18th IDENTEX—
International Oral and Dental
Health Exhibition
[57] =>
|
© 32 pixels/Shutterstock.com
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CAD/CAM
1 2023
57
[58] =>
| about the publisher
international magazine of dental laboratories
Imprint
Publisher and Chief Executive Officer
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t.oemus@dental-tribune.com
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
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Franziska Schmid
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Dr Tran Thanh Phong
Niels Plate
Dr Yusuke Takayama
Dr Marco Tudts
International Administration
International Headquarters
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Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
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General requests: info@dental-tribune.com
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www.dental-tribune.com
Chief Content Officer
Claudia Duschek
Clinical Editors
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those of Dental Tribune International GmbH.
58
CAD/CAM
1 2023
[59] =>
Also
• Highly aesthetic due to multicolor shades – ideal for the anterior region
• Highest filler content (86 % w/w) for long-lasting durable restorations
• Resembles natural teeth perfectly
• No firing required
• Can be polished and repaired optimally
VOCO GmbH · Anton-Flettner-Straße 1–3 · 27472 Cuxhaven · Germany · Freecall 00 800 44 444 555 · www.voco.dental
i co
isc
• For the fabrication of definitive crowns, inlays, onlays, veneers
and implant-supported crowns
e as mult
rd
Exceptional material providing strength
for CAD / CAM restoration
a
bl
i la
lo
av
STRONGEST in their class
blocs /
disc
[60] =>
Partners
in excellence.
United
by smiles.
ClearCorrect®, the Straumann
Group’s flagship orthodontic
brand, is excited to announce
new products and clinical
features, an improved digital
workflow, added support, and
treatment planning services
to help doctors treat more
complex cases.
To become a partner
or learn more visit:
clearcorrect.com
Acc.1249_en_01
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/ Digitally planned highly aesthetic restorations
/ Guided maxillary arch implant restoration: Language and cross-border collaboration are no barrier with hybrid workflow
/ A clinical case report on maxillary compromised dentition treated with Straumann Pro Arch in a digital workflow
/ Individual PEEK healing abutments and impression copings
/ Realising optimal integration of function and aesthetics - An interview with Dr Marco Tudts, edelweiss dentistry
/ Digital workflow for dental offices and laboratories—where are we now? - An interview with Niels Plate from Dentsply Sirona
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