CAD/CAM international No. 2, 2023
Cover
/ Editorial
/ Content
/ E-glass fibres need more fine- tuning before they can be useful in CAD/CAM resin composites
/ Intra-oral scans may present more humane option for evaluating clefts in infants
/ News
/ Industry news
/ “Digital technologies are fundamentally changing the dynamics of our industry” - An interview with Stephan Kreimer, a master dental technician from Germany
/ Aspen Dental’s digital denture transformation - An interview with Eric Kukucka
/ Zero-bake technique: A simplified approach to zirconia aesthetics - An interview with Giuliano Moustakis
/ Extremely minimally invasive mock-up-guided veneer preparations in the aesthetic area
/ Restoration of a fractured ceramic crown with a digital workflow
/ Endocrowns milled from CAD/CAM composites for high strength and flexibility
/ The copyCAD 3: Crown legacy
/ Treatment of severe oral pathology in pre-geriatric patients: A proposal for a clinical protocol for same-day dentistry
/ “Alone we can do so little, together we can do so much”—Helen Keller
/ Manufacturer News
/ Meetings
/ International Events
/ Imprint
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[1] =>
untitled
issn 1616-7390 • Vol. 14 • Issue 2/2023
international magazine of dental laboratories
industry news
Post-COVID recovery fuels success
of cost-conscious solutions
interview
Zero-bake technique: A simplified approach
to zirconia aesthetics
case report
Restoration of a fractured ceramic crown
with a digital workflow
2/23
[2] =>
untitled
Partners
in excellence.
United
by smiles.
ClearCorrect®, the Straumann
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new products and clinical
featuresȜȿêśȿĸřƋƎŧǁĔĎȿĎĸĭĸơêŐȿ
ǂŧƎōǗŧǂȜȿêĎĎĔĎȿƕƨƋƋŧƎơȜȿêśĎȿ
ơƎĔêơřĔśơȿƋŐêśśĸśĭȿƕĔƎǁĸćĔƕȿ
ơŧȿĴĔŐƋȿĎŧćơŧƎƕȿơƎĔêơȿřŧƎĔȿ
ćŧřƋŐĔLJȿćêƕĔƕȡ
To become a partner
or learn more visit:
clearcorrect.com
Acc.1249_en_01
[3] =>
untitled
editorial
|
Magda Wojtkiewicz
Managing Editor
To mill or to print? That is the question
The introduction of CAD/CAM milling and 3D-printing
technologies to dentistry has significantly reduced the
possibility of inaccuracies in the fitting of prosthetic restorations. These new technologies have gained the appreciation of dental professionals as well as patients, who have
realised that they no longer have to tolerate the unpleasant
aspects of conventional impression taking or attend several
appointments for a restoration. Patients enjoy the benefits
of receiving a permanent crown in a single visit and dental
professionals the shorter, cleaner and more predictable
workflow. Many dentists, laboratory owners, dental assistants and dental technicians agree that digital impressions
and digital technologies for design and manufacture will
soon replace conventional methods of fabricating dentures, splints, bridges, crowns and even veneers. Increasingly, it is not just milling but also 3D-printing technology
that is being used to produce CAD/CAM dental restorations. How does a laboratory or dentist know which is
better: milling or 3D printing? The answer depends on
what do you need the most—speed, exceptional accuracy
and aesthetics, or lower costs?
The first aspect to consider is the material from which the
final restoration is to be made. Milling uses many different
materials (e.g. titanium alloy, cobalt–chromium–molybdenum
alloy, PEEK, and other polymers, and PMMA and other resins)
but ceramic materials, such as leucite and lithium disilicate
glass-ceramics, which are the most natural-looking replacements for missing tooth substance and are available in a
wide range of shades and translucencies, give most predictable, durable and highly aesthetic results. 3D printing works
with a vast number of different materials too, including
non-precious metal alloys (e.g. cobalt–chromium and titanium alloys), composite resins and ceramics—however,
these are single-coloured, so the printed restorations may
require more finishing than milled restorations.
The second thing to consider is convenience. Nowadays,
3D printing is faster than milling, and according to many
dental professionals, 3D printing is easier to use than milling,
but this is a very subjective opinion and largely depends on
the workflow the user is accustomed to. Many dentists who
own chairside milling machines use them only in easier
cases where a single crown or inlay is required and send
orders for other restoration types to the dental laboratory
for more reliable and detailed results.
Another important factor is accuracy. In this regard,
3D printers do not have a clear advantage over milling.
However, milling tools are limited as milling machines
cannot be made smaller than the tools they use. Because
milling is a removal process and printing is an additive
process, 3D printers are better able to create curves,
holes, and very small and complicated shapes than
milling machines are.
Cost is usually important for both dental professionals
and patients. 3D printers are becoming increasingly affordable, which is great for technology-minded dentists
and laboratory owners. Industrial 3D printers are still expensive, but the average cost of each product fabricated
is cheaper compared with milling. In addition, 3D printing
enables the fabrication of multiple parts at once, and it
produces little or no waste.
The possibilities of using 3D-printing technology in
dentistry seem endless, but there is still much to discover
and learn. Milling is still the most predictable technology
to use for permanent fixed restorations, guaranteeing
consistency and enabling the highest aesthetics.
We can expect that as 3D-printing technology continues
to evolve, this method of fabrication will play an ever
greater role in transforming the field of dentistry.
Sincerely,
Magda Wojtkiewicz
Managing Editor
CAD/CAM
2 2023
03
[4] =>
untitled
| content
editorial
To mill or to print? That is the question
03
news
E-glass fibres need more fine-tuning before they can be useful
in CAD/CAM resin composites
Intra-oral scans may present more humane option
for evaluating clefts in infants
page 40
Will a scan aid actually help with intra-oral implant scans?
06
08
09
industry news
Post-COVID recovery fuels success of cost-conscious
dental implant solutions and digital dentistry
Redefining implant therapy with digital planning,
guided placement and use of CONNECT abutments
12
16
industry report
page 46
CEREC or 3D printing: Which technology for in-office manufacturing? 18
interview
“Digital technologies are fundamentally changing the dynamics
of our industry”
22
Aspen Dental’s digital denture transformation
24
Zero-bake technique: A simplified approach to zirconia aesthetics
28
case report
page 54
Extremely minimally invasive mock-up-guided veneer preparations
in the aesthetic area
32
Restoration of a fractured ceramic crown with a digital workflow
Endocrowns milled from CAD/CAM composites
for high strength and flexibility
38
The copyCAD 3: Crown legacy
Treatment of severe oral pathology in pre-geriatric patients:
A proposal for a clinical protocol for same-day dentistry
46
40
50
practice management
Cover image courtesy of
Rostyslav Drala/Shutterstock.com
issn 1616-7390 • Vol. 14 • Issue 2/2023
2/23
“Alone we can do so little, together we can do so much”
54
manufacturer news
58
meetings
All about the patient: The 2024 ITI World Symposium
international magazine of dental laboratories
61
Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024 62
International events
64
about the publisher
industry news
Post-COVID recovery fuels success
of cost-conscious solutions
interview
Zero-bake technique: A simplified approach
to zirconia aesthetics
submission guidelines
65
international imprint
66
case report
Restoration of a fractured ceramic crown
with a digital workflow
04 CAD/CAM
2 2023
[5] =>
untitled
rative
sto
Re
tics
don
tho
Or
lant
Imp
res
ntu
De
ep
Sle
Simplify
ZRUNÁRZVDQG
expand your practice
Expand your
treatment offerings
NEW DEXIS IS 3800
DEXIS™ IOS Solutions seamlessly
LQWHJUDWHVLQWR\RXUGHQWDOZRUNÀRZ
KHOSLQJ\RXWRVLPSOLI\SURFHVVHV
LQFUHDVHSURGXFWLYLW\DQGIDFLOLWDWHSUDFWLFH
expansion. Say hello to more time for what
really matters — your patients.
Find out more at dexis.com
© 2023 Dental Imaging Technologies Corporation. All rights
reserved; DXIS00275 /RevA
dexis.com
[6] =>
untitled
| news
E-glass fibres need more
fine-tuning before they can be useful
in CAD/CAM resin composites
By Dental Tribune International
Dental restorations often rely on CAD/CAM resin composites for their precision and reliability. However, ensuring
the longevity and durability of these restorations remains
a challenge. The integration of bidirectional E-glass fibres
beneath the composites offers potential benefits in
enhancing fracture resistance and directing crack propagation, thus potentially minimising catastrophic failures.
A recent study has delved into understanding these
dynamics further, finding that the exact placement of
fibre layers under the composites needs consideration in
order to balance resistance and risk of catastrophic failure.
Endodontically treated teeth are more prone to fractures
and often have a reduced lifespan compared with nontreated teeth. The main challenge is preventing fractures
below the cemento-enamel junction, which can cause
unrepairable root fractures. While endocrowns and
overlays have emerged as alternatives to traditional
restorations, concerns remain. A promising approach to
reinforcing restorations is the use of composites reinforced
with fibre, especially glass fibre, and such reinforced
composites possess superior mechanical properties
compared with particulate-filled resins.
The researchers in the study sought to determine whether
the presence and position of E-glass fibre reinforcement
affects the restoration’s load-bearing capacity, fatigue resistance and fracture pattern. To do so, they created 90 specimens
composed of a bidirectional fibre-reinforced composite layer
between a superficial layer of a CAD/CAM resin composite
of different thicknesses and a particulate-filled resin sub-
06 CAD/CAM
2 2023
structure of different thicknesses, the CAD/CAM layer simulating the coronal restoration and the particulate-filled resin
simulating the resin composite core build-up of an endodontically treated tooth. They used 30 specimens of unreinforced
CAD/CAM resin composite as control.
Half of the samples underwent compressive loading and the
other half cyclic loading. The former showed that the control
samples had the highest load at failure and that breaking
force decreased with reducing CAD/CAM resin composite
thickness. Under compressive loading, the CAD/CAM resin
composite displayed high resistance, especially when integrated with a fibre layer, which directed crack propagation
laterally. The cyclic loading showed that the fractures typically occurred at lower stress levels than those defined
by maximum strength. Notably, the layer thickness of the
CAD/CAM resin composite played a significant role in fatigue
resistance. Thicker layers had higher resistance, but the
positioning of the fibre layer had implications for stress distribution. Specimens with balanced tensile and compressive
stresses showed that the fibre layer deviated the crack, indicating the potential for reducing non-restorable tooth fractures.
Analysis of the fracture surfaces, using stereomicroscopy
and scanning electron microscopy, elucidated fracture
origins and directions.
Editorial note: The study, titled “Exploring the influence of
placing bi-directional E-glass fibers as protective layer
under a CAD-CAM resin composite on the fracture
pattern”, was published online on 19 September 2023 in
Dental Materials, ahead of inclusion in an issue.
[7] =>
untitled
Anatomically shaped ,
individualised PEEK gingiva
formers and impression posts
Features
3DWLHQWVSHFLȴFHPHUJHQFHSURȴOH
Made of biocompatible PEEK
&DQEHRUGHUHGLQGLYLGXDOO\RUIURPWKHVDPH
dataset as a “gingiva former + impression post set”
camlog.com/en/products/cadcam
The individual DEDICAM PEEK gingiva formers and impression posts are offered for the
CAMLOG®, CONELOG®, iSy®, CERALOG® and BioHorizons® implant systems. Only open
impression posts can be ordered for BioHorizons®. DEDICAM® services are not available
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.
[8] =>
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| news
Techniques for taking impressions of clefts in infants have not changed in over 70 years. New research has probed the advantages and acceptability of the use of intra-oral scanners.
Intra-oral scans may present
more humane option for
evaluating clefts in infants
By Anisha Hall Hoppe, Dental Tribune International
The study involved seven infants aged 0–28 days diagnosed
with complete unilateral cleft lip and palate. Impressions of their
clefts were taken with the conventional method using an irreversible hydrocolloid impression material and with an intra-oral
scanner. Stone models of the conventional impressions were
scanned, creating virtual 3D models, and the intra-oral scans
were saved as virtual 3D models and 3D-printed.
The virtual models from both methods were superimposed to
compare the alveolar arch width and alveolar cleft defect. The
maximum alveolar arch width and maximum distance between
the premaxillary segments were measured on the physical
models from both techniques using vernier callipers. The superimposed 3D scans of the conventional and digital impressions
showed significant differences in three of the cases. However,
08 CAD/CAM
2 2023
the calliper measurements showed no significant variation
between the conventional and digital impressions.
Additionally, the infants’ guardians completed a questionnaire
on their acceptance of both impression techniques, and their
answers revealed a distinct preference for the digital method.
Two significant findings were that the guardians felt that the
conventional method was more invasive and that they believed
their infant had suffered during its application.
The study indicates a shift away from traditional impressions
owing to associated risks and the stress it places on both
patients and guardians. Digital impressions emerged as safer
and preferred because they minimised risks to infants as well
as eased guardians’ concerns. The study also showed that
digital impressions are accurate and efficient. Digital impression taking also offers the advantage of creating reliable
models for future treatment planning and provides visual aids
to parents that showcase the potential improvements in their
infant’s condition.
Editorial note: The study, titled “Diagnostic evaluation and
guardian assessment of using digital impression in neonates
versus the conventional techniques”, was published online
on 30 August 2023 in the Alexandria Dental Journal, ahead of
inclusion in an issue.
© AM_art/Shutterstock.com
Clefts of the lip and/or palate and alveolar bone are the most
common congenital anomalies of the head and neck and result
in feeding, psychological, craniofacial and speech challenges.
In infants, care may involve preoperative appliances, for which
impressions of their clefts are required. Conventional impression taking techniques pose risks like ingestion and suffocation.
A study at Alexandria University has assessed the reliability of
digital versus conventional impressions in reproducing unilateral
cleft lip and palate in newborns and found digital impressions
to be as accurate but more acceptable for guardians.
[9] =>
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news
|
Will a scan aid actually help with
intra-oral implant scans?
New research suggests using scan aids has both pros and cons
By Dental Tribune International
The use of intra-oral scanners for full-arch digitisation
of edentulous arches with multiple implants has not
been recommended, owing to significant errors. A study
by researchers in Freiburg and Berlin in Germany
compared the accuracy of intra-oral scans for multiple
implants with and without the use of a scan aid. The goal
was to understand the potential improvements the scan
aid could provide in the context of edentulous arch
scans, assessing parameters such as linear deviation,
precision and software recognition of scan bodies.
The findings highlight the role of scan aids in improving
registration of scan bodies and reducing linear deviation
in intra-oral scans.
Having less distinct anatomical surface morphology,
the edentulous jaw makes it difficult to stitch intra-oral
scan images accurately to form a complete virtual
model, and the intra-oral environment can introduce
additional inaccuracies. Efforts to overcome these
issues have included devices that create an optical bridge
or increase the scannable surface, aiming to minimise
stitching errors, but require additional time-consuming
steps that add complexity to the process. Nonetheless,
these devices have been shown to improve scanning
accuracy.
© vetkit/Shutterstock.com
A prior study introduced an optical bridge for universal
use that can be adjusted chairside and is easy to handle.
It tested three different designs and materials for trueness, precision and clinical applicability. The most userfriendly and accurate scan aid had an irregular design
and a grey colour. The aim of the current study was to
evaluate the accuracy of this universal 3D-printed scan
aid in vivo.
The study used a case–control format, scanning implants
in the edentulous jaw with and without the universal scan
aid. Twenty-two participants with an edentulous arch and
at least three implants were selected. The patients had
received CAMLOG SCREW-LINE, SICace (SIC invent) or
Straumann Standard Plus implants, and system-specific
scan bodies were used. Two types of intra-oral scanners,
the CS 3600 from Carestream Dental (CS) and TRIOS 3
from 3Shape (TR), were employed. The scans were
capped at 9 minutes, because it has been found that
repeated scanning does not increase accuracy in areas
with minimal surface morphology.
Failure to register the scan body during scanning was
reported for 25% of Straumann, 20% of Camlog and 8%
of SIC scan bodies. For the CS scanner, 83% of scan
bodies were successfully scanned with the scan aid and
70% without, compared with 96% and 86%, respectively,
for the TR scanner.
The scan aid statistically significantly minimised the
total mean linear deviation when using the CS scanner.
However, for the TR scanner, there was no difference.
As for precision, statistically significant differences were
found between the two scanners when the scan aid was
not used. The scan aid decreased precision significantly
for the TR scanner. Other parameters showed increased
variability, particularly regarding precision within each
group of scan bodies, suggesting that the scan aid’s
usefulness might be influenced by the specific scanning
technology used.
For instance, the CS scanner uses active triangulation,
which may be more prone to errors in edentulous arch
scans and could benefit more from the scan aid than the
TR scanner, which uses confocal microscopy. The use
of the scan aid also improved the software’s recognition
of scan bodies for both scanners.
The authors cautioned about the interpretation of
accuracy regarding the results, owing to inherent errors
in extra-oral reference models and potential deviations
related to scan body height. They concluded that, while
the scan aid can significantly improve linear deviation
with the CS scanner and enhance software recognition
of scan bodies, it may also lead to increased variability
in precision.
Editorial note: The study, titled “Enhancing intraoral
scanner accuracy using scan aid for multiple implants in
the edentulous arch: An in vivo study”, was published in
the August 2023 issue of Clinical Oral Implants Research.
CAD/CAM
2 2023
09
[10] =>
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[11] =>
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[12] =>
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| industry news
Post-COVID recovery fuels success
of cost-conscious dental implant
solutions and digital dentistry
By Elena Generalova, Canada
The long-awaited post-pandemic recovery and
reopening of dental practices for patients after the
COVID-19 pandemic has not only produced a spike
in the growth of dental procedures but also highlighted the need to reconcile the damage done to
the industry, including supply chain issues, economic
hardship and global inflation. Patients and dental
professionals have grown more sensitive to cost and,
as a result, are more open to discount and value
implant products. The growing acceptance of these
more affordable products is set to shift the dental
implant market.
Chart 1: Dental Implant and Final Abutment Market by Segment, Europe, 2022–2029. Chart 2: Dental Implant Market by Segment, Europe, 2022–2029.
12 CAD/CAM
2 2023
[13] =>
untitled
industry news
The most prominent difference between premium,
value and discount implant solutions is the cost,
premium brands costing several times more than
value or discount brands. These price differences not
only reflect research and development and quality
assurance expenses, but also include additional costs
such as the inclusion of training programmes, dental
practice support and extended service from the
manufacturer.
Owing to the high cost of dental treatment and limited
coverage, cost-effectiveness has been always at the
forefront of the dental industry, and the permanent
crisis era of post-COVID recovery has only fuelled the
need for lower-cost implants. Dental insurance coverage remains limited and is usually provided under
an employment benefits package. While the overall
market growth will continue to be constrained by reimbursement and unemployment rates, the lack of it,
to some extent, will drive the need for cost-sensitive
and affordable treatment.
Historically, premium dental implant companies have
dominated the competitive landscape in Europe, but
they have recently faced increased competition from
value and discount brands. In addition, the premium
segment market is mainly shared by four main companies: Dentsply Sirona, Envista Holdings Corp., the
Straumann Group and ZimVie. The growing prevalence
of local manufacturers and an increasingly costsensitive consumer demographic have contributed to
overall price depreciation in the total dental implant
market that has been fuelled by a growing share of the
value and discount segments in the total dental implant
market value. The combined market share of the value
and discount segments is projected to be over half of
the total dental implant market value by the end of the
forecast period.
Similar to the dominance of premium implants, stock
abutments have historically prevailed as the predominant segment of the final abutment market.
Recent improvements in manufacturing capability and
product affordability have resulted in the rapid growth
of the CAD/CAM abutment segment relative to the
stock abutment and custom-cast abutment segments.
CAD/CAM abutments offer significant improvement in
aesthetics and clinical outcomes. The segment became the largest segment in the total final abutment
market in 2022, closely followed by the stock abutment
segment.
Digital dentistry
Further development and adoption of digital dentistry will continue to drive the growth in the dental
implant and bone grafting material markets. Driving
|
Chart 8-2: Leading Competitors, Dental Implant Market, Europe, 2022
Chart 3: Leading Competitors, Dental Implant Market, Europe, 2022.
the CBCT scanner market is the development of
computer-guided surgery software for treatment
planning and implant placement. Based on the treatment plan, the dentist also has the option of using
a surgical guide to assist in placement of the implants.
CAD/CAM technology is increasingly being used to
manufacture customised final abutments as well,
thereby creating a more stable and aesthetic restoration.
Dental manufacturers invest in the digital dentistry
transformation via collaborations with start-ups, education centres and other companies globally to expand
technological capabilities, outreach and local experience. The Straumann Group, for example, has invested
in China to establish a Straumann manufacturing,
innovation and education centre by 2029. The company also founded a new technological and innovation
centre in Switzerland.
Open-architecture systems enable integration with
other components, even those from different manufacturers. Companies producing CAD/CAM abutments
are opening their systems to make the process of
sending a scan easier for dental professionals. Nobel
Biocare’s system, for example, can now receive CAD
files from 3Shape scanners too. Dentsply Sirona too
has opened its CEREC software to support compatibility and a smooth workflow.
Closed systems used to be the only option in the early
days of CAD/CAM development, limiting the dentist’s
choice of components to a single manufacturer.
The shift towards open CAD/CAM systems makes
the process of ordering CAD/CAM abutments more
accessible to the market and is therefore expected
to increase the demand in volume for CAD/CAM
products. In addition, it allows for cross-promotion
of a broader range of products from different manufacturers.
CAD/CAM
2 2023
13
[14] =>
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| industry news
Recent significant events relating
to digital dentistry market
In May 2023, Henry Schein announced the acquisition
of Brazilian company S.I.N. Implant System. The company specialises in value dental implant solutions and
has been expanding into the US market. Henry Schein
is planning to integrate S.I.N. into its Global Oral
Reconstruction Group. The combined forces of the
two companies are set to form a global supply of dental
implant and bone regeneration materials to address
the growing demand in both emerging and developed
markets. The acquisition is expected to be completed
in the second half of this year.
“Companies producing
CAD/CAM abutments are
opening their systems to make
the process of sending a scan
easier for dental professionals.”
In April 2023, ZimVie announced the launch of
RegenerOss CC Allograft Particulate and RegenerOss
Bone Graft Plug, extending the company’s dental bone
grafting portfolio, primarily focusing on the North American
market. Both products are processed by RTI Surgical
and marketed by ZimVie.
In April 2023, Medentika, a member of the Straumann
Group since 2016, announced the launch of a brand
awareness campaign for its MPS multiplatform portfolio of dental implants and prosthetic components.
The campaign is called “This is MEDENTiKA”.
In March 2023, ZimVie introduced the CAD and
FULL SUITE modules for its RealGUIDE digital dentistry
software platform at the International Dental Show in
Germany. The FULL SUITE integration provides a
seamless workflow between the CAD module and
RealGUIDE’s existing Plan, App and Guide modules,
offering a one-stop solution for surgical and restorative
treatment.
In February 2023, BEGO and Rapid Shape announced
their partnership allowing Rapid Shape customers to
process BEGO’s Varseo materials on Rapid Shape’s
D20+, D30+ and D50+ printers. This allows users
of those 3D printers to produce a broad range of
restorative solutions with BEGO’s VarseoSmile and
VarseoWax materials.
14 CAD/CAM
2 2023
In January 2023, Nobel Biocare announced its acquisition of Mimetis Biomaterials, a spin-off from the
Biomaterials, Biomechanics and Tissue Engineering
group of the Polytechnic University of Catalonia in
Spain. Nobel and Mimetis have partnered in the
development of materials since 2016, the newest
product of which is creos syntogain, the latestgeneration synthetic bone grafting material developed
by Mimetis. Through its partnership with Mimetis,
Nobel has been able to expand its portfolio of regenerative solutions.
In its annual report for 2022, the Straumann Group announced 2023 additions to its portfolio, including value
dental implant systems, abutments, grafting materials
and growth factor. This included an Anthogyr line
extension with the Axiom X3 tissue-level implant, the
extension of the BLX and TLX implant family lines, an
addition to the Variobase abutment family and the
Zygoma-S implant designed for the zygoma anatomyguided approach. The company also announced the
continuous global roll-out of cerabone plus, a bovine
bone grafting material with sodium hyaluronate,
starting with Germany, Austria, Switzerland and the
Nordic countries. The company also announced the
global release of the Medentika multiplatform and implant system. Other new products are the fully tapered
TLX tissue-level implant system for immediate protocols, the Neodent two-piece screw-retained zirconia–
zirconia connection implant with a tapered design and
the Neodent Helix GM Narrow implant, also for immediate protocols. The company is planning a continuous
global roll-out of its Emdogain growth factor, featuring
the latest extension of its indications to flapless surgery
and peri-implant therapy.
about
Elena Generalova is analyst team
leader at iData Research. She specialises
in research projects on the medical
technology industry, including the
global market for dental materials
and the European market for dental
implants, bone grafting materials and
other biomaterials for dentistry.
For over 19 years, iData Research has been a strong
advocate for data-driven decision-making within the global
medical device, dental and pharmaceutical industries.
By providing custom research and consulting solutions,
iData empowers its clients to trust the source of data
and make important strategic decisions with confidence.
More information can be found at https://idataresearch.com.
[15] =>
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© MIS Implants Technologies Ltd. All rights reserved.
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
[16] =>
untitled
| industry news
Redefining implant therapy with
digital planning, guided placement
and use of CONNECT abutments
By Dental Tribune International
Dr Arias explained to Dental Tribune International that his
lecture, titled “Hard and soft tissue management as well
as digital control in the aesthetic outcome”, addresses
the realm of digital planning in dentistry, exploring the
revolutionary advancements that technology has brought
to the field. He said: “As we embark on a journey into
the realm of guided implant placement and the use of
CONNECT abutments through digital precision, we will
explore how digital tools and techniques have enhanced
precision, efficiency and patient outcomes in various
dental procedures.”
Dr Juan Arias Romero has a private clinic in Madrid in Spain and he
often contributes to journals and provides courses and lectures on
topics related to periodontics, implantology and aesthetic multidisciplinary
dental treatments.
According to implantology and periodontics specialist
Dr Juan Arias Romero, a new synergy between digital
planning, guided implant placement and the use of
MIS Implants Technologies’ CONNECT abutments has
the potential to redefine implant dentistry. In a free webinar available on demand on MIS Implants Academy platform, Dr Arias addresses hard- and soft-tissue management in aesthetically compromised cases and how digital
tools can help clinicians to plan for and achieve the best
possible outcome.
Dental patients are increasingly motivated by aesthetics,
and Dr Arias reminds us that the success of a case
depends as much on the position and architecture of
the tissue as it does on the final position, colour, shape
and size of the teeth. Digital dentistry makes it possible
for clinicians to plan tissue and implant position before
treatment, and this improves the predictability and
quality of the treatment outcome.
16 CAD/CAM
2 2023
Delving into the intricacies of guided implant placement
through a number of case studies, Dr Arias demonstrates
how computer-generated surgical guides enhance accuracy and predictability during surgery and how harnessing the power of intra-oral scanners and specialised
software can enable dental professionals to create treatment plans that are tailored to each patient’s anatomy
and to the desired outcome. The lecture also demonstrates
how CONNECT abutments can provide unparalleled
precision when used together with CAD/CAM software
and how digital technologies enable improved decisionmaking when it comes to the fit, function and aesthetics
of each case.
Additionally, webinar participants gain insights into a
range of digital tools, such as 3D imaging, intra-oral
scanning and CAD/CAM, and into the integration of
digital solutions in treatment planning, restoration design
and overall patient care. The lecture also addresses the
collaboration between clinicians and dental laboratories.
The webinar is intended for all dentists who want to
explore the field of digital dentistry and have an interest
in the management of hard and soft tissue for aesthetic outcomes. Dr Arias hopes that the presentation
will empower dental professionals with the knowledge
and tools needed to embrace the future of dental
implant procedures. Participants have the chance
to earn continuing education credits upon completion
of a quiz. More information can be found at www.
mis-implants-academy.com.
[17] =>
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[18] =>
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| industry report
CEREC or 3D printing:
Which technology for in-office
manufacturing?
Dr Rainer Seemann & Max Milz, Germany
For over 35 years, CEREC has been the go-to solution
for the fabrication of high-quality restorations in the
dental practice, offering the speed and convenience
of single-visit dentistry to both patients and clinicians.
Every year, five million restorations are milled on CEREC
machines around the world.
Now an exciting technology for in-office manufacturing is
following in the footsteps of CEREC: in-office 3D-printing
solutions leverage some of the same technologies
as CEREC, such as accurate intra-oral scanning and
CAD/CAM software. The difference lies in the manufacturing process: milling high-strength materials versus
depositing resins in a process known as digital light
processing (DLP).
With the introduction of every new technology, a question
arises: will the new method replace or complement
the existing technology? Dentsply Sirona is the
only company offering both in-office manufacturing
18 CAD/CAM
2 2023
technologies at scale. This gives us a unique view on
which technology is most suitable for which indications
to enable excellent results for both patients and practices.
In a nutshell, milling is ideal for manufacturing highquality permanent restorations made from materials
with extensive clinical track records and expected
survival rates of over ten years. In-office 3D printing
is most suitable for temporary applications, such as
temporary restorations, surgical guides, models and
splints.
In-office 3D-printing deposits liquid resins in a stepwise
manner, allowing for the creation of complex designs.
Printer resins suitable for the fabrication of dental devices
are those with a maximum filler content comparable
to that of flowable dental composites and have lower
strength values compared with materials utilised in milling
systems. This is because the printing resin must be
light-polymerised and high levels of filler diffract light and
lower polymerisation efficiency.
[19] =>
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industry report
Recently, some resin brands have launched new materials marketed as ceramic restorative materials. While
these materials contain ceramic particles as fillers, they
technically are still lightly filled composite materials with
strengths that do not exceed 150 MPa. High-strength
milling materials for CEREC, such as glass-ceramic, zirconia
and highly filled composites, however, have three to
six times greater strength (530–850 MPa).1 These types
of milling materials are backed by clinical evidence that
demonstrates their suitability for use in definitive dental
restorations. By nature of the DLP printing requirements,
3D-printing materials lack comparable long-term durability,
making 3D printing most suitable for (complex) temporary
applications, such as surgical guides, bite splints, models
and other plastic appliances. At the current stage of
technology and given the lack of solid clinical evidence,
caution is warranted for the printing of permanent crowns,
even if advertisements for these materials imply the
production of ceramic restorations. They remain, in fact,
composite resin crowns.
Milling and 3D-printing technologies can be combined
to reduce labour and increase predictability in clinical
procedures. For example, to restore an edentulous space
with an implant, a printed surgical guide and provisional
restoration can be fabricated with a 3D printer, and the
|
definitive crown can be manufactured in the CEREC milling
machine—all within one digital treatment plan.
Implementing CEREC in a practice follows a well-established
workflow with a history of more than 35 years. When
employing in-office 3D printing, it is important to consider the complete process, involving printing, cleaning
and polymerising. Conventional 3D printing requires the
use of chemicals such as isopropanol for cleaning. Safe
use of isopropanol necessitates a fume hood for ventilation and personal protective equipment to protect the
operator. Additionally, to ensure patient safety, special
dental polymerisation units must be used in order to
guarantee complete polymerisation of the printing resin.
Advanced printing solutions automate printing and
post-processing to ensure staff safety and save valuable
staff time.
Economic factors ultimately drive the adoption of technologies in dental practices. Both CEREC and in-office
3D printing are highly attractive for dental practices
owing to the improved practice efficiency, supporting the
business case for investment in this technology. Both
technologies serve different indications, and dentists’
decision to invest should be based on the benefits to their
practice.
CAD/CAM
2 2023
19
[20] =>
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| industry report
An important economic factor for crowns is the revenue
for different types of crowns. Clinically proven permanent
crowns made from glass-ceramic or zirconia command
two to three times higher prices than do composite resin
crowns.2 Printed crowns may play a role in the value segment,
but to make the same revenue, a dental practice would
have to place two to three times as many composite restorations versus ceramic crowns. Using long-term proven
materials such as zirconia also lowers the risk of rework
that may arise from newer printed composite materials
with limited clinical data.
In conclusion, in-office 3D printing is a highly attractive
technology that will enrich dentistry. At its current level
of development and research, it is highly suitable for intermediate, temporary restorations and temporary applications,
like night guards, guides and models. This technology
complements the strength of the proven CEREC technology
for rapid manufacture of clinically proven permanent
restorations. A dental practice using both technologies
effectively can expect satisfied patients and growth in
revenue and margins.
Editorial note: More information about 3D printing and
CEREC can be found on Dentsply Sirona’s website,
www.dentsplysirona.com. The list of references can be
found at dentsplysirona.com/en/lp/cerec-or-3d-printing.html.
20 CAD/CAM
2 2023
about
Dr Rainer Seemann is vice president
for global clinical research at
Dentsply Sirona. Furthermore, he is a
professor in the department of operative,
preventive and paediatric dentistry at
the University of Bern in Switzerland.
He worked in several positions at the
dental school and clinic of Charité—
Universitätsmedizin Berlin in Germany
before he joined Dentsply in 2006. From 2014 to 2015, he
worked as senior business development manager in Hong
Kong. Dr Seemann studied dentistry in Berlin, obtained his PhD
in 2005 and holds an MBA in healthcare management.
Max Milz is group vice president for
connected technology solutions at
Dentsply Sirona. He joined the company
in January 2021 to lead its clinical
software and services business and to
drive the transition to a new cloud platform.
He is responsible for the company’s
equipment, software and cloud
platform businesses globally,
including imaging, CAD/CAM and dental chair units.
Previously, he was at Siemens for 12 years, working across
the company’s businesses with a focus on strategy and digital
transformation, particularly in the healthcare and digital
automation businesses. During his time at Siemens,
he worked across the globe, including in China for five years.
Milz holds a master’s degree in public policy from Harvard
University in the US and a master’s degree in environment,
law and economics from the University of Cambridge in the UK.
[21] =>
untitled
Register at
www.dds.berlin
Digital
Dentistry
Show
In collaboration with
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[22] =>
untitled
| interview
“Digital technologies are
fundamentally changing
the dynamics of our industry”
An interview with Stephan Kreimer,
a master dental technician from Germany
By Iveta Ramonaite, Dental Tribune International
Stephan Kreimer is a dental CAD/CAM specialist and
advisor for digital dentistry and 3D printing. He is also the
managing director of a dental laboratory in Warendorf
in Germany. In this interview with Dental Tribune International, he discusses his personal journey from a
conventional to a digital laboratory and weighs up the
advantages of integrating dental technologies into one’s
workflow.
Mr Kreimer, when did you first start working in the
dental field, and what led you to a career in dentistry?
Technology has always been an interest of mine.
Since 2009, I have been able to combine this interest
in technology with dentistry through my education
in dental technology. At the time, my parents were
operating a conventional dental laboratory in Germany
that made little use of digital technologies such as
CAD/CAM.
After completing my master’s in dental technology, I took
over as managing director of our family laboratory. I was
betting strongly on innovative technologies such as
CNC milling and 3D printing and closed collaborations
with leading manufacturers, including 3Shape and
Formlabs. Smartly combining the passion for aesthetics
and craftsmanship, which is inherent to our industry, with
the enormous potential of digital technologies is definitely
the way forward.
Stephan Kreimer
22 CAD/CAM
2 2023
Your dental laboratory has eagerly adopted digital
technologies into its workflow. Could you tell us more
about it and discuss some of the digital solutions
you are using?
It has been a journey. We started as a conventional
dental laboratory and have been operating with traditional
workflows for over 30 years. In 2009, we adopted our first
CAD software but outsourced all of our digital production
to service providers. Things changed quickly when
we invested in our first 3D printer, a Formlabs Form 2,
in 2016. At the time, the system was not optimised for
dentistry, but it was clear that it had great potential.
Within the less than five years since then, most of our
customer base has adopted intra-oral scanners and
we scaled our digital production capabilities significantly.
Today, we use an imes-icore milling machine and multiple
3D printers that run almost 24/7 and work with both
3Shape and exocad. Around 70% of our customers send
us digital impressions.
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How did you integrate digital technologies, including
3D printing and CAD/CAM, into your laboratory?
It was definitely through trial and error. Especially in the
early days, which was just a few years back, 3D printing
was not well optimised for a dental workflow. Interfaces
to materials, software and other workflow requirements
have not been coordinated well between different manufacturers. This has led to the formation of a highly active
international community of dental technicians who exchange through social media what they have learned.
Personally, I’ve learned a lot from my peers around
the world, and I’m equally giving back to the community
and the manufacturers. Dentistry is at the intersection of
multiple disciplines, and we need to have good communication to make progress.
The rate of innovation in digital dentistry is extremely high.
We now see manufacturers coordinating much better
and creating more accessible ecosystems that are much
easier to use. At the same time, most of the potential is
still untapped and will become apparent as we undergo
significant transformations within our industry.
Having worked with digital technology for over a
decade now, what benefits do you see of using
dental technology, especially 3D printing, in a dental
laboratory?
To me, dental technology is about combining the best
of two worlds: analogue and digital. We still need and
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will continue to need traditional craftsmanship to meet
the high requirements for individualised aesthetics in
complex cases. At the same time, the holistic digital
workflow works well in an increasing number of
areas, enabling significant increases in efficiency while
maintaining or improving overall quality. Digital fabrication in particular enhances production speed and
reproducibility.
Dentistry is constantly evolving. What lies ahead for
dentistry, and what dental technology is most likely
to shape its future?
In my view, we are now at a point where most of the
industry understands and embraces the vast potential of
digital technologies. At the same time, we are just about
to move from an early adopter stage to the early majority
stage when it comes to the adoption of digital technologies. In Germany, for example, only 15% of dental
practices are using intra-oral scanners, much less than
in the US. However, the trend towards digital impressions
is accelerating fast!
We are undergoing a paradigm shift in dentistry because digital technologies are fundamentally changing
the dynamics of our industry. We will see entirely new
business models, and together we will establish new
standards of care. It is an exciting time, and for those
who embrace this change, there will be many opportunities.
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Aspen Dental’s
digital denture transformation
An interview with Eric Kukucka
By Dental Tribune International
The world of removable prosthodontics is rapidly
growing, and Eric Kukucka is one of the foremost experts
in the space. Recently, he made the transition from
private practice to vice president of clinical removable
prosthetics and design technologies at dental service
organisation Aspen Dental. Dental Tribune International (DTI)
spoke with him about his involvement in the development of digital denture technologies, the exciting
advancements in the field of digital dentures and
obstacles to their adoption.
Mr Kukucka, for how long have you been a denturist?
What attracted you to this field?
I’ve been a denturist since 2010, and there were several
factors that initially brought me to this field. Dentures
are a thriving business, so the promise of financial
reward was attractive. I also love being able to work with
my hands. As I grew in my career, I delighted in being
able to give people back their smiles and their quality
of life, and the monetary appeal became secondary.
I quickly learned that there is no greater reward than
being of service to others.
What kick-started your digital denture journey?
About ten years ago, I was working with Ivoclar, which
is a worldwide dental company that produces a range
of products and systems for dentists and dental technicians. I was lecturing for Ivoclar as well as working
on various research and development projects related
to materials for removable prosthetics. In 2014, I was
shown the alpha prototype of the Ivoclar digital denture,
and I was blown away! The product was so impressive
and so disruptive that I knew I wanted to be part of it
right from its infancy.
Being a denturist provided me with the unique perspective of working on the clinical and the lab side, so I was
well positioned to work on the multifunctional validation of the product as we conducted the alpha testing.
Over the years of testing, we implemented many different iterations of workflows, material processes and
manufacturing concepts. This also led to the development of advanced milling technologies able to fabricate a monolithic denture that was both white and pink
in one single uninterrupted manufacturing process.
Development of scanning technology also continued,
and we were able to move from desktop scanners to more
innovative and handheld wireless intra-oral scanners
that could scan not only inside the mouth but also
physical impressions and gypsum models.
Eric Kukucka
24 CAD/CAM
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[25] =>
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During this evolution, I also developed a relationship
with the counterpart that was working with Ivoclar
on the digital dentures, a company named 3Shape.
3Shape produces desktop and intra-oral scanners as
well as dental design software for all types of dental restorations. As part of the collaborative Ivoclar–
3Shape team, I also helped develop scanning strategies for the TRIOS intra-oral scanners, so I’ve been
able to see the journey of digital dentures all the way
from conception through to more widespread use
and to being a valued component in any dental
facility that prides itself on employing the latest technology in the field.
Have these digital denture workflows changed in
the years since?
One of the best features of digital dentures from a training and implementation perspective is that when moving from analogue to digital, the clinical workflow can
remain the same. While there are more efficient workflows that allow for greater flexibility, dental professionals
who are providing removable prosthetic therapy do not
need to change their current workflow when they switch
to digital dentures. The biggest change that comes
with digital dentures is data acquisition, how the data
captured clinically is rendered in the design software,
the manufacturing methodology, and the process that
supersedes it.
However, for those who want to overcome the challenges of conventional workflows, there are various
methods for the delivery of dentures in two appointments
rather than the traditional three to five appointments
that may be necessary with more conventional
methods.
To capture that efficiency, the biggest change we’ve
seen is the process and workflow for immediate dentures. With an intra-oral scanner, dental professionals
can scan the patient’s oral cavity, render a design and
then deliver the dentures at the next appointment when
the teeth are being extracted. This technology has been
revolutionary both on the clinical side and on the lab
side, because we can now digitally visualise where
a patient’s natural teeth were and where the new
teeth will be. This truly provides unparalleled results for
the clinician and the patient.
Another revolution of digital denture technology is the
ability to deliver the final denture at the try-in stage.
In the conventional analogue process, dental professionals
have to perform a wax try-in, where all of the teeth are
individually set in wax. This is a very labour-intensive and
technique-sensitive process that requires extreme care
and is prone to human error as well as material deficiencies, which can result in extensive and expensive corrective measures. In contrast, with digital dentures, you
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can deliver that same quality—or even higher quality—
dentures for a fraction of the cost to the clinic and in
a fraction of the time at that try-in appointment. Moreover, if the denture isn’t completely correct, making adjustments is efficient, effective and predictable
by applying the changes via the software with a few
keystrokes and mouse clicks.
Today, at our Aspen Dental locations that offer
digital dentures, there is an over 80% success rate
at that denture delivery appointment. Just think:
if you fit 100 dentures a month and 80% of the time
you deliver those dentures successfully, you will
have gained 80 appointments in your schedule that
month. That means new and existing patients aren’t
waiting as long resulting in an increase in more available chair time that can be used to deliver high quality
removable therapy to more patients.
“For dental laboratory
technicians, digital dentures
offer consistency in the
design process and greater
customisation.”
What benefits does the digitalisation of the denture
process bring for the clinician, the dental laboratory
technician and the patient?
First and foremost, the most significant benefit for all
three parties is the ability to electronically preserve
the patient’s initial data acquisition, whether that is a
scan of the teeth, dentures or edentulous oral cavity,
as well as the preservation of the final design file of
the restoration. For the patient, the electronic preservation of that data means that, if a patient loses
a denture, a replacement denture can be fabricated
within 24–48 hours without having to take another impression or come in for any additional appointments.
That’s simply not possible with conventional dentures. In addition, digital dentures have greater retention, stability and strength than dentures produced
in the analogue manner. It’s important to note that
digitally manufactured prostheses have a uniform
thickness feature that provides the patient with true
physiological comfort.
For dental laboratory technicians, digital dentures
offer consistency in the design process and greater
customisation. For clinicians, the improved workflow,
efficiency and accuracy of digital dentures reduce
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[26] =>
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the chair time needed per denture patient. The use
of digital dentures results in fewer postoperative
adjustments, thereby freeing up operating chair time
for clinicians to provide care to a greater number of
patients.
Are there any common obstacles that prevent
dental professionals from adopting and integrating
digital workflows?
Resistance to change applies in every profession, and
the dental industry is no exception. Often, we have reservations about adopting new technologies or techniques
because what we’ve been doing has been working—
that if it isn’t broke, don’t fix it mentality comes into play.
26 CAD/CAM
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There’s also some resistance to the cost associated
with switching to digital technology as well as the shift
from conventional manufacturing to subtractive or
additive manufacturing, namely 3D printing. I understand that clinicians are hesitant to work with a technology that uses different materials and manufacturing
processes and has financial ramifications. My message
to those clinicians would be to try out the technology
by providing removable prosthetic treatment to a few
patients. Partner with a manufacturing centre or lab that
is skilled in digital dentures and do five, ten, 15 cases
until you are comfortable with the process and can see
the benefits for yourself. Then, it’s much easier to make
that investment.
[27] =>
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“The biggest change
that comes with
digital dentures is data
acquisition, how the data
captured clinically is rendered
in the design software
and the manufacturing
methodology.”
and knowledge to help shepherd Aspen through the
digital transformation. This was a great opportunity, so
I agreed. I very quickly fell in love with the organisation,
not just because of its commitment to digital technology,
but also because I was able to convey my clinical
knowledge and skills to our dentists through our various
onboarding programmes and learning and development initiatives.
After over a decade in private practice, why did you
choose to join Aspen Dental?
Before I joined Aspen, I was an industry leader lecturing at some of the most prestigious conferences
in the world, as well as publishing articles, working
on various research and development projects and
co-authoring textbooks. I truly valued private practice and loved working in research and development
and, most importantly, treating patients with removable therapy. Fast-forward to January 2021, when
Aspen Dental decided to go digital with its dentures.
Dr Sundeep Rawal, the senior vice president of implant
support at Aspen and a long-time colleague, asked
me to come on board as a consultant to use my skills
I helped establish the curriculum alongside our vice
president of clinical support, Dr Andrew De La Rosa,
and when we first delivered the learning programme,
I asked every dentist in the room how many dentures they
had done in dental school. In the room of 30 dentists,
the average had made just two dentures. That’s when
I realised, in an organisation where we do half a million dentures a year and someone can graduate and
go into an office and do up to 100 dentures a month
with very little experience, I could have an enormous impact on hundreds of thousands of patients
and hundreds of dentists. Our chief clinical officer,
Dr Arwinder Judge, asked me whether I wanted to
make a change and come join Aspen Dental full time
on the clinical team. Without hesitation, I decided to
sell my private practices and join Aspen full time, not
just to help lead the digital transformation, but also
to improve the quality of the removable prostheses
we deliver here at Aspen Dental, irrespective of
whether those are produced digitally or using analogue methods. Ultimately, it was the organisation’s
mission and the clinical support team that attracted
me, but the ability to provide countless dentists, dental technicians and team members with the training
they need to deliver the best possible removable prosthetic experience to patients is what made me fully
commit to Aspen Dental. I am honoured to be part of
the clinical support team here at Aspen Dental and
truly changing the way we deliver care to millions of
patients every year!
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Zero-bake technique: A simplified
approach to zirconia aesthetics
An interview with Giuliano Moustakis
By Kuraray Noritake Dental
1
Fig. 1: Working out the details in the interproximal area with rotary disc-shaped instruments.
The percentage of restorations made of zirconia in
a monolithic (full-contour) design is steadily increasing.
As an enabler of this development, companies like
Kuraray Noritake Dental have introduced high-performance
zirconia materials with well-balanced optical and mechanical properties, along with innovative finishing solutions.
A popular example is KATANA Zirconia YML with its multilayered flexural strength, translucency and colour structure.
Combined with Esthetic Colorant for KATANA Zirconia and
CERABIEN ZR FC Paste Stain, it is very well suited for a
simplified approach to zirconia aesthetics: the zero-bake
technique. In this interview, we had a conversation with
dental technician Giuliano Moustakis about its benefits and
areas of application.
Mr Moustakis, why is there a need for a new technique
related to the finishing of monolithic zirconia restorations?
Like many users of restorative materials, I truly believe that the
trend towards monolithic zirconia restorations is here to stay.
28 CAD/CAM
2 2023
The reason is that there is a huge number of patients
who place great value on high-quality dental treatments,
but have a limited budget. Many of them are interested
in metal-free restorations that blend in nicely with the
surrounding dentition and are able to withstand the test
of time. Reasonable cost is more important to them than
highest-end aesthetics. The new materials available on the
market allow us to produce restorations with the desired
properties, but we need to think about how to combine
them in the most effective way to be able to respond to
patients’ demands, including the financial one.
Please would you describe the zero-bake technique?
This technique is based on a monolithic restoration design
carried out in the preferred design software. In this step, it is
important to focus on a natural surface morphology—about
80% of the morphology is realised in the digital manufacturing procedure. After milling, some morphological details
(the last 20%) are added with hand instruments. My personal
set of instruments consists of two kinds of diamond discs
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2
Fig. 2: Integration of the micromorphology with a round-ended straight carbide bur.
used for the interproximal areas of bridges (with virtually no
pressure), a round-ended straight carbide bur (fine), Panther
stones and a zirconia-blade carving instrument. However,
any set of instruments that feels comfortable in the hands of
the user may be selected for this task. Taking into account
the volumetric shrinkage during sintering and the final polishing and glazing, the structure created is ideally slightly
over-contoured and clearly defined. It is definitely worth investing time in this preparatory step, as it will make our work
much easier later in the process. After surface texturing,
selected colours of Esthetic Colorant for KATANA Zirconia—
specific dyeing liquids designed for the imitation of natural
optical effects—are applied to the surface.
Do you have any recommendations on how to proceed
with this set of liquids?
Just follow the colour reproduction of the adjacent
natural teeth. With Esthetic Colorant, we want to create
3
Fig. 3: Basic chromatic map for individualisation in the anterior region.
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beautiful illusions, and nature is our best source of inspiration. To be able to copy what we see, however, we need
to understand the properties and behaviour of the materials we are using. Consequently, I strongly recommend
testing them extensively, for example practising on remnants of zirconia blanks before moving on to real patient
cases. The duration of the testing period should depend
on the outcomes, which should be highly predictable by
the time the materials are used in the first patient case.
I experimented and practised with Esthetic Colorant for
about six months and used it in the first case after one
month of practising.
Nowadays, there are five effect liquids which I use on a
daily basis in almost every case:
4
1. A plus—used mainly in the vestibular cervical and palatal
cervical and mamelon areas to increase the chroma of
A dentine shades;
2. BLUE—used to reproduce the bluish enamel colour found
in the area of the incisal edges and occlusal cusps;
3. GRAY—used (often in addition to BLUE) to reproduce
the greyish enamel colour found on the incisal edges
and occlusal cusps;
4. ORANGE—used to give an orange appearance to
the cervical area and to intensify the contours of the
mamelons; and
5. BROWN—used to reproduce the dentine colour in the
cervical area and to darken the colour in the main groove.
5
In addition, there is a liquid with a special function I value
highly: OPAQUE. This modifier liquid is applied on the intaglio surface of a restoration to mask discoloured or metal
abutments. In order to intensify the effects of this and other
liquids, they may be applied to a single spot up to three
times.
How do you apply Esthetic Colorant, and what are the
steps that follow once you have applied the liquids?
For application, I use the dedicated Liquid Brush Pen for
Esthetic Colorant. It allows for a controlled application of
the desired amount of liquid and thus supports predictable
outcomes. Once all Esthetic Colorant liquids have been
applied, it is essential to dry the zirconia at a temperature
between 80 and 200 °C for a minimum of 30 minutes.
During application of the liquids and drying, any contact
with metal must be prevented. Therefore, the brushes used
during application must be metal-free, and the same holds
true for the tray. By adhering to this rule, discoloration is
effectively prevented. The subsequently selected sintering
6
Fig. 4: Restoration after sintering. Fig. 5: Frontal view of a complex restoration,
including gingival parts, with information on where to apply which shade of
Esthetic Colorant. Fig. 6: Basal view of the restoration with OPAQUE applied
to mask the screws and VIOLET and PINK to add colour to the gingival parts.
Fig. 7: Occlusal view with colour recommendations.
7
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8
Fig. 8: Example of a dentine core restoration. The surface morphology was refined with a Panther stone.
protocols are not affected by the effect liquids—and this is
true for all types of zirconia from the KATANA Zirconia
Multi-Layered series. Once sintered and cooled, the surface of the restoration is finished with a set of polishing
instruments. My tip in this context is to be careful not to
destroy the micromorphology created in the pre-sintering
step. To add the final gloss and natural fluorescence, the
surface is treated by sandblasting for the application of
CERABIEN ZR FC Paste Stain, fixed in a single glaze firing
procedure.
Does the technique also work without glazing?
Yes, it is definitely possible to do without this step. In that
case, however, the restoration will not offer a fluorescent
effect. Whenever a restoration is finished without glazing,
the surface must be perfectly polished. If completely
smooth, the hardness of the material will not cause any
harm to the opposing dentition.
Why is it important to develop new design and finishing
concepts nowadays?
To my mind, a lack of time is the greatest issue of modern
dental technology. Owing to a lack of skilled personnel and
an expected decrease in the number of dental laboratories
in many countries around the globe, we have to keep looking for concepts that help us reduce the time pressure
and make our work easier. While simplifying procedures,
however, we need to provide for the same or even higherquality outcomes. This is exactly what I wanted to achieve
when starting to develop the zero-bake technique. My
personal gain is more free time.
Why do you share your ideas with others by working as
an instructor and lecturer?
I simply enjoy interacting with my peers, equipping them
with knowledge and helping them benefit from good ideas.
about
What are the main indications for the zero-bake
technique?
Personally, I use it most often in the context of complex
restorations and in the posterior region, especially when the
available space is limited. It allows for minimal wall thicknesses, and the surface is—when well polished—more antagonist-friendly than a lithium disilicate surface. In other
cases, and depending on budget, digitally produced dentine
core crowns are a great option. The dentine core is milled
from KATANA Zirconia YML and the enamel added
using CERABIEN ZR Luster porcelains. Esthetic Colorant,
CERABIEN ZR Internal Stains and CERABIEN ZR FC Paste Stain
may be added for individual effects. Compared with traditional full porcelain layering, this concept is quicker, involves
a lower shrinkage, offers a high stability due to the specific
framework design and requires a thinner wall thickness
(e.g. 0.6 mm dentine core plus 0.6 mm porcelain).
Giuliano Moustakis has more
than 30 years of expertise as dental
technician. He was born in Greece but
currently resides in Germany, where
he has a laboratory in Falkensee.
He studied dental technology in Athens
in Greece and over the years has
completed further studies in Germany
and Japan, including the maxillofacial
prosthetic technician programme of the International
Association for Surgical Prosthetics and Epithetics, advanced
education in functional diagnostics of the temporomandibular
joint and the implant prosthetics curriculum for dental technicians
of the Deutsche Gesellschaft für Zahnärztliche Implantologie
(German association of dental implantology). He has been
a global instructor at Kuraray Noritake Dental since 2019.
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Extremely minimally invasive
mock-up-guided veneer preparations
in the aesthetic area
Dr Alessandro Pezzana, Italy
namely the gaps between his teeth. This had become
such a problem for him that he avoided showing his teeth
in photographs. He had high aesthetic expectations of
treatment and desired complete closure of the anterior
diastemas.
The patient was in good general health and did not report any medical problems. He was certain that his oral
hygiene was good, which was supported by the fact that
he did not have any caries.
Records and diagnosis
1a
1b
Fig. 1a: Initial situation. Teeth in intercuspal position, frontal view. Fig. 1b:
Initial situation. Teeth in protrusion, frontal view.
This clinical case describes an aesthetic approach to the
anterior dentition using veneers. The differential thickness
of each veneer was obtained on the basis of extremely
minimally invasive preparations. Such preparations are less
invasive for enamel integrity than veneer preparations carried
out directly on the tooth. The controlled preparations were
carried out using a working mock-up created on a wax-up
that closed the diastemas between the anterior teeth.
Case report
A 25-year-old male patient came to the practice to resolve
an aesthetic problem regarding the anterior dentition,
2
An intra-oral physical examination, vitality test and probing
were conducted, periapical radiographs were taken and
initial tooth colour was assessed. There were no signs
or symptoms of periodontal disease. The patient had
previously had orthodontic treatment requiring the extraction of the third molars. At the time of the appointment, the patient had excellent Class I canine and molar
occlusion. The maxillary arch presented with a diastema
and further gaps between the central and lateral incisors.
The diagnosis was diastemas after orthodontic therapy.
Treatment plan
The treatment method adopted aimed to afford better
conservation of the dental tissue than is possible with
conventional veneer preparation performed directly on
the tooth. This extremely minimally invasive approach
3
Fig. 2: Initial photograph showing a detail of the maxillary arch. Fig. 3: Occlusal photograph of the anterior sextant.
32 CAD/CAM
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would be achieved with a mock-up for advanced aesthetic dentistry permitting controlled preparation, that
is, preparation that is calibrated on the different thicknesses of the mock-up. This basis would be used to
create semi-indirect veneers for space closure (Type IIB
veneers according to Magne and Belser).1
Treatment
During the first appointment, photographs (Figs. 1–3)
and alginate impressions of the dental arches were
taken. After photographic study of the case, the necessary aesthetic and functional corrections were performed by means of an analogue diagnostic wax-up
phase. The wax-up was transferred to the patient’s
mouth in the form of a mock-up that he tested in his
mouth for a few days prior to the operative session.
At the following appointment, this was used as a working mock-up for calibrated preparation, that is, a mockup-guided approach for extremely minimally invasive,
controlled tooth reduction.
4a
4b
4c
Fig. 4a: Analogue wax-up on the gypsum model, palatal view. Fig. 4b:
Analogue wax-up on the gypsum model, vestibular view. Fig. 4c: Silicone
index for moulding the mock-up in composite for the provisional restoration.
been shown that such a covering of the incisal edge
achieves a higher survival rate than preparations with
a palatal chamfer.4, 5
To simulate the final result as already seen with the analogue wax-up as accurately as possible, the waxed-up
model was scanned.2 For moulding the mock-up from
the wax-up (Figs. 4a & b), a silicone index was created on
the wax-up (Fig. 4c). Composite (Structur 3, VOCO) was
injected into this silicone key to create the mock-up. The
diagnostic mock-up was temporarily cemented (Provicol
QM Aesthetic, VOCO) in the patient’s mouth for a few
days until the operative session.
At the next appointment, the mock-up took on the role
of a working guide for controlled preparation. Controlledthickness reduction grooves were made in the mock-up
for orientation, as they were used to determine the
depth of the preparation and thus the desired material
thickness of the veneers (Fig. 5). For providing clear orientation, the guiding grooves were marked with a pencil
(Fig. 6). Where the residual mock-up remained, the tooth
was intact (extremely minimally invasive preparation).
Only in the areas where the mock-up had been completely ground down was there an effective preparation of
the tooth structure (Fig. 7). Compared with conventional
veneer preparation, for which the dentist grinds the tooth
structure directly from the beginning, this procedure
allowed for much more conservative tooth reduction.
It was decided not to intervene in the lateral and protrusive movement.
The first step was to perform window or Walls, Steele
and Wassell Type A preparations,3 meaning that the
preparations were only carried out on the vestibular aspect, without finishing margins and without any
reduction of the incisal edge. However, an incisal butt
joint margin was carried out to cover the incisal edge
without any vertical reduction in the palatal area. It has
5
6
7
Fig. 5: Operative phase in which the mock-up acted as a guide for highly
conservative, controlled preparations. Fig. 6: Guide grooves marked with
pencil for calibrated preparation primarily on the composite. Fig. 7: Mock-up
removed with pencil marks where the preparation would continue directly
on the tooth (sacrificing the mock-up spared healthy hard tissue).
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8a
8b
Fig. 8a: Completed extremely minimally invasive preparations without
finishing lines ready for digital impression taking. Fig. 8b: First veneer
fabricated by digital milling.
Once the final preparations had been obtained (Fig. 8a),
they were scanned, initiating the digital phase of the
workflow that ended with the fabrication of the veneers
using a CAD/CAM milling unit (M2 Teleskoper, Zirkonzahn).
The veneers were made of a highly filled nano-ceramic
hybrid material (Grandio blocs, Shade A2, low translucency; VOCO; Fig. 8b).
Once they had been cleaned, the prepared teeth were
rinsed thoroughly and dried with a gentle jet of compressed air. The veneers were inserted carefully by exerting
slight pressure. The chromatic effect met the expectations of both the patient and the clinician (Figs. 9 & 10).
Before being finished and polished, the veneers created
using CAD/CAM technology underwent chromatic characterisation so that the pigmentation (FinalTouch, VOCO)
was fixed under this thin layer of composite.
The dental dam used to obtain isolation was secured
using special cervical clamps for incisors (clamp #212,
Hu-Friedy; Figs. 11 & 12). This was followed by proper
adhesive priming of the surfaces to be luted to one
another (inner surfaces of the restorations and surfaces
of the prepared teeth). As a protective measure in view
of the subsequent clinical steps, the adjacent surfaces that were not to be covered were isolated using
PTFE tape.
9
The tooth surfaces were then conditioned, first by pretreatment with glycine powder, which through micro-abrasion
increases the retentive potential of the bonding (Fig. 13).
Etching was then performed using 35% orthophosphoric
acid (Vococid, VOCO) for 20 seconds (Fig. 14). The acid
was then removed by suction and rinsing for 20 seconds,
and the surface was dried with compressed air to obtain
a matt chalky white appearance. The universal adhesive
(Futurabond U, VOCO) was applied and gently rubbed
for 20 seconds using a brush (Single Tim, VOCO; Fig. 15).
The solvent was then evaporated thoroughly with compressed air for at least 5 seconds to obtain a thin, immobile and shiny layer of adhesive, which was polymerised
from various directions using a high-power LED curing light (Celalux 3, VOCO) for 10 seconds each time, in
accordance with the manufacturer’s instructions. This
created a matt–shiny preparation surface that was evenly
coated with adhesive.
“The working mock-up ensures
greater thickness control of the
veneers before proceeding with the
precision impression for the digital
design of the final veneers.”
For the pretreatment of the inner surfaces of the veneers, abrasive sandblasting with 25–50 μm particles of
aluminium oxide was performed at 1.5–2 bar pressure,
and a silane adhesive coupling agent (Ceramic Bond,
VOCO) was applied and left to act for 60 seconds
and then dried for 5 seconds. The veneers were finally
cemented using a dual-polymerising universal luting
composite (Bifix QM, VOCO; Fig. 16). The veneers were
inserted (Fig. 17) and fixed by means of polymerisation
at marginal level using a Celalux 3 mesially and distally
from the vestibular side, followed by mesial and distal
polymerising from the palatal side. In order to avoid an
oxygen inhibition layer and thus avoid poor polymerisation,
10
Fig. 9: Veneer fit test. Fig. 10: CAD/CAM veneers after characterisation, finishing and polishing.
34 CAD/CAM
2 2023
[35] =>
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case report
11
a glycerine gel was applied to all margins prior to
polymerisation (Liquid Strip, Ivoclar). By means of this
oxygen inhibition gel, a significant improvement of the
adhesive margins could be achieved. The glycerine was
rinsed off, and at the end of the setting time of approximately 3 minutes, it was then possible to proceed with
elimination of the excess material using a metal instrument and dental floss, interproximally. The interproximal
contact zones were finished using abrasive strips.
After checking the occlusion and making corrections
in accordance with conventional functional concepts,
normal finishing and polishing was performed using
diamond polishers (Dimanto, VOCO). The patient was
completely satisfied with the significant improvement
in his smile (Figs. 18–22).
|
12
13
Discussion
Based on an analysis of the scientific literature concerning the closure of anterior diastemas, a semi-indirect
approach using nano-hybrid composite veneers was
chosen.6 The clinical indication of diastema closure classifies the veneers used for this case as Type IIB according
to the Magne–Belser classification.1 Since feldspathic
ceramic veneers were outside the patient’s budget, such
an indirect technique was ruled out. The direct layering
technique was ruled out because the patient had high
aesthetic expectations. It was decided to use veneers
14
15
16
17
Fig. 11: Isolation of the operative field using a dental dam, frontal view. Fig. 12: Isolation of the operative field using a dental dam, occlusal view. Fig. 13: Isolation
using PTFE and appearance of the sandblasted surfaces. Fig. 14: Orthophosphoric acid etching of a substrate that was still enamel thanks to the extremely
minimally invasive approach adopted. Fig. 15: Application of the adhesive luting agent to the surfaces to be bonded. Fig. 16: Bifix QM luting system (VOCO)
applied to the tooth #21 stump and PTFE tape covering the adjacent teeth. Fig. 17: Insertion of the veneers.
CAD/CAM
2 2023
35
[36] =>
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| case report
18
19
20
Fig. 18: Final result, frontal view. Fig. 19: Final result, right lateral view. Fig. 20: Final result, left lateral view.
on both the central and the lateral incisors, as this would
make it possible to obtain more harmonious relative
dimensional proportions.
The wax-up must first be transferred to the mouth in
the form of a provisional prototype with a dual clinical function as a diagnostic mock-up for aesthetic
and functional aspects and as a working mock-up for
is gradually destroyed, resulting in a far more minimally
invasive preparation than that performed directly on the
tooth. Using special calibrated burs, this preparation
ensures the most enamel-sparing thicknesses possible
and the highest aesthetic and functional characteristics.
The working mock-up ensures greater thickness control of the veneers before proceeding with the precision
impression for the digital design of the final veneers.
The adhesive protocols described were compared with
authoritative sources (Magne)8 and with recent literature
(Blatz et al.).9
Conclusion
Full patient satisfaction was achieved. The success of
the treatment was due to the combination of two factors:
minimal tooth preparation and complete closure of the
diastemas without adverse repercussions on shape,
proportions or chromatic integration.
21
This case has demonstrated that less is better. Indeed,
mock-up-guided veneer preparations reduce the biological sacrifice of the tooth to a minimum while guaranteeing function and maximising the long-term aesthetics.
This approach also demonstrates how conventional and
digital workflows can be combined effectively.
Editorial note: This article was first published
in 3D printing—international magazine of
dental printing technology, Vol. 2, Issue 2/2022.
Please scan this QR code for the list of references.
22
Fig. 21: Teeth in intercuspal position one year after the treatment, frontal
view. Fig. 22: Teeth in protrusion one year after the treatment, frontal view.
calibrated preparation, that is, a guide for controlled, extremely minimally invasive tooth reduction.7 The diagnostic mock-up is the composite provisional restoration for
the usual in-mouth fit test, and it allows immediate and
effective communication with the patient and makes it
possible to test in-mouth tolerability for a few days prior
to the operative session. These prototypes fitted on the
individual teeth have a wow effect on patients, as they
provide an in-mouth preview of the aesthetic results
to be achieved. In the initial stages of tooth preparation,
the working mock-up for controlled preparation is calibrated based on the physical dimensions of the mock-up.
With controlled preparation, the provisional restoration
36 CAD/CAM
2 2023
about
Dr Alessandro Pezzana graduated
in dentistry from the University of Turin
in Italy in 2012. Since 2013, he has
been practising in his own practice,
Studio dentistico Pezzana e Togno,
in Omegna in Italy. He also teaches
and researches aesthetic and adhesive
dentistry at the University of Turin.
Dr Pezzana’s areas of expertise are
aesthetic restorative dentistry, endodontics and dental photography.
He can be contacted at alessandro.pezzana@hotmail.it.
[37] =>
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THE GLOBAL DENTAL CE COMMUNITY
REGISTER FOR FREE
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@DTStudyClub
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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.
[38] =>
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| case report
Restoration of a fractured ceramic
crown with a digital workflow
Dr Joseph Sabbagh, Lebanon
1
2
Fig. 1: Pre-op view of the fractured ceramic crown. Fig. 2: Placement of a temporary resin bridge.
The following case presents the restoration of a
fractured ceramic crown with a three-unit bridge using a
digital workflow. A 38-year-old female patient presented
to our dental practice complaining of discomfort in the
maxillary left area. The clinical examination revealed a
fractured ceramic crown on the posterior abutment (tooth #27)
3a
3b
3c
3d
Figs. 3a–d: Digital impression taking with the intra-oral scanner.
38 CAD/CAM
2 2023
of a three-unit bridge (from tooth #25 to tooth #27) placed
seven years earlier by her previous dentist (Fig. 1).
The first step was to remove the old bridge and to check
the abutment preparation. A temporary resin bridge was
placed with Temp-Bond (Kerr; Fig. 2).
[39] =>
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case report
4a
4b
4c
4d
5
6
|
Figs. 4a–d: 3D-printed models with the new layered zirconia bridge. Fig. 5: Internal and external surfaces of the zirconia bridge. Fig. 6: Post-op view
of the cemented restoration.
One week later, a digital impression was taken using
an intra-oral scanner (DEXIS IS 3800; Fig. 3) and sent via
the DEXIS IS Connect platform to the dental laboratory.
In the laboratory, the design and milling of a new zirconia
bridge were performed.
Four days later, the new layered zirconia bridge was sent
to the practice along with 3D-printed models (Fig. 4). The
final zirconia bridge emphasises the quality and precision
of a digital workflow (Fig. 5).
After the try-in, the final restoration was cemented in the
mouth using glass ionomer cement (Fuji I, GC). Six weeks
later, the patient came back for a postoperative check-up,
during which perfect contact points and good adaptation
with the soft tissue were seen (Fig. 6).
This case demonstrates the successful integration of
cutting-edge dental technology, precise craftsmanship
and meticulous care in providing our patient with a durable,
functional and aesthetically pleasing zirconia bridge,
ultimately improving her oral health and comfort.
Editorial Note: Please scan this QR code
for more information about digital workflow
with DEXIS.
about
Dr Joseph Sabbagh obtained his
master’s degree in restorative dentistry
and his PhD in biomaterials from
the Université catholique de Louvain
in Belgium. He worked as an
associate professor at the Faculty of
Dental Medicine of the Lebanese
University in Beirut in Lebanon for a
number of years and now practises
in Beirut and Brussels in Belgium. Dr Sabbagh is active
in clinical and in vitro research, having a particular interest
in biomaterials, aesthetic dentistry and endodontics, and has
had over 25 scientific papers published in indexed journals.
He is a member of various associations and boards.
CAD/CAM
2 2023
39
[40] =>
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| case report
Endocrowns milled from
CAD/CAM composites
for high strength and flexibility
Drs Lucas J. Echandia & Martin I. Ibañez, Argentina
1
2
3
Fig. 1: Initial situation: failure of periodontal anatomical integrity due to overcontoured amalgam filling in tooth #45, and cracked and lost amalgam on tooth #46.
Fig. 2: Dental dam isolation for removal of the old restoration from tooth #45 using ultrasonic instrumentation. Fig. 3: Matrix system positioned for
correct adaptation of the margin on tooth #45.
Introduction
In the case described in this article, the patient benefited
from the innovative clinical use of a high-quality milled
composite material (Grandio blocs, VOCO) for indirect
restorations in the posterior sector. The advantages over
direct restorations described here are better aesthetic
results, flexibility and easy handling without any of the usual
inconveniences, such as volume shrinkage, air bubbles
between the increments or incomplete polymerisation.
4
5
Fig. 4: Building the distal wall to convert the cavity from a Class II to a Class I configuration. Fig. 5: Completed filling with Grandio.
40 CAD/CAM
2 2023
[41] =>
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case report
6
7
|
8
Fig. 6: Occlusal view of the pulp chamber and cavity after preparation for the milled endocrown. Fig. 7: Tooth #46 before the intra-oral scan.
Fig. 8: Clip F temporary filling to allow the patient to rest during the milling process.
Case presentation
Case history
A 58-year-old female patient came to the dental practice for a routine dental appointment and had lost an
amalgam restoration the previous day. The patient was
apparently in good health and had no systemic conditions. Her dental history revealed that about 16 years
previously root canal therapy had been performed on
tooth #46, and the tooth had subsequently been treated
with an amalgam filling. Pointing to the tooth, she said
that she must have broken the tooth and lost a little
piece of it the day before. When asked whether she had
9a
9b
“The advantages over direct
restorations described
here are better aesthetic
results, flexibility and
easy handling [...].”
any symptoms, she replied that she had no complaint
regarding any of her teeth.
9c
Figs. 9a–c: Creation of the CAD for the endocrown (a). Grandio blocs A3 LT block ready for milling (b). Endocrown milled from Grandio blocs (c).
CAD/CAM
2 2023
41
[42] =>
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| case report
The clinical examination revealed an amalgam filling
over the asymptomatic root of tooth #46 and the overcontoured amalgam filling in tooth #45, which had facilitated inflammatory and hyperplastic changes to the
surrounding gingival margin, and tooth #46 had lost
several coronal areas of the residual hard tissue and
most of its lingual wall and presented with some microcracks on the residual surface (Fig. 1). Tooth #45 did not
show any clinical symptoms on the pulp vitality test.
The diagnosis concluded:
10
11
Fig. 10: Final endocrown upside down. Fig. 11: Final endocrown after
chromatic characterisation of the occlusal grooves and fissures with
FinalTouch and subsequent polishing.
The patient wished to receive a clear explanation
of the reason for her clinical problem and subsequent treatment. She then asked for an aesthetic
and functional restoration in the shortest time possible.
Records and diagnosis
Radiographically, no carious lesions were detected.
The periapical radiograph of tooth #46 showed a relatively non-homogeneous endodontic filling characterised
by poor condensation and incomplete apical sealing
because the gutta-percha did not fill the whole circumference of the apical foramina. Nevertheless,
this tooth had been asymptomatic for 16 years, so it
was decided not to opt for endodontic retreatment.
The radiograph also showed an overcontoured filling
in tooth #45.
12
– endodontic underfilling in tooth #46;
– fractured dental restorative material with loss of
material on tooth #46;
– various enamel cracks on tooth #46;
– contour of the existing restoration of tooth #45 biologically incompatible with oral health; and
– marginal overcontouring of the filling in tooth #45.
Treatment steps
The main therapeutic objective was rehabilitation of
function and aesthetics with a direct restoration
(replacement of the amalgam filling in tooth #45,
since the tooth was vital) and an indirect restoration
(endocrown on tooth #46). The secondary objective
was to avoid multiple appointments.
After the removal of the old fillings and isolation with
a dental dam (Nic Tone) to achieve a dry working field,
the treatment was performed on the two teeth (Fig. 2).
A W8 clamp hook (Hu-Friedy) was used to keep the
dental dam in place. The sectional matrix was stabilised
along the axial distal wall of the cavity of tooth #45
using Unimatrix R (TDV Dental; Fig. 3).
For the adhesive preparation of tooth #45, Vococid 35%
phosphoric acid gel (VOCO) was used to perform a
13
Fig. 12: Total etching of both enamel and dentine with a 37% phosphoric acid gel. Fig. 13: Drying of tooth #46 with absorbent paper strips instead of airflow
to avoid overdrying of the dentine.
42 CAD/CAM
2 2023
[43] =>
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case report
|
selective-etching technique on the enamel. The precautionary etching step was followed by application of
the adhesive agent Futurabond U (VOCO), which was
applied to both the enamel and dentine.
The direct restoration of tooth #45 used the lightpolymerising, nano-hybrid composite Grandio. We
rebuilt the distal wall, initially with Grandio, in order
to convert the Class II configuration into a Class I
cavity design (Fig. 4). This strategy was chosen to
make the handling of the proximal and occlusal filling
easier. To achieve this, a regular incremental layering
technique was used (Fig. 5). Finally, we performed
finishing and polishing of the occlusal surface of
tooth #45.
For the endocrown on tooth #46, we first revised the
pulp chamber using ultrasonic tips (Helse Ultrasonic)
and then the tooth cavity with various rotary instruments. We performed minimal shoulder preparation in
accordance with the conventional rules for ceramic restorations, avoiding undercuts and preserving minimum
thicknesses (Fig. 6). An intra-oral scan of the revised
surfaces was performed with the TRIOS intra-oral
scanner (3Shape; Fig. 7). After that, a temporary filling
with Clip F (VOCO) was prepared for the time needed
for chairside manufacture of the indirect restoration
(Fig. 8).
The next step was the creation of the digital design
for the endocrown with inLab CAD Software
(Dentsply Sirona) and 10-minute endocrown fabrication using a low-translucency Grandio blocs block
(A3 LT) processed with the CEREC MC XL milling
machine (Dentsply Sirona; Fig. 9). After the endocrown had been milled (Fig. 10), it was pretreated
and chromatic characterisation was performed with
FinalTouch characterisation material (VOCO) for a
more natural result.
15a
14
Fig. 14: Securing the endocrown by applying slight pressure allowed excess
luting material to ooze out at the preparation margins.
According to the manufacturer’s instructions for use,
since Grandio blocs is made of a nano-hybrid composite, there is no indication for etching with hydrofluoric acid or phosphoric acid. Instead, the pretreatment
was performed with 25–50 μm aluminium oxide particles
to sandblast the inner surfaces of the restoration to
be luted and the occlusal grooves and fissures for subsequent chromatic characterisation. The oxide dust
produced was removed using a suction device, and
an ultrasonic bath was used to clean the pretreated
restoration, which was then dried with oil-free air,
followed by final cleaning with medical alcohol
(optional).
After pretreating the occlusal grooves and fissures and
the application of Futurabond U, a maximum layer
15b
Figs. 15a & b: Light polymerisation after removal of the excess luting material.
CAD/CAM
2 2023
43
[44] =>
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| case report
16
17
Fig. 16: Astonishing results with excellent marginal adaptation and aesthetics. Fig. 17: Occlusal adjustments and articulation confirming the astonishing results.
thickness of 0.5 mm of FinalTouch was applied over
these areas. Light polymerisation was performed with
the Celalux 2 LED curing light (VOCO) for 20 seconds,
followed by finishing and polishing of the indirect restoration with diamond polishers (Dimanto, VOCO; Fig. 11).
New isolation of the working field was performed and
the temporary filling removed to prepare tooth #45
for cementation of the endocrown. Total etching of
both the enamel and dentine with a strong (37%)
phosphoric acid gel (Etch-37, BISCO) was performed
(Figs. 12 & 13).
The inner surface of the restoration was then silanised
for 60 seconds using a brush wet with the silane
coupling agent Ceramic Bond (VOCO) and then gently
dried with oil-free air. During this phase, we paid careful
attention to avoid touching the surfaces to be luted.
The dual-polymerising permanent luting system
used on the inside surface of the restoration to be
18
Fig. 18: Occlusal view of the excellent final results.
44 CAD/CAM
2 2023
luted always requires a suitable bonding agent. The
bonding agent selected for this purpose was the
dual-polymerising universal adhesive Futurabond U,
which we applied to the inner surface and rubbed
with a disposable brush (Single Tim, VOCO) for
20 seconds and, afterwards, we dried off the
adhesive layer using oil-free dry air for 5 seconds
in order to remove any residual solvent. Polymerisation of the bonding agent took 10 seconds with
the Celalux 2, which has a high light intensity of
1,000 mW/cm².
Permanent adhesive cementation of the endocrown
was done with Bifix QM (VOCO), a radiopaque, dualpolymerising composite-based luting system for the
permanent adhesive luting of metal, ceramic and
composite restorative pieces. We had a maximum
working time in reduced light of about 2.5–3.5 minutes.
We applied Bifix QM directly on to the prepared areas
and secured the endocrown by applying gentle pressure
(Fig. 14).
[45] =>
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case report
|
“[...] milled CAD/CAM
composite resin endocrowns
are not only a more
conservative approach
but also more stable [...].”
The chemical setting time is 3 minutes. Once we had
removed the excess Bifix QM with a foam pellet
(Pele Tim, VOCO) and a disposable brush (Single Tim,
VOCO), it was possible to considerably reduce the
polymerisation time using additional light polymerisation. This light setting was performed at the luting
margins with the Celalux 2 for 20 seconds from
the vestibular side and a further 20 seconds from the
lingual side (Figs. 15).
19a
19b
Figs. 19a & b: Comparison of the pre- and post-treatment radiographs.
Initial periapical radiograph characterised by an overcontoured dental filling
in tooth #45 and endodontic underfilling in tooth #46 (a). Final periapical
radiograph confirming the good adaptation of both restorations (b).
Conclusion
Results and discussion
The fully aesthetic and functional results were remarkable and were achieved in a single chairside session,
to the full satisfaction of both patient and dentist
(Figs. 16–19).
This patient was treated with an endocrown because
of the impossibility of a direct restoration owing to the
insufficient thickness of the remaining walls 16 years
after root canal treatment. This helped avoid unnecessary loss of healthy tooth structure, was time-saving, as
post-endodontic treatment with a build-up followed by
a regular ceramic overlay would have required multiple
sessions, and it had a lower cost of the treatment for
the patient.
This new approach using CAD/CAM-fabricated endocrowns reduces the disadvantages associated with
endocrowns produced in laboratories or those made
of ceramic materials.
Acknowledgement
The authors would like to thank the patient for her
efforts and willingness to allow us to solve the case
with this new approach. One week later, her husband
underwent the same treatment with a Grandio blocs
CAD/CAM-fabricated endocrown.
about
Restoration with an endocrown posed a lower risk
of chemical failure owing to fewer adhesive interfaces.
In the case of a build-up and overlay, we would have
had two adhesive interfaces (dental tissue to build-up
and build-up to crown or overlay), instead of just one
(dental tissue to endocrown). Similarly, there was a
lower risk of biomechanical failure of an endocrown
than with more invasive preparation, for example with
metal posts.
The most recent scientific evidence demonstrates that
milled CAD/CAM composite resin endocrowns are
not only a more conservative approach but also more
stable over time than ceramic indirect restorations.
When restoring endodontically treated teeth, endocrowns produced using composite resin materials
showed more uniform stress distribution and higher
fracture resistance.
Dr Lucas J. Echandia is an associate
professor in clinical prosthodontics at
the Universidad Católica de Córdoba
in Córdoba in Argentina. He can be
contacted at Centro Odontológico,
Echandía-Meloni, José Pacifico Otero
2090, X5009HSX Córdoba, Argentina,
lucasechandia85@gmail.com.
Dr Martin I. Ibañez is an associate
professor in oral implantology
at the Universidad Católica de Córdoba
in Córdoba in Argentina.
He can be contacted at
martin.ibanez@ibaimplantes.com.
CAD/CAM
2 2023
45
[46] =>
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| case report
The copyCAD 3: Crown legacy
Dr Yassine Harichane, France
1
2
Fig. 1: Pre-op panoramic dental radiograph. Fig. 2: Close-up of the patient’s granddaughter’s teeth.
Introduction
You may remember the movie TRON: Legacy, in
which young Sam Flynn dives into the game Tron to
find his father. He discovers a virtual world thanks to
an incredible paternal legacy. The film emphasises
the importance of familial transmission and the
opportunities offered by digital technology. In this
article, we aim to demonstrate the value of this in
a dental context by presenting a clinical case of
transmission from a granddaughter to a grandmother
that used technological tools that open up a world of
possibilities.
In our first article (“The copyCAD”, CAD/CAM 2/2020),
we demonstrated how to restore a smile by copying
and pasting dental anatomy. In the next article (“The
copyCAD 2: Complete success for a complete denture”,
CAD/CAM 2/2021), we described the technique of
copying and pasting a provisional complete pros-
4
3
thesis to fabricate a final prosthesis. In this article,
we will merge the two approaches by creating complete
prostheses from a natural smile. Join us on this digital
adventure!
Case report
An 83-year-old patient presented for consultation with
a diagnosis of unsuitable fixed restorations and unusable dental support (Fig. 1). The treatment plan involved creating an immediate removable complete provisional prosthesis for both jaws before considering
definitive prostheses and focused on aesthetic restoration. Despite having had her fixed restorations for
years, the patient was not happy with them. The patient
was accompanied by her 34-year-old granddaughter,
who had a unique smile with natural aesthetics and
flaws (Fig. 2), and the patient agreed to have her prostheses created based on her granddaughter’s dental
anatomy.
5
Fig. 3: Analysis of the facial and smile aesthetics. Fig. 4: Intra-oral scan of the patient’s granddaughter’s teeth. Fig. 5: Simulation of the treatment results.
46 CAD/CAM
2 2023
[47] =>
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case report
6
|
7
Fig. 6: Intra-oral scan STL file. Fig. 7: Virtual design of the dental prostheses.
In the dental practice, the first step was to take a digital
impression and photographs of the patient. A facial
analysis similar to Digital Smile Design (DSD) was performed to define important points, such as the midline
and the incisal edges (Fig. 3). To incorporate the dental
anatomy of the granddaughter, her smile was recorded
in 2D and 3D using photographs and a digital impression
of her dental arches (Fig. 4). A 2D pattern was drawn from
the photographs and integrated into the grandmother’s
DSD (Fig. 5). The treatment plan was then validated by
the patient, and the information and impressions were
sent to the dental laboratory.
In the dental laboratory, the dental technician created
a virtual assembly of the patient’s dental arches.
“[...] the patient agreed
to have her prostheses
created based on
her granddaughter’s
dental anatomy.”
The missing posterior teeth were replaced by creating a
prosthetic base with commercial teeth. For the anterior
teeth, the DSD was used to determine the position of
8
Fig. 8: 3D-printed try-in prostheses.
CAD/CAM
2 2023
47
[48] =>
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| case report
9
10
Fig. 9: Smile with the 3D-printed try-in prostheses. Fig. 10: Close-up with the 3D-printed try-in prostheses.
the midline and the incisal edges. The technician virtually removed the grandmother’s anterior teeth while
maintaining the virtual landmarks. Using the digital impression of the granddaughter’s teeth (Fig. 6), the dental
technician imported the anterior teeth into the design
using the STL file. The teeth were positioned one by
one, respecting the virtual landmarks, resulting in
functional and aesthetic prostheses (Fig. 7). The try-in
prostheses were 3D-printed and sent to the dental
office (Fig. 8).
During the second appointment, the residual teeth were
extracted, and the 3D-printed try-in prostheses were
placed. Despite anaesthesia, aesthetics and function
could already be assessed. On the second postoperative
day, the patient evaluated and validated the aesthetics
and function (Figs. 9 & 10). Modifications can still be
made at this stage and communicated to the dental
11
Fig. 11: 3D-printed provisional prostheses.
48 CAD/CAM
2 2023
technician. However, in this clinical case, no changes
were necessary.
The next laboratory step involved creating the provisional prostheses by duplicating the try-in prostheses
validated by the patient. The base and teeth were
separated virtually. The artificial gingiva was milled from
a pink resin disc, and the prosthetic teeth were milled
from a Shade B1 resin disc according to the patient’s
preference. The teeth were bonded to the base using
an adhesive following the manufacturer’s instructions.
The result was impressive from both a technical and
aesthetic standpoint (Fig. 11).
At the dental office, the patient returned for a check-up
to monitor healing and have the sutures removed. The
provisional prostheses were tried in (Figs. 12 & 13). The
function was preserved thanks to minimally invasive
[49] =>
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12
|
13
Fig. 12: Close-up with the 3D-printed provisional prostheses. Fig. 13: Lateral views with the 3D-printed provisional prostheses.
“The aesthetics exceeded
the expectations of both
the patient and her
granddaughter [...].”
surgery, which preserved the bone crests, and retention and support were confirmed. The aesthetics
exceeded the expectations of both the patient and her
granddaughter, both of whom had not imagined that
such a high level of technical performance was possible. The dentist–prosthetist duo were thrilled by the
satisfaction expressed by the patient and her granddaughter (Fig. 14).
Conclusion
Transmitting a legacy to one’s descendants is a profoundly human and natural act. It can encompass a
lifetime’s accumulated wealth, exceptional knowledge
or fundamental moral values, among many others.
However, when this transmission occurs in the opposite
direction, from descendants to ancestors, it becomes
particularly remarkable, especially when it involves
passing on a smile. Typically, a child possesses a
unique anatomical signature of their smile, making it
challenging to determine the influence of the father or
the mother. However, in this clinical case, a granddaughter transmitted the anatomical characteristics of
her smile to her grandmother. This legacy enabled the
patient to regain youthfulness in the most natural way
possible.
This transmission was made possible solely by the
capabilities of modern technological tools, allowing for
digital copy–paste procedures. The dentist–prosthetist
duo can now replicate an individual’s smile with astonishing precision and seamlessly apply it to another
individual. When the donor and recipient are connected
by family ties, the crown becomes a precious legacy
that is passed between the generations.
Disclosure
The author did not report any disclosures.
Acknowledgement
The author wishes to thank certified dental technician
Benoit Garrault of Laboratoire SERAZIN in France
and his team for their skills.
14
Fig. 14: Post-op situation.
about
Dr Yassine Harichane graduated
from the former Paris Descartes
University in France and conducted
a number of research projects there.
He is an author of numerous publications
and a member of the cosmetic dentistry
study group at the University of Paris.
He can be contacted at
yassine.harichane@gmail.com.
CAD/CAM
2 2023
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| case report
Treatment of severe oral
pathology in pre-geriatric patients:
A proposal for a clinical protocol
for same-day dentistry
Dr Mauro Fazioni, Nicolò Surico, Rita Consolaro & Dr Stefano Orio, Italy
Introduction
Modern restorative and prosthetic dentistry have undergone significant advances over the last five years.
Innovations in dental materials have truly transformed
clinical applications by improving the performance
of restorations in the oral cavity. Clinicians can now
achieve ultrathin restorations using the current generation of hybrid composites, highly aesthetic zirconia and
reinforced glass-ceramics, to name a few, and restorations from these materials are achievable through
simpler procedures in the dental laboratory.
2
1
3
Fig. 1: Initial facial photograph. Fig. 2: Intra-oral photograph of the initial
situation. Fig. 3: Areas of chronic inflammation of transmucosal tissue
evident after removal of the maxillary prosthesis. Fig. 4: Intra-oral scans of
the maxillary and mandibular arches. Fig. 5: Virtual removal of the maxillary
prosthesis in exocad software.
4
5
50 CAD/CAM
2 2023
This achievement is possible thanks to digitalisation
procedures that guarantee greatly improved design
techniques and the fabrication of medical devices in the
laboratory utilising modern milling technologies. When
applied in the laboratory, these tools provide manufacturing options that substantially expand the range
of potential treatments. In-house methods can employ
almost any manufacturing procedure, working with
dry to wet ceramic composite materials, hybrids, metals,
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6
|
7
Fig. 6: Maxillary and mandibular prostheses designed with Ivotion libraries. Fig. 7: The R5 is compatible with the unique Shell Geometry of the Ivotion disc.
etc., in contrast to external milling centres, which
frequently standardise production protocols, limiting
applications.
The dentistry department of the IRCCS Ospedale Sacro
Cuore Don Calabria, a hospital in Negrar in Italy, has
been investigating clinical care models for dental pathologies that clinicians will face in the coming years.
Understanding and comprehending these emerging
diseases means developing tools that are capable of
addressing the needs of future patients, and the treating team needs to be able to handle these new methods
of addressing patient needs and diseases. The following
are some important emerging fields of interest:
– applying artificial intelligence for diagnosis, previewing,
3D modelling and treatment simulation;
– restorative approach to same-day dentistry in terms
of materials and methods;
– treatment of severe oral pathology in pre-geriatric
patients involving same-day dentistry;
– dental malocclusions and orthodontic treatment with
aligners;
– treatment of severely worn dentition with in-house
procedures; and
– risks of and clinical strategies for clear aligner therapy.
“Clinicians can now
achieve ultrathin restorations
using the current generation
of hybrid composites (…).”
– compromised masticatory ability;
– spontaneous oral pain;
– recurrent infections of the mouth and oral tissue;
– deterioration of the dental system;
– periodontal disease; and
– xerostomia.
Changes in physical appearance are an important component of modern ageing, especially for people over 65.
Description
Adult patients with severe or extremely severe oral
disease compromising the functions of the stomatognathic system are becoming increasingly prevalent.
Unlike in the past, these patients are fully integrated
into society. The lifestyle and dietary habits of these
patients, even when they are older than 75 or 80, are comparable to those of younger adults, particularly in terms
of their expectations. Clinically, these patients present
with severe signs and symptoms that are frequently
seen in other systemic diseases, including:
8
Fig. 8: Denture in the vhf CAM software module for the R5.
CAD/CAM
2 2023
51
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| case report
“A deficiency in dental occlusion has the same impact as
inflammation from periodontal disease in changing the
alveolar bone structure.”
Age-related changes in the anatomical and functional
integrity of the oral cavity have an effect on more than
just dental health; they also affect the pathogenesis
of systemic disease and nutrition. A deficiency in dental
occlusion has the same impact as inflammation from
periodontal disease in changing the alveolar bone
structure.
9
Fig. 9: Adapter plate with the Ivotion disc inserted. Fig. 10: Extremely high
level of morphological and surface detail produced with the simultaneous
monolithic milling of the pink aesthetics and the teeth.
One of the greatest challenges to overcome is the
need to minimise the number of appointments while
continuing to provide effective treatment. Recently,
materials with high aesthetic and functional predictability have been introduced to the market, enabling
rehabilitation of the completely edentulous arch in a
very short amount of time. The intra-oral impression
can be instantly accessed in the patient’s habitual intercuspation. Condylar determinants can be evaluated
realistically with a digital facebow, combined with
CBCT, and masticatory movements can be reproduced. Full-arch reconstruction with complete dentures is possible using 3D modelling software in just
a few minutes, providing an accurate assessment
of recovery of the vertical dimension of occlusion.
It has become possible to reconstruct the integrated
functional and aesthetic profile initially shared with the
patient using simulations.
Materials and methods
For teeth and prosthetic bases,
cross-linked PMMA from the
Ivotion denture system (Ivoclar)
is recommended. Thanks to its
unique Shell Geometry, it allows
for excellent outcomes with a
single milling, thus optimising time
significantly. Optimisation of time
and results are made possible by
the use of the latest-generation,
innovative milling machines that
are extremely accurate and compatible with all commonly used
milling techniques. A modern system that provides the technician
and clinician with incredibly
10
52 CAD/CAM
2 2023
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case report
“Production of complete
prostheses with this
digital workflow is 100%
accurate and predictive
regarding timing.”
|
12
precise milling details, compatible with a same-day
dentistry regimen, is the R5 five-axis milling machine
(vhf camfacture).
Clinical case
A 75-year-old female patient in good mental and physical health presented with an implant-supported denture
in the maxillary arch with widespread peri-implantitis
and burning mouth syndrome (Figs. 1–3). In the lower
jaw, she presented with a removable complete denture,
abraded teeth and incongruence between the base
and alveolar process. The patient reported pain and
bleeding in the maxillary arch with compromised stability
of the mandibular denture.
The 3D files of the prostheses were exported to the
Ivotion denture system’s specific CAM module (Ivoclar
Vivadent Manufacturing; Figs. 4–6). The prostheses
were milled using the Ivoclar-exclusive Shell Geometry
processing capability of the R5 (Figs. 7–9). In 4 hours,
the complete maxillary and mandibular prostheses had
been fabricated (Fig. 10). For the maxillary prosthesis,
we immediately relined it after removing the framework
that had been screwed to the prosthesis and then
screwed it in (Fig. 11). Re-evaluation with a digital
facebow and data comparison were made possible by
remote control (Figs. 12 & 13).
Conclusion
Full-mouth restoration in a single session was made
possible by the method of intra-oral scanning of the
arches, immediate prosthetic design and milling of the
Ivotion discs using the R5. Based on our clinical findings, this technique optimises time as well as expenses
for the complete rehabilitation procedure in the sameday dentistry protocol. Production of complete prostheses with this digital workflow is 100% accurate
and predictive regarding timing. The latest technology
allows for highly precise evaluations of the accuracy
of occlusal determinants, release planes and simulation
of masticatory movement. The patient receives rehabilitation of both arches and accurate reconstruction in a
single day.
11
13
Fig. 11: Denture in situ. Fig. 12: Extra-oral situation at the four-week check-up.
Fig. 13: Detail of the morphology and texture of the anterior teeth at four weeks.
about
Dr Mauro Fazioni graduated
with a DDM from the University of
Verona in Italy in 1992. Since 2005,
he has been a consultant in the
research and development department
of some of the most important digital
dentistry companies on the topics
of intra-oral scanning, prosthetic
design software, guided surgery and
machinable materials applied in fixed prosthodontics and
implant restorations. In 2017, he founded MCD Consulting,
a company specialising, among others, in digital head
and neck investigations, clinical protocols for head and neck
reconstructions, and head and neck laboratory prototypes.
In 2020, he founded the Accademia Italiana di Odontostomatologia
Digitale (Italian academy of digital dentistry), an independent
study group on digital applications in dentistry and
maxillofacial surgery. He began collaborating with the
digital dentistry department of IRCCS Ospedale Sacro Cuore
Don Calabria, a hospital in Negrar in Italy, in 2020.
He speaks and publishes on same-day dentistry and protocols
in digital dentistry. He can be contacted at mauro@fazioni.com.
www.mcdconsulting.it
www.aiod.it
Nicolò Surico and Rita Consolaro are oral and facial
3D design specialists.
Dr Stefano Orio is the director of the dental centre
of the IRCCS Ospedale Sacro Cuore Don Calabria,
a hospital in Negrar in Italy.
CAD/CAM
2 2023
53
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| practice management
“Alone we can do so little, together
we can do so much”—Helen Keller
By Jerko Bozikovic, Belgium
We are entering the fourth quarter of this year but let
us get back to 2023 resolutions. Have you made any as
a team in your clinic? Have you taken the time to reflect
how the year before went, what went well, what were
some points of improvement? Have you taken time and
space to celebrate as a team how you managed to do
the best you all could in the recent quite challenging
times? Have you taken time to sit together as a team
and create plans for the whole year together? How
would you like the next year to look like as a team and
as a practice? Have you considered individual staff’s
goals as well as team goals in the short, mid- and long
term? This is important because we all know you cannot run the show without having a strong, motivated
and engaged team.
54 CAD/CAM
2 2023
TEAM—together everyone achieves more
Let us talk about how you can involve your team so
that members become more engaged, more skilled
and more motivated. There are some key points I want
to discuss. The invitation to you is to see whether you
already have integrated them or whether these might
be some ideas to explore.
Communication
No team functions if their communication is poor.
Good communication requires that there are enough
occasions where communication plays a leading role in
content and form for successful interactions.
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|
© Jason Valendy
practice management
Johari window.
“Talent wins games, but
teamwork and intelligence
win championships.”
—Michael Jordan
Are there enough formal moments, like meetings, where
you can go over responsibilities? These are moments
when it is clarified who has responsibility for what and
who can step in when needed into which task or role.
Meetings should not be long and boring or one-way
communication. Involve your team members, for example
by having them present some aspects of their job so that
others learn from it too or share some patient success
stories as well as how they dealt with some challenging
situations. This gives opportunity for great fun and
moments of growth.
Open feedback culture
Do you have a clear framework for which communication
tools are to be used in which context (e-mail, phone, chat,
Teams, in person, etc.)? I have seen in many teams that
this framework is often not clear.
Nothing is as important for a well-oiled team as having an
open feedback culture. Feedback should not be kept only
for official occasions, like evaluations, but should be given
on a daily basis. Here are some tips on how to do this:
Are there enough informal moments for team communication, like sharing lunch together? We need time at
work where we cultivate the relationship between the
team members in a way that is not always related to work.
A great example is the social custom of fika in Sweden
and Finland, when work or other daily activities are
interrupted in order to get together, drink tea or coffee,
or eat something. It happens at a scheduled time and is
deliberately used to pause and socialise. Conversations
around work are consciously avoided, and the intention
is to enhance team spirit and relationships.
– Find a balance between positive and constructive feedback. People really become demotivated if they do not
know how their work is being perceived. Giving compliments from time to time creates wonders. Not getting
feedback often is a cause of demotivation and people
leaving the company or practice.
– Receiving occasional constructive feedback is also crucial.
If we are not told what we can improve, then we cannot grow
and might risk making the same mistakes. We need to be
aware that most people have the intention to do their job well,
and yet we need to give feedback sometimes. That means
“Effective teamwork begins and ends with communication.”
—Mike Krzyzewski
CAD/CAM
2 2023
55
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© VectorMine/Shutterstock.com
VectorMine/Shu te stock.com
| practice management
“It takes humility to seek
feedback. It takes wisdom to
understand it, analyse it and
appropriately act on it.”
—Stephen Covey
that they are not aware of doing something that is not desired,
otherwise they would not do it, so that is a blind spot for
them—the Johari window explains perfectly what that blind
spot is all about (Fig. 1). A great sentence to use in addressing
this is “I have seen you doing something I don’t think you
are aware of, otherwise you would not do it.” This prompts
a direct response from the other person asking what the
thing mentioned is, creating an opportunity for engagement.
Introducing feedback this way avoids being harsh.
– When feedback is given, always give feedback on behaviour,
never on personality. We need to separate these, but many
may perceive it to be the opposite. The person receiving
the feedback may feel like he or she is being attacked personally rather than being given feedback on something he
or she has done. To avoid this, you could start such a conversation with “I want to give you feedback on something
I have seen you doing, not on who you are.”
– A nice way of creating this open feedback culture
comes from the bestseller The One Minute Manager by
Ken Blanchard (it is quite an old book, but the ideas are
still very relevant): spend 1 minute with each team member
every day giving feedback, one day on something
positive and the other day on something to be improved.
This feedback should be given in all directions, top-down,
bottom-up and lateral. Do not be scared to also ask for
some feedback from your team members.
56 CAD/CAM
2 2023
Delegation
Delegating is probably one of the most difficult and scariest
things to do and yet crucial for any team to function. Sometimes, delegation is avoided because of limiting beliefs,
such as thinking you have no time to train people, they will
not do what needs to be done, they are not responsible or
capable enough to do it, or nobody does it better than you
do it. Recognise some of these? And yet, the benefits are
so incredible: more motivation, more engagement, people
finding the necessary means, people assuming more responsibility. You cannot know nor do everything yourself,
so helping your business grow does not mean working
harder and doing more, but working smarter, and delegating
is one of these smarter ways to work.
When you delegate, it is important to check what you can
ask of whom. Is the person already competent or do you
need to train that person? Will you delegate only tasks or
also responsibilities? It is very important to have that clear
in your mind and in your communication to the relevant
people.
Creating a good framework for how to delegate will be a
game changer. Here are nine steps for efficient delegation.
Check which ones you are already following and which
ones you could improve on:
1. Determine the task clearly.
2. Select the individual or team you want to delegate to.
3. Evaluate capabilities and training needs if required.
4. Explain the reasons why you want to delegate.
5. Communicate the desired results clearly.
6. Determine the resources that the individual or team
can count on (people, time, tools, etc.).
7. Set deadlines: state what needs to be done by whom
and by when.
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practice management
8. Support and communicate throughout the entire
delegation process.
9. Provide feedback on the results at the end of the task
or project.
Wrap-up
Team members are precious; it is important to foster
a wonderful relationship with them. They often have
more contact with the patients than you have, so value
them, give them responsibilities, be honest with them,
inspire them, motivate them and let them make their
own choices too. Every day, I work with teams in the
corporate world and in dental clinics, and to determine
whether the business or practice is thriving it is enough
to see how the team is doing. If they are bonded,
aligned, open, proactive, the clinic will thrive; however
if there is not a strong team, one can feel it in the clinic
and see it in the results. Therefore, investing in your
team and enabling your team to invest in themselves
and each other might be a great resolution for the
next year!
Editorial note: This article was first published in aligners—
international magazine of aligner orthodontics, Vol. 2,
Issue 1/2023 and an edited version is provided here.
|
“Delegation requires the
willingness to pay for
short-term failures, in order to
gain long-term competency.”
—Dave Ramsey
about
Jerko Bozikovic is a specialist
in communication skills, emotional
intelligence, time and stress
management, leadership and change
management. He is fascinated by
human behaviour and finds working
with people on personal development
to be a daily challenge and blessing.
He speaks seven languages and has
offered his training courses in four languages since 2001.
He embraces and embodies the motto “Love the life you live;
live the life you love”. He can be contacted via LinkedIn.
AD
ROOTS SUMMIT IS
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COMING TO ATHENS
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CAD/CAM
57
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2 2023
LUKVYZLPUKP]PK\HSJV\YZLZVYPUZ[Y\J[VYZUVYKVLZP[PTWS`HJJLW[HUJLVMJYLKP[OV\YZI`IVHYKZVMKLU[PZ[Y`;YPI\UL.YV\W.TI/KLZPNUH[LZ[OPZHJ[P]P[`MVY18.5 continuing education credits;OPZJVU[PU\PUNLK\JH[PVUHJ[P]P[`OHZILLUWSHUULK
HUKPTWSLTLU[LKPUHJJVYKHUJL^P[O[OLZ[HUKHYKZVM[OL(+(*VU[PU\PUN,K\JH[PVU9LJVNUP[PVU7YVNYHT(+(*,97[OYV\NOQVPU[LMMVY[ZIL[^LLU;YPI\UL.YV\W.TI/HUK+LU[HS;YPI\UL0U[LYUH[PVUHS.TI/
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| manufacturer news
Transition to a modern digital laboratory
Four ways for dental laboratories to benefit from digital workflows
“For a lab, every second counts,” according to Lee Culp, certified dental
technician and CEO of Sculpture Studios, a dental laboratory in Apex in
North Carolina in the US. The use of intra-oral scanners by dentists is
booming, and coupled with a dental laboratory’s need for speed, this could
soon mean that CAD/CAM, once considered by some laboratories a more
efficient and predictable way to work, may soon become the only way for
all laboratories to work. Here are four cost-effective ways that 3Shape can
power the transition to a modern digital laboratory.
CAD workflows with AI-powered indications
The backbone of a laboratory’s digital workflow is 3Shape Dental System
CAD software. From designing simple crowns to designing dentures,
3Shape Dental System’s intuitive next-next and artificial intelligencesupported (AI-supported) workflows make designing fast and predictable.
3Shape Dental System gives users everything they need to create and
share restorative proposals with their customers digitally. They can then
send designs off for production to a growing range of fully integrated mills
and 3D printers with 3Shape Produce. In addition, the software uses
AI technology to make mundane workflow tasks like sectioning teeth more
efficient. However, 3Shape AI does even more. It integrates seamlessly
with 3Shape Automate, the company’s AI-driven design service, and with
3Shape Design Service. Laboratories needing design help can take advantage of the two fully integrated design services 24/7. Turnaround time
for 3Shape Automate is as little as 5 minutes.
Fast precision scanning
For now, laboratories may still need to convert analogue impressions to
digital models. 3Shape’s award-winning desktop scanners make this simple.
There is a 3Shape laboratory scanner for every budget in the company’s
58
wide range of scanners, which includes the recently released F8 dualmodel scanner and four Generation E scanner models. The new F8 laboratory scanner is engineered for efficient dual-model scanning workflows and
enables articulator scanning. Its innovative design allows laboratories to do
more in less time with fewer scanner interactions and workflow steps.
Laboratory management software
“With my laboratory management software from 3Shape, I do everything
from callbacks, retention, financial measurements, production measurements, case tracking and more. And I do it all from my phone,” said Culp.
3Shape recently launched its cloud-based 3Shape Lab Management
Software. It enables laboratories to organise every case, whether analogue or digital, transform client relationships, manage client expectations
and effortlessly collaborate across teams while streamlining every task to
make the laboratory run more efficiently.
Support and ongoing training
3Shape’s LabCare service package is the safest way to ensure success and
secure an investment. LabCare provides unlimited software upgrades,
support, hands-on training, events and unique product discounts.
However, it is completely optional, and instead, users can choose 3Shape’s
basic non-subscription package at no additional cost.
Go digital now
By going digital, dental technicians will experience efficiency gains and
accuracy improvements. The best part is that laboratories can start small,
as 3Shape solutions are scalable.
www.3shape.com/en/software/dental-system
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manufacturer news
|
DEXIS IOS Solutions expands its portfolio and ecosystem
New end-to-end digital workflows for dental practitioners
DEXIS IOS Solutions is pleased to announce the expansion of its
portfolio and ecosystem through new digital end-to-end workflows. The new and enhanced workflows are designed to align
with the objective of DEXIS IOS Solutions to support dental practitioners in accelerating their workflows, resulting in increased
productivity and an improved patient experience. To reinforce
this objective, DEXIS IOS Solutions is focused on three crucial
principles: ease of use, productivity and practice expansion.
Practitioners can now easily expand their range of services
through aligner and denture treatments, as well as in-house printing,
offering their patients personalised and innovative care.
The new prescriptive workflows are being developed concurrently
with ongoing innovations in the broader portfolio of Envista
Holdings Corp., beginning with a new orthodontic workflow in
combination with Ormco’s Spark clear aligners that enables practices to
easily add aligner therapy to their treatment options. A new patient
engagement app within DEXIS IS ScanFlow enables practitioners
to show patients a simulated outcome of their orthodontic treatment, enabling them to visualise the treatment outcome chairside.
Integrated digital transfer of the data sets to the Spark software
streamlines the process, facilitating prompt treatment.
“By further integrating DEXIS IOS Solutions into the broader
Envista offerings, we are providing dentists with the solutions they
need to provide exceptional and personalised care for their patients.
We are committed to helping dental practitioners improve patient
outcomes and grow their practice through digital innovation,” said
Amir Aghdaei, president and CEO of Envista.
DEXIS IOS Solutions has also collaborated with SprintRay’s
3D-printing ecosystem for definitive ceramic crowns to simplify
in-office printing and make same-day restorations a reality.
SprintRay Cloud Design leverages artificial intelligence to streamline
the design of crowns, appliances and surgical guides within minutes.
Practitioners can scan their patients with any DEXIS intra-oral
scanner and upload the data set directly from either DTX Studio Clinic
or IS ScanFlow to the SprintRay portal, eliminating the need to
manually select files, enter redundant patient information and
design the restoration or appliance.
“By combining DEXIS intra-oral scanners
with SprintRay’s ecosystem, dental practitioners can offer same-day delivery of crowns
and appliances, increasing their productivity
by completing more procedures in a shorter
amount of time,” said Aghdaei. “Offering
same-day restorations can give practitioners a distinct competitive advantage,
as patients often prefer the convenience
of single-visit appointments, enabling dental
practitioners to expand their services and attract
patients seeking fast and convenient dental treatment.”
To further enhance the capabilities of the DEXIS IOS Solutions
portfolio, IS ScanFlow (Version 1.0.9) now includes a denture
scanning workflow that streamlines the treatment planning process by combining the capture of the bite registration and prosthesis along with the edentulous and denture scans, eliminating
the manual process of matching and aligning data sets by the
laboratory. The software also provides embedded scan tips to
optimise and simplify the edentulous data acquisition.
In addition, DEXIS IOS Solutions is introducing the IS 3800 wired
scanner, which offers the same high-speed performance as the
award-winning IS 3800W wireless scanner. The IS 3800 wired
scanner is highly ergonomic and weighs just 190 g without the
cable, making it one of the lightest intra-oral scanners available.
It complements the IS 3800W scanner, which weighs only 240 g
and is the lightest wireless intra-oral scanner in the industry.
The latest DEXIS IOS Solutions innovations provide dental practitioners with access to intuitive technology that simplifies and
streamlines treatment, thereby boosting productivity. With an
extended ecosystem and diverse range of new treatment options,
practitioners can partner with Envista for access to prescriptive
end-to-end workflows or opt for open workflows, which
enable collaboration with their preferred laboratory
or manufacturer. The new workflows further align
with Envista’s intention to digitise, personalise and democratise dental care, supporting dental practitioners in the provision
of optimal patient care through enhanced productivity and predictability of
treatment.
For more information about DEXIS IOS Solutions’
products and services, visit our website.
www.dexis.com
CAD/CAM
2 2023
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| manufacturer news
Durable temporary restorations with a high accuracy
V-Print c&b temp from VOCO for 3D-printed composite
temporary restorations
Germany-based dental material manufacturer VOCO has
expanded both the use of additive production techniques
and its V-Print family with its latest material development,
V-Print c&b temp. This new 3D-printing material offers
a practical solution for the manufacture of even multi-unit
temporary restorations in complex prosthetic treatment in
the digital workflow.
Digital designs mean patients can be involved from even before
treatment begins. The restoration is planned, designed and
visualised digitally, giving predictable results for both the dentist
and the patient. Additive production allows numerous design
possibilities compared with the subtractive alternative. With
V-Print c&b temp, patients receive durable temporary restorations with a high accuracy of fit before the final restoration is
produced.
60 CAD/CAM
2 2023
Highly filled composite with great flexibility
Using V-Print c&b temp to fabricate temporary restorations provides
expanded possibilities such as characterisation, simple repair if
needed and shape adjustments with composite in the course of
treatment. The high surface quality allows simple processing and
polishing. The translucency and natural fluorescence of V-Print c&b temp
exceed all aesthetic demands of a temporary restoration.
V-Print c&b temp is a highly filled composite and categorised as an
EU Class IIa medical device. Its exceptional physical properties, such
as high flexural strength (132 MPa), low abrasion (119 μm) and low water
absorption (18 μg/mm³), make V-Print c&b temp ideal for long-term
temporary restorations too, as confirmed by our laboratory tests.
www.voco.dental
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meetings
|
All about the patient:
The 2024 ITI World Symposium
By ITI Foundation
The ITI World Symposium is back and better than
ever. In Singapore from 9 to 11 May 2024, more than
50 world-renowned speakers will present at the
world’s largest scientific implant dentistry event.
Building on the highly successful online edition, the 2024
ITI World Symposium will once again put patients at
the centre of the action.
Over three days, more than 4,000 participants will
experience real patients and their stories on stage.
The speakers will discuss various treatment options based on the latest scientific evidence. Additionally, world-class clinicians will provide commentary on exclusively recorded clinical procedures live
on stage.
“With our unique, patient-centred programme, we aim
to combine practical, clinical insights with the discussion of scientific findings,” explained International
Team for Implantology (ITI) President Dr Charlotte
Stilwell. “We ran a survey in our community last year to
identify the topics of greatest relevance currently, and
these form the core of our scientific programme: softtissue management, guided bone regeneration/bone
augmentation, immediate implants, peri-implantitis and
the digital workflow.”
Registration for the ITI World Symposium is open
at worldsymposium.iti.org. ITI members as well as
those who register early will benefit from significant
discounts.
CAD/CAM
2 2023
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| meetings
Long-awaited Digital Dentistry Show
to premiere in Berlin in June 2024
By Dental Tribune International
Now is an exciting time for dentistry. Technological
innovations lie at the heart of the profession and are
significantly advancing personalised dental care. To provide
a platform to celebrate digital innovations in the field and
educate the dental team, DDS.Berlin has collaborated
with the Digital Dentistry Society, and they are bringing a
highly immersive experience to the capital of Germany—
the Digital Dentistry Show.
Scheduled for 28 and 29 June 2024 at the Arena Berlin,
the event promises to deliver engaging educational and
social opportunities with a special focus on digital products and the digital workflow in dentistry.
Through live product presentations, workshops, discussion sessions and an exhibition, the 2024 Digital Dentistry
Show seeks to provide attendees with first-hand knowledge of digital dental products and services and to offer
space for personalised advice and face-to-face interactions with industry leaders. With the focus on robust
The 2024 Digital Dentistry Show will offer cutting-edge knowledge and
skills that will help dental professionals better navigate technological advancements in the field. Located in Berlin’s Alt-Treptow inner-city district,
the 6,500 m2 Arena Halle offers high-quality professional infrastructure.
(All images: © Markus Nass)
The Badeschiff is a picturesque floating public swimming pool area overlooking the Spree river.
62 CAD/CAM
2 2023
[63] =>
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meetings
|
The Escobar is an extension of the Badeschiff that includes a covered bar area.
research evidence, the scientific programme will feature
presentations by prominent opinion leaders, including
Drs Henriette Lerner, Alessandro Cucchi, Mirela Feraru,
Howard Gluckman, Fabrizia Luongo and Setareh Lavasani,
and cover a wide range of topics, such as artificial intelligence, the digital workflow in maxillofacial surgery and
full-arch rehabilitation, and digital bone surgery. Attendees
will have the opportunity to earn valuable continuing
education credits.
Besides a strong educational aspect, the 2024 Digital
Dentistry Show will serve as a social hub for dental
experts, professional organisations, manufacturers
and publishers who are looking to form or expand
their network of like-minded, future-oriented individuals.
To be hosted at one of Berlin’s industrial pearls, the
unique event location offers a rich history and a distinctive
modern feel.
The adjacent Escobar and the Badeschiff spaces will
enhance the relaxed and jovial atmosphere, underlining
the informal and engaging nature of the show.
The 2024 Digital Dentistry Show is expected to attract over
2,000 eminent dental professionals from around the world.
You are invited to be one of them!
More information on registration and the scientific
programme can be found online at the event’s official
website at dds.berlin.
Attendees will also have access to the Sonnendeck of the Escobar, where they will be able to enjoy delicious food and drinks.
CAD/CAM
2 2023
63
[64] =>
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| meetings
GNYDM 2023
5th EAS Congress
24–29 November 2023
New York, USA
www.gnydm.com
29 February – 2 March 2024
Valencia, Spain
www.eas-aligners.com
ADF 2023
exocad Insights 2024
28 November–2 December 2023
Paris, France
www.adfcongres.com
9–10 May 2024
Palma de Mallorca, Spain
www.exocad.com/insights2024
CIOSP 2024
ITI World Symposium 2024
24–27 January 2024
São Paulo, Brazil
www.ciosp.com.br/en
9–11 May 2024
Singapore
www.iti.org/start
AEEDC 2024
ROOTS SUMMIT
6–8 February 2024
Dubai, UAE
www.aeedc.com
9–12 May 2024
Athens, Greece
www.roots-summit.com
159th Chicago Dental Society
Midwinter Meeting
DDS.Berlin
22–24 February 2024
Chicago, USA
www.cds.org/midwinter-meeting
28–29 June 2024
Berlin, Germany
www.dds.berlin
64 CAD/CAM
2 2023
© 06photo/Shutterstock.com
International events
[65] =>
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|
© 32 pixels/Shutterstock.com
submission guidelines
Xxxxxx
How to send us your work
Please note that all the textual components of your submission must be combined into one MS Word document.
Please do not submit multiple files for
each of these items:
· the complete article;
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and
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In addition, images must not be embedded into the MS Word document. All images must be submitted separately, and
details about such submission follow below under image requirements.
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Article lengths can vary greatly—from
1,500 to 5,500 words—depending on the
subject matter. Our approach is that if
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topic justice, then please make the article
as long or as short as necessary.
We can run an unusually long article in
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topic for which each part can stand
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In short, we do not want to limit you in
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and if you have specific questions, please
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Also, please remember that images
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You may submit images via e-mail or
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Please number images consecutively
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then use lowercase letters to designate
these in a group (for example, 2a, 2b, 2c).
An abstract of your article is not required.
Please place image references in your article wherever they are appropriate,
whether in the middle or at the end of a
sentence. If you do not directly refer to the
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Author or contact information
The author’s contact information and a
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exact information you would like to appear in this section and format it according to the requirements stated above. A
short biographical sketch may precede
the contact information if you provide us
with the necessary information (60 words
or less).
In addition, please note:
We also ask that you forego any special
formatting beyond the use of italics and
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size of a postage stamp!).
Questions?
Magda Wojtkiewicz
(Managing Editor)
m.wojtkiewicz@dental-tribune.com
CAD/CAM
2 2023
65
[66] =>
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| about the publisher
international magazine of dental laboratories
Imprint
Publisher and Chief Executive Officer
Torsten R. Oemus
t.oemus@dental-tribune.com
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Schmid
Copy Editors
Sabrina Raaff
Ann-Katrin Paulick
Contributors
Jerko Bozikovic
Rita Consolaro
Dr Lucas J. Echandia
Dr Mauro Fazioni
Elena Generalova
Dr Yassine Harichane
Dr Martin I. Ibañez
Stephan Kreimer
Eric Kukucka
Max Milz
Giuliano Moustakis
Dr Stefano Orio
Dr Alessandro Pezzana
Dr Joseph Sabbagh
Dr Rainer Seemann
Nicolò Surico
International Administration
International Headquarters
Chief Financial Officer
Dan Wunderlich
Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
General requests: info@dental-tribune.com
Sales requests: mediasales@dental-tribune.com
www.dental-tribune.com
Chief Content Officer
Claudia Duschek
Clinical Editors
Nathalie Schüller
Magda Wojtkiewicz
Editors
Franziska Beier
Jeremy Booth
Anisha Hall Hoppe
Iveta Ramonaite
Executive Producer
Gernot Meyer
Advertising Disposition
Marius Mezger
Art Director
Alexander Jahn
Magazine
subscription
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Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
CAD/CAM
— international magazine of
dental laboratories
Scan the QR code to register and read
the magazine online free of charge.
For print subscriptions, contact
info@dental-tribune.com (fees apply).
Copyright Regulations
All rights reserved. © 2023 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH
is expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for
typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International GmbH.
66 CAD/CAM
2 2023
[67] =>
untitled
Anything goes.
The smart milling and grinding machine from vhf.
5
Axes
10
Discs
60
Blocks
16
Tools
Dry
Wet
The R5 from vhf thrills even the most experienced dental technician. Why? Because it
LVH[WUHPHO\YHUVDWLOHDQGRĭHUVWKHIUHHGRP\RXQHHG KDQGOHDQ\PDWHULDOIURPDQ\
manufacturer – no matter if it’s blocks, discs, or prefab blanks for titanium custom
abutments. And also the easy to operate DENTALCAM software is included – with no
extra license fees. So you get a machine that leaves nothing to be desired – all on a
PLQLPDOIRRWSULQWDQGIRUDVXUSULVLQJO\DĭRUGDEOHSULFH
)LQGRXWPRUH vhf.com/R5
Mill
Grind
Auto
Clean
CAM
Software
incl.
[68] =>
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/ Aspen Dental’s digital denture transformation - An interview with Eric Kukucka
/ Zero-bake technique: A simplified approach to zirconia aesthetics - An interview with Giuliano Moustakis
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/ Restoration of a fractured ceramic crown with a digital workflow
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