CAD/CAM international No. 2, 2011
Cover
/ Editorial
/ Content
/ Healthy and harmonised function via computer-guided occlusal force management
/ Reducing surgical morbidity with CBCTguided implant surgery
/ Implant-prosthetic troubleshooting— When dental technicians and dentists break into a sweat!
/ “Patient education needs to be part of the daily activities of a practice”; Interview with Dr Reena Gajjar
/ “Sirona products function like the pieces of a puzzle”; Interview with Jost Fischer - Chairman and CEO of Sirona
/ Moving the dental world from analogue to digital: 3Shape’s success story continues
/ Intraoral impression-taking: Digital datasets soon to catch on everywhere
/ Dental Wings collaborates with absolute Ceramics
/ CEREC SW 4.0 now available
/ Record-breaking IDS 2011
/ Subscription
/ International Events
/ Submission guidelines
/ Imprint
/ Subscription
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[1] =>
CAD0211_01_Title
CAD0211_01_Title 21.09.11 16:03 Seite 1
issn 1616-7390
Vol. 2 • Issue 2/2011
CAD/CAM
digital dentistr y
international magazine of
2
2011
| case report
Reducing surgical morbidity with
CBCT-guided implant surgery
| feature
Moving the dental world from analogue
to digital: 3Shape’s success story continues
| trends
Intraoral impression-taking:
Digital datasets soon to catch on everywhere
[2] =>
CAD0211_01_Title
emax_2010_ad_bruguera_e_A4.qxd
22.2.2010
13:44 Uhr
Seite 1
“I’M TRULY IMPRESSED:
IT WORKS. WHAT ELSE
CAN I SAY!”
August Bruguera, Dental Technician, Spain.
You will be amazed at the versatility of the
IPS e.max system. The high-strength IPS e.max
lithium disilicate can be processed using press or
CAD/CAM techniques: The choice is yours, depending on the case at hand and the requirements.
ic
m
a
r
e
all c
need
u
o
y
all
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Principality of Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
[3] =>
CAD0211_01_Title
CAD0211_03_Editorial 23.09.11 12:40 Seite 1
editorial _ CAD/CAM
I
Dear Reader,
_At IDS 2009, we had already caught a glimpse of how dentistry would be changing
in the future. This year’s show affirmed what many were expecting: the digitisation of dentistry is in full swing or, as Daniel Wismeijer, Professor of Oral Implantology and Prosthetic
Dentistry at the Academic Centre for Dentistry in Amsterdam, put it: “Digital dentistry is like
a bullet train coming at us and its impact will be significant.”
Claudia Salwiczek
These developments are leading to substantial changes, affecting how dentists and dental
technicians will carry out their profession in the future. It seems safe to say that intra-oral
scanners, for example, are going to replace traditional impression-taking methods completely. With this scanning technology, patient data is gathered more comfortably and
precisely, easily, faster and, as a result, at a lower cost. Diagnosis and treatment planning are
now possible in 3-D, suggesting the real possibility of a virtual patient.
Since its launch in 2010, CAD/CAM has been committed to accompanying these developments by informing its readers about the latest treatment concepts and technologies and
how these can be integrated into today’s treatment concepts for the benefit of everyone
involved—the patients and the dental professionals. It is absolutely essential that dentists
and dental technicians become acquainted with these new technologies, and CAD/CAM
thus strives to serve as a platform for information exchange.
In order for the magazine to achieve its full potential, we need your input and encourage
you to participate in this exchange. Please feel welcome to submit scientific articles, case
reports, industry reports, reviews (meetings, products, etc.) and news for publication.
We appreciate your feedback greatly and are eager to engage with you about your views
on digital dentistry.
Best wishes,
Claudia Salwiczek
Managing Editor
CAD/CAM
2_ 2011
I 03
[4] =>
CAD0211_01_Title
CAD0211_04_Content 22.09.11 17:04 Seite 1
I content _ CAD/CAM
I editorial
03
I trends
Dear Reader
38
| Claudia Salwiczek, Managing Editor
Intraoral impression-taking:
Digital datasets soon to catch on everywhere
| Manfred Kern
I case report
06
Healthy and harmonised function
via computer-guided occlusal force management
| Dr Robert Kerstein
14
Reducing surgical morbidity with CBCT-guided
implant surgery
| Dr Daniel J. Velinsky
I news
42
Dental Wings collaborates with absolute Ceramics
43
CEREC SW 4.0 now available
I meetings
44
| Yvonne Bachmann
I clinical technique
18
Implant-prosthetic troubleshooting—When dental
technicians and dentists break into a sweat!
| Dr Georg Bach & Christian Müller
48
26
An interview with Dr Reena Gajjar, My Dental Hub
30
An interview with Mr Jost Fischer, Sirona
International Events
I about the publisher
49
50
I feature
Record-breaking IDS 2011
| submission guidelines
| imprint
issn 1616-7390
Vol. 2 • Issue 2/2011
CAD/CAM
digital dentistry
international magazine of
2
2011
| case report
Reducing surgical morbidity with
CBCT-guided implant surgery
34
Moving the dental world from analogue to digital:
3Shape’s success story continues
| Bernhard Moldenhauer & Matthias Diessner
04 I CAD/CAM
2_ 2011
| feature
Moving the dental world from analogue
to digital: 3Shape’s success story continues
| trends
Intraoral impression-taking:
Digital datasets soon to catch on everywhere
On the cover: CopranColor zirconium colouring system, courtesy of
White Peaks Dental Systems GmbH & Co. KG, www.white-peaks-dental.com.
[5] =>
CAD0211_01_Title
isostatic zirconium blanks
Made in Germany
exclusively made from
raw materials of Tosoh - Japan
zirconium colouring liquids in 16 classic shades,
chrome-cobalt, titanium, PMMA and wax blanks,
Calidia series CAD/CAM milling systems,
free CAM software and scanners.
we are certified to the highest standards of
%, US-FDA, IDENTCERAM and DIN EN ISO 13485
White Peaks Dental Systems GmbH & Co. KG
Langeheide 9
45239 Essen, Germany
www.white-peaks-dental.com
info@white-peaks-dental.com
phone: +49 281 20 64 58-0
[6] =>
CAD0211_01_Title
CAD0211_06-12_Kerstein 22.09.11 17:13 Seite 1
I case report _ occlusal force management
Healthy and harmonised
function via computer-guided
occlusal force management
Author_ Dr Robert Kerstein, USA
Fig. 1a_A smile defect of
discoloured teeth and
presence of a diastema.
Fig. 1b_Four anterior veneers
placed to improve smile defects.
Fig. 2_Smile Design Wheel that
incorporates patient psychology,
health, function and aesthetics.
Fig. 2
06 I CAD/CAM
2_ 2011
Fig. 1a
Fig. 1b
_The minimally invasive (MI) concept was initially introduced in physical medicine and adopted
into dental medicine in the early 1970s with the
application of diamine silver fluoride to teeth.1 This
was followed by the development of preventive
resin restorations (sealants) in the 1980s2 and the
atraumatic restorative treatment (ART) approach3
with Carisolv (MediTeam) in the 1990s.4 Since its
inception, the focus of MI dentistry has been
caries detection and treatment.5 It has
not yet been comprehensively
adopted in other fields of
dental medicine; however,
the comprehensive concept of minimally invasive cosmetic dentistry (MICD) and its
treatment protocol
were introduced in
2009 with the basic
aim of a clinician
effecting optimum
clinical therapeutic improvements in
smile enhancement,
while performing corrective procedures that
require as little clinical intervention as possible.6 Additional
guidelines for MICD treatment are:
_the adoption of the “Do No Harm” philosophy to
maximise possible preservation of healthy oral
tissues;
_the proper selection of appropriate dental materials;
_the use of supportive procedure methodologies
that offer clinicians an “evidence-based” treatment approach that will reliably improve treatment outcomes.
With respect to smile design, the intervention level of a selected MICD treatment will
depend on the types of smile defects present,
combined with the subjective perception of the
patient’s own pre-treatment smile condition
(Figs. 1a & b). Some of the more common smile
defects are:
_presence of diastemas;
_discoloured teeth;
_worn and flattened incisal edge contours;
_missing teeth;
_rotated and misaligned teeth;
_teeth internally stained by fluoride or through
childhood disease;
_gingival absence, leading to visible “black triangles”;
_uneven crestal gingival heights;
_maxillary and/or gingival excesses resulting from
altered passive eruption;
[7] =>
CAD0211_01_Title
CAD0211_06-12_Kerstein 22.09.11 17:13 Seite 2
case report _ occlusal force management
I
Fig. 3_Veneer preparations conserve
tooth structure compared with full
coverage crowns.
Fig. 4_Articulated casts require
remounting to ensure minimal spatial
distortions at case delivery.
Fig. 3
_malocclusion according to Angle’s classification;
and
_reverse smile curve.
Contemporary aesthetic dentistry can correct
most of these defects utilising a simple, comprehensive, MI approach that places equal emphasis on patient psychology, health, function and
aesthetics. Each of these aspects of treatment consideration can be best analysed using the decisionmaking system of the Smile Design Wheel, which
includes each individual aspect as a continuum
(Fig. 2).6
_Smile design with all-ceramic,
partial coverage restorations
All-ceramic, partial coverage adhesive restoration (porcelain veneers, inlays and onlays) is
considered one of the MI treatment options in
MICD treatment as opposed to placing complete
coverage restorations (full crowns) that require
significantly more tooth preparation. In certain
situations, no-preparation veneers may be placed
but only if the final aesthetics will not be compromised by the added thickness of the labio-lingual
restorative material that a no-preparation veneer
creates.
Adhesive restorations conserve tooth structure
because less tooth preparation is required for
mechanical retention of the restoration when porcelain-enamel adhesion is employed (Fig. 3). Less
Fig. 5
Fig. 4
mechanical retention preparation is required to
stabilise a bonded porcelain restoration in comparison with a non-bonded restoration. The chemical adhesion between etched porcelain and etched
enamel provides increased retention. Less tooth
preparation can minimise untoward pulpal responses that frequently result when a vital tooth
is prepared for full coverage.
Another significant patient benefit of employing adhesive restorations is that treatment time
is usually shortened to only two visits:
_first visit: partial coverage preparation, provisionalisation that incorporates the desired smile
design improvements, and one inter-occlusal
registration;
_second visit: porcelain try-in, enamel adhesion,
occlusal adjustments and case finishing.
During the second visit, the clinician cannot
perform any insertion occlusal adjustments prior
to bonding these very brittle restorations in place,
as they cannot safely withstand any occlusal alterations without introducing the possibility of
restoration fracture.
_Shortened treatment times can
introduce occlusal errors
However beneficial these short treatment times
may be for the patient, they may have two potentially problematic post-insertion results:
Fig. 6a
Fig. 5_Articulating paper markings
do not measure occlusal force
by paper mark appearance,
regardless of their depth of colour,
mark size or shape. Paper markings
cannot determine tooth contact
timing sequences either.
Fig. 6a_T-Scan III recording handle
with USB connection.
Fig. 6b_T-Scan III desktop.
Fig. 6b
CAD/CAM
2_ 2011
I 07
[8] =>
CAD0211_01_Title
CAD0211_06-12_Kerstein 22.09.11 17:13 Seite 3
I case report _ occlusal force management
Fig. 7
Fig. 8a
Fig. 7_T-Scan III graphical display
illustrates excessive occlusal force
in colour for simplified analyses
by the clinician.
Fig. 8a_T-Scan III sensor schematic.
Fig. 8b_T-Scan III high definition
recording sensor.
_patient discomfort owing to difficult occlusion
initially post-insertion;
_potentially shortened restoration lifespan.
These sequelae result from the lack of repeated
inter-occlusal remounts, which conventional
prosthodontic cases commonly undergo. Remounting at metal try-in, porcelain bisque try-in
and possibly once more prior to prosthesis installation greatly improves the accuracy of the true
maxillo-mandibular, inter-arch spatial relationships (Fig. 4). This reduces the number of occlusal
adjustments required at insertion, thereby preserving restorative material thickness and restoration strength.
Adhesive restorations are almost incapable of
being reliably remounted. Because of the minimal
preparation configuration of partial coverage,
non-bonded, all-ceramic restorations, they are
unstable on their supporting teeth. Mousses,
waxes, silicone putty, injected impression materials and impression tray seating can all easily dislodge the non-bonded restorations from their supporting teeth when taking inter-occlusal records.
The movement of non-bonded restorations can
also occur during a “pick-up” or transfer impression. The instability of non-bonded restorations
complicates all aspects of any remounting procedure greatly.
Fig. 9_Legend of colour-coded
occlusal force data.
Fig. 10_Doughnut-shaped paper
mark supposedly indicates
high force.
08 I CAD/CAM
2_ 2011
Fig. 9
Fig. 10
Fig. 8b
Without the series of laboratory remounts
that a cemented prosthesis often undergoes, the
all-ceramic restoration is susceptible to significant spatial misalignment and excessive occlusal force that can go undetected clinically until
after the insertion has been started. This lack of
proper detection of the location of problematic
force is worsened by the fact that articulating
paper markings do not measure the occlusal
forces or the occlusal contact timing sequence
in any quantifiable way, regardless of the false
and often-advocated paper marking beliefs
(Fig. 5).7–16
Poor maxillo-mandibular spatial relationships
and occlusal force detection can be reliably overcome when an MI clinician employs computerguided occlusal analysis technology at restoration
insertion (T-Scan III, Tekscan; Figs. 6a & b). When
properly used after the completion of bonding
procedures, this digital occlusal technology helps
to locate regions of excessive occlusal force
accurately within the occlusal surfaces and incisal edges of the newly placed restorations. The
clinical reduction of these excessive forces leads
to easier post-insertion acceptance of the new
occlusion and increases the restoration’s lifespan.
_Computer-guided occlusal
analysis system
The T-Scan III Computerized Occlusal Analysis
System offers precision technology that analyses
occlusal contact force and time sequences in
0.003-second increments and graphically displays
them in movie form.17,18 The system simplifies
occlusal adjustments at aesthetic prosthesis insertion, as it quickly isolates excessive force concentrations and time-premature contacts, so their
eradication is predictable and effective (Fig. 7). The
preservation and longevity of ceramic restorations
are enhanced, as any potentially destructive occlusal forces are isolated at delivery, and then
removed prior to the patient’s long-term use of the
new smile design prosthesis.
[9] =>
CAD0211_01_Title
CAD0211_06-12_Kerstein 22.09.11 17:13 Seite 4
case report _ occlusal force management
The occlusal force
and time-sequence
data are relayed to
a PC through a highdefinition recording
sensor that measures
contact-varying relative force sequentially as differing tooth
contacts interact at
the occlusal surfaces
(Figs. 8a & b). DurFig. 11a
ing a turbo-mode recording, the sensor is
scanned 3,000 times per second, resulting in a
dynamic movie of changing occlusal forces that
can be incrementally viewed in a slow-motion
playback.
This dynamic playback separates all the force
variances into their contact order, while simultaneously grading their relative occlusal force, so
that a clinician can observe them for diagnosis and
possible treatment. In two or three dimensions, the
contact timing sequence can be played forwards
or backwards continuously or in 0.003-second
increments, to reveal an occlusal “movie” that
describes the occlusal condition.19 In the 3-D playback view, the force columns change both their
height and colour designation. In the 2-D contour
view, the colour-coded force concentration zones
alter size, shape and colour as the occlusal forces
change (Fig. 7). Warmer colours indicate forceful
contacts, while darker colours indicate lower force
contacts (Fig. 9).
_Limitations of articulating
paper markings
Clinicians routinely employ articulating paper
to visualise the presence of occlusal contacts, their
force and their time simultaneity. They determine
whether contacts are forceful by subjective judgement of the paper markings for their supposed
force content.
Fig. 13
Fig. 12
Fig. 11b
In dental medicine, it is strongly advocated and
strongly believed by many clinicians that the characteristics of the paper markings indicate occlusal
forces.10,12–16 The appearance characteristics of the
paper markings are based upon:
a) the size of the mark: large marks supposedly
indicate higher forces; small, light markings indicate lesser forces;
b) the relative colour depth and intensity of the ink
mark: the darker the mark and/or its colour intensity, the higher the force content; the lighter
the mark, the less force content present;
c) the presence of doughnut and halo shape(s):
these shapes indicate that the contact is forceful because these contacts do not have ink in the
middle (Fig. 10).
Despite the persistence of the “clinical beliefs”
listed above, there is no published scientific evidence that supports that these appearance characteristics actually indicate the relative force of
occlusal contact.7–11 Studies on articulating paper
markings demonstrate consistently that occlusal
forces cannot be reliably determined based upon
their size or colour. Additionally, paper markings
have never been shown in any study to be able to
describe contact-timing sequences.7–11
Figure 11a clearly illustrates the limitations of
the articulating paper in describing force and that
I
Fig. 11a_Upper first molar with three
large paper marks and upper second
molar with mesial scratchy
paper markings.
Fig. 11b_Opposing lower molars
with large black paper marks on first
molar and small, light marks
on the second molar.
Fig. 12_T-Scan III data of upper
right first and second molar
occlusal forces.
Fig. 13_Pre-op fractured veneers.
Fig. 14_Replacement of
broken veneers completed
with six new veneers.
Fig. 14
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I case report _ occlusal force management
Fig. 15a
Fig. 15b
Fig. 15c
Fig. 16
Fig. 15a_Paper markings of
protrusive movement
pre-treatment.
Fig. 15b_T-Scan data of
early protrusion.
Fig. 15c_High force on distal
incisal region #11.
Fig. 16_Mid-treatment paper
markings of protrusive movement.
the clinical belief that the appearance of paper
markings can indicate forceful contacts is flawed.
Three large marks are present on tooth #16 and
small scratchy marks on the mesial of tooth #17.
Note the lightly exposed dentine on tooth #17,
where the scratchy red marks are located. Visual inspection of the dark marks on tooth #16 is believed
to indicate that high force contacts are present
there. The clinician has been indoctrinated to
believe that this is the case. Figure 11b shows the
counter-arch paper marks with large black marks
on tooth #46 and lighter marks on tooth #47.
The T-Scan data shows that the small contacts
present on the mesial aspect of tooth #17 are actually a region of extreme occlusal force and the
neighbouring three large dark marks on tooth #3
are actually three regions of very low occlusal force
(Fig. 12). Notice that tooth #17 makes up 48 % of
the patient’s right arch, half of the total occlusal
forces. This explains why there is visible exposed
dentine. Years of unseen occlusal overload on this
tooth (and the opposing tooth #47) have worn the
enamel, whereas tooth #16 with its very big, dark
marks has intact enamel.
Compared with the results of the T-Scan III,
it becomes clear that the characteristics of paper
markings do not in any way describe the occlusal
forces. Computer-guided occlusal analysis illustrates the true nature of the occlusal contact force
patterns. This offers clinical insight about the
degree of occlusal force demonstrated by articulating paper markings.
10 I CAD/CAM
2_ 2011
Lastly, had the advocated
“beliefs” about the characteristics of paper markings been
used as a guide for the clinician
who, in this case, was attempting to make decisions regarding occlusal adjustment to
control force, the clinician
would have clearly chosen the
wrong teeth to adjust, despite
seeking to diminish the occlusal overload. This example
illustrates that clinicians’ eyes
and the articulating paper
markings do not illustrate
occlusal forces reliably. Computer-guided occlusal analysis clarifies which articulating
paper markings should be
treated so that the operator
makes appropriate treatment
decisions as to which tooth
contacts truly require force
lessening.
Therefore, T-Scan III technology represents the
essence of MI dentistry with respect to dental
occlusion. A clinician treats only what needs to be
treated and should not perform random occlusal
adjustments judged with the naked eye according
to paper markings. This method of judging force is
so prone to error that it will always have more invasive results than when properly performed computer-guided occlusal adjustment is employed.
_Computer-guided occlusal analysis
for a case of six anterior veneers
Improved force and timing of all tooth contacts,
both static and functional, can be precisely adjusted when corrections to the paper labelling are
guided by computer analysis. The following case
illustrates the utilisation of computer-guided occlusal analysis to refine the protrusive movement
on six anterior veneers.
A 21-year-old female patient presented for replacement of six anterior veneers owing to visible
material fractures (Fig. 13). The old veneers were
removed, the teeth were slightly re-prepared, and
six new Empress II veneers (Ivoclar Vivadent) were
placed (Fig. 14).
After the veneers had been cured and the excess
bonding material trimmed, gross occlusal adjustments were performed to return the patient
to the pre-treatment vertical dimension of occlusion. Although the lingual veneer margins were
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case report _ occlusal force management
I
incisal to the original vertical
stops on the anterior teeth,
some excess bonding cement
required removal to maintain
the vertical dimension.
Next, protrusion and laterotrusive excursions were analysed with the T-Scan III system
to determine whether extreme
forces were present at the incisal edges or on the lingual
functional inclines of the veneers. The maxillary anterior
lingual surfaces provide toothborne ramps for the lower anterior teeth to glide over during
mandibular excursions. Controlling any extreme forces on
the lingual veneer ramps will
aid in ceramic material longevity.
Dynamic excursive functions are recorded by instructing the patient to
occlude through the T-Scan III sensor into his/her
maximum inter-cuspal position (MIP), holding the
teeth together for one to two seconds, then commencing an excursive movement across the guiding teeth.20–22 Right–left and protrusive excursions
can be recorded for force analysis. Only the protrusive excursion will be discussed here. Figure 15a
illustrates the first articulating paper labelling of
the protrusive movement made as the mandibular
incisors leave the MIP and travel towards the incisal edge. Note that there is a dark long protrusive
track line on the distal-incisal aspect of tooth #12,
a shorter line on the distal of tooth #11 and a horizontal line on the incisal edge of tooth #11. Despite the appearance of these ink representations,
the paper labelling offers no indication as to
whether any high force region even exists.
Figures 15b and c describe the movement as
recorded by the T-Scan III. As the excursion progresses after the patient leaves the MIP position
(Fig. 15b) and transitions onto the anterior teeth,
tooth #11 becomes very forceful near the incisal
edge (tall pink force column) as the protrusive
movement advances to include only the incisors
(Fig. 15c). If left untreated, possible fracture of the
distal incisal edge of this veneer could result from
the extreme force applied each time the mandible
protrudes.
To correct this excessive protrusive force, adjustments guided by the recorded force data were
employed. The disto-incisal paper track line was
Fig. 17a
Fig. 17b
Fig. 17c
Fig. 17d
occlusally adjusted with a medium coarse diamond
bur with water spray. Following this first adjustment sequence, a new recording was made to ascertain new force and time changes resultant from
the previous adjustment. These new force and time
aberrations were isolated, labelled and adjusted.
This was repeated until no extreme occlusal forces
were present throughout the duration of the protrusive excursion and moderate to low forces were
shared between the guiding inclines and incisal
edges.
Fig. 17a_End of treatment paper
markings of protrusive movement.
Fig. 17b_Corrected post-op
early protrusion.
Fig. 17c_Corrected post-op
mid-protrusion.
Fig. 17d_Corrected post-op
end protrusion.
Figures 16 and 17a show the mid-treatment
and final articulating paper markings of protrusive
movement. Note that in Figures 15a, 16 and 17a,
the paper markings offer no quantifiable force or
time information to guide corrective adjustments.
Figures 17b to d illustrate that in the corrected final protrusive movement there are shared force
transitions between teeth #11 and 21 all through
the movement. The computer-guided result has
protrusive contacts that never reach the potentially damaging force levels seen preoperatively
(Fig. 15b).
This case illustrates the use of computer-guided
occlusal analysis with adhesive restorations to
minimise excessive occlusal forces that result from
the all-ceramic restoration placement, where the
bonding process must precede all occlusal adjustments. This reversal of the conventional placement process (absent of inter-occlusal remounts)
can introduce significant occlusal errors that are
poorly discerned with articulating paper. Com-
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I case report _ occlusal force management
puter-guided occlusal analysis affords the operator precision, occlusal force isolation and predictable control of restorative occlusal error, which
aids in prolonging the longevity of the all-ceramic
restorations.
_Conclusion
For MICD, computer-guided occlusal analysis
systems offer data on quantifiable pressure, force
and contact time sequence that can be employed
to guide the occlusal adjustment of the restoration
to precise measurable endpoints.2, 3 These endpoints establish uniform force distribution, bilateral simultaneity and measurable immediate
disclusion, and minimise the damaging effect of
concentrated, excessive, isolated occlusal force.
Avoiding potentially destructive intra-oral use, the
overall prosthetic occlusal scheme preserves the
ceramic materials utilised in the procedure, ensuring long-term survival.
Lastly, occlusal adjustments that are guided by
T-Scan III technology represent the essence of
MICD because a clinician treats only what needs to
be treated and does not perform random subjective occlusal adjustment based on mere judgement
of paper markings with the naked eye. Measured
occlusal force and timing data direct the MI clinician to adjust only the locations of excessive force,
while leaving the areas of measured low occlusal
force untouched. Cosmetic restorations and tooth
structure are therefore preserved and overtreatment is minimised. The clinical implementation of
this technology mirrors the core message of the
“Do No Harm” philosophy._
_References
1. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Diammine silver fluoride and its clinical application.
J Osaka Univ Dent Sch 1972;12:1–20.
2. Houpt M, Fukus A, Eidelman E. The preventive resin
(composite resin/sealant) restoration: nine-year results. Quintessence Int 1994;25(3):155–9.
3. Smales RJ. Yip HK. The atraumatic restorative treatment (ART) approach for the management of dental
caries. Quintessence Int 2002;33(6):427–32.
4. Munshi AK, Hegde AM, Shetty PK. Clinical evaluation
of Carisolv in the chemico-mechanical removal of
carious dentin. J Clin Pediatric Dent 2001;26:49–54.
5. World Dental Federation. Minimal Intervention in the
management of dental caries. FDI policy statement 2002.
6. Koirala S. Minimally invasive cosmetic dentistry—
Concept and treatment protocol. Cosmetic Dentistry
2009(4):28–33.
7. Carey JP, Craig M, Kerstein RB, Radke J. Determining
a relationship between applied occlusal load and
articulation paper mark area. The Open Dentistry
Journal 2007;1:1–7.
12 I CAD/CAM
2_ 2011
8. Saad MN, Weiner G, Ehrenberg D, Weiner S. Effects of
load and indicator type upon occlusal contact markings. J Biomed Mater Res B Appl Biomater 2008;
85(1):18–22.
9. Millstein P, Maya A. An evaluation of occlusal contact marking indicators. A descriptive quantitative
method. J Am Dent Assoc 2001;132(9):1280–6.
10. Glickman I. Clinical Periodontics. Saunders and Co
1979(5):951.
11. Reiber T, Fuhr K, Hartmann H, Leicher D. Recording pattern of occlusal indicators. I. Influence of indicator
thickness, pressure, and surface morphology. Dtsch
Zahnarztl Z 1989;44(2):90–3.
12. Dawson, PE. Functional occlusion: from TMJ to smile
design. Mosby, Inc 2007(1):347.
13. McNeil, C. Science and practice of occlusion. Quintessence Publishing 1997:421.
14. Okeson J. Management of temporomandibular disorders and occlusion. CV Mosby and Co 2003(5):416,
418, 605.
15. Kleinberg I. Occlusion practice and assessment. Knight
Publishing 1991:128.
16. Smukler, H. Equilibration in the natural and restored
dentition. Quintessence Publishing 1991:110.
17. Maness WL. Force movie. A time and force view of occlusion. Compend Contin Educ Dent 1989(10):404–8.
18. Kerstein RB, Grundset K. Obtaining measurable bilateral simultaneous occlusal contacts with computeranalyzed and guided occlusal adjustments. Quin Int
2001;32(1):7–18.
19. Kerstein RB. Tekscan-Computerized Occlusal Analysis.
In: Maciel RN. Bruxismo. Editora Artes Medicas Ltda.
Sao Paolo, Brazil 2010.
20. Kerstein RB. Reducing chronic massetter and temporalis muscular hyperactivity with computer-guided
occlusal adjustments. Compendium of Contin Educ
Dent 2010;31(7):530–43.
21. Kerstein RB. Combining technologies: A computerized
occlusal analysis system synchronized with a computerized electromyography system. Cranio 2004;
22(2):96–109.
22. Kerstein RB, Chapman R, Klein M. A comparison of
ICAGD (immediate complete anterior guidance development) to mock ICAGD for symptom reductions in
chronic myofascial pain dysfunction patients. Cranio,
1997;15(1):21–37.
_about the author
CAD/CAM
Dr Robert Kerstein works
in private practice in Boston,
Massachusetts. He was
Assistant Clinical Professor at
the Department of Restorative
Dentistry, Tufts University
School of Dental Medicine
from 1983 to 1998.
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08.03.2011 18:10:01 Uhr
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I case report _ implant surgery
Reducing surgical
morbidity with CBCTguided implant surgery
Author_ Dr Daniel J. Velinsky, USA
Fig. 1_Scan guide.
Fig. 2_Scan guide with scan bite.
Fig. 1
Fig. 2
_The patient, a 62-year-old woman, was referred by a local periodontist for an implant evaluation. Her record stated that she was a “difficult
patient owing to medical complications”. Her
stated desire was that she wanted “to be able to
chew”.
which were exacerbated by any antibiotic use.
She therefore refused antibiotics for any elective
dental treatment.
Medical history
Figs. 3 & 4_Procera software
diagnostic work-up.
The review of systems was negative. The patient
was a non-smoker and drank alcohol socially.
She was allergic to iodine and took only hormone
replacement medication. She used organic products
in her life whenever possible. She stated that she
suffered from persistent, recurring yeast infections,
Diagnostic findings
The patient was healthy, her oral hygiene excellent and there was no evidence of active periodontal disease. Her cancer screening was negative.
The temporomandibular joint was quiet with normal range of motion, and she was missing teeth #1
to 4. Her initial radiographic assessment revealed
a relatively low maxillary sinus in the area of the
prospective implants.
_Initial actions: December 2002
Fig. 3
Fig. 4
14 I CAD/CAM
2_ 2011
The patient was referred to an oral surgeon for
an evaluation of her upper right maxilla. With a relatively low sinus, we determined that the patient
would need a unilateral maxillary sinus lift and
augmentation. This was discussed with the patient,
who subsequently refused treatment owing to the
need for perioperative antibiotic coverage for these
procedures. She would also not accept a removable
partial denture. She opted to initiate no further
treatment at this time and desired only a regime
of routine maintenance.
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case report _ implant surgery
Fig. 5
_Secondary presentation: August 2006
The patient was re-examined this time with
guided implant surgery in mind. She stated that
she would accept surgery if it could be done without
antibiotics. We conceived a team approach that
included me (restorative dentist), Dr William E. Lippisch (oral surgeon) and dental technician Michael
Hennessy.
_Treatment goal
The patient’s treatment goal was to have posterior teeth that would enable her to chew. Furthermore, she wanted treatment performed without
the use of systemic antibiotics. Our team’s goal
included a treatment plan that would result in integrated implants, restored with single, non-splinted
crowns, performed with a flapless, minimally invasive guided surgical technique. We planned a
one-stage approach without temporisation. The
patient agreed to one preoperative antibiotic dose
of 2,000 mg amoxicillin and a five-day course of
Peridex oral rinse.
_Scan-guide construction
An appointment was set up and a polyvinylsiloxane impression of her upper arch, a polyvinylsiloxane bite registration and an impression of the
lower arch were taken. Models were mounted and
a wax-up constructed, giving ideal placement of
Fig. 8
I
Fig. 6
future implants for area #2, 3 and 4. From this
wax-up, a scan guide (Fig. 1) was constructed with
implants for area #2, 3 and 4, according to the
Nobel Biocare design. Gutta-percha markers were
placed in the guide for the dual-scan technique.
A flange was designed to hold the prospective
anchor pin.
Fig. 7
Fig. 5_Procera Guide.
Fig. 6_Implant placement
using guide.
Fig. 7_Healing caps.
Inspection windows were produced in the guide
to ensure its proper and complete seating in the
mouth. This is paramount for a proper relationship
of the radiographic guide to the present dentition
in the CBCT scan, which helps to verify that the
laboratory-fabricated surgical guide was properly
seated in the mouth during the surgical phase.
Prior to the CBCT, a polyvinyl-siloxane bite (Fig. 2)
was taken with the scan guide in place to be used
during the CBCT and for subsequent mounting of
the case on a semi-adjustable articulator. This would
then replicate the surgical plan.
_Surgical-guide fabrication
A CBCT scan was taken using Nobel Biocare’s
‘double scan’ technique. This allowed for a combination of the radiographic scan guide to the patient’s Dicom CT information in the Nobel Guide
Software. A virtual surgery was performed with the
Nobel Guide Software (Figs. 3 & 4). We decided that
implants could be placed in such a manner as to
avoid the sinus lift and augmentation.
Fig. 9
Fig. 8_Abutments torqued in place.
Fig. 9_Crowns at time
of cementation.
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I case report _ implant surgery
Fig. 10
Fig. 11a
Fig. 10_Final CBCT of placement.
Figs. 11 & 12_Images at 3.5 years.
Fig. 11b
As a team, we decided upon the final scenario.
Restorative, surgical and laboratory issues were
discussed and common conclusions decided. A
Nobel Guide surgical guide was ordered through
the software and subsequently produced via stereolithographic rapid prototyping. The guide was
tooth borne with one surgical pin included to aid stabilisation (Fig. 5). Inspection windows were placed
in the guide to ensure full seating during implant
surgery.
At this point in dentistry, it can be agreed that
implants are successful. Dentists must not forget that
they are treating patients and not teeth or implants.
We must listen to our patients and figure out their
desires and needs in order to really be successful. In this
instance, conventional implant dentistry may have led
to an open procedure with grafting of the sinus. By
using a guided technique, implants of maximum length
were planned and placed, achieving the same goal,
but more importantly, respecting the patient’s desires.
_Surgery: December 2006
_Conclusion
The patient was anaesthetised using local anaesthesia. The Procera Surgical Guide was placed,
ensuring complete seating using the inspection windows. We determined that the patient had maximum
attached gingiva. A tissue punch was used through
the guide, while it was held in place by finger pressure. The guide and the tissue plugs were removed.
Then, the guide was replaced. The Nobel Biocare
Guided Surgery protocol (Fig. 6) was followed, including placement of a stabilisation pin and use of
a guided template abutment. After all three implants had been placed, the guide and any tissue
tags present were removed, and healing caps placed
on each implant (Fig. 7). In accordance with the plan,
no temporary crowns were placed.
By adopting a team approach with a restorative
dentist, oral surgeon and laboratory technician, we
were able to design a biologically sound and supportive prosthesis. Using CBCT technology, we were
able to maximise our diagnostic skills in order to idealise the surgical and restorative results. Using minimally invasive techniques, we were able to address
the patient’s medical needs and desires by reducing
the need for antibiotics and open surgical techniques.
At four months, a standard open-tray impression
was taken to produce a mounted master model
with a gingival mask. Stock abutments were chosen
and modified by me and single-unit porcelain veneer crowns were constructed in the laboratory.
At a secondary appointment, the healing caps were
removed and the modified abutments placed and
torqued (Fig. 8) according to the manufacturer’s
specifications. The crowns were tried in, cemented
and the occlusion adjusted (Fig. 9).
_Acknowledgments
_Discussion
This case was not about the design and success
of implant placement procedures, but about patient
management, using a team approach and a stateof-the-art technique (Nobel Guide) to achieve a
patient’s desired request.
16 I CAD/CAM
2_ 2011
Fig. 12
By looking at the placement of the implants in
the post-operative CBCT (Fig. 10), the level of accuracy was achieved with guided surgery. A 3.5-year
follow-up appointment revealed optimal gingival
and osseous health (Figs. 11 & 12).
I would like to thank my team members Dr
William E. Lippisch and Michael Hennessy of Hennessy Dental Laboratory for assisting me during all
stages of the case._
_contact
CAD/CAM
Dr Daniel J. Velinsky
800 SE Osceola Street, Suite B
Stuart, FL 34994
USA
office@drvelinsky.com
[17] =>
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[18] =>
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I clinical technique _ implant-prosthetic troubleshooting
Implant-prosthetic
troubleshooting—
When dental technicians and
dentists break into a sweat!
Authors_ Dr Georg Bach & Christian Müller, Germany
_Implant-prosthetic troubleshooting usually
starts at an advanced stage of the implant-prosthetic treatment, i.e. when implants have already
been inserted, and the next step is the insertion of
prostheses on the artificial abutment teeth. This
point in time is extremely unfavourable for several
reasons, one being that—owing to the already
completed surgical phase—there is no opportunity
for intervention and modification of the implant
placement, and the other reason being that the
patient feels he or she is on the verge of a success-
Figs. 1–4_The former prosthesis
(with two maxillary implants);
note the discrepancy between the
translucent templates and the axis
of the plastic front teeth.
18 I CAD/CAM
2_ 2011
fully completed treatment and does not realise
that difficulties may now arise, which in extreme
cases could result in failure of the entire treatment.
This development usually ends in mutual accusations and forensic disputes.
_“Incorruptible”—The dental master
model
In a worst-case scenario, it will not become
apparent that the inserted implants cannot be
Fig. 1
Fig. 2
Fig. 3
Fig. 4
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clinical technique _ implant-prosthetic troubleshooting
Fig. 5
Fig. 6
Fig. 7
Fig. 8
treated dentally, or only with extreme difficulty,
owing to unfavourable placement in the jawbone
until the dental master model has been created by
the dental technician after casting or after the
check-bite at the very latest.
functional problems, he disliked the fact that the
maxillary front teeth were not visible even when
he opened his mouth half-way.
“Plaster is incorruptible!”. This conclusion, attributed to Freiburg dental surgeon Prof Eschler,
was deliberately kept trivial; however, it is simply
and utterly true. The dental master model shows
the realities concerning placement of the implant,
its axis, also with regard to abutment teeth, and the
transition to the gingiva.
_Exemplary patient cases
Our report will demonstrate, based on a few
exemplary patient cases, the solution possibilities,
but also the limits of implant-prosthetic troubleshooting—especially in terms of achieving a
sustainable result for patient, dentist and dental
technician.
_Unidentified jaw misalignment
(Figs. 1–8)
The problem
Two years ago, a male patient (in his mid-70s)
had received two implants in the maxilla, followed
by treatment with telescopes and a partial prosthesis. The patient stated that “the work did not
agree with him right from the start”. Aside from
I
Figs. 5 & 6_After interdisciplinary
planning between dental technician
and dentist, two additional distally
located implants were inserted;
the four artificial abutment teeth
each received a telescopic crown.
We used individual insertion keys
to facilitate incorporation of the
telescopes.
Fig. 7_Initial X-ray image with two
implants (treated with telescopes)
in the maxilla.
Fig. 8_Condition after the increase
of abutment teeth in the maxilla,
each inserted distally of the previous
implants.
Just by looking at the maxillary prosthesis it was
easy to notice the metal portions of the prosthesis,
which were placed extremely palatinally, showing
through. An examination of the oral cavity revealed a considerable discrepancy between the
implant placement and the axis of the plastic front
teeth!
Our solution
A wax-up marked the beginning of the actual
treatment. It was modified until the patient was
satisfied with the placement of his teeth and his
subsequent appearance. Based on the results of
this treatment planning, we were able to determine
which position and alignment would be required
for two additional implants (distally of the existing
ones).
This in turn resulted in the creation of a drilling
template, which was used during the insertion of
the two additional artificial abutment teeth. After
osseointegration of these two implants in regions
#14 and 24, the new partial prosthesis (now supported by four implants (two existing and two new
ones) was produced and integrated step by step.
Aside from cases like the one mentioned above,
which are usually the result of design errors and/or
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I clinical technique _ implant-prosthetic troubleshooting
Fig. 9_The mesial abutment tooth
of a bridge entirely supported by
implants in the left maxilla was lost.
After healing of the soft tissue,
a further implant was inserted in
a position as close as possible to
the former implant position.
The illustration shows the dental
master model with the
customised abutment.
Fig. 10_The former bridge structure
was used as a customised “spoon”
for the newly added implant so that
a customised abutment could be
created for the additional implant
to be mounted distally (note the loss
of vertical distance) for use
in the existing restoration.
Fig. 11_Customised abutment tooth
as a terminal abutment.
Fig. 12_Patient’s oral condition.
Fig. 9
Fig. 10
Fig. 11
Fig. 12
design flaws, there is additional, yet different
implant-prosthetic troubleshooting—covering primarily implant fractures or failure of individual
implants within an extensive supra-structure.
This considerably smaller part of implant-prosthetic problem areas, as compared with the group
of design errors mentioned above, will be covered and evaluated in this article. The purpose
of this is to demonstrate solutions so that the
patients affected receive a modified solution in
order to preserve the existing and very expensive
work.
old female patient for 10 years. Therefore, she only
came to recall and follow-up examinations sporadically. The problem-free period ended abruptly
when swelling and bite pain occurred in the left
half of the maxilla. A panoramic tomography
revealed radiological indications of a profound
osseous defect around the mesial implant, which
had to be removed on the same day. The issue then
was the entire supra-structure. The patient insisted that this structure be preserved owing to the
financial cost of having a new structure created
after re-implantation.
_Loss of implant due to peri-implantitis
Our solution
(Figs. 9–18)
A bridge structure in the second quadrant had
been in place without any problems in a 50-year-
A new implant was inserted after the soft tissue
and bone had healed in the area where the lost
implant had previously been in place. The bridge
structure that had been temporarily affixed on
the remaining implant was used as guidance for
Fig. 13
Fig. 14
The problem
Figs. 13 & 14_We were able
to preserve the bridge
in the left maxilla.
20 I CAD/CAM
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clinical technique _ implant-prosthetic troubleshooting
I
Fig. 15_Three implants had originally
been inserted to treat anodontia
in the second quadrant.
Figs. 16 & 17_The distal implant
was lost; the detailed view shows
the non-functional crown #25.
Fig. 18_Condition after
re-implantation distally of the
implant localisation.
Fig. 15
Fig. 16
Fig. 17
Fig. 18
incorporation of a replacement implant and then
removed for the actual implant procedure.
ing in markedly restricted indications for diameterreduced implants.
After osseointegration of the artificial abutment
tooth, we inserted a plastic abutment and made a
casting of the integrated bridge structure with polyether casting material. This customised abutment
was transformed into metal and the bridge structure finally cemented in place after a trial insertion.
The problem
_Implant fracture (Figs. 19 & 20)
Diameter-reduced implants can often be implanted even in a reduced osseous bed and aid in the
avoidance of augmentations. However, when introduced into the market, diameter-reduced implants
were frequently used for other indications as well;
some clinicians even recommended using them
as standard implants. Stress phenomena caused
a considerable number of implant fractures, result-
Fig. 19
The case presented here reflects the typical
progress of this early phase. A purely implantsupported (two abutments) extension bridge was
incorporated into the fourth quadrant. A diameter-reduced implant was used in spite of an orovestibular bone dimension that would have been
sufficient for supporting a standard implant. The
result was that the distal implant fractured after
eight years.
Our solution
In one surgical session, we removed both the
implant fragment remaining in the bone by way of
an osteotomy and placed a further distal implant.
Fig. 20
Fig. 19_The distal
(diameter-reduced) implant
of a bridge supported entirely
by fractured implants.
Fig. 20_An additional implant was
inserted distally after removal of the
fragment that had remained in the
bone. After integration of the implant,
a new bridge supported entirely
by implants was created, while
incorporating the former implant.
CAD/CAM
2_ 2011
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Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Figs. 21–25_Owing to the loss of
prospective abutment teeth #43 and 33
during the prosthetic treatment phase,
the remaining front teeth #42, 41, 31
and 32 received telescopic crowns.
Fig. 26_The partial prosthesis
showed insufficient mounting.
Figs. 27–29_With the aid of 3-D
imaging and planning, four implants
were inserted in regions
#46, 43, 33 and 36—without any
augmentative treatment.
Fig. 30_After osseointegration of
the artificial abutment teeth, two
side-tooth bridges entirely supported
by implants and four individual
crowns were integrated with the
remaining mandibular teeth.
After its osseointegration, we incorporated a completely new bridge using the existing mesial implant.
The results achieved here can help us learn from
design errors and select a different approach for
future cases, so that we can also treat patients who
have had failure of a comprehensive prosthetic
restoration. Our last case will illustrate this situation.
_The unsuccessful conventional
treatment versus the successful,
well-planned implantological procedure
(Figs. 21–34)
The problem
Finally, we would like to present an unusual case:
an unsuccessful conventional treatment that was
Fig. 27
Fig. 28
Fig. 30
Fig. 31
22 I CAD/CAM
2_ 2011
replaced with implantological treatment carried
out in close collaboration between the dentist
and dental technician. The patient had experienced
considerable complications during prosthetic treatment (the goal being a telescopic partial prosthesis
supported by teeth #43 and 33, while preserving
the front teeth #42 to 32, which had been cariesfree and without fillings until then, and replacement of teeth #47 to 44 and 34 to 37). First, tooth
#33 fractured and had to be extracted, in spite of
the fact that preparation and casting had already
been done. Treatment was replanned after this
event, and teeth #42, 41, 31 and 32 were also prepared (the goal being telescopic crowns). Shortly
before implementation, tooth #43 also had to be
extracted. The patient was unable to give the exact
reasons for this. This left her with four teeth—#42,
41, 31 and 32—which all had telescopic crowns.
Fig. 29
[23] =>
CAD0211_01_Title
Bella Center
Copenhagen
APRIL 26- 28, 2012 s "%,,! #%.4%2 s COPENHAGEN s $%.-!2+
Welcome to the 45th Scandinavian Dental Fair
The leading annual dental fair in Scandinavia
The 45th SCANDEFA invites you to exquisitely meet the Scandinavian dental market and
sales partners from all over the world in springtime in wonderful Copenhagen
SCANDEFA 2012
Exhibit at Scandefa
Is organized by Bella Center
and is being held in conjunction
with the Annual Scientific
Meeting, organized by the
Danish Dental Association
(www.tandlaegeforeningen.dk).
Book online at www.scandefa.dk
Sales and Project Manager, Christian Olrik
col@bellacenter.dk, T +45 32 47 21 25
175 exhibitors and 11.422
visitors participated at
SCANDEFA 2011 on 14,220 m2
of exhibition space.
Travel information
Bella Center is located just a 10 minute taxi drive from Copenhagen
Airport. A regional train runs from the airport to Orestad Station,
only 15 minutes drive.
Fotos from Bella Center, Wonderful Copenhagen
2012
Check in at Bella Center’s newly built hotel
Bella Sky Comwell is Scandinavia’s largest design hotel.
The hotel is an integral part of Bella Center and has direct
access to Scandefa. Book your stay on www.bellasky.dk
www.scandefa.dk
Scandefa_Ann_A4_ENG_2012.indd 1
01/06/11 14.16
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I clinical technique _ implant-prosthetic troubleshooting
Fig. 32
Fig. 33
Figs. 31–33_Three-dimensional
diagnosis and planning (see dental
pins) of the third and fourth quadrant.
Anchoring of the partial prosthesis was poor; the
patient was able to loosen it with minimal tongueapplied pressure. The pronounced tendency of the
would be possible without carrying out augmentation procedures. We then prepared a virtual
implant plan, the results of which led us to prepare
a drilling template.
The remaining front teeth proved very helpful as
a place for securely anchoring the template. By
opting for a shortened row of teeth with one implant each in the region of the former six-year molars and an additional artificial abutment in each
of the former cuspid areas, we were able to keep the
dimensions of the template relatively small.
Fig. 34
Fig. 34_Orthopantomogram after
incorporation of four implants, three
of which were diameter-reduced
Roxolid (Straumann) implants.
prosthesis saddles to cave in also resulted in complications in the form of multiple recurrent pressure sores. The patient was referred to us at this
point. The reason for this according to her dentist
was that implants, which the patient had inquired
about, could be inserted neither in the extended
front-tooth area nor in the side-tooth area owing
to the narrow and atrophied alveolar ridge.
Our solution
It was true that the alveolar ridge on both sides,
starting with the cuspid region and extending to
the area where the molars had been previously,
was fairly pointed, and the course of the osseous
limbus alveolaris displayed a pronounced sagging
distally of the previous pre-molar zone.
The patient thus showed considerable osseous
deficits in both the oro-vestibular and horizontal
dimension. In order to assess the basic possibilities
of oral implants, we decided to perform 3-D imaging, which proved extremely helpful in this complex patient case. After illustration of the osseous
situation, there were indications that implantation
24 I CAD/CAM
2_ 2011
The insertion of four implants in the regions of
teeth #46, 43, 33 and 36 and their osseointegration
were followed by treatment with the supra-structures, which consisted of two bridges in regions
#46 to 43 and 33 to 36, entirely supported by
implants, and four individual crowns on the front
teeth. The restorations were temporarily affixed
for six months and then cemented in place._
_contact
CAD/CAM
Dr Georg Bach
Rathausgasse 36
79098 Freiburg/Breisgau
Germany
doc.bach@t-online.de
MDT Christian Müller
Carl-Kistner-Straße 21
79115 Freiburg/Breisgau
Germany
chmue10@aol.com
[25] =>
CAD0211_01_Title
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Oekhm[[abod[mii[b[Yj_ed
Ekh[Z_jehii[b[Yjj^[X[ijWhj_Yb[iWdZl_Z[ei\hecWhekdZj^[mehbZ\ehoek
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[26] =>
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CAD0211_26-29_MyDentalHub 22.09.11 17:19 Seite 1
I feature _ interview
“Patient education needs
to be part of the daily
activities of a practice”
An interview with Dr Reena Gajjar, Canada
It soon became apparent that the treatment plan
acceptance rate was increasing dramatically with
these materials.
My husband, Dr Ken Hebel, began employing
these materials and experienced the same response. Patients asking about treatment options
were presented with the printable materials to
review and take home. We both found that in addition to enhanced case acceptance, this material
was a referral driver.
Dr Reena Gajjar
_My Dental Hub is premier web-based dental
patient education software. Accessible via your
computer or mobile device, including the iPad, it
provides patients with informative material on
major areas in dentistry, including 3-D animations.
Patients are then empowered to make educated decisions about the proposed treatment.
CAD/CAM spoke to Dr Reena Gajjar about the
idea behind and the benefits of the software.
_CAD/CAM: How did the idea for My Dental
Hub evolve?
Dr Gajjar: My Dental Hub (formerly Click &
Print) started back in 1996, when I joined my
husband’s prosthodontic practice. Having a background in computer graphics, I developed educational printable materials using images and
simple explanations for our practice. These were
used exclusively during patient consultations.
26 I CAD/CAM
2_ 2011
This digital educational tool, facilitation of patient comprehension and acceptance of proposed
treatment manifested in a software program, was
originally called Click & Print, which contained
printable forms and a few animations that demonstrated dental procedures. Click & Print was sold on
a disk for several years. Four years ago, we started
to notice a shift in the way that companies were
doing business—becoming cloud based—and we
made the investment to convert our disk-based
product to a web-based product. The development
took over a year, but the investment proved to be
a smart decision, since we emerged as My Dental
Hub—the first cloud-based patient education and
practice-marketing solution.
As a cloud-based company, we have the ability
to constantly upgrade and update our product
offering, and customise our solutions to the needs
of our clients. As the dental industry starts moving
towards cloud-based solutions, we are well positioned to offer solutions to meet the needs of the
individual dental practice, as well as the collaborative needs of dental organisations.
_How do/did you obtain the information used in
the software? Do you collaborate with universities
and/or companies?
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feature _ interview
Most of the software content was written and
developed by Dr Hebel and me. We collaborated
with dental colleagues for some of the clinical content; however, all the 3-D animations are designed
and created in-house. The users of our program
play an important role in the development of our
content, since we develop content based on what
our clients need.
I
practice to do a consultation in three simple steps
and then e-mail the entire consultation to their
patients. It automates the consultation process.
It’s very simple and highly effective!
Users can link their practice website
to the Website Content template,
which is personalised with the
doctor’s logo and contact information.
My Dental Hub also offers mobile applications
(apps), available on iPad, iPhone and Android
tablets, containing all our animations and slide
shows. The iPad app is extremely popular in dental
practices as an easy way to explain treatment to
patients. It provides an exceptional presentation
on oral-hygiene instruction, which invariably is
a significant driver in any dental practice.
Users can also embed any of the
narrated animations or slideshows
directly in their practice website to
maintain branding and consistency.
Clients submit requests for content they would
like to see, and based on popularity and demand,
we develop the content. So, in fact, it is actually our
users that have guided the direction of the content
in the software. This is one of the tremendous
advantages of being a web-based company. As we
develop new content, we upload it to the program,
and it is immediately available to our users. No
need to wait for next year’s disk upgrade!
_Convincing patients to invest in dental treatment, e.g. an implant treatment, is a challenging
task. How will My Dental Hub help?
We believe that there are three primary components to case acceptance. Patients will invest in
dental treatment if they understand the problem
and understand the treatment that is being offered,
but more importantly, patients must understand
the value of the treatment and how that treatment
will improve the quality of their life (whether it is
related to improving function or aesthetics). The
content in My Dental Hub has been specifically
developed to address these components of patient
education in a language that patients will understand. The 3-D animations are used to visually
explain the procedure and the benefits of the treatment, and the printable (e-mailable) documents
serve as reinforcement of the animations and as
a resource for patients to review at home.
_What are some of the additional features the
software offers?
One of the key features of the software is the
ability to e-mail the animations and documents to
patients. This allows the dental practice to extend
their consultation from their office into the patient’s home, where patients can share and discuss
the recommended treatment with those involved
in the decision-making process.
My Dental Hub has several modules within the
program. We offer animations, image documents,
narrated slide shows, customisable text documents,
a document creator, a patient and photo management section allowing the practice to upload and
store patient images, as well as a presentation-creation module. Our newest module, Easy Consult,
has been extremely popular and is currently our
most-used module. Easy Consult allows the busy
CAD/CAM
2_ 2011
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Easy Consult allows the busy practice
to do a consultation in three
simple steps and then e-mail the
entire consultation to their patients.
In addition, we offer a product called Web Site
Content that allows users to place any of our
animations and slideshows on their websites or
linked to their website. High-quality animations
on a website allow patients to obtain information
about the procedures offered by the practice and
facility. External marketing includes websites,
advertising, mailings, etc. that are done virally
through e-mail or regular mail. Many dentists are
not trained in marketing and find it inherently
difficult to embrace marketing to grow their
business. Many do not know how, many just don’t
think they need to.
Many dentists do not take the time to educate
their patients or understand the value of patient
education. Many feel that patients will accept
treatment on the sole basis that the dentist told
them they need it. That may have been the way
it was, but we now live in an information-based
society, and if patients do not receive adequate
information from their dentist, they will seek it
elsewhere. (Hopefully, that won’t be the competitor down the street!)
We did a survey of our My Dental Hub clients
to determine how effective patient education was
in their practices. Our end users told us that they
had experienced an increased case acceptance
of 53%! This number indicates the importance
of educating patients, and the impact it has is
apparent in any business, including the business
of dentistry.
The process of patient education needs to be
woven into the daily activities within a practice.
This requires enhanced staff training and implementation. Many dentists do not invest the
time to integrate the process into their practice
procedures. Acceptance of a practice philosophy
mandates that training for implementation is as
important as training in the procedure.
Instant presentations make even the
most complex case presentations
easy, with supporting documents
ready to be printed or e-mailed.
28 I CAD/CAM
2_ 2011
offer a powerful branding and marketing tool for
a practice.
_In your opinion, what are the most common
mistakes dentists make in patient education/
marketing their dental practice?
There are two types of marketing that dental practices should do—internal and external
marketing. Internal marketing includes posters,
brochures, discussions, etc. delivered within the
_Can My Dental Hub also be a helpful tool for
cutting through language barriers or communicating with disabled patients?
Absolutely! A picture is worth a thousand
words. Visual images and especially animations
tell a story, even if the words cannot be understood. Many of our dentists use our iPad app for
that reason. Even with the narration turned off,
patients use the iPad to browse the animations
and learn about the different dental procedures
offered by the practice. Most of us are visual
learners. In situations in which there may be
a communication barrier, we find that our client
base uses the animations as a component of
informed consent.
_Is the software available in different languages?
The software is currently only available in
English; however, we are working on translating
the software into Spanish and French. We have
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many international practices that have requested
translations and our goal is to offer the program
in multiple languages, thus catering to an international clientele.
animations to patients to show them a dental
procedure, no one would have believed it possible.
Today, this is the way of the world and the way
business is being done.
_How much does the software cost? Are updates available free of charge?
My Dental Hub is a suite of products and is
subscription based. All updates are included in the
subscription fee. The full package includes animations, slideshows, documents, patient and photo
management, presentations, and Easy Consult.
The software comes with an unlimited licence,
which means that within a practice, there can
be an unlimited number of computers and users.
The subscription also includes unlimited training,
unlimited support, all updates and upgrades, all
new content, an unlimited number of e-mails,
unlimited storage of patient data, photos and
documents and daily backup. We offer special
pricing for American Academy of Periodontology
members (we were chosen as their exclusive
patient-education provider), and other organisations. Pricing can be found on our website. We also
offer a “lite” version of the software that provides
access to all of our animations and narrated slideshows on both computers and mobile devices.
I believe that with the incorporation of digital
tools into a dental practice, “elegant simplicity
and seamless connectivity” with patients and
Hundreds of videos with narration
can be accessed easily.
Industry leading, stunning animations
explain dental procedures in a clear,
concise manner.
colleagues will become the standard. Those who
embrace today’s technology will be tomorrow’s
industry leaders.
A simple photo management module
organises patient photos and
offers easy to use editing tools.
Web Site Content allows the practice to link
their website to the entire library of narrated
animations and slideshows so patients can
browse through all the content and/or they can
embed specific content directly into their website.
We also offer a free ten-day trial that can be
requested on our website.
_In your opinion, how will digital tools change
the dental practice and the way in which doctors
communicate with their patients?
The entire world is digital—not “becoming”
digital. Dentists must embrace this new means
of doing business simply because it is now a
component of everything, from paying a bill in
a restaurant to travel, shopping and doing something as basic as reading.
In terms of communication, digital tools enable a dental practice to communicate quickly,
easily and effectively with patients or referrals.
No more printing, no more mailing, diminished
expense and waste.
Society is changing. People are more aware
of their environment and doing their part to go
“green”. With simple tools, a dental practice can
deliver high-quality education directly and exemplify “environmental friendliness” as well. Ten
years ago, if you had told people you could e-mail
We all live in a connected world. My Dental Hub
is about being at the epicentre of that connection
in the dental world.
For more information please call +1 877 789
4448 or visit www.mydentalhub.com._
CAD/CAM
2_ 2011
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“Sirona products
function like the
pieces of a puzzle”
Mr Jost Fischer: IDS 2011
was absolutely fantastic! The
spirit of the visitors, our staff
and distribution partners was
unbelievably high. It absolutely
showed that the economy in
Germany is doing well, which for
us as market leader is always
a very good sign.
_You introduced a large
number of new products at IDS.
Which of these is your personal
favourite?
I consider all of our products
my favourite. Everything we do
makes sense and is a vital contribution to Sirona’s success. At the
end of the day, what is important to us is that our customers
invest not only in a product or
device, but also in their future.
Sirona SINIUS.
_The increasing significance of digital dental
technology was already on everyone’s lips long
before IDS 2011. As the focus of this year’s show,
digital technology is clearly going to reshape
the world of dentistry by becoming part of dayto-day work at dental practices and laboratories.
CAD/CAM spoke to Jost Fischer, Chairman and
CEO of Sirona, whose vision is to put digital dental technology in everyone’s mouth, literally.
_CAD/CAM: With more than 1,000 m2,
Sirona had a strong presence at IDS 2011. What
was your experience of this year’s show?
30 I CAD/CAM
2_ 2011
We are an innovator in our
industry and continuously strive
to improve. Our systems are
upgradeable, meaning that additional features and future technologies can
be added on. Furthermore, every single one of
our products integrates into the digital workflow
of the dentist or laboratory technician. Sirona
products function like the pieces of a puzzle. All
our offerings fit into this concept.
_Which products were launched at IDS?
A major product we launched at IDS is the
ORTHOPHOS XG 3D, a machine that can be used
as a 3-D and a real 2-D machine. We think that
the XG 3D is going to be the breakthrough in 3-D
imaging in the general practitioner’s office. Not
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I
only specialists, but also GPs will be able to take
3-D images.
We also introduced SINIUS, a new treatment
centre. SINIUS is the star of our new efficiency
class. This unit saves the dentist time. It is compact, very design oriented and, according to the
feedback we have received thus far, very appealing to female dentists.
In our instrument division, we launched
SIROBoost, a powerful turbine that allows for
uninterrupted workflow.
In our CAD/CAM division, we gave visitors
a preview of our new software CEREC 4.0, which
will be launched this summer. It offers a new
interface and additional features, more fun, creativity and ease of use. We have already received
enthusiastic feedback on our preview model from
the CEREC community and intend to perfect the
software over the next few months.
And finally, as patient marketing is a very
important aspect of dentistry today, we launched
an integrated face scanner. Thanks to the integration of a 3-D scanner into GALILEOS, X-rays
and surface anatomy scans can be taken simultaneously. The result is a lifelike depiction of the
anatomical structures of the face, teeth and
bones. This accurate image of the patient’s face
assists the dentist in planning treatment and
makes it easier for the patient to understand the
treatment proposed.
_That is quite a large number of new products!
Yes, we have a constant flow of innovations.
Over the past six years, we have spent more than
US$250 million on R&D. More than 220 engineers
are employed by Sirona and a lot more work
throughout our network. In order to enhance
communication and innovation, we have just
opened the Sirona Center of Innovation in Bensheim, Germany, where we have the largest dental
plant in the world. The Center of Innovation is at
Sirona’s campus, where we aim to foster innovation and bring the dental community together.
Everyone is invited to visit us there to see the
latest developments in dentistry and to get a
glimpse of the future.
Both products were very prominently exhibited at IDS 2011 and did not only receive the
honours of this award, but also the approval of the
market. InEos was developed for dental technicians and they love it! It is intuitive, and scanning
with this device is fast, precise and efficient. It has
met with great success and is a cornerstone of
our lab offerings.
The CEREC Biogeneric software is the most
intuitive software out there. It analyses the
patient’s individual dentition as basis for the
Sirona ORTHOPHOS XG 3D.
Sirona at IDS Cologne 2011.
_Two Sirona products, inEos Blue desktop
scanner and CEREC and inLab Biogeneric software, were named amongst the 2010 WOW!
winners for 2010’s most innovative tools in
the dental laboratory industry by the Journal of
Dental Technology. Did these products still create
a buzz at IDS?
CAD/CAM
2_ 2011
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innovative technologies that can even be
linked through CEREC meets GALILEOS.
They are the drivers of today’s digital
dentistry.
The third largest division is our treatment centre division. We are global
market leader here as well. This is the area
in which we have our roots and it is still
a brand shaper for Sirona. Finally, our
instrument division is our forth and
smallest division. That’s Sirona.
We are very happy with our position
on the market and are continuously
growing. Last year, we recorded growth
of 7.9 %. For the first quarter of this year,
we registered 15.8 % growth.
Sirona GALILEOS.
restoration, which will consequently have a perfect, natural fit. With it, we have eliminated the
need for a tooth library. The method is extremely
simple: with a single click of the mouse, the user
is able to create crowns, veneers, inlays and
onlays, as well as anatomically sized bridges.
_What is the size of each Sirona division and
how are they linked?
Of our four divisions, our CAD/CAM division,
led by our chairside system CEREC, is the largest,
followed very closely by our imaging division.
The CAD/CAM- and the imaging divisions create
_What activities is Sirona involved in
regarding giving back to the community?
We take our social responsibility very
seriously. Giving back to the community
is an important part of Sirona’s activities.
We believe that we have a responsibility
towards the needy and thus engage in corporatewide and local activities. For example, we supported clinics in Peru, Tanzania and Ghana with
equipment donations. Some of these activities
are a joint effort between Sirona and our distribution partner Henry Schein, such as our support
of the largest non-profit organisation SCO Family of Services in New York, for which Henry Schein
and Sirona held a combined charity event.
We also set up a relief fund immediately after
the catastrophe in Japan. The purpose of the fund
was to provide support and aid to colleagues
affected by the disaster. About €8,200
was collected through fundraising events
at Sirona’s Bensheim and Salzburg locations, as well as at IDS. Sirona subsequently increased this donation to €20,000.
_What is Sirona’s vision of dentistry
of the future?
Certainly, we see digital dentistry, including CAD/CAM, becoming central to
the dental office. We have worked hard
to make this happen over the past years
and are well on our way. If you were to
fast-forward five years, you would most
likely see CAD/CAM and digital dentistry
in every office, certainly in the more
developed countries. That’s what we
believe in, and it would be a great reward
for Sirona to be the top brand driving this
development._
Sirona CEREC
Software.
32 I CAD/CAM
2_ 2011
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I feature _ home story
Moving the dental world from analogue to digital:
3Shape’s success
story continues
Authors_Bernhard Moldenhauer & Matthias Diessner, Germany
From right to left: Nikolaj Deichmann
(CFO), Tais Clausen (CTO) and one of
the in-house developers at 3Shape.
(Photo courtesy of 3Shape, Denmark)
_During SCANDEFA, a major dental fair in
Scandinavia, DTI recently visited the 3Shape headquarters in the heart of down-town Copenhagen to
learn about the company’s new products and future
strategies. The historical building alongside Kongens Nytorv square and the Royal Danish Theatre
has light and airy rooms, a perfect environment for
a young, passionate and ambitious organisation
driven to develop the best technological solutions in
3-D scanning and CAD/CAM.
Often referred to as the “Google of the Dental
Industry”, 3Shape was launched eleven years ago in
a one-room apartment by two young and ambitious
34 I CAD/CAM
2_ 2011
graduate students from the Technical University of
Denmark and Copenhagen Business School—Tais
Clausen and Nikolaj Deichmann. At the time,
Clausen was completing his master’s thesis on
a groundbreaking 3-D scanning technology and
Deichmann was finalising his Master’s degree in Finance and Economics. Having met through friends,
they joined forces to participate in the prestigious
Venture Cup business plan competition, established
by McKinsey and Co., in which they finished second.
Throughout the competition, they constantly considered the manner in which the technology could
be commercialised and thus the idea of launching
3Shape was born.
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I
Initially, Clausen and Deichmann approached companies in the hearing-aid industry with the idea of developing a qualitycontrol system for hearing-aid shells and ear
moulds. Similar to a dental restoration, the devices need to be custom fitted to the patient’s
hearing canal and are traditionally made by
taking an ear impression that is then manually
sculpted, cut and used to make a mould—
a time-consuming, manual procedure.
“During these first meetings, we realised that
we could actually create a mass customisation
production system,” Deichmann remembered.
“So instead of just checking the quality we
decided to go directly for changing the workflow completely, from a manual process, where
you spend several hours shaping the hearingaid shells, to a completely digital workflow.”
3Shape digitised the entire manufacturing process by introducing a 3-D scanner for ear impression
taking, as well as the management software and CAD
software needed to simulate the position of all the
electronic components that need to fit into the
patient’s ear along with the shell, taking up minimal
space and using CAM software for controlling
the manufacturing equipment. They developed the
system for a specific hearing-aid manufacturer but
retained the rights to sell the technology to others.
At the time, there were only six companies that
controlled approximately 90 % of the global hearingaid market and within a period of three years, all of
them went from a completely manual to an entirely
digital production. Today, about 90 % of all hearingaid devices are produced using 3Shape’s technology.
Clausen and Deichmann were always aware of the
3-D scanning technology’s enormous potential so
they soon looked to other industries where the manufacturing processes are similar to the hearing-aid
industry, such as dental laboratories. In 2004, 3Shape
began to receive an increasing number of requests
from dental companies interested in the technology.
“We quickly decided that if we wanted to replicate
our success in the hearing-aid industry, we needed to
go for the full solution to have a very user-friendly
system that the dental laboratories would adopt.
Therefore, we went to a lot of laboratories, small ones
and big ones, and tried to figure out how we could
optimise the processes instead of just finding a better way to make zirconia copings. From the very beginning, our vision was to achieve a complete switch
from analogue to digital,” Deichmann explained.
3Shape introduced its first 3-D dental scanner
and CAD/CAM software for virtual restoration design
at the International Dental Show (IDS) in Cologne in
2005 and the system became a raving success. In the
following years, the company extended and enhanced
their dental laboratory product range by continuously
responding to and involving their customers from
the early stages of the product development process.
Always busy, the 3Shape booth
at IDS 2011 in Cologne.
“Perhaps the most important lesson we have
learned is that innovation is only successful if it
moves and is guided in directions that truly benefit
professionals in their daily work,” Clausen, CTO and
head of the 3Shape development team, pointed out.
Today, CAD/CAM has conquered dental laboratories and clinics, ensuring high profitability by maintaining top-level quality through standardised and
controlled treatment and production processes that
also benefit the patient. In Germany, traditionally
an early adopter of new technologies, approximately
82 % of all ceramic restorations are already produced
using CAD/CAM technology. “The question today is
no longer if CAD/CAM will endure in the industry, but
rather when all dental professionals will be taking
advantage of it,” Clausen said.
After having conquered the dental laboratory
industry, 3Shape also extended the proven technologies to dental clinics. “We analysed all existing scanning systems on the market and defined what we like
and what we didn’t like about them. We wanted to
create a system that incorporated all the advantages
and eliminated all the drawbacks of the existing systems. Our solution really needed to be faster, easier,
more accurate and more reliable,” Deichmann said.
At the opening day of IDS 2011, 3Shape launched
its newest achievement, the TRIOS intra-oral scanning solution, which aims to revolutionise the dental
CAD/CAM
2_ 2011
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I feature _ home story
tially export virtual set-ups to other systems, such
as for appliance manufacturing.
Surprisingly, 3Shape is the only major dental
company that offers easily integrable solutions. All
products are designed as plug-and-play solutions
and feature open interfaces for connection to thirdparty applications. 3Shape has won Ernst & Young’s
Entrepreneur of the Year in the Innovation category
in Denmark three times. This prestigious award
recognises innovation, leadership, state-of-the-art
products, an international network and a clear strategy to pursue continuous growth.
Tais Clausen demonstrating TRIOS
during the 3Shape press conference
at IDS 2011.
practice. The 3Shape booth was literally flooded
with dentists trying to get a glimpse of the sleek and
elegantly designed scanner.
One of the TRIOS 3-D scanner’s notable features
is that it does not require dentists to apply spray or
powder to coat the patient’s teeth, making scanning
an easy, fast and comfortable process that does not
ruin scan accuracy by adding material to teeth surfaces. In addition, it can scan any material, such as
metals, semi-transparent materials and skin. It only
requires minimal training for use in clinical practice.
The scanner captures over 3,000 2-D images per
second, which is 100 times faster than a conventional
video camera. Dentists who viewed the presentations
at IDS stated that an “impression-free” dental practice seems to be just around the corner.
An open communication interface allows dentists
to send the scanned data via the Internet directly to
the laboratory of their choice, where the technician
can start designing the restoration immediately
using 3Shape Dental System software or the appropriate interface to third-party software. The TRIOS
communication software includes a tool to visualise
the technician’s solutions for the patient, for example on an iPad, while the patient is still in the chair,
which is especially important for anterior cases.
The system is designed to give dentists high-quality restorations and treat more patients rather than
spending time and money on chairside milling. It handles a wide range of indications and produces quality
3-D data that can easily be realised by any laboratory.
Generally, digital data is controllable, predictable
and available any time, requiring only minimal space.
This guarantees that the dentist owns and is able to
use patient data without limitation and can poten-
36 I CAD/CAM
2_ 2011
Today, 3Shape’s development team consists of
more than 100 developers of 22 different nationalities, with a least 30 PhDs amongst them. All their
products and solutions are born from the union of
cutting-edge technology with the latest trends in the
industry and the markets. 3Shape product managers
and key developers have regular meetings with distribution partners around the world to keep each
product at the top of its class. During the life cycle, the
products are developed in close collaboration with
partners who understand and continue to gather the
needs of their customer base and the market.
But even with ten years of outstanding history,
3Shape never stops looking ahead. The company
believes that the age of fully digital dentistry is only
a few years down the road (of course there will always
be smaller, traditional dental practices)._
_about 3Shape
CAD/CAM
3Shape is a privately held company headquartered in
Copenhagen and boasts the largest team dedicated
to scanner and software development for the dental
industry. It is based in Denmark and Ukraine, has
production facilities in Poland, and support offices in
the US and China. Customer support service branches
are located in Copenhagen, New Jersey (USA) and
Shanghai (China), thus virtually covering every time
zone. The very close collaboration between customer
support and the development team allows for an
unprecedented level of efficiency in responding to
partners’ requests for assistance, which is typically
available in 12 of the world’s major languages.
3Shape A/S
Holmens Kanal 7
1060 Copenhagen
Denmark
info@3shape.com
www.3shape.com
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CAD0211_38-40_Kern 22.09.11 17:23 Seite 1
I trends _ digital datasets
Intraoral impression-taking:
Digital datasets soon
to catch on everywhere
Author_ Manfred Kern, Germany
Fig. 1
Fig. 2
Fig. 1_Short-wave blue light with
structured light projection.
(Photo courtesy of Ender)
Fig. 2_Single images are matched to
create a digital full-arch model, basis
for construction and milling of the
framework. (Photo courtesy of Mehl)
Fig. 3_Optoelectronic intraoral scan
using the C.O.S. Lava system. Crown
preparation and preparation margin
are portrayed exactly. In addition to
framework manufacture, the dataset
enables production of an SLA resin
model including the antagonist teeth.
Fig. 4_Intraoral scan (C.O.S. Lava)
of a molar with a cusp-supported
Fig. 3
_The annual meeting of the German Society
of Dentistry and Oral Medicine (DGZMK), held in
conjunction with the Society for Dental Ceramics (AG
Keramik), the DGZMK’s professional society, is a major
event that critically examines experiences with allceramics and CAD/CAM methods in clinics and practices. At this year’s meeting, the 10 th Annual Ceramic
Symposium, Prof Bernd Wöstmann, Head of Prosthodontics at the University of Gießen in Germany, focused in his paper on the progress that has been made
in the digitisation of intraoral impression-taking.
Naturally, perfectly fitting restorations that can be
seated without further correction are every dentist’s
wish. This requires exact impressions of the preparation
and dental arch. Quite some time ago, digitisation made
Fig. 5
Fig. 4
38 I CAD/CAM
2_ 2011
inroads into this discipline, beginning in 1985 with the
first digital impressions by Prof Werner Mörmann at
the University of Zürich. Prof Wöstmann explained that
en route to an exact restoration, creating an image of
the intraoral situation either as a real or a virtual model
is a very crucial step—it is only possible to produce the
final restoration indirectly, whether it is an inlay or
a multi-unit fixed dental prosthesis bridge (FDP).
Owing to material and haptic conditions, it is still
impossible to produce a “flawless” conventional (stone)
model from classical impressions with elastomeric impression material. Every virtual model produced on the
basis of a classical impression is inexact, regardless of the
accuracy of the scanning procedure itself. It thus makes
sense to perform scanning directly in the oral cavity.
Fig. 6
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trends _ digital datasets
Fig. 7a
Now that producing all-ceramic restorations without CAD/CAM has become almost unthinkable, the
next step has already been taken towards complete
digitisation of the process from preparation to seating
the prosthesis: optical scanning to create a digital,
intraoral impression. In terms of clinical use, the devices—CEREC AC (Sirona), C.O.S. Lava (3M ESPE), iTero
(Cadent-Straumann)—are similar, but they function
according to different principles. Technically, the
systems are similarly constructed, but the procedures
for acquiring the 3-D datasets differ.
The acquisition unit of CEREC AC uses short-wave
blue light and functions according to the principle
of structured-light projection (Fig. 1). The scanning
procedure captures single images; the angled imaging
function acquires tooth areas below the equator and
thus increases accuracy. Through matching, several
images are computed of a quadrant or whole arch
(Fig. 2), as are the antagonist dentition and bite record.
The wavefront sampling of C.O.S. Lava captures
the tooth shape by moving the video camera over the
teeth. The distance to the camera can be calculated
from the changing position of individual pixels during
filming, giving rise to a 3-D image of the dental arch
(Figs. 3 & 4).
The functioning of the iTero scanner is based on
the principle of laser triangulation. The image captures
the tooth and vertically scans 300 levels, each 50 µm
deep (Figs. 5 & 6).
Fig. 9
Fig. 8
Fig. 7b
According to Prof Wöstmann, the scanning accuracy of CEREC AC and C.O.S. Lava corresponds to
a conventional hydrocolloid or polyvinyl-siloxane impression. The differences were not significant.1 Measurements of crown copings fabricated with C.O.S. Lava
yielded an average of 33 µm (± 16 µm) for all marginal
gaps. Copings produced using the conventional impression-taking technique had a mean marginal gap of
69 µm (± 25 µm). Syrek et al. found comparable results
in a clinical study.2 The mean marginal gap of conventionally manufactured crowns was 71 µm, as compared
with 49 µm for the C.O.S. Lava crowns. For CEREC 3D,
the literature cites a tolerance of 40 µm (± 21 µm).3
Another advantage of digital impressions is that the
scanned preparation can be checked directly on the
screen, where imperfections can also be immediately
corrected (Figs. 7 & 8). For patients with an easily triggered gag reflex, these scanning methods greatly improve treatment comfort. Further benefits result from
fewer working steps involved, especially in the practice.
Choosing an impression tray, mixing the elastic impression compound, waiting during setting and disinfection,
as well as producing a model are no longer necessary.
Fewer treatment and working steps also mean fewer
sources of error and better standardisation, which in
turn can improve the predictability of treatment outcome. Prof Wöstmann cautioned that with crown margins that are clearly subgingival, the optical systems
reach their limits; thus, conventional impression-taking
techniques are still used in such cases.
I
preparation for a ZrO2 crown
framework. (Figs. 3 & 4 courtesy
of Wöstmann)
Fig. 5_ITero is equipped with a laser
camera. It is the third intraoral
scanner on the European market.
Fig. 6_ITero scans the tooth
at several levels using laser
triangulation.
Figs. 7a & b_The virtual
“prep-check” checks the preparation
margins and the occlusal reduction
against the antagonist tooth.
(Photo courtesy of Lauer)
Fig. 8_The full-arch scan for an FDP
construction using the iTero system.
(Figs. 5, 6, 8 & 10 courtesy
of Straumann)
Fig. 9_SLA resin model using
the C.O.S. Lava system.
(Photo courtesy of 3M ESPE)
Fig. 10_Digitally milled resin model
using the iTero system.
Fig. 11_Construction of an FDP.
Fig. 10
Fig. 11
CAD/CAM
2_ 2011
I 39
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I trends _ digital datasets
Fig. 12
Fig. 13
Fig. 12_SLA model (acrylic)
for trying in the framework.
Fig. 13_Trying in the
ZrO2 framework.
Fig. 14_Veneering and articulation.
(Figs. 11–14 courtesy of Baltzer)
_Digital impressions are more accurate
At the 12th annual meeting of the International Society of Computerized Dentistry, Prof Gerwin Arnetzl,
University of Graz, compared the accuracy of digitally generated impressions with that of conventional
elastic impressions. When conventional impressions
demonstrate an elastic recovery of 98.5 % after deformation, a fitting accuracy of 35 to 75 µm for an inlay cavity can be expected. For cast pieces, additional
tolerances of up to 46.5 µm accumulate,4 so that indirectly manufactured crowns can attain deviations
of up to 114 µm.5
Different elastomeric impression techniques can
cause considerable deviations. For instance, in analogue impression-taking using different impression
materials and trays, dimensional changes compared
with the reference (a cast metal control) varied between 0.32 and 1.17 %. A deviation of 49 µm was
found for standard and 122 µm for control impressiontaking.6 As a rule, however, the studies on analogue
impression-taking techniques were performed using
2-D measurements; the new studies on the imaging
accuracy of optical methods were conducted with
3-D volume difference analyses.
Digitally or optically produced images by different
operators exhibited a measurement accuracy of 11 µm.7
With the analogue impression-taking technique, the deviations for a whole quadrant ranged from 72 to 101 µm,
while the measurement error tolerance of digital images is only about 35 µm, thanks also to the enhanced
accuracy made possible by angled images. Potential
sources of error in the digital impression-taking technique are scanner adjustment, magnetic interference
fields during image processing, image noise and the
software. According to Prof Arnetzl, these results prove
that given the correct use of a camera or scanner, digitally generated data exhibits fewer errors and greater
accuracy than the conventional impression-taking
technique with elastomeric impression materials.8
A virtual model of the maxilla/mandible is computed from the scans of the quadrants or complete
40 I CAD/CAM
2_ 2011
Fig. 14
dental arch with the antagonist dentition. Via the
Internet, the dentist sends the datasets from C.O.S.
Lava or iTero to the manufacturer, where they are
checked before being used to produce a resin model
(Figs. 9 & 10). After CAD construction of the restoration, the dental technician can either mill the framework in his/her own laboratory or have it done at
the milling centre. The resin model is needed to layer
on the veneers and perform articulation. CEREC AC
also computes a virtual model (Fig. 11). Frameworkfree crowns and short-span FDPs can be milled immediately, directly from the dataset, in the practice’s
laboratory or in another dental laboratory with an
online connection to the practice. For veneered crowns
and multi-unit bridges, a stereolithographically produced resin model (SLA) is necessary, which is provided by InfiniDent (Sirona) and makes veneering the
framework and articulation possible (Figs. 12–14).
Optoelectronic impression-taking systems are extremely promising. Owing to the offered advantages in
standardisation, quality assurance and patient comfort,
digital intraoral impression-taking systems have great
potential for the future. In the coming years, they will be
seen in ever-increasing numbers in daily dental practice. The datasets they create, thanks to the exchange of
information online, simplify communication between
the dentist and the dental technician, regardless of
distance. Supplemental facial photos, information on
tooth colour, individualisation, material, occlusal concept, etc. can also be attached. All of this happens without conventional impression-taking and the associated
gag reflex, wax check-bite and stone model._
Editorial note: A complete list of references is available
from the author at kern.ag-keramik@t-online.de.
_contact
CAD/CAM
Manfred Kern
German Society of Computerized Dentistry –
International Society of Computerized Dentistry
secretariat@dgcz.org
www.dgcz.org
[41] =>
CAD0211_01_Title
Post and search for jobs & classifieds
worldwide on the largest media
platform in dentistry!
Our global online classifieds and career sections are the best solution for filling
job vacancies or selling and purchasing equipment for the dental office. Your postings
will be available to over 650,000 dental professionals, all readers of the Dental Tribune
newspapers, which are published in more than 25 languages worldwide.
For more information and free posting opportunities please go to:
www.dental-tribune.com
[42] =>
CAD0211_01_Title
CAD0211_42_DentalWings 22.09.11 17:24 Seite 1
I industry news _ business
Dental Wings
collaborates with
absolute Ceramics
_Dental Wings, Canadian provider of dental
CAD/CAM solutions, has signed a broad cooperation agreement with absolute Ceramics (biodentis
GmbH), an industrial manufacturer of dental prosthetics based in Leipzig, Germany. According to
Dental Wings, the agreement will enable absolute
Ceramics to integrate Dental Wings’ DWOS software platform into its CAD/CAM system, broadening functionality considerably.
DWOS is a commercially available open-software system that offers dental laboratories the
flexibility to use data from multiple systems and
sources in designing prosthetics. With DWOS installed at its production centre and in its matchpoint
Scan/Design system, absolute Ceramics will be able
to offer custom abutments for all leading implant
systems, in addition its own Infix technology. The
common software platform will also make absolute
Ceramics’ digital workflow compatible with the
LAVA COS intraoral scanner sold by 3M ESPE, which
absolute Ceramics offers to its customers.
“A shared standard software platform enables fast
moving companies like biodentis to offer a new level
of flexibility and functionality to customers—which
was unthinkable just a few months ago,” Meinhard Schmidt, Dental Wings Chairman, commented.
“Using DWOS allows absolute Ceramics to provide
integrated workflows to their customers. At the same
time, it does not prevent them from competing for
prosthetic business with other partners in our collaboration. That shows that we are offering a truly open
platform with benefits for large and small players
across the dental arena. Interest in our initiative with
Straumann and 3M ESPE to establish and shape
global standard software is growing and we are working with a number of companies who have responded
to our open invitation to join us,” Schmidt added.
Frank Preuss, founder and CEO of biodentis, the
company behind the absolute Ceramics brand com-
42 I CAD/CAM
2_ 2011
mented, “The collaboration not only allows us to
offer a full product portfolio to our customers but
helps us to support truly digital workflows between
dentists and dental technicians even across so far
closed system boundaries.”
According to Dental Wings, the need for standardisation in digital dentistry is acute, as the
number of different systems has risen considerably,
adding complexity for dentists and dental laboratories. Standardised software could resolve this
situation and is expected to be the main driver of the
digital market in the coming years.
In March 2011, Dental Wings joined forces in a collaborative partnership with 3M ESPE and Straumann
to create an open-standard software platform for
use across a range of dental applications. At the same
time, 3M ESPE and Straumann announced their intention to adopt Dental Wings’ DWOS platform as the
core operating software in their CAD/CAM solutions.
Biodentis is the fourth company to join the initiative._
_contact
CAD/CAM
Dental Wings
2030 Pie IX, Suite 219
Montreal, Quebec H1V 2C8
Canada
info@dental-wings.com
www.dental-wings.com / www.dwos.com
absolute Ceramics
Weißenfelser Straße 84
04229 Leipzig
Germany
info@absolute-ceramics.com
www.absolute-ceramics.com
[43] =>
CAD0211_01_Title
CAD0211_43_Sirona 22.09.11 17:25 Seite 1
industry news _ Sirona
I
CEREC SW 4.0
now available
_A sharp focus on essentials, attractive and modern design, plus the streamlined production of clinically
and aesthetically perfect dental restorations—these are
the defining features of Sirona’s innovative CEREC SW 4.0
software, which is now poised to make its market debut.
A key highlight is the intuitive user interface, which has
been redesigned using the latest software development
tools. All the settings and processing steps can now be
visualised with the aid of self-explanatory icons and
photorealistic images. As a result, newcomers will find
it easy to get to grips with the CEREC system and experienced users will be able to achieve even more convincing results than in the past.
initial restoration proposal. The user can then
modify this proposal with the aid of the new
biogeneric variation tool. For cases in which
the user wishes to make manual adjustments,
Sirona has developed a completely new and
intuitive interface concept: CEREC SW 4.0 anticipates the user’s needs and projects the relevant design tools directly onto the restoration.
This minimises search times and mouse movement. By simply clicking the appropriate tool
and holding down the mouse button, the user
can work directly on the tooth. The modifications to the restoration are immediately visible.
The CEREC system enables dentists to create allceramic restorations directly in-house. During a single
treatment session, they can acquire digital impressions
of the patient’s teeth as a basis for designing patientspecific crowns, inlays, onlays, veneers and temporary
bridges. In just a few minutes, these restorations can
be machined out of ceramic blocks with the aid of the
CEREC MC XL milling unit, ready for immediate placement. The new software provides clear and comprehensible guidance at all times.
_Multiple restorations created
in parallel
_Intuitive user guidance via the phase
and step bars
To cater for patients with multiple clinical
indications, the new software allows dentists to
work in parallel on several different restorations
during a single treatment session. As a result,
they are ideally placed to offer their patients a complete
portfolio of aesthetic and functionally effective therapy
solutions. Depending on the specific therapy requirements, dentists can combine various indications and
design modes, and thus master clinical challenges that
are routinely encountered in everyday practice with ease.
The new software generation goes a step further
towards streamlining the design process. The system
guides the user step-by-step through the entire production process. For this purpose, the software employs
a clearly structured graphical element, the phase bar,
that indicates exactly which design phase the user has
reached. The software functions and options adapt
themselves dynamically as the work proceeds. The user
interface remains clear and uncluttered, and only those
items that are relevant are displayed at any given time.
Appealing to experienced and new users alike, the
software upgrade is available free of charge to CEREC
Club members. CEREC Connect users will likewise enjoy
the benefits of the new features, and welcome the new
design and intuitive mode of working. The new user
interface has been implemented on a one-to-one basis
in the CEREC Connect 4.0 software._
_Manually adjustable biogeneric
occlusal surfaces
Sirona Dental Systems GmbH
Fabrikstraße 31
64625 Bensheim
Germany
It goes without saying that the new-generation software automatically creates patient-specific occlusal
surfaces. Based on an intact tooth, the patented biogeneric design function identifies the patient’s typical
morphological characteristics and then generates an
_contact
Fig. 1
Fig. 2
Fig. 1_CEREC SW 4.0 conveniently
displays the appropriate tools directly
beside the virtual model.
Fig. 2_Self-explanatory icons
and photorealistic images are the
defining features of the new intuitive
CEREC 4.0 user interface.
CAD/CAM
contact@sirona.de
www.sirona.com
CAD/CAM
2_ 2011
I 43
[44] =>
CAD0211_01_Title
CAD0211_44-46_Ids 22.09.11 17:27 Seite 1
I meetings _ IDS 2011
Record-breaking
IDS 2011
Author_Yvonne Bachmann, Germany
Photos: Koelnmesse GmbH
_With 115,000 visitors and nearly 2,000 exhibitors, this year’s International Dental Show (IDS)
was the biggest dental trade show ever. The show
boasted a 9 % increase compared with 2009. People
from 148 countries travelled to Cologne to see new
products, learn about innovative treatment methods and network with other dental professionals.
Exhibitors from 85 countries seized the opportunity
to establish and further contacts, win new customers
and open up new markets.
“The world’s leading dental trade fair IDS closed,
having achieved outstanding results,” the organisers
44 I CAD/CAM
2_ 2011
summed up after five busy days. Organisers and
exhibitors were especially pleased with the large
number of visitors from abroad. “The most customers
we’ve had so far are from abroad,” Marian Tempel,
responsible for marketing at Korean company Neobiotech, told CAD/CAM on the third day of the
exhibition. IDS visitors came mainly from Latin America and South America, Australia, the US and Canada,
but also from Italy, France, the Netherlands, Spain,
the UK, Switzerland, Russia, Ukraine, Turkey, Israel,
China and India. The exhibition halls were constantly
busy and booths extremely well visited. According
to the exhibitors, 66 % of which came from outside
[45] =>
CAD0211_01_Title
CAD0211_44-46_Ids 22.09.11 17:27 Seite 2
meetings _ IDS 2011
I
Germany, representatives of everything related to
dentistry—dental practices and laboratories, trade,
the higher education sector—visited their booths. The
trade show meant a huge financial success for many
exhibitors. Many companies took numerous orders,
both domestically and internationally.
“We have succeeded in making IDS even more
attractive, both domestically and internationally.
The strong increase in international participants
especially shows that IDS is the world’s leading dental trade show,” Dr Martin Rickert, Chairperson of the
Association of German Dental Manufacturers, said.
“Participants were able to forge high-quality business contacts between industry and trade professionals as well as between the industry, dentists and
dental technicians. Thus, the trade fair once again
signalled better times ahead and generated momentum that will help the dental sector stay on course for
a successful business year.”
Koelnmesse Executive Vice-President Oliver P.
Kuhrt added: “IDS more than satisfied everyone’s
expectations. Once again, IDS offered a whole range
of new products and excellent opportunities to
exchange information, communicate with partners
and place orders. That’s why exhibitors, visitors and
media representatives were all delighted with the
trade fair.”
A visitor survey carried out during IDS found that
not only exhibitors, but also trade visitors considered
the exhibition a success. According to the organisers,
95 % of the respondents indicated that they were
satisfied/very satisfied with the event. They were
pleased with the range of products and had achieved
their goals at the trade fair. Furthermore, 93 % would
recommend a visit to IDS to a close business associate.
“It’s my first time at the IDS and this is the biggest
dental trade fair I have ever been to. I have scheduled
three days to see everything,” Dr Dusan Dimitrijevic
told CAD/CAM. This dentist from Serbia brought
his son and second-year dental student Lazar with him
to Cologne.
_Focus on digital innovation
This year, the focus of interest was on the innovative
new products and technologies on display. According
to Dr Rickert, the trade fair demonstrated that digital
processes and technologies are becoming increasingly
popular, since they facilitate even more efficient and
higher quality treatments. In particular, products and
systems that offer users and patients improvements in
preventative care, diagnostics and dental treatment
were in high demand. Those include ultrasound systems with expanded capabilities that enable painless
and professional preventative care, digital intra-oral
scanners, improved root-canal
treatment methods, new dental
filling materials, aesthetic dental
crowns and bridges that look
most natural, as well as improved
digital X-ray diagnostics that
are especially useful in the field of
implantology.
“As far as we are concerned,
the trade fair was very successful,”
said Jost C. Fischer, Chairperson
and CEO of Sirona Dental Systems,
leader in CAD/CAM technology.
“The number of visitors was amazing. In fact, all of our employees
were in dialogue around the clock.
You could clearly see that the
economy has picked up again.
As a result, the atmosphere at the
fair was extremely positive. In my
opinion, it was the best IDS ever.”
Jürgen Schwichtenberg, President of the Association of German Dental Technicians’ Guilds (VDZI), an
IDS partner, was also very pleased with the trade fair.
“From the point of view of the dental technician trade,
the IDS 2011 once again proved the dental sector’s
innovative power. Considering the variety of products
on display in Cologne and the rapid development of
new, particularly digital technologies, it will be even
more important in the future for dental technicians to
actively supplement these new technologies and solutions with their expert knowledge and to put these
into practice in their laboratories in order to ensure an
all-round high-quality treatment. Our partners in the
dental industry in general and dentists in particular will
be able to continue to rely on these important services.”
CAD/CAM
2_ 2011
I 45
[46] =>
CAD0211_01_Title
CAD0211_44-46_Ids 22.09.11 17:27 Seite 3
I meetings _ IDS 2011
One partnership that was started at IDS is becoming an important political aspect of the profession:
collaboration between the VDZI and the European
Association for Dental Technology. The aim of the
collaboration is to combine dental technology expertise and provide further training of the highest
standard in both theory and practice so that practitioners can learn about the latest state-of-the-art
dental technology.
_Speakers’ Corner well visited
Many IDS visitors took advantage of the Speakers’ Corner feature to gather information on the
latest developments in science and research. Around
80 exhibitors presented their new products and technologies. The presentation topics included implant
systems, digitisation, dental aesthetics, laser technology, dental anaesthesia and the benefits of modern stress management for dentists.
Dr Peter Engel, President of the German Dental
Association (GFDI), one of the IDS organisers, is happy
with the positive outcome of the trade fair: “Even
more visitors and exhibitors than in previous years
can mean only one thing: The profession is progressive and medium-sized German businesses are fostering innovation—and they’re attracting enormous
interest internationally.”
At the exhibition, the GFDI held a coordinating
conference for aid organisations, at which over
40 participants presented aid projects seeking to
improve the dental health of the world’s poor. The
projects were developed by dentists and dental
students who work in impoverished regions all over
the world. Some of them also work in Germany. They
provide dental services to a range of disadvantaged
patients, including orphans, homeless people, disabled patients, drug addicts and inhabitants of remote areas, who would not receive treatment otherwise. To do this work, dentists and students often
have to overcome enormous challenges. The coordinating conference offered participants a special
opportunity to share their experiences in organising
aid efforts.
In collaboration with the VDZI, the GFDI will also
organise the 35th IDS, which will take place from
12 to 16 March 2013._
46 I CAD/CAM
2_ 2011
[47] =>
CAD0211_01_Title
Implants_Probeabo_A4_Implants_Abo_A4 22.09.11 10:41 Seite 1
implants
international magazine of
oral implantology
You can also subscribe via
www.oemus.com/abo
Subscribe now!
I hereby agree to receive a free trial subscription of implants
international magazine of oral implantology (4 issues
per year).
One issue free of charge!
Last Name, First Name
Company
I would like to subscribe to implants for € 44 including
shipping and VAT for German customers, € 46 including shipping and VAT for customers outside of Germany, unless a written cancellation is sent within 14 days of the receipt of the trial
subscription. The subscription will be renewed automatically
every year until a written cancellation is sent to OEMUS MEDIA
AG, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to
the renewal date.
Reply via Fax +49 341 48474-290 to
CAD/CAM 2/11
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Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written
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Signature
OEMUS MEDIA AG
Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-0, Fax: +49 341 48474-290, E-Mail: grasse@oemus-media.de
[48] =>
CAD0211_01_Title
CAD0211_48_Events 22.09.11 17:28 Seite 1
I meetings _ events
International Events
2011
IFED World Congress
21–24 September 2011
Rio de Janeiro, Brazil
www.ifed.org
EAO 2011
12–15 October 2011
Athens, Greece
www.eao.org/eao-congress
AAID Annual Meeting
19–22 October 2011
Las Vegas, NV, USA
www.aaid-implant.org
Dental-Facial Cosmetic
International Conference
28 & 29 October 2011
Dubai, UAE
www.cappmea.com
International Congress
on 3-D Dental Imaging
4 & 5 November 2011
Dallas, TX, USA
www.i-cat3d.com
Competence in Esthetics 2011
11 & 12 November 2011
Vienna, Austria
www.ivoclarvivadent.com
DGI Annual Meeting
24–26 November 2011
Dresden, Germany
www.dgi-ev.de
Greater New York Dental Meeting
25–30 November 2011
New York, NY, USA
www.gnydm.org
AAOMS Dental Implant Conference
2–4 December 2011
Chicago, IL, USA
www.aaoms.org
2012
Nobel Biocare Symposium 2012
21–23 March 2012
Gothenburg, Sweden
www.nobelbiocare.com
IDEM Singapore
20–22 April 2012
Singapore
www.idem-singapore.com
CAD/CAM & Computerized Dentistry
International Conference
3 & 4 May 2012
Dubai, UAE
www.cappmea.com
2013
International Dental Show
12–16 March 2013
Cologne, Germany
www.ids-cologne.de
48 I CAD/CAM
2_ 2011
[49] =>
CAD0211_01_Title
CAD0211_49_Submission_CAD0110_49_Submission 22.09.11 17:28 Seite 1
about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:
In addition, images must not be embedded into the MS Word
document. All images must be submitted separately, and details
about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from 1,500 to 5,500 words—
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the article as long or as short as necessary.
We can run an unusually long article in multiple parts, but this
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In short, we do not want to limit you in terms of article length,
so please use the word count above as a general guideline and if
you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
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Please do not use underlining.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line between paragraphs. Please do
not add tab stops.
_We require images in TIF or JPEG format.
_These images must be no smaller than 6 x 6 cm in size at 300 DPI.
_These image files must be no smaller than 80 KB in size (or they
will print the size of a postage stamp!).
Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available.)
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
your article.
Abstracts
An abstract of your article is not required.
Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
or less).
Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Claudia Salwiczek (Managing Editor)
c.salwiczek@dental-tribune.com
CAD/CAM
2_ 2011
I 49
[50] =>
CAD0211_01_Title
CAD0211_50_Impressum 22.09.11 17:29 Seite 1
I about the publisher _ imprint
CAD/CAM
digital dentistry
international magazine of
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
International Media Sales
Western Europe
Matthias Diessner
m.diessner@dental-tribune.com
Managing Editor
Claudia Salwiczek
c.salwiczek@dental-tribune.com
Eastern Europe
Grzegorz Rosiak
g.rosiak@dental-tribune.com
Product Manager
Bernhard Moldenhauer
b.moldenhauer@dental-tribune.com
Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
The Americas
Jan M. Agostaro
j.agostaro@dental-tribune.com
Designer
Franziska Dachsel
f.dachsel@dental-tribune.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Nadine Parczyk
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 4 84 74 302
Fax: +49 341 4 84 74 173
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Marketing & Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Editorial Board
Prof Albert Mehl, Switzerland
Prof Gerwin Arnetzl, Austria
Dr Stefan Holst, Germany
Hans Geiselhöringer, Germany
Dr Ansgar Cheng, Singapore
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
www.dental-tribune.com
Copyright Regulations
_CAD/CAM international magazine of digital dentistry is published by Dental Tribune Asia Pacific Ltd. and will appear in 2011 with four issues. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I CAD/CAM
2_ 2011
[51] =>
CAD0211_01_Title
CADCAM_Abo_A4_Implants_Abo_A4 22.09.11 16:59 Seite 1
CAD/CAM
digital dentistry
international magazine of
Subscribe now!
I would like to subscribe to CAD/CAM (4 issues per year) for
€44 including shipping and VAT for German customers, €46 including shipping and VAT for customers outside Germany, unless a
written cancellation is sent within 14 days of the receipt of the
trial subscription. The subscription will be renewed automatically every year until a written cancellation is sent to Dental
Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig,
Germany, six weeks prior to the renewal date.
Last Name, First Name
Company
Street
ZIP/City/County
E-mail
Signature
Reply via Fax +49 341 48474-173 to
CAD/CAM 2/11
Dental Tribune International GmbH or per E-mail to
n.parczyk@dental-tribune.com
Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written
cancellation to Dental Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany.
Signature
DENTAL TRIBUNE INTERNATIONAL GMBH
Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-302, Fax: +49 341 48474-173, E-Mail: n.parczyk@dental-tribune.com
[52] =>
CAD0211_01_Title
Dental SystemTM
For Lab Efficiency and Productivity
The most extensive and versatile CAD/CAM system
for dental laboratories.
Dental System™ introduces new generation
additions and cutting-edge technician-friendly
features, including unprecedented indications and
powerful tools that improve lab productivity.
Meet us at exhibitions alll over the world where
3Shape staff will demonstrate its latest innovative
CAD/CAM technologies.
3D TECHNOLOGY DESIGNED
THE WAY YOU WORK
• Integrated online user manual in 11 languages
• Virtual attachment design
• Simultaneous modeling of upper and lower jaw
• Removable Partial Design
• Dynamic Virtual Articulation
• 3rd generation abutment design
• Smile Composer – full anatomy bridges
• Sophisticated implant bars
3Shape A/S
Holmens Kanal 7
1060 Copenhagen, Denmark
Phone: +45 7027 2620
3Shape, Inc.
571 Central Ave., Suite 109
New Providence, New Jersey 07974
Phone: +1 908 867 0144
www.3shapedental.com
)
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/ “Sirona products function like the pieces of a puzzle”; Interview with Jost Fischer - Chairman and CEO of Sirona
/ Moving the dental world from analogue to digital: 3Shape’s success story continues
/ Intraoral impression-taking: Digital datasets soon to catch on everywhere
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