CAD/CAM international No. 2, 2018
Cover
/ Editorial by Dr Scott D. Ganz
/ Content
/ Importance of 3-D printing in dentistry
/ Mastering the implant digital workflow
/ Treatment with digital planning and guided surgery of a fully edentulous patient
/ Restoring function and aesthetics with monolithic zirconia restorations
/ Immediate implantation with CAD/CAM and functional restoration in the aesthetic zone
/ Aesthetic Digital Smile Design: 2-D-/3-D-assisted communication and software design
/ Dynamic navigation by innovative registration
/ Patient preference fuelling transition in US$1.6 billion American and European overdenture market
/ Industry
/ Interview: “Dentsply Sirona offers dental professionals different workfl ow options”
/ Interview: MIS introduces new CONNECT abutment system
/ Meetings
/ Submission guidelines
/ International imprint
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[1] =>
issn 1616-7390 • Vol. 9 • Issue 2/2018
2/18
CAD/CAM
international magazine of digital dentistry
case report
Treatment with digital planning
and guided surgery
trends & applications
Aesthetic Digital Smile Design:
2-D-/3-D-assisted communication
cone beam supplement
Dynamic navigation
by innovative registration
[2] =>
Connected to the future
™
DTX Studio design
Boost your digital journey with speed and
precision and be connected to DTX Studio suite,
a growing digital platform connecting dental
treatments from beginning to end. The LS 3
scanner comes with color and full-articulator
scanning. With the touchscreen, you can even
directly manage the scans at the scanner itself.
Become the go-to digital lab and benefit from
the unique access to authentic prosthetic
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your business flexibility and receive cases from
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restorations, provisionals, surgical templates
and models in-lab.
GMT 55034 © Nobel Biocare Services AG, 2018. All rights reserved. Distributed by: Nobel Biocare. KaVo is either registered trademark or trademark of Kaltenbach & Voigt GmbH in
the United States and/or other countries. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain
case, trademarks of Nobel Biocare. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. For prescription use only. See Instructions for Use for full
prescribing information, including indications, contraindications, warnings and precautions.
[3] =>
editorial
|
Dr Scott D. Ganz
Editor-in-Chief
Is there a “magic formula”?
As we approach one of the most attended and important international meetings of the year, EuroPerio9,
some thoughts come to mind. Is there a relationship between diagnosis, treatment planning, the use of CBCT,
and the final restorative aspect with the long-term maintenance of bone and soft tissue? While there may not be
any scientific publication that addresses all of these issues
together, one thing that we know for sure is that implants
that we place today may be required to stay in function
for 20, 30, 40 years and beyond as people are living longer and longer.
Therefore, our profession needs to be constantly
searching for the magic formula that will help patients
maintain their natural teeth and, if they do lose teeth, maintain implant-supported restorations for their lifespans.
Implant restorations require maintenance over time, just
like a restoration on a natural tooth. The magic formula
may be different for every person, as there are variations
in host factors, such as DNA and genetic predispositions, diet, parafunctional habits and environmental issues. However, when teeth are missing, it is important to
understand the aetiology before offering future treatment
recommendations.
Currently, the use of CBCT provides essential information regarding the individual anatomical presentations
and confirms existing bony topography, bone volume,
root position within the alveolus, pathological entities,
and much more. Combined with computers and interactive treatment planning software, clinicians can now
confidently recommend one or more treatment options
based on an accurate assessment of the present condition of the oral environment. We can no longer separate
the surgical and restorative components of implant reconstruction now that it is possible to merge CBCT data
with data sets from intraoral scans or optical scans of an
impression or a stone cast. Restoratively driven treatment
planning can be achieved when all members of the dental
implant team communicate using today’s exciting technology, and whether bone grafting or soft-tissue grafting,
whether immediate implants or delayed loading protocols
are followed, we owe it to our patients to operate from a
position of knowledge. Our goal should be to provide the
most appropriate treatment for our patients, to maximise
the longevity of such treatment, to avoid surgical or prosthetic complications, and to avoid or manage the potential
of peri-implantitis as our patient population ages.
As always, through the pages of this current Dental
Tribune International publication, it is our goal to educate
our readers by providing state-of-the-art concepts and
content from around the globe. It is through education
and knowledge that we may find that magic formula for
each and every patient we are fortunate enough to treat.
We hope that you enjoy the articles contained within, and
if attending, enjoy the multi-specialty presentations at
EuroPerio9. Keep on learning!
Dr Scott D. Ganz
Editor-in-Chief
CAD/CAM
2 2018
03
[4] =>
| content
editorial
Is there a “magic formula”?
03
Dr Scott D. Ganz
opinion
Importance of 3-D printing in dentistry
06
Prof. Daniel Wismeijer
page 12
Mastering the implant digital workflow
08
Dr Ross Cutts
case report
Treatment with digital planning and guided surgery
12
Drs Phillip Garrett, Kyle Trobough, Ryushiro Sugita & Anna Pitz
Restoring function and aesthetics with monolithic zirconia restorations 18
Dr Ara Nazarian
Immediate implantation with CAD/CAM and functional restoration
page 22
22
Drs Feng Liu, Xiaorui Shi & Miaozhen Wang
trends & applications
Aesthetic Digital Smile Design: 2-D-/3-D-assisted communication
28
Dr Antonello Demartis, Luca Borro & Dr Valerio Bini
cone beam supplement
Dynamic navigation by innovative registration
36
Dr Ricardo Henriques
page 52
business
Patient preference fuelling transition in overdenture market
40
Graeme Fell & Jeffrey Wong
industry
Digital integration from beginning to end
42
Laboratory scanning with Maestro MDS 500
44
interview
Cover image courtesy of MStockPic/
www.shutterstock.com
issn 1616-7390 • Vol. 9 • Issue 2/2018
2/18
CAD/CAM
international magazine of digital dentistry
“Dentsply Sirona offers dental professionals different workflow options” 46
MIS introduces new CONNECT abutment system
50
meetings
EuroPerio9: Anton Sculean becomes new president of the EFP
52
Interview with Prof. Søren Jepsen, Scientific Chair of EuroPerio9
54
International Events
56
about the publisher
case report
Treatment with digital planning
and guided surgery
trends & applications
Aesthetic Digital Smile Design:
2-D-/3-D-assisted communication
cone beam supplement
Dynamic navigation
by innovative registration
04 CAD/CAM
2 2018
submission guidelines
57
international imprint
58
[5] =>
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Multiple options
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03/18
Learn about the printing benchmark in
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[6] =>
| opinion
Importance of 3-D printing
in dentistry
Prof. Daniel Wismeijer, Netherlands
This article is from an interview with Prof. Wismeijer
on understanding 3-D printing in the digital workflow.
He spoke to Dental Tribune at the CAD/CAM & Digital
Dentistry Conference held on 4 and 5 May in Dubai in
the UAE.
One of the problems, however, is that these technologies are all in verticals. The technologies are not horizontally connected together. So, what we’re looking for is a
horizontal connection between all these vertical technologies to get the digital workflow to really work for dentists.
Prof. Daniel Wismeijer
We’re here at the 13th CAD/CAM conference in Dubai.
This is the second time I’m here; the first time I was here
was about three years ago at the tenth edition. The CAD/
CAM conference is focusing on the digital workflow in
dentistry.
And what is interesting about the digital workflow is,
it’s showing us how dentistry is going to be changing
in the coming years. What we see is that we’re getting
away from the analogue and going full digital. Digital diagnostics let us look at our patients from a virtual
perspective. We do the CAD, the planning; we go into
CAM; we have the milling; we have the 3-D printing. And
then we can execute the total treatment, as we go to
the patients ourselves. So, looking around here at this
conference, we see a lot of industry that understands
the change that we are up against in dentistry. They’re
here presenting the technologies that they all have in their
portfolios.
06 CAD/CAM
2 2018
Today, I gave a presentation on 3-D printing in dentistry.
Some of the questions that were posed to me after my
presentation told me that people do not fully understand
yet what 3-D printing actually is; they asked me: “Can I
use that printer for printing metals?” No, you can’t. “What
can I read to learn more about digital dentistry?” Well, my
idea would be to get a book on 3-D printing. This could be
a very easy and simple book to help you understand the
technologies behind 3-D printing. When you understand
the technologies, then you can also find a way of implementing these technologies into the workflow. It’s not just
plug-and-play; it’s not “here you have a machine and now
you can get to work”. No, you have to understand the role
the machine plays in the total digital workflow in dentistry.
You have to understand which machines you need to make
the digital workflow work for you. So, it’s not just about
reading up on the end solutions; it’s also reading up on the
basics, the technology itself, and learning about subjects
that you need to first understand; that is, what digital dentistry is and what 3-D printing is. If you don’t understand
the basics, it’s going to be very difficult to understand the
final execution of all these technologies in your workflow.
My advice is: be humble, be prepared to learn, be
prepared to unlearn everything that you have learnt in
the past and relearn the new technologies to be able to
function properly in the new digital workflow.
© Alex Mit/Shutterstock.com
Questions are directed to me all the time: “How are we
going to do this?” “Could you explain how I can integrate
this into my workflow?” But, if you don’t have the proper
software and you haven’t learnt how to use it, then you’re
going to get into trouble when you try to implement it. So,
the credo here is that you have to learn, unlearn and relearn to understand what’s happening in digital dentistry.
[7] =>
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[8] =>
| opinion
Mastering the implant
digital workflow
Dr Ross Cutts, UK
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 1: Dental Wings intraoral scanner. Fig. 2: Printed models. Fig. 3: 2-D X-ray. Fig. 4: 3-D X-ray.
Whether we like it or not, we are embracing the digital era in our brave new world. Many dental practices
are now becoming paper-free – a digital innovation – and
even using tablet computers to record patient details
and medical histories. We are continually surprised by the
rising age of the technologically savvy patient, particularly
those of a certain generation who perhaps we assume
would be less so than the perceived iPhone generation.
This change in the patient demographic and attitude
towards technology is filtering through to us in the dental profession. The nuts and bolts of implant dentistry
tends to lend itself more readily to the digital revolution of
dentistry in the UK and now globally. Many practitioners
Fig. 5
opposed to or reluctant to embrace it are actually being
influenced by it through shifting workflows in dental laboratories, even where more traditional clinical practices
are followed chairside. Quite often, wet impressions are
poured and stone models are scanned to produce STL
files for laboratories to process during crown and bridge
unit manufacturing.
As an implant clinician, one does not have to invest in
a CT scanner or chairside intraoral scanner—there are
ways that other centers and laboratories can provide
these services. However, having these tools at one’s disposal greatly increases one’s efficiency and means one is
not reliant on external services for one’s patients.
Fig. 6
Fig. 5: CodiagnostiX. Fig. 6: CodiagnostiX surgical guide.
08 CAD/CAM
2 2018
.9
[9] =>
opinion
|
So how do we begin the implant digital workflow? Successful implant treatment
begins with thorough case assessment and
planning of the proposed restoration. This
is important for all cases, not just what we
deem the complex ones. Even the most experienced implant clinician can miss a potential treatment planning hazard, especially
during a busy day. Accurate study model
casts are an essential part of this; however,
Fig. 8
we can now use intraoral scans preopera- Fig. 7
tively to begin the digital workflow. We take a Fig. 7: Printed guide and sleeves. Fig. 8: Postoperative radiograph of implant placement.
scan rather than impressions to form digital
fraught with complexities and should be reserved for
models. Our laboratory can then use these to create digexperienced clinicians. The accuracy of surgical guides
ital wax-ups of proposed treatment outcomes.
“If you fail to plan—then you plan to fail”—Benjamin Franklin
We are routinely used to 2-D radiographic imaging techniques in dentistry, but with the availability and access to
CBCT scanning devices now, we are able to assess bone
quantity and quality of proposed implant surgical sites.
With ever-reducing doses of 3-D imaging and improving
accuracy, we are able to use CBCT scans, combined
with clever software packages such as coDiagnostiX
(Dental Wings), to plan safe and accurate implant placement and restoration. We are able to preoperatively plan
precise implant placement with safe surgical margins
away from important anatomical structures, such as the
inferior alveolar nerve or maxillary sinus. From this, we are
then able to design and either mill or print a surgical guide
to use for precise implant placement.
Even with assisted surgery or guided surgery, there
are sometimes certain restrictions that prevent us from
achieving the most ideal implant placement, such as this
case shown where posterior access in the second molar region was reduced, so achieving the perfect parallel
was extremely difficult.
There are fully guided systems available that allow
for absolutely precise implant placement, but these are
Fig. 9
should not be used to make up for a lack of surgical competency however.
There are many factors to be considered when using
surgical guides, including whether the guide is tooth-,
soft tissue- or bone-supported. Tooth-supported allows
the greatest degree of accuracy.
If tooth-supported,
· are there windows in the guide that direct full seating
of the guide?
· are the teeth that support exact positioning of the
guide mobile? Any mobility adds a degree of inaccuracy.
· is the guide made from a direct intraoral scan or a scan
of a study model? If scanning a study model, is this
an accurate stone model representation? Otherwise,
there is the risk of poor seating and inaccuracy of the
guide.
If soft tissue-supported, mobility completely negates
any accuracy of the guide, so it should only be used for
a pilot drill and then a more conventional surgical protocol adopted.
Fig. 10
Fig. 11
Fig. 9: Surgical placement of LL67 implants. Fig. 10: Scanbodies in situ. Fig. 11: Tissue level implants.
CAD/CAM
2 2018
09
[10] =>
| opinion
Fig. 12
Fig. 13
Fig. 14
Fig. 12: Crowns on printed model. Fig. 13: Implant crowns in situ. Fig. 14: Scanbodies with composite flow material to increase scan accuracy.
If bone-supported,
· raising of a very large surgical flap is likely.
· it is very difficult to ensure accurate full seating of a
bone-supported guide in the precise planned position
and this relies upon external fixation.
Once the implants are placed in situ and fully integrated,
we then have a choice of conventional wet impression
techniques versus digital intraoral scanning. For the majority of cases, intraoral scanning is extremely predictable
and reliable—more so than conventional techniques—
with milled (and lately printed) models having excellent
properties and less accumulation of processing errors.
However, deeply placed implants relative to adjacent
teeth with deep contact points are very difficult to scan
and pick up. Straumann tissue level implants offer a very
straightforward restorative platform to scan from.
With greater numbers of implants and fewer teeth to act
as reference points, intraoral scanning becomes less reliable—particularly across the arch—so we need to exercise
caution and be aware of its limitations. We have used composite flow stuck to the soft tissue to increase reference
points for our scanners, increasing their ability to stitch
images more accurately together. With this in mind, we
cannot assume the scan is accurate and any framework
fabricated would be non-passive; therefore, we must use
other methods to verify the scan’s accuracy. We have found
locking temporary abutments within a composite framework intraorally the easiest and most reproducible way to
Fig. 15
Fig. 16
do this. It then allows us to design and mill a truly passive
framework by Createch and a temporary acrylic bridge.
Conclusion
There are many opportunities to opt in and out of using
technology regarding the digital implant workflow. For anyone considering capital investment, the most important
question to ask is, how will or can this improve the outcomes
I provide to my patients, and then determine whether that
warrants the expenditure. Too often are we subjected to
sales pitches of the next biggest thing by company sales representatives and gadgets and gizmos end up by the wayside.
Acknowledgements to Andy Morton and Ian Murch,
the fantastic laboratory technicians at Borough Crown
and Bridge that I work closely with.
contact
Dr Ross Cutts is the principal
dentist at Cirencester Dental Practice
in Cirencester in the UK. He can be
contacted at cuttsrg@aol.com.
Fig. 17
Fig. 15: Verification jig locked in situ to gain implant passivity. Fig. 16: Createch framework fit surface. Fig. 17: Finished screw-retained bridge in situ.
10 CAD/CAM
2 2018
[11] =>
Dentsply Sirona does not waive any right to its trademarks by not using the symbols ® or ™. 32671431-USX-1801 © 2018 Dentsply Sirona. All rights reserved
Planning and
guided surgery
Digital
impression
Restorative
solutions
Digital implant workflow
Connect to the future
From data capturing, planning, guided surgery to the final restorative
solution, with the digital implant workflow from Dentsply Sirona you have
all the support you need to save time, grow your business and provide
patients with the best possible care.
www.dentsplysirona.com
[12] =>
Treatment with digital planning
and guided surgery of a fully
edentulous patient
© Guschenkova/Shutterstock.com
| case report
Drs Phillip Garrett, Kyle Trobough, Ryushiro Sugita & Anna Pitz, US
Introduction
Edentulism is a worldwide health issue. This case describes how treating a fully edentulous patient with computerised digital planning (coDiagnostiX and Straumann
Guided Surgery) can lead to precise 3-D implant positioning and an optimised prosthetic outcome.
dibular dentition (Fig. 1). The patient requested a conventional removable prosthesis for the maxillary arch and a
fixed option to replace his mandibular dentition. His previous
maxillary overdenture had poor retention and was planned
to be remade. Full-arch extractions were completed three
months prior to implant placement. An immediate denture
was fabricated and delivered on the day of the extractions.
Initial situation
Treatment plan
A male patient aged 59 presented with a previously fabricated maxillary overdenture and failing maxillary and man-
The treatment plan involved the placement of five
Straumann mandibular implants to support a fixed hybrid
Fig. 1
Fig. 2
Fig. 3
Fig. 4
12 CAD/CAM
2 2018
.9
. 12
[13] =>
case report
Fig. 5
Fig. 6
Fig. 7
Fig. 8
prosthesis. Four of the dental implants were to be used
for the provisional fixed prosthesis to attain cross-arch
stabilisation during osseointegration. The patient was
referred for a CT scan using a dual-scan protocol with
coDiagnostiX (Figs. 2–4). The virtual planning strategy was to bypass the mandibular canals and mental
foramina and make use of all available bone by using
a predictable procedure that was simple and affordable for the patient. Once designed, the guide and
prosthesis STL files were imported into a separate CAD
programme to design the occlusal fixation guide. Both
the surgical guide (Figs. 5–7) and the occlusal fixation
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
CAD/CAM
2 2018
|
13
[14] =>
| case report
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
guide (Fig. 8) were fabricated using additive manufacturing techniques.
Surgical procedure
Bilateral local anaesthesia was administered. The vertical dimension of occlusion was measured extraorally
using a Boley gauge with facial landmarks on the patient’s nose and chin. The occlusal fixation guide was
positioned opposing the patient’s maxillary conventional
denture and verified with polyvinylsiloxane (PVS) bite
registration (Figs. 9–12). While the patient was in centric
occlusion, four 1.3 mm diameter osteotomies were created in the labial plate through the alveolar mucosa using
the Straumann template fixation drill (Figs. 13 & 14). The
surgical guide was removed, and crestal incisions were
made bilaterally, extending to the external oblique ridge.
Distal releasing incisions and an anterior releasing incision
4 mm to the left of the midline were made (Figs. 15 & 16).
After full-thickness flap reflection, the mental foramina
and neuromuscular bundles were visualised and isolated
(Fig. 17). The surgical placement guide was inserted and
Fig. 21
Fig. 22
Fig. 23
. 31
Fig. 24
Fig. 25
Fig. 26
. 34
14 CAD/CAM
2 2018
[15] =>
case report
Fig. 27
Fig. 28
Fig. 29
Fig. 30
stabilised using four 1.3 mm diameter Straumann template fixation pins (Fig. 18). Sequential osteotomy preparation was completed to depth through Straumann 5 mm
T-sleeves at each site using the Straumann Bone Level
Tapered (BLT) fully guided surgical kit (Figs. 19–21). After
removal of the surgical placement guide, alveoloplasty
of approximately 5 mm was completed (Fig. 22). Restorative space, osteotomy depth and avoidance of vital
anatomical structures were verified. Two Straumann BLT
SLActive implants (RC, 4.1 mm in diameter, 10 mm in
length) were placed at sites #35 and 45. Two Straumann
BLT SLActive implants (RC, 4.1 mm in diameter, 12 mm
in length) were placed at sites #32 and 42, and
a single Straumann BLT SLActive implant (RC, 4.1 mm
in diameter, 8 mm in length) was placed at site #31
(Figs. 23 & 24). Straumann angled screw-retained abut-
Fig. 31
Fig. 32
Fig. 33
Fig. 34
Fig. 35
Fig. 36
CAD/CAM
2 2018
|
15
[16] =>
| case report
temporary copings were placed
on implants #35, 32, 42 and 45
(Figs. 31–33). Copings were luted
to the conventional denture using
cold-cure pink acrylic resin.
Fig. 37
ments were torqued to 15 Ncm, and sites with thin labial
bone around the implant were grafted with autogenous
bone as needed. The flaps were repositioned and sutured with 4/0 chromic gut (Figs. 25 & 26).
Restoration procedure
After implant placement, the mandibular complete
denture was reinserted with fast-set PVS material placed
on the intaglio surface to indicate implant location
(Figs. 27–30). Space was made for the temporary copings, the healing caps were removed and Straumann RC
about
Dr Phillip Garrett obtained his dental
degree from the School of Dentistry
at the University of Texas Health
Science Center at San Antonio in the US
in 2015. After graduation, he remained
in San Antonio and immediately began
specialty training in the graduate
periodontics department. He is currently
in his third year and plans to begin
working in Phoenix in the US after receiving his certificate in
periodontics in May. He is actively involved in clinical research,
with a focus on implant surface topography and nanotechnology.
Dr Kyle Trobough is a second-year
resident in the graduate periodontics
department at the School of Dentistry
at the University of Texas Health
Science Center at San Antonio. He
graduated with a DDS in 2016 and
immediately began specialty training in
the graduate periodontics department.
He received a BS in mechanical
engineering from Southern Methodist University in Dallas in the
US. His interests include digital implant dentistry and merging
CAD/CAM processes with a digital dentistry workflow.
16 CAD/CAM
2 2018
The prosthesis was converted
from the pre-existing conventional
complete denture to an interim fixed
detachable prosthesis by reducing the flanges and providing adequate hygiene space (Figs. 34 &
35). Occlusal screws were torqued
to 15 Ncm, and the occlusion was
adjusted to have uniform contacts
in centric relation and balanced
occlusion in excursive movements.
The screw access holes were filled with extra-light viscosity PVS material (Fig. 36). A postoperative radiograph
was taken after delivery of the prosthesis (Fig. 37).
Outcome and conclusion
Utilisation of the template fixation pins was an essential step in transitioning the mucosa-borne occlusal
guide to a secure bone-supported guide. The pins are
designed to ensure the digitally planned guide is in the
correct surgical position to provide a restoratively driven
outcome. In this case, the virtual planning models and
the actual outcome demonstrated that the Straumann
Guided Surgery system provides a high level of precision
for the purposes of implant positioning.
Dr Ryushiro Sugita is a third-year
graduate prosthodontics resident
at UT Dental in San Antonio.
He received his DDS from Tokyo
Medical and Dental University.
After dental school, he enrolled in the
residency programme in the Department
of Geriatric Dentistry and gained
experience in major reconstructive
procedures. After practising for number of years in Japan,
he entered the Graduate Prosthodontics Program
at UT Dental in San Antonio.
Dr Anna Pitz is a second-year
graduate prosthodontics resident at the
School of Dentistry at the University of
Texas Health Science Center at San
Antonio. Prior to residency, she graduated
with a DDS in 2016 from Virginia
Commonwealth University in Richmond
and a BS in biology from Wake Forest
University in Winston-Salem, both in the US.
[17] =>
[18] =>
| case report
Restoring function and
aesthetics with monolithic
zirconia restorations
© sunlight19/Shutterstock.com
Dr Ara Nazarian, US
With greater public awareness about cosmetic dental reconstructions, the dentist is often challenged with
greater demands from the patient. This increased demand for aesthetic restorative treatment challenges the
dentist, laboratory technician and dental manufacturers
to develop techniques and materials to satisfy the discerning patient. Utilising digital planning, modern materials and effective techniques, the restorative team can
succeed in restoring a smile to proper form, function and
health. The case presented in this article demonstrates
the significance of a systematic approach to planning,
preparation and material selection in full-mouth reconstruction of a patient’s dentition.
Case presentation
A woman in her early forties was referred to my practice by her dental provider because she was dissatisfied
with the appearance of her smile. The patient explained
that she felt that her existing teeth and restorations were
unattractive because of recurrent caries, wear and colour
18 CAD/CAM
2 2018
(Fig. 1). Most importantly, she mentioned that she was
suffering from tension headaches, grinding and a limited
range of function.
Initial diagnostic evaluation at the first appointment
consisted of a series of digital images with study casts, a
centric relation bite record, a facebow transfer and a fullmouth set of radiographs. In the maxillary arch, the patient had several teeth with worn composite and veneer
restorations, as well as abfractions with cervical caries.
In the lower arch, several existing composite restorations
had worn and exhibited caries on the facial cervical areas. Although there were no restorations present in the
mandibular anterior teeth, there was severe wear of the
incisal edges, possibly due to grinding and other parafunction.
Planning
After reviewing the clinical findings and the mounted
models, the patient was diagnosed with a restricted
.1
[19] =>
case report
envelope of function and decreased vertical dimension from continuous wear. In order to develop a treatment plan and determine whether the vertical dimension could be increased, a diagnostic 3-D White
Wax-Up (Arrowhead Dental Laboratory) was fabricated
(Fig. 4).
In the wax-up, the vertical dimension was increased by
1.5 mm. Also, based on information gathered from the
initial consultation and digital images, it was determined
that the maxillary central incisors could be lengthened
by 1.3 mm to improve the aesthetics. The canines would
also be lengthened to restore canine guidance in lateral
excursions. Regarding the mandibular anterior teeth, the
goal was to correct the length-to-width ratio and create
a less worn appearance.
As a result of the information gathered from the diagnostic wax-up, it was determined that aesthetics and
function could be enhanced by restoring the entire dentition. The final treatment plan would consist of crown restorations, placing composite cores where needed from
teeth #17–27 in the upper arch and teeth #37–46 in the
lower arch.
The material of choice for these crown restorations
would be Zenostar (Wieland/Ivoclar Vivadent). According to the manufacturer, this translucent zirconia material
combines excellent flexural strength with the aesthetics
of natural tooth shades.
With full-contour Zenostar restorations, there are two
methods of achieving the desired shade: the Zenostar
brush infiltration technique or the Zenostar staining technique. Six pre-shaded zirconia blanks—pure, light, medium, intense, sun and sun chroma—form the basis for
reproducing the patient’s natural dentition. Owing to their
warm, reddish nuance, Zenostar Zr Translucent sun and
sun chroma are suitable for restorations with individual
colour characterisation and can therefore be used for
patients whose own natural dentition deviates from the
classical tooth shades.
Fig. 1
Fig. 2
|
Preparation
Once informed consent had been obtained from the
patient, treatment was initiated.
After anaesthetic had been administered, the existing
veneer and crown restorations were removed and the
teeth cored with composite if there was any indication of
recurrent caries remaining in the respective tooth.
Adhese Universal bonding agent (Ivoclar Vivadent) was
applied following the manufacturer’s protocol and cured
using the Bluephase LED curing light (Ivoclar Vivadent).
Using MultiCore Flow Light (Ivoclar Vivadent), build-ups
were accomplished on the teeth that required cores.
A Clear Reduction Guide (Arrowhead Dental Laboratory)
provided with the White Wax-Up was used to ensure
adequate reduction for the definitive restorations. Using
a coarse-grit chamfer diamond bur (Komet), the entire
dentition was prepared for Zenostar crowns, starting
from teeth #17–27 and then teeth #37–46.
A full-arch impression was taken using Instant Custom
Trays (Good Fit). Made of a proprietary material (PMMA)
that becomes mouldable when heated in boiling water,
these trays provide a quick, efficient way of capturing
a dimensionally accurate impression with uniform thickness of the impression material.
Once moulded and customised to the patient’s maxilla and mandible, full-arch impressions were taken using
a heavy and light polyvinylsiloxane impression material
(Panasil, Kettenbach).
After the impressions had been completed, a bite relation jig fabricated on the White Wax-Up models was tried
in the mouth. Medium-body impression material (Panasil)
was placed into the relation jig and seated in the patient’s
mouth on to the prepared teeth (Figs. 5 & 6).
The patient was asked to bite into the relation jig until she
reached the vertical stops and the material set. Instruc-
Fig. 3
Figs. 1–3: Pre-op retracted view.
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Fig. 4
Fig. 5
Fig. 6
Fig. 4: White Wax-Up. Bite jig relined, capturing full-arch bite. Figs. 5 & 6: Impression.
tions for the size shape and colour of the final restorations
was forwarded to the dental laboratory (Arrowhead Dental Laboratory), as were the White Wax-Up models. Also,
a stump shade (Ivoclar Vivadent) was selected for shade
matching of the preparations to assist the laboratory technician in creating natural-looking restorations.
Provisionalisation
Provisional restorations, which would aid in determining the best size, shape, colour and position for the
definitive restorations, were made from Sil-Tech (Ivoclar
Vivadent) impressions of the White Wax-Ups provided by
the dental laboratory.
Using the B1 shade of Visalys Temp (Kettenbach), the
Sil-Tech mould was quickly filled and placed on the patient’s
prepared dentition. Within minutes, the provisional restorations were fabricated and effortlessly trimmed with trimming burs (Komet). Once the teeth had been desensitised
with Systemp.desensitizer (Ivoclar Vivadent) and dried, the
provisional restorations were temporarily cemented using
Temp-Bond Clear (Kerr). The patient was instructed about
their care and use in eating, speaking and biting.
A few weeks later, the patient returned for evaluation of aesthetics, phonetics and bite. Already, she
Fig. 7
Fig. 8
exhibited excitement about and confidence with her
provisional restorations, commenting that all her coworkers had remarked that she looked younger and
happier.
Most importantly, the patient said that she no longer
experienced discomfort in her temporomandibular joint
and that her bite had never felt better. Since no adjustment or modification of the temporary was needed, the
dental laboratory was instructed to replicate the White
Wax-Up when fabricating the definitive restorations.
Laboratory considerations
The White Wax-Ups, colour photographs, impressions
and bite relations were forwarded to the dental laboratory (Arrowhead Dental Laboratory). A scan of the White
Wax-Ups was used to select an appropriate arch form,
tooth size and occlusion from the library of teeth available
in the 3Shape software (Fig. 7).
Using 3Shape Communicate, images of the proposed
reconstruction were forwarded to my office by e-mail.
Any minor adjustments in tooth shape and contour were
communicated with the technical adviser to achieve the
most ideal aesthetics. Once approved, the milling process was begun (Fig. 8).
Fig. 9
Fig. 7: 3Shape virtual design. Fig. 8: Zenostar monolithic restorations on model. Fig. 9: riva luting plus cement.
20 CAD/CAM
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. 10
[21] =>
case report
Fig. 10
Fig. 11
|
Fig. 12
Figs. 10–12: Post-op retracted view.
Cementation
Before try-in of the definitive restorations, the provisional
restorations were removed using the Easy Pneumatic
Crown and Bridge Remover (Dent Corp) and any remaining provisional cement was cleaned off the prepared
teeth. The maxillary and mandibular zirconia restorations
were tried to verify fit, form and shade. After the patient
had been shown the retracted view for acceptance, the
cementation process was initiated.
riva luting plus (SDI), a resin-modified, self-curing glass
ionomer luting cement, was used for the cementation of
these zirconia restorations because it can be used without special preparation using cleaning agents, nor does
it require any bonding agent (Fig. 9).
According to the manufacturer, riva luting plus utilises
SDI’s proprietary ionglass filler. Ionglass is a radiopaque,
high-ion-releasing reactive glass used in SDI’s range of
dental cements. riva luting plus releases substantially
higher levels of fluoride to assist with remineralisation
of the natural dentition. This higher level of fluoride has
a proven antimicrobial activity against three cariogenic
bacteria: Streptococcus mutans, Streptococcus sobrinus
and Lactobacillus.1 In addition, riva luting plus has low
solubility in the oral environment, increasing the material’s ability to resist degradation and wear at the margins
caused by oral acidity.
The preparations were washed and dried to the extent that they were still slightly moist. At this time, the cement capsules were depressed consecutively to activate
and placed in the ultramat 2 (SDI) amalgamator for only
ten seconds for trituration.
Using the applicator dispenser (SDI), the cement was
loaded into the restorations (Fig. 8), starting from the midline and working distally. With a very low film thickness
and creamy consistency, riva luting plus cement was
dispensed into the restorations with easy insertion and
seating.
Removal of excess cement was cleaned up in about
two minutes at the gel phase. After the cement was fully
set at five minutes, the occlusion was verified and adjusted. The overall health and structure of the soft tissue
and restorations were very good. The patient was extremely satisfied with the definitive results (Figs. 10–12).
The occlusion was checked and verified with T-Scan
(Tekscan) to make sure that all of the proper points of
contact were in their ideal positions to ensure longevity
of the reconstruction. The patient no longer experienced
pain and was very pleased with her new enhanced smile
(Fig. 10).
Conclusion
In conclusion, having a systematic method for treatment planning, material selection, tooth preparation and
cementation, the dental provider will be able to address
the needs of the patient more effectively and efficiently.
Because of this and more, the final outcome will be much
more predictable aesthetically and functionally.
Acknowledgement
Special thanks to Chris Barnes and his staff at Arrowhead
Dental Laboratory for the fabrication of the restorations
depicted in this case.
about
Dr Ara Nazarian maintains a private
practice in Troy in the US with an
emphasis on comprehensive and
restorative care. He is a diplomate
of the International Congress of
Oral Implantologists and Director
of the Ascend Dental Academy.
He has conducted lectures and
hands-on workshops on aesthetic
materials, grafting and dental implants throughout the US,
Europe, New Zealand and Australia.
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Immediate implantation
with CAD/CAM and functional
restoration in the aesthetic zone
ig. 7
Drs Feng Liu, Xiaorui Shi & Miaozhen Wang, China
ig. 10
Fig. 1
Fig. 2
Fig. 3
Fig. 1: Pre-op frontal view of the anterior teeth. Fig. 2: Pre-op occlusal view
of the anterior teeth. Fig. 3: Pre-op panoramic radiograph. Fig. 4: Pre-op
CT analysis.
tion. In this article, we present a case of multiple tooth
fractures due to trauma. After tooth extraction, immediate implantation and guided bone regeneration (GBR)
were performed. During the prosthetic procedure, the
design and transfer of the emergence profile of the soft
tissue, functional design and occlusal adjustment, as well
as the CAD/CAM process, were satisfactorily realised to
achieve the aesthetic and functional goals.
Fig. 4
Case report
The aesthetics are always a significant challenge during
implant restoration, especially in the aesthetic zone, in
addition to the full consideration required regarding func-
Dental history
A 40-year-old female patient had sustained trauma to
her anterior teeth caused by accidental syncope three
ig. 13
ig. 16
Fig. 5
Fig. 6
Fig. 5: Frontal view of the anterior teeth immediately post-op. Fig. 6: Occlusal view of the anterior teeth immediately post-op.
22 CAD/CAM
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[23] =>
case report
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
|
Fig. 7: Frontal view of the anterior teeth three months post-op. Fig. 8: Occlusal view of the anterior teeth three months post-op. Fig. 9: Patient smiling
three months post-op. Fig. 10: The overjet and overbite between the implants and the mandibular anterior teeth. Fig. 11: The emergence profile three months
post-op. Fig. 12: Two impression copings connected for the implant level impression.
weeks before. The clinical examination found that tooth
#11 had been luxated; the crowns of teeth #12 and 21 had
fractured, with the residual margin extending 3–5 mm
below the gingiva and the teeth affected by Grade III mobility; and the crown of tooth #22 had fractured, with the
residual margin at gingival level. There were no obvious
abnormalities in the remaining teeth (Figs. 1–4). After
excluding major systemic diseases, it was decided that
she required fixed implant restoration with high demands
regarding aesthetics and function.
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 13: Reshaping of the artificial gingival contour on the model in order to obtain a good gingival aesthetic effect (performed by dental technician Samuel Chou).
Fig. 14: Provisional restoration on the model. Fig. 15: Insertion of provisional abutments. Fig. 16: Modification of the gingival contour under the pontic.
Fig. 17: Finishing of the reshaping of the gingiva. Fig. 18: Frontal view of the provisional restoration just after delivery.
CAD/CAM
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| case report
Fig. 19
Fig. 22
Fig. 20
Fig. 21
Fig. 23
Fig. 19: The patient smiling with the provisional
restoration in situ. Fig. 20: The patient smiling
after adjustment of the labial contour of tooth
#13. Fig. 21: Frontal view of the anterior teeth
after adjustment of the labial contour of tooth
#13. Fig. 22: ICP contact on tooth #13 after
reshaping of the lingual surface with resin (12 µm
occluding paper, red). Fig. 23: Lateral guidance
on tooth #13 after reshaping of the lingual surface
with resin (12 µm occluding paper, red).
Treatment procedure
Teeth #12, 21 and 22 were extracted. Tooth #11 underwent early implantation and tooth #22 immediate implantation with GBR (Figs. 5 & 6). After three
months of healing, osseointegration had taken place.
An implant level impression was taken for fabricating a
provisional bridge supported by temporary abutments
for teeth #12–22. The technician modified the shape of
the artificial gingiva on the model in order to form the
proper gingival curve and emergence profile, then finished the provisional bridge, while the dentist modified
the gingival shape using an olive-shaped bur intraorally
(Figs. 7–18).
The aesthetic and functional outcomes of the provisional restoration were checked. The tip of tooth #13
was too low to achieve a good smile line. When checking
the intercuspal position (ICP) and lateral excursion using
80 µm occluding paper, tooth #13 was found to be
out of contact. After reshaping the labial contour and filling the lingual surface with resin, tooth #13 had good
ig. 28
ig. 31
contact and guidance during ICP and lateral excursion
(Figs. 19–23).
Once the aesthetic and functional outcomes had been
confirmed, the anterior guidance of the provisional restoration was recorded on an articulator (Artex, Amann
Girrbach) and its individual incisal guide table (Figs. 24–27).
Next, the emergence profile of the provisional restoration
was transferred and the cast model was made and
mounted on the articulator (Figs. 28–33).
The cast model was scanned step by step to obtain
a digital model and this was integrated with a virtual articulator. The anterior guidance of the virtual articulator
was set according to the data from the provisional restoration. Next, the design was completed on computer and
the titanium-based zirconia abutment and fixed zirconia
bridge produced via CAM. After staining and glazing,
the final restoration was completed (Figs. 34–41). The
final restoration demonstrated a good outcome, both
aesthetically and functionally (Figs. 42–50).
ig. 34
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 24: Facebow transfer of the provisional restoration. Fig. 25: Mounting of the provisional restoration. Fig. 26: Mounting of the mandibular model according
to ICP bite registration. Fig. 27: According to the anterior guidance of the provisional restoration, the individual incisal guide table was set.
24 CAD/CAM
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[25] =>
case report
|
Fig. 11
Fig. 28
Fig. 29
Fig. 30
Fig. 32
Fig. 33
Fig. 14
Fig. 31
Fig. 28: Emergence profile after shaping by the provisional restoration. Fig. 29: Individual impression coping. Fig. 30: Implant level impression. Fig. 31: Insertion
of 5 mm healing abutments to obtain sufficient retention for the bite registration material. The same posterior ICP bite registration was used as for the provisional
restoration in order to ensure the ICP was stable. Fig. 32: ICP bite registration on the healing abutments. Fig. 33: Cross-mounting of the maxillary cast model.
Fig. 17
Discussion
This patient came to the clinic just after the trauma, and
according to the intraoral condition, immediate implan-
tation could have been carried out. However, owing to
the unexplained accidental syncope, diseases of the central neural system were to be excluded first, so delayed
dental treatment was suggested.
Fig. 21
Fig. 34
Fig. 35
Fig. 36 Fig. 22
Fig. 37
Fig. 38
Fig. 34: Step-by-step model scanning. Fig. 35: The provisional digital model was matched with the cast digital model. Fig. 36: The incisal guide table was set
in the virtual articulator. Fig. 37: Design of the abutment. Fig. 38: Design of the bridge.
CAD/CAM
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| case report
Fig. 39
Fig. 40
Fig. 41
Fig. 39: Manufacture of the restoration with multilayer zirconia. Fig. 40: Final restoration (performed by dental technician Chunyu Duan). Fig. 41: The zirconia
bridge without any ceramic veneer.
restoration can be adjusted step by step or the shape
of the soft tissue can be designed first, the provisional
restoration manufactured to meet the aesthetic demand
directly, then the soft tissue intraorally adjusted and
reshaped.
Three weeks later, after a general physical check-up,
implantation was begun. Usually, operation within 48 hours
after tooth extraction is considered as immediate implantation, while operation within the first six weeks after tooth extraction is considered as early implantation.
Therefore, in this case, implant #11 was early implantation and implant #22 immediate implantation. The preoperative CT analysis showed that the labial side of the
alveolar ridge of teeth #12, 11 and 22 was deficient;
thus, GBR was needed in order to obtain sufficient bone
quantity.
In this case, we followed the second option. After using
an olive-shaped bur to adjust the form of the gingiva
under the pontic, making it match the provisional restoration, which had already been well designed and manufactured, a perfect soft-tissue outcome was achieved.
After three months of healing, both hard and soft tissue
around the implants had been well maintained, providing
a sufficient foundation for the maxillary restoration. In order to form a good gingival shape, either the provisional
By means of regular methods to transfer the emergence profile, it was copied to the final restoration, which
is the foundation for the good soft-tissue effect of the
final prosthesis.
Fig. 42
Fig. 43
Fig. 44
Fig. 45
Fig. 46
Fig. 47
Fig. 42: The titanium-based zirconia abutment. Fig. 43: Frontal view of the anterior teeth just after delivery. Fig. 44: ICP occlusal contact (12 µm occluding
paper, red). Fig. 45: Protrusive contact just after delivery; only tooth #11 achieved contact (12 µm occluding paper, black). Fig. 46: After occlusal adjustment,
the protrusive contact was even on the restoration (12 µm occluding paper, black). Fig. 47: Protrusion just after delivery.
26 CAD/CAM
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[27] =>
case report
Fig. 48
|
Fig. 49
This was a difficult implant-supported aesthetic restoration case. With the great efforts of the surgeons, prosthodontists and technicians, a satisfactory result was achieved.
The surgeons in this case were Drs Feng Liu and
Miaozhen Wang and the prosthodontists were Drs Feng
Liu and Xiaorui Shi. The restoration was completed by
dental technicians Samuel Chou and Chunyu Duan.
about
Fig. 50
Fig. 48: Frontal view of the anterior teeth after two weeks. Fig. 49: Patient
smiling two weeks after delivery of the final restoration. Fig. 50: CT analysis
post-op.
It was also very important to obtain the proper anterior
guidance during the maxillary incisal implant restoration
procedure. We carried out the adjustment of the anterior
guidance during the provisional restoration procedure.
Once the patient had adapted, we set the individual incisal guide table according to the provisional restoration,
cross-mounted the cast model with the provisional restoration model and used the same data to form the anterior
guidance of the final restoration.
When manufacturing the final restoration, a CAD/CAM
system was used. Digital models, ICP relationship and
data on anterior guidance were integrated into the virtual
articulation system. In the process of CAD, the precise
design of both aesthetic and functional aspects could be
realised.
In this case, a titanium-based zirconia abutment and
zirconia bridge were used. The zirconia material used on
the titanium base was a special zirconia with extremely
high strength, which can guarantee excellent strength
and durability of the restoration even if very thinly applied.
The zirconia material used for the bridge restoration was
a kind of CAD/CAM zirconia with a high translucency and
3-D multilayer colour. Without any ceramic veneer, only
with a little staining and glazing, an excellent colour and
translucent effect can be achieved.
Dr Feng Liu is a clinical professor
at and director of the clinical division
aesthetic dentistry training centre
at Peking University Hospital of
Stomatology in Beijing in China.
He is a certified member and China
chairperson of the European Society
of Cosmetic Dentistry, a certified
international trainer of the International
Society of Computerized Dentistry, Chairman of the Chinese
Society of Digitized Dental Industry, and a standing committee
member of the Chinese Society of Esthetic Dentistry.
Dr Xiaorui Shi
is an attending doctor at the Peking
University Hospital of Stomatology.
She is a member of the European
Society of Cosmetic Dentistry and
a youth committee member of the
Chinese Society of Esthetic Dentistry.
Her focus is on aesthetic and functional
reconstruction of complex cases.
Dr Miaozhen Wang is an attending
doctor at the Peking University Hospital
of Stomatology. She is a member of
the European Society of Cosmetic
Dentistry and European Association
for Osseointegration. Her focus is on
implant surgery, digital implantation
and aesthetic reconstruction
of soft and hard tissue.
CAD/CAM
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[28] =>
| trends & applications
Aesthetic Digital Smile Design:
2-D-/3-D-assisted communication
and software design
Fig. 1
Fig. 2
Introduction
The communication between dentist and patient is
important, especially in cases of partial or complete
aesthetic restoration in the anterior (smile makeover).
Nowadays, it is important not only to treat oral pathol-
ogy, but also to request an aesthetic evaluation of the
patient’s smile to obtain results that respect the patient’s
aesthetic expectation. The smile is our business card
and represents the first thing that distinguishes us in
human relationships, in work and in social life. It is necessary to know that a smile can appear unpleasant even
if there are no evident issues or pathology, influencing
people/patients’ psychologically. The clinician should
understand the psychological needs of desire, perception and personality to explain in a better way the necessary therapeutics and/or aesthetic choices. When a
smile is being designed, these parameters are fundamental and dependent on the communication with the
patient and they should be considered in the evaluation
of a 360° clinical approach. It often happens that patients are not able to identify their expectations, so dentists must be able to consider whether their exigencies
can be satisfied.
What does the clinician need to plan an aesthetic
dentistry treatment? What is needed to plan a smile
that is integrated into the face? The diagnostic history
of each clinical case must include anamnesis, analogue
and digital clinical models, radiographic examination, intraoral and extraoral photographs, functional analysis,
aesthetic dentofacial analysis, intraoral diagnosis, static
Fig. 3
28 CAD/CAM
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© sunlight19/Shutterstock.com
Dr Antonello Demartis, Luca Borro & Dr Valerio Bini, Italy
.1
ig. 7a
[29] =>
trends & applications
|
Fig. 5
Fig. 4
and dynamic extraoral diagnosis, the psychological approach to the patient and informed consent.
Of benefit for the clinician, regarding the patient, is to
employ intuitive language in taking a subtle approach to
the patient, and he or she must subject himself or herself
to the expertise of aesthetic dentistry to become the real
protagonist of aesthetic dentistry. As patients’ requests
mainly relate to aesthetics, we must depend on the definition of “aesthetic smile” to know how to apply it appropriately. Is there a concept of “beauty” achievable in
aesthetic dentistry? In our opinion, a smile cannot lose
its meaning, attraction and personality; therefore, it has
psychological, sociological and communicative involvement. Only through effective communication can we answer to the needs of the evolution of the past 50 years.
Today, it is easy and possible to communicate regarding
aesthetics, owing to the instant availability of the digital
image and since the image is a universal language, easy,
immediate and decoded.
With the progress of technology and the introduction
of digital photography, programme and protocols have
been introduced to facilitate communication increasingly through the preview of the treatment result that the
patient will receive (smile design or oral design). More
generally, Digital Smile Design (developed by Dr Christian
Fig. 1
Fig. 7a
Fig. 6
Coachman) allows the use of presentation software
(Keynote, Apple, or PowerPoint, Microsoft) or software
specifically dedicated to dentistry. In addition to these,
regarding 2-D aesthetic pre-visualisation, it is possible
to use image editing software, such as Photoshop Smile
Design as described by Dr Edward McLaren and Aesthetic Digital Smile Design (ADSD) by Dr Valerio Bini.
A detailed smile analysis and its design are fundamental parts of this method and indispensable for the formulation of the treatment plan for the clinical case. The first
step involves the acquisition of images and video (static
and dynamic dentofacial) on the basis of the ADSD protocol (Figs. 1–3). The import of these important elements
into the aesthetic digital file of the patient is complementary to the anamnesis because they are integral to the
objective intra- and extraoral examination.
Fig. 2
Fig. 3
Fig. 7b
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[30] =>
| trends & applications
Fig. 8a
Fig. 8b
Fig. 8c
Fig. 8d
The second step involves the aesthetic analysis according to the main guidelines. Dynamic smile analysis
and dentolabial phonetic analysis are identified in their
characteristics through recording images caught during
sleep, speaking and smiling, allowing better understanding of the variation of the soft perioral tissue.
Nowadays, digital technology is a successful reality
and a confirmed part of daily life in wider society; consequently, the digital workflow in dentistry has become
suitable for all professionals.
Aesthetic Digital Smile Design
The dentist must communicate and explain to the patient how the smile can be improved and personalised;
therefore, it is necessary pre-visualise the outcome of an
ideal aesthetic treatment to show it to the patient using
images.
In order to satisfy the exigencies of both the patient and the team in a clinical case, the methodology
of ADSD allows the clinician to analyse and provide
an indication of the dimensional and morphological
aesthetics of the tooth volume, starting from the acquisition of 2-D elements useful to the aesthetic analysis
through photographs, an instrument we can all have
in our clinic. The smile design digitally realised in 2-D
offers the ability to obtain new and predictable compositions of aesthetic tooth design using images in 2-D
with visual perception in 3-D (picture-in-picture). Digi-
Fig. 8e
30 CAD/CAM
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[31] =>
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[32] =>
| trends & applications
Fig. 9a
Fig. 9b
Fig. 9c
Fig. 9d
tal processing of the images can be done in different
ways according to the exigencies of the smile designer;
currently ADSD can be executed using the well-known
graphics editing programme Adobe Photoshop CC
(Adobe Systems).
ADSD uses a particular set-up dedicated to the smile
designer, through which it is possible to use this well-designed software in a simple way by the dental team. The
ADSD method provides a photographic result that as far
as possible reflects the clinical reality. Forms, colours,
disposition and aesthetic dental composition are inseparable from the aesthetic facial composition. They perform
a primary role through the 3-D visual perception that the
digital dental image editing yields. Once the images have
been imported into the work area of the software, the
frontal and lateral photographs (digital orthogonal projection planning) are aligned to develop the dentofacial
mapping related to all its main components (ADSD digital
face mapping; Figs. 4 & 5).
Fig. 10a
Fig. 10b
32 CAD/CAM
2 2018
ig. 10
Through the visual information provided, the smile design or oral design is a useful way to communicate to
the patient the envisioned aesthetic dental composition
of the smile, synonymous with predictability. This offers
a great instrument for communication in a 360° clinical
approach, especially with the dental team. The modelling
and placement confer the aspect and the visual 3-D perception of the tooth morphology that the dental team will
copy in the CAD modelling phase (Fig. 6).
3-D modelling
In aesthetic dentistry, the role of 3-D has begun to assume greater importance both in the optimisation of the
clinical workflow and as an important improvement to
the efficiency in communication between dentist and
patient. 3-D modelling is a technical discipline that provides the virtual reconstruction in 3-D of an object in the
real world. This discipline, which has its origins in architecture and design, is used in unusual contexts, such
Fig. 10c
[33] =>
trends & applications
Fig. 10d
Fig. 10e
as biomedical field. Dentistry was the first discipline to
use 3-D modelling as an instrument perfectly integrated
into the work process. Other medical disciplines followed
and now this technique is frequently used in clinical and
research contexts.
|
Fig. 10f
activators, such particular molecules that polymerise if
exposed to a luminous ray of a certain wavelength. A subgroup of SLA is digital light processing (DLP), a technology that uses light to polymerise resins as well, but the
luminous source is the beam emitted from a projector in
LED (not laser).
Because of this, smile design could be defined as dental
specialisation that can certainly use 3-D as a significant
instrument of support for a large part of clinical and diagnostic activity. 3-D in smile design overcomes all of the
limits of 2-D technology. Currently, 3-D permits the user
to select teeth from a 3-D library, available in commercial
software, or to realise a personal database starting from
an intraoral scan (Figs. 7a & b).
The advantage that 3-D technology certainly can offer
is relevant: it allows the design of patient-specific teeth
directly in 3-D, allowing quick access to all production
systems, including rapid prototyping. There are many
software programmes available that facilitate working in
3-D, and among these, there is one that is appreciated for
a series of characteristics that are different from the others, such as its ease of use, being entirely free of charge
and its infinite versatility. The factotum software is called
Meshmixer and is from Autodesk, a leader in 3-D software. It allows the designer to work at 360° on the mesh,
generating an infinite series of modification (Figs. 8a–e).
Fig. 10g
3-D prototype
An important improvement to the workflow of smile
design is the printing of prototypes with the new 3-D
printers, facilitating an increase in the efficiency in the
modality of communication between dentist and patient.
From a clinical point of view, dentistry, more than the
others, is a discipline that permits a very concrete and
realistic use of 3-D printing. There are different printing
technologies now available, but in dentistry, the technologies mainly used are stereolithography (SLA) and
PolyJet (Stratasys).
SLA is a printing technology that uses photosensitive
resin to produce physical objects thorough the use of
laser light. This photosensitive resin contains photo-
Fig. 10h
Fig. 10i
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[34] =>
| trends & applications
Fig. 11a
Fig. 11b
PolyJet technology ejects drops of resin from nozzles
on to the build tray and the resin is polymerised by a diffused light of a determinate wavelength. Unlike SLA technology, PolyJet makes use of high-cost machinery without providing added value considering that the same is
obtainable with some low-cost technologies. Owing to our
experience, we prefer to utilise an SLA printer to realise a
3-D resin model, and based on this, a silicone key (negative reproduction) is fabricated, then we place the acrylic
resin into the silicone key and thereafter insert it into the
patient’s mouth and wait until it solidifies. In the meantime,
we remove any excess material from the silicone key. After
polymerisation, we remove the silicone key and finish the
resin plate as best we can. Once these steps have been
completed, we show to the patient our vision of the aesthetics of his or her smile, based on our earlier analysis
with digital analysis of photographs and successively prototyped in 3-D simulated in his or her mouth, and we evaluate with him or her the envisioned final result (Figs. 9a–d).
3-D model that is cost-effective and reproducible to obtain a prototype from a digital photograph of the smile.
Meshmixer software for 3-D design has the advantage of
being open source and using it requires minimal learning.
Moreover, with Meshmixer, one can create in an easy way
a personal digital dental database complementary to the
2-D library. The database can be modified following the
rules of smile design that has as its purpose 3-D printing of
a model in resin characterised by high accuracy of details.
This article originally appeared in DT France 6&7/2018.
about
Dr Antonello Demartis is a cosmetic
dentist in private practice.
Discussion
In our opinion, photography provides the ideal morphological indication of the new smile that should be
communicated to the patient. With ADSD 2-D methodology, we obtain some indication useful also for the team
that can develop, through 3-D modelling, a prototype silicone key to test in the mouth with resin. The purpose of
aesthetic pre-visualisation with ADSD is to demonstrate
to the patient what we can obtain from the aesthetic
analysis of photographs and the possible treatment plan
(Figs. 10a–i). The problem today, in this communication
with 3-D, is the absence of a texture that looks similar to
that of the natural dentition, so when the model is shown
to the patient, it may evoke a negative reaction owing to
what may appear to be a very poor integration. Such visualisation of a natural texture can at present be obtained
only with photography (Fig. 11a & b).
Conclusion
A series of technical procedures have been proposed
that involve digital smile design, ranging from 2-D to 3-D.
This article has described an alternative method for a
34 CAD/CAM
2 2018
Luca Borro is a specialist architect
in medical 3-D modelling and
multidisciplinary innovation in medicine.
Dr Valerio Bini is a prosthetic and
cosmetic dentist. He is the author of
numerous articles published in national
and international journals on digital and
cosmetic dentistry and has presented
papers at international conferences on
aesthetic dentistry and aesthetic medicine.
He is the developer of Aesthetic Digital
Smile Design, an aesthetic virtual
planning method helpful for aesthetic dentofacial analysis.
Dr Bini is an active member of the Digital Dentistry Society.
He can be contacted at info@studio-bini.com.
[35] =>
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[36] =>
| cone beam supplement
Fig. 2
Fig. 1
Fig. 3
Fig. 1: Trace registration Head-Tracker. Fig. 2: Trace registration Jaw-Tracker. Fig. 3: Trace registration tracer tool.
Dynamic navigation
by innovative registration
Dr Ricardo Henriques, Portugal
Background
3-D implant planning and mapping that plan to the real
surgical environment are two important steps in implant
rehabilitation.1, 2 Misplaced implants can create difficult
aesthetics, functional and biological problems and can
result in implant loss.3–5
There are three ways to transfer a planned implant’s
position into the real patient’s jawbone:
1. mental navigation, so-called freehand navigation,
2. static navigation using surgical templates,6 and
3. dynamic navigation using a stereoscopic camera.7, 8
36 CAD/CAM
2 2018
The freehand approach is totally dependent on the surgeons’ experience, skills and mindset during treatment
and creates the highest deviations compared to the other
approaches.2
The usage of surgical templates provides a higher
accuracy compared to freehand surgery, but has a few
limitations, such as the inability to modify the plan once
the surgical template has been manufactured. Surgical
templates require longer drills which can make their use
quite difficult or even impossible. Other concerns are
irrigation issues and incompatibility with advanced surgical protocols.
[37] =>
cone beam supplement
|
Fig. 4
Fig. 6
Fig. 7
Fig. 5
Fig. 4: CBCT image made using a standard protocol (without radiographic marker). Fig. 5: Prosthetic implant plan using the Navident software. Fig. 6: Modified implant plan with six-degree vestibular angulation. Fig. 7: Navident trace registration user interface.
Dynamic navigation is, at present, the most effective way
to transfer the planned implant’s position to the real patient
as it guides the surgeons’ motions using real-time feedback. It is especially useful to reduce flapped procedures
with the advantage of improved soft-tissue healing, patient
comfort and reduced bone resorption. Dynamic navigation allows planning modifications at any time, even during
treatment, and can be used in cases with limited mouth
opening or in combination with osseodensification drills.
The dynamic navigation concept
using trace registration
In this approach, the patient’s jaw and the surgical drill’s
location are being tracked by the navigation system’s tracking camera, using special tags affixed to them. To correspond between the physical patient’s jaw and its on-screen
cone beam computed tomography (CBCT) scan representation, the tag installed on the patient’s jaw must be
mapped with the CBCT scan. The mapping of the trackable
jaw tag to the CBCT scan is called registration. Traditionally,
the patient would have to be CT-scanned with an artificial
radiographic marker, also known as “fiducial”, which has to
be later identified in the CT images by the navigation system’s software in order to enable the registration.7
The innovative trace registration method (Navident,
ClaroNav) eliminates the need for this artificial fiducial
body to be present in the image, by replacing it with
natural high-contrast surfaces, such as tooth crowns
or abutments already present in the image. Therefore,
it eliminates the need for patient exposure to a new
dedicated CT scan with a fiducial. The level of radiation
is an important issue in diagnosis.9, 10 This new method
also eliminates the need to have a special stent prepared to couple the fiducial or trackable tag to the jaw
in a highly stable and repeatable manner, which was
previously essential for the performance of accurate
navigation.
To treat the maxilla, a pattern tag, or Head-Tracker, is
positioned on the patient’s head like glasses with contact points that don’t move with patient muscle contractions or lower jaw movement (Fig. 1). This ensures that
the Head-Tracker maintains a stable relationship with the
skull, and thus the maxilla. For the mandible, another pattern tag, called Jaw-Tracker, is temporarily connected to
one to two teeth using dual-cure composite resin (without etching the teeth to allow for easy removal; Fig. 2).
This Jaw-Tracker can also be used for the maxilla instead
of the Head-Tracker.
CAD/CAM
2 2018
37
[38] =>
| cone beam supplement
The surgeon chooses four to six identifiable landmarks
on structures which are rigidly attached to the jawbone (teeth, abutments) and are easily visible in the
CBCT scan. In the next step, the surgeon traces a path
on the surface of each one of the marked structures
with a tracer tool, also tracked by the camera (Fig. 3).
The system collects 100 points on each one of the
traced structures, and optimally matches them to the
CT image data to register the Head-Tracker or JawTracker, with the patient’s maxillary or mandibular CBCT
scan, respectively.
Advantages of trace registration
The most important advantages of the trace based
over the fiducial/stent-based registration method are:
1. No need to design and fabricate a stent or guide in
advance, eliminating the associated preparation time
and effort, as well as the potential risk for inaccuracy
due to improper seating of the stent during the scan
or procedure.
2. An existing CBCT scan can be used, there is no need
for a special scan with stent and fiducial(s). The scan
may be taken in full occlusion resulting in easier digital
prosthetic planning.
3. No stent or guide is in the patients’ mouth during treatment, allowing the same access space in the oral cavity
during surgery as with a freehand approach.
Possible limitations
1. At least four high-contrast structures fixed to the jaw
bone must be available and accessible for tracing.
Fig. 8
Fig. 8: Dynamic surgical guidance using Navident.
38 CAD/CAM
2 2018
These can be teeth, abutments, bone screws, orthodontic brackets and wires, or similar structures. With
fully edentulous patients, regions of the jaw bone itself
may be exposed and used as landmark regions.
2. Each of the traced regions should not have changed in
appearance or location relative to the jaw bone since
the scan was taken. If guidance is critical and changes
to the jaw such as changes in teeth position are a
concern, a fresh scan prior to surgery is advised.
Case presentation
The treated patient was a 54-year-old female with a
removable prosthesis, who wished to have a fixed solution. The patient was a non-smoker without medical
problems. Intraoral examination revealed the absence
of tooth #24 and bone resorption where the teeth had
been extracted.
Planning procedure
A CBCT scan was taken without any radiographic
marker (Fig. 4). The images were taken with a Carestream
8100 3D (Henry Schein). The field of view used was 80 x
90 mm and a voxel size of 150 µm. The exposition parameters were 84 kV and 4 mA.
The images were analysed and converted into DICOM
files and then converted into a 3-D virtual model by the
Navident software. A virtual crown and implant were
planned to have 2 mm of buccal bone and a restorative
space at the centre of the crown (Fig. 5). The virtual
[39] =>
cone beam supplement
Fig. 9
Fig. 12
Fig. 10
|
Fig. 11
Fig. 13
Fig. 14
Figs. 9–14: Surgical result as virtually planned.
implant planning was then modified creating an angulation of six degrees in vestibular direction, so the surgeon would be guided to initiate bone preparation with a
six-degree vestibular angulation (Fig. 6).
Surgical procedure
Local anaesthesia was performed in region #24 and
aseptic and sterile conditions were applied to prevent
infections. The Head-Tracker was positioned and inspected for stability. Trace registration was performed
by marking four landmarks on teeth using a panoramic
3-D presentation of the jaw, then tracing the landmark regions with the tracer tool while the camera and
software collected 100 points on each tooth (Fig. 7).
Navident automatically registered the Head-Tracker with
the patient’s maxillary CBCT scan based on the collected
points.
In the next step, drill calibration and accuracy check
were performed before the use of each drill. A small incision for a reduced flap was made. All osteotomies were
performed at 800 rpm. The virtual implant angulation
was pre-surgically modified six degrees in vestibular
direction, so the osteotomy could be initiated on that
angle.
Next, the virtual implant was repositioned intraoperatively on the Navident software and the rest of the site
preparation was carried out according to the final angulation with osseodensification drills (Fig. 8). The osteotomies were made with two angulations and tracked in real
time and the same procedure was applied for the implant
insertion. A cover screw was attached before the surgical area was sutured. The patient reported no discomfort
during the surgery.
Postoperative evaluation
The patient reported no pain or swelling. Radiographic
and clinical images were taken with a direction indicator screwed onto the implant. The postoperative evaluation showed that the position of the implant exactly
corresponded to the virtual planning made beforehand
(Figs. 9–14).
Conclusion
The patient benefited from a treatment with a reduced
flap and precise implant placement using dynamic navigation technology with an innovative trace registration
method.
Trace registration in combination with dynamic navigation proved to be a valid technology for osteotomy
preparations and implant placement. It does not require
a dedicated CT with a radiographic marker nor the fabrication of a stent or clip.
When clips or stents are difficult or impossible to use,
or even in every dental patient case, trace registration
can be the best solution for dynamic navigation implant
placement.
contact
Dr Ricardo Henriques
Private Practice
R. S. Martinho, 423 – R/C
4505-164 Argoncilhe, Portugal
rh4dni@gmail.com
CAD/CAM
2 2018
39
[40] =>
| business
Patient preference fuelling
transition in US$1.6 billion American
and European overdenture market
Graeme Fell & Jeffrey Wong, Canada
The transition to fixed-hybrid restorations from removable options is driving sales growth in the US and
European overdenture market. While the removable
overdenture market is still growing, an increasing number of people are opting for fixed-hybrid restorations.
This is a result of patient preference and awareness about
the benefits of fixed full-arch restorations, as well as demographic factors. While the shift is occurring across
both the US and Europe, some of the more mature markets in each region are seeing lower growth rates.
Trends in total overdenture market
The US and European market for overdentures and
implant-supported bridges is poised to experience midsingle-digit growth by 2024, reaching approximately US$2
billion as reported by iData Research.1 This analysis includes the markets for overdentures (implant-supported,
removable implant-supported bar-retained and fixedhybrid overdentures) and implant-supported bridges (cemented and screw-retained). Market growth is expected
to result from the transition to premium fixed-hybrid restorations, which have higher average selling prices than do
alternatives. While competitive price cuts and inexpensive
solutions are limiting potential market growth, these factors
are primarily offset by high unit growth. Market growth is
expected to be higher in the US, whereas the more mature
European market will experience lower single-digit growth.
Increased marketing and patient awareness
fuelling US market
In 2017, the US overdenture market grew notably,
largely owing to increasing patient awareness with regard to implant-supported overdentures. Several entities, such as ClearChoice Dental Implant Centers, have
widely advertised their services across the US, attracting more patients not only to their companies, but also
towards implant-supported restorations in general. Furthermore, laboratory consolidation is occurring throughout the country, absorbing small-scale laboratories that
lack the financial means to invest in new technology.
With various corporate entities competing for market
share in dental implants through advertising, patient
awareness is expected to continue increasing.
Demographic factors are also driving the market in the
US. In 2017, over 49 million people in the country were
estimated to be over 65 years old, accounting for 15.2 %
of the population. By 2024, this demographic is expected
to exceed 17 %, reaching 20 % by 2050.2
This age group represents the largest demographic of edentulous patients. Consequently, the growth of the elderly population
will result in more potential patients seeking
implant-supported full-arch restorations.
Furthermore, the rising wealth of retirees,
relative to that of previous generations, will
increase interest in new technologies and
premium products, further pushing this
market forward.
Maturing removable
implant-supported bar-retained
overdenture market in Europe
Fig. 1: Fixed-hybrid vs total overdenture market in US and Europe (2017 vs 2024).
40 CAD/CAM
2 2018
The European market for implant dentistry
is considerably more mature than that of the
[41] =>
business
|
US, but will still see growth
as a result of demographic
factors, economic recovery
and the mentioned transition
to fixed-hybrid restorations.
The European market, particularly in the northern regions,
has in the past consisted
of a larger share of removable implant-supported barretained overdentures than in
the US. However, this market is maturing considerably,
with removable implant-supported bar-retained overdentures being cannibalised by
both implant-supported and
fixed-hybrid restorations. This
transition has been brought Fig. 2: Implant bar market competitive landscape for CAD/CAM manufacturers in US and Europe (2017).
about by both patient and
dentist preference.
Increasingly competitive implant-supported bar
market despite Nobel Biocare’s leading position
Most of the European economies are starting to experience growth after a slow recovery from the European
debt crisis. This trend is especially prevalent in western
Europe, where Germany, France and the UK saw high
gross domestic product growth in 2017. Rising spending
habits and patient preference for permanent fixed teeth
have driven demand for premium-priced fixed-hybrid
restorations. The average selling price for fixed-hybrid
overdentures is the highest of all segments, owing to the
high number of fixtures required and the more expensive
fixed prosthesis. Consequently, increased market penetration of these restorations will buoy the average selling
prices of the total market in the face of price competition,
driving up market value.
Among CAD/CAM manufacturers, Nobel Biocare maintained its leading market share in 2017, despite increased
competition across the market. The increasing affordability
of CAD/CAM systems has allowed laboratories to enter
the CAD/CAM implant-supported bar market in a significant
way. This, combined with other competitors expanding their
milling capabilities, has resulted in a highly competitive market in the US and Europe. Amidst market consolidation and
technological development, attractive pricing and unique
solutions will allow competitors to maintain market share.
Editorial note: This article is based on iData Research’s
2018 US market report suite for overdentures and European
market report suite for overdentures, which were both published in May. Reference list is available from the publisher.
about
Graeme Fell is a Research Analyst at iData Research and
was the lead researcher for the 2018 US and Europe market
report suites for overdentures and implant-supported bridges.
His work has included a number of other research projects
in other dental and medical device segments.
Jeffrey Wong is the Strategic Analyst Manager at
iData Research. He has been involved in numerous
dental market research projects over many years and
now leads a team involved in that market and many others.
© BAIVECTOR/Shutterstock.com
Further contributing to the maturing market is the
decline in the number of fully edentulous patients. While
single-unit implant-supported restorations are increasing the demand for crowns, they are concurrently taking market share away from bridges. In turn, partial restorations are taking market share away from full-arch
implant-supported restorations. Improvements in dental
health will mean fewer and fewer teeth will require replacement. Conversely, Europe is experiencing a marked
demographic shift: low birth rates and higher life expectancies are dramatically changing the shape of the
population. In 2017, people aged 65 and over were an
estimated 19.2 % of the overall population, an increase
of 0.3 % compared with the previous year and an increase of 2.4 % compared with ten years earlier. This
trend will continue throughout the forecast period. While
these two market factors oppose each other, the growth
of the elderly population will ultimately result in more
potential patients seeking implant-supported full-arch
restorations.
iData Research is an international market research
and consulting firm focused on providing market intelligence
for the medical device, dental and pharmaceutical industries.
More information about the company’s research
can be found at https://idataresearch.com/.
CAD/CAM
2 2018
41
[42] =>
| industry
Digital integration
from beginning to end
Breaking down boundaries between clinician and technician
By DTI
KaVo LS 3
Nobel Biocare recently introduced an expanded CAD/
CAM portfolio, designed to enhance flexibility and connectivity between treatment partners. This new offering is
made possible through the company’s close collaboration
with KaVo. Bringing complementary areas of expertise
to the partnership, these two leading dental innovators
are now developing fully integrated digital equipment
and software solutions designed to bring about seamless beginning-to-end treatment workflows for clinics
and laboratories. New KaVo imaging equipment and
DTX Studio software are part and parcel of the two companies’ joint efforts.
DTX Studio
42 CAD/CAM
2 2018
Nobel Biocare is expanding its CAD/CAM offering with
new flexibility and connectivity.
New imaging device
The KaVo LS 3 desktop scanner starts the digital
journey for the clinician and laboratory technician with
speed, colour and precision. Designed to enhance efficiency, it seamlessly connects to DTX Studio design software for fast restoration planning. Even when working on
the most complex cases, dental technicians can save
time without compromising quality: a complete jaw scan
[43] =>
industry
|
NobelProcera
can be performed in
under 60 seconds with
an accuracy of up to 4 µm,
according to the ISO 12836 standard for assessment.
The scanner is equipped with an advanced optical
system that captures the fine textures and colours of
the dental model for true visualisation; and scans can
be managed directly on the scanner itself, using its
intuitive 5 in. touch-screen interface. Designed with an
awareness of the virtue of mechanical simplicity, its
spacious, open measurement field provides easy access to the case and makes it possible to mount a full
articulator, thus further increasing efficiency at the dental laboratory.
Connectivity for everyone
The DTX Studio suite offers exciting new solutions to
connect the dental professional with the entire treatment
team at each stage of dental implant treatment. It integrates the very latest technologies and equipment, from
patient imaging acquisition to post-treatment follow-up—
including diagnostics, treatment planning, implant surgery and restoration design.
Furthermore, it is now possible to manage 2-D and 3-D
data from radiographic and optical sources in a single
software application throughout the practice. DTX Studio
for clinics processes data in dentistry-relevant workspaces and is geared towards daily use in both Windows
and macOS environments. It provides users with tools
for ease and efficiency, such as online collaboration between NobelClinician and DTX Studio for laboratories,
allowing the production of a TempShell provisional restoration in-house for same-day, immediate screw-retained
provisional restorations.
For dental laboratories, the DTX Studio suite provides
a new opportunity to become the go-to laboratory of the
future, facilitating flexibility in the choice of workflow and
business model. The design software will accept intraoral
scan files from systems such as TRIOS (3Shape), iTero
(Align Technology), True Definition Scanner (3M) and
CS 3600 (Carestream
Dental), as well as files
from other desktop scanners. Furthermore, laboratory owners will benefit
from the best of two worlds: direct access to premium
NobelProcera centrally manufactured products, including bars; and open output with the option to produce
cement-retained restorations in-house.
Authentic restorations made for precision fit
Using the new KaVo LS 3 in combination with DTX
Studio, dental technicians can access the full portfolio
of NobelProcera restorations. With the resulting smooth,
fast workflows, they can choose to produce authentic,
precise-fitting NobelProcera CAD/CAM solutions outsourced to state-of-the-art facilities in Mahwah in the US
and Chiba in Japan.
Prostheses are manufactured in accordance with an
ISO 13485-compliant quality management system and
cleared by the U.S. Food and Drug Administration where
required, and the output quality of each is monitored.
This results in products demonstrating a high degree of
precision fit, mechanical stability, and years of safe and
reliable performance. When assistance is needed, direct
local support is available from Nobel Biocare specialists
fully trained on the workflow.
Digital production on demand
NobelProcera Scan and Design Services help laboratories consistently meet increasing demands for highquality implant-based restorations without requiring substantial investments in new equipment and staff training.
The dental professional can send a case from any one
of the 25 approved scanners to NobelProcera Scan and
Design Services and then receive precision-fit bars,
abutments and implant crowns, or a 3-D printed model.
Whether using an intraoral or desktop scanner, the process is simple, and within a matter of days, the precisely
manufactured restoration is shipped to the laboratory
with a material authenticity certificate and a five-year
product warranty.
CAD/CAM
2 2018
43
[44] =>
| industry
Laboratory scanning
with Maestro MDS 500
Dr Terence Whitty, Australia
The digital dental workflow has three components:
scanning or acquiring data, computer-aided design (CAD)
and computer-aided manufacture (CAM). All components
are very important, but just as in the analogue world,
the acquisition of data, namely scanning, is arguably the
most important.
The introduction of accurate intraoral scanners has
really increased the popularity of digital dental data acquisition; however, these devices are still expensive and
some come with outrageous compulsory annual fees
for both the dental surgery and the dental laboratory,
just about holding them to ransom just to use the device.
The alternative has been used for years and that is the
humble laboratory scanner.
44 CAD/CAM
2 2018
Laboratory scanners were traditionally only for upmarket laboratories, as these devices were originally pricey.
They were also often inaccurate, especially when used
for implant-retained prostheses. The dental model was
poured and the dies sectioned and then these were
scanned separately and recombined in software as a
virtual model. Impression scanning was only a wish with
the early scanners and some tried, but had poor results.
A great deal has changed in only a few years, and with the
introduction of the fifth-generation scanner from Maestro
3D, it is apparent that the laboratory scanner has definitely
come of age with an accurate, reliable, fully programmable
scanner. With this new release, there is an emphasis on
major improvements in scanning in general and especially
[45] =>
industry
impression scanning, with the MDS 500 scanner able to
scan any type of impression, be it of polyvinylsiloxane or
of various rubbers or alginates, most without any scanning
spray. The scanning software instantly inverts the scan,
ready for export to any dental CAD software, including
Maestro 3D’s own comprehensive Dental Studio package.
The technology behind the MDS 500 is an advanced
variant of structured light, or striped light as it is commonly known, and this is the technology Maestro 3D has
always adopted, as it has always been superior to laser
stripe scanners. It is interesting to note that other companies are just catching up in adopting this technology.
The scanner is a closed-case-type scanner, contrary
to popular designs at the moment, and this has been purposely done to achieve the highest standard of accuracy,
precision, resolution and repeatability that only this type
of design can offer. This is especially true in light of the
high-precision demands for implant-retained prostheses.
There is a conjecture by some companies about the
colour of the light that needs to be projected by a structured light scanner and they assure their customers that
blue light is superior. The facts are that scanner cameras
are monochrome greyscale; therefore, the only effect that
blue light brings is a lower contrast of the image. If the
|
goal to be pursued is the highest precision, accuracy and
resolution 3-D scan, white light is better than blue light.
The MDS 500 is a well-thought-out, affordable scanner
capable of incredible accuracy. Furthermore, it, of course,
saves files in industry standard STL and various other
formats. My advice is to check it out today.
contact
Dr Terence Whitty is a well-known
dental technology key opinion leader and
lectures nationally and internationally
on a wide variety of dental technology
and materials science subjects.
He is the founder and owner of Fabdent,
a busy dental laboratory in Sydney
in Australia specialising in high-tech
dental supply and manufacture. Using
the latest advances in intra- and extraoral scanning and CAD/
CAM, including milling, grinding and 3-D printing technologies,
most applications are covered, including orthodontics, fixed and
removable prostheses, computer implant planning and guidance,
temporomandibular joint dysfunction syndrome, as well as
oral and maxillofacial, sleep and paediatric dentistry. He has
published articles in various international journals. He can be
contacted on +61 2 93137971 or via www.fabdent.com.au.
CAD/CAM
2 2018
45
[46] =>
| interview
“Dentsply Sirona offers
dental professionals
different workflow options”
By DTI
Dentsply Sirona covers every single step, from the diagnosis with imaging systems to treatment planning and
execution and prosthetic restorations. What sets us apart
from our competitors is that Dentsply Sirona offers dental
professionals different workflow options. Some may, for
instance, focus fully on chairside treatments. This means
that dentists carry out the entire treatment process and
even produce their restorations in their own practices.
Another option is what we refer to as the clinic-tolaboratory workflow. It involves working with external
partners and dental laboratories. Dentsply Sirona also
offers services for this workflow. Each workflow has its
own distinct advantages and the choice, ultimately, depends on the particular benefits that users—whether
dentists or dental technicians—regard as more advantageous. Besides the two flagship workflows, there are
many more options on how to combine elements of each,
offering dentists the freedom to adjust their workflow
according to their individual situation.
Dr Volker Winter
Opened almost two years ago, the Digital Dental
Academy (DDA) is one of the most modern training
centres for dental professionals in Europe and the
world’s largest CEREC training institute. The DDA, with
its advanced laboratories and high-tech devices, offers
individual training programmes for every level of knowledge on CEREC, guided implantology, 3-D planning and
diagnostics.
This March, at the Digital Implant Workflow Press Forum, an event devoted to the promotion of knowledge on
digital processes in dentistry and organised at the DDA
by Dentsply Sirona, Dental Tribune International (DTI) had
the opportunity to speak to Dr Volker Winter, Product
Manager for CAD/CAM at Dentsply Sirona, about digital
technology and its benefits for implant dentistry.
There is a wide range of systems for digital implant
workflows available on the market. What advantage
does Dentsply Sirona offer dental professionals?
46 CAD/CAM
2 2018
In a chairside workflow, the first step is to plan a prosthetic proposal with CEREC. The basis for implant planning is a 3-D radiographic image. This image is matched
with the CEREC Omnicam scan and the prosthetic proposal, allowing all the important information, such as
vital anatomical structures, bone quality and prosthetic
requirements, to be seen at a glance so that the implant
can be positioned ideally. To achieve the best possible implementation of the planning, dental professionals can design and produce the surgical guide (CEREC
Guide 2) for the implant placement themselves. The final
prosthetic restoration can also be designed and manufactured with CEREC. The CEREC MC XL enables the
placement of customised abutments or screw-retained
crowns in a single visit.
In the clinic-to-laboratory workflow, the dentist sends
out the 3-D imaging data to Dentsply Sirona’s mySimplant
Planning Service to receive a plan based on the patient’s
individual situation. The dentist can also order a patientspecific Simplant Guide through mySimplant Planning
Service for guided surgery. For the design and man-
[47] =>
interview
ufacture of the final restoration, the digital file from the
intraoral scan is sent to a dental laboratory via Sirona
Connect. Alternatively, the order can be initiated automatically in Atlantis WebOrder, also via Sirona Connect.
The great advantage of the digital implant workflow is
its flexibility: dental professionals can decide freely on
those parts of the workflow that they want to keep inhouse, those where they would like external support and
those that should be outsourced completely. The ability
to implement all these processes with a strong and experienced partner—Dentsply Sirona—is unique in the market. Dental professionals can rely on proven protocols
and thus gain surety in their treatment planning.
Dentsply Sirona offers integrated workflows with a
complete product portfolio in which all components work
together seamlessly. Owing to their high degree of standardisation, our digital workflows improve the predictability of a treatment outcome and allow for fewer sessions,
increasing clinical safety and patient comfort. Dentsply
Sirona products are based on a solid foundation of research and development, as well as years of experience
and documentation.
How can CAD/CAM technology improve the quality
of the workflow for implant specialists in particular?
The advantage of CAD/CAM technology is that it
standardises processes, making them safer and faster.
|
This starts with radiographic images, which offer the
third dimension required for digital implant planning.
The planning works digitally as well. The special feature
of virtual treatment planning is the ability to produce a
custom-made surgical guide, which has been proven to
increase the safety of the surgical procedure.
For prosthetic restorations, digital workflows are especially useful owing to their high precision and timesavings. As already mentioned, this creates more comfort
for the patient and possibly fewer sessions at the dentist.
In November 2017, Dentsply Sirona received an
honourable mention for CEREC Guide 2 for the third
Innovaatio (Innovation) Award. What makes this
surgical guide so special and to what extent does it
enhance the digital implantology workflow?
We were delighted to have received this award. It is
a tribute to our concept of providing sophisticated solutions for everything from diagnosis to planning to final
patient care. The surgical guide not only supports the
surgical procedure itself but also the exact implementation of the planned prosthetic situation.
The surgical guide improves implantation and achieves
a precision during the surgical procedure that is hardly
possible freehand. This safety benefits the treatment
and thus the patient. It is extraordinary that as a dentist,
one can produce this surgical guide directly within one’s
CAD/CAM
2 2018
47
[48] =>
| interview
practice—quickly and inexpensively. This is only possible
through digitisation.
the treatment of their patient. This also includes training
our customers to properly implement our workflows.
How have dentists responded to the trend of digital
dentistry? Do you think that the majority of practices
and laboratories will soon be using or considering
using digital technologies?
When we talk about digitisation in general, the question is no longer whether dentists and dental technicians
are increasingly digitising their practices and dental laboratories, but how they are doing it. This has become
very clear at international dental congresses and fairs. It
is important that these technologies bring tangible benefits, such as better image quality, treatment safety or
time-savings. Digital technologies simplify the work of
dentists and dental technicians and even introduce new
treatment options. I am convinced that this will become
standard everywhere in the long term.
Dentsply Sirona invests a great deal in CAD/CAM education and offers courses and individual training—
the DDA is an excellent example of that. How has this
service been received so far?
I have to say that the DDA is not a Dentsply Sirona facility, but was founded by CEREC enthusiasts involved in
the Deutsche Gesellschaft für computergestützte Zahnheilkunde [German society for computer-aided dentistry].
Dentsply Sirona CAD/CAM supported the spacious course
facilities with 20 CEREC units, five treatment centres
(Teneo), a radiographic device, and eight inLab workstations with dental laboratory scanners, milling units and
sintering ovens. Dental professionals can also familiarise
themselves with the new CEREC Zirconia workflow, with
which full-contour zirconia restorations can be produced
in just one session. All areas are part of a fully digital network, from the radiographic device to the treatment centre.
Dentsply Sirona is the market leader in the field of
CAD/CAM systems for the dental practice and among
the leading providers in digital imaging. As digitisation becomes more prominent, it is becoming increasingly important to avoid isolated solutions—the controllability and
the overview are lost. We make every effort to combine the
individual components into customer-oriented solutions.
Our customers appreciate that it is not required of them
to become an IT or engineering specialist in order to use
them. Instead, they can concentrate on their actual work,
48 CAD/CAM
2 2018
The first year of the DDA was already a great success, with
about 140 courses attended by some 1,000 participants,
according to Dr Klaus Wiedhahn, one of the co-founders.
The concept of relocating an important pillar of qualified
CEREC training to the DDA, in addition to offering basic seminars in medical practices, has proven a complete success.
Thank you very much for the interview.
[49] =>
The Dental Tribune
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[50] =>
| interview
MIS introduces new
CONNECT abutment system
By DTI
Screw-retained solutions, known for their predictable retrievability, represent a secure and easy means
of prosthetic restoration. MIS Implants Technologies
offers a wide variety of abutments for screw-retained
restorations, available for all MIS implant platforms
(narrow, standard and wide). This past February, at the
fourth Global Conference, held in the Bahamas, MIS
announced the release of its CONNECT system in the
coming months. Dental Tribune International (DTI) spoke
with Dr Shelly Akazany, Implants Product Manager at
MIS, about the features and clinical advantages of this
new solution.
In your opinion, what are the challenges that dentists
practising implantology are faced with today?
Beyond the core challenge faced in the field of implantology of attempting to replicate nature by creating a
physiological alternative using a prosthesis, patients are
also demanding shorter treatment times while not wanting to compromise on high-level aesthetic results. Dentists need to overcome these challenges while having to
face various cases and rarely ideal conditions, both from
the perspective of anatomical limitations and the habits
and expectations of patients.
How can the right abutment improve the clinician’s
comfort while working and influence the outcome of
implant treatment?
The abutment is actually the component that connects
the implant concealed within the bone and the outside
world, since it creates the interface with the soft tissue/
gingiva. In other words, it ultimately creates the connection between the surgical result and the aesthetic one.
The better and healthier the peri-implant anatomy enabled by the abutment, the longer the surgical result will
be maintained, as well as the aesthetic one in terms of
gingiva.
Could you describe the new CONNECT abutment
system?
The CONNECT system features an intra-gingival, narrow and modular abutment and is designed with a low
profile, providing a tissue level solution for various gingival
heights. Actually, its modularity enables the connection
or interface with the soft tissue that I mentioned. This ver-
50 CAD/CAM
2 2018
[51] =>
interview
|
Dr Shelly Akazany
satility enables choosing the most suitable component
for any situation or clinical indication, in order to maximise
the result in terms of soft tissue.
What are the clinical indications for this new screwretained solution?
Because of its versatility, the CONNECT may be used
in multiple- or single-unit restorations, for both digital and
conventional procedures. It may also be used for provisional or final prosthetic restorations.
What are the main characteristics that distinguish
the CONNECT system?
The CONNECT is a one-time abutment, meaning that
it does not need to be removed during the rehabilitation
workflow. This enables a prosthetic procedure above the
connective tissue level, as opposed to at implant level,
and this facilitates bone preservation. The system allows for a broader range of screw-retained prostheses
in the aesthetic zone owing to its narrow, low-profile
internal connection, may be used in one- or two-stage
procedures, and supports long-term biological stability
by increasing the distance from the bone. Additionally,
in CAD/CAM restoration planning, the abutment may be
scanned and is incorporated into a partial or fully digitally
guided procedure.
CAD/CAM
2 2018
51
[52] =>
| meetings
European Federation of Periodontology
Anton Sculean becomes new president of the EFP
and focuses gum health for over-60s
Raising awareness of the importance of keeping gingivae healthy
throughout a whole lifetime, particularly among people aged over
60, is one of the priorities of the European Federation of Periodontology (EFP), the leading global organisation on periodontal
science and practice. Other aims include strengthening the leadership of the EFP around the world and promoting the status of
periodontology among dentists and other health professionals.
More than 75 experts and officers from 30 national scientific
societies specialising in periodontal health and implant dentistry
gathered in Vienna in Austria on 17 March to celebrate the EFP’s
annual general assembly and to discuss future projects. Highlights
of the meeting included the appointment of Prof. Anton Sculean as
new EFP President, the launch of the EFP mobile app, the international dissemination of the Perio and Caries project, and reports on
the final preparations for European Gum Health Day 2018 in May
and the EuroPerio9 congress.
Sculean, chair of the department of periodontology and executive director of the School of Dental Medicine at the University of
Bern in Switzerland, has taken over the helm as EFP President
from Prof. Gernot Wimmer, Senior Scientist and Privatdozent at the
Medical University of Graz in Austria. Other major appointments by
the assembly included Prof. Lior Shapira (Israel) as new executive
committee officer and coordinator of European Gum Health Day 2019,
and Prof. Filippo Graziani (Italy) as President-elect. In addition,
Prof. Nicola West (UK) and Dr Monique Danser (the Netherlands)
will join the EFP’s executive committee in 2019 as secretary general and treasurer, respectively.
The EFP’s general assembly included the official announcement
of European Gum Health Day 2018, which was celebrated on
12 May to raise public awareness across Europe of the importance of keeping gingivae healthy throughout life. “Health begins
with healthy gums” is the slogan chosen by the EFP to remind
authorities and the public that gingival health is an achievable and
cost-effective way to improve general health, public health and
quality of life.
Prof. Anton Sculean
By joining European Gum Health Day 2018, more than 39 national
societies of periodontology organised at the national level a wide
range of public events, conferences, communication projects,
periodontal check-ups and other activities, under the coordination
of Dr Xavier Struillou.
EuroPerio9—The world-leading congress
Participants of the Vienna general assembly were informed of the
latest preparations for EuroPerio9, which will take place in Amsterdam in the Netherlands between 20 and 23 June and is widely
regarded as the world’s leading congress in periodontology and
implant dentistry. The scientific programme features innovative
session formats, and more than 100 presentations will be deliv-
Prof. Lior Shapira
52 CAD/CAM
2 2018
[53] =>
meetings
|
ered by world-class speakers, supported by a record number
of more than 1,700 abstracts, which will be presented via
oral presentations, poster discussions and e-posters.
Furthermore, the EFP officially launched the phase of
international dissemination of its Perio and Caries project, supported by Colgate, which allows all EFP-affiliated societies to take advantage of a wide array of scientific and educational content, including brochures,
reports, infographics, videos and other material.
The Perio and Caries awareness project builds on
the knowledge extracted from Perio Workshop 2016,
the top-level scientific conference organised by the
EFP jointly with the European Organisation for Caries
Research in November 2016 in La Granja in Spain. EFPaffiliated societies are offered all Perio and Caries publications free and encouraged to disseminate, edit or translate
them if they wish. This process has proved successful with a
similar initiative previously developed by the EFP, the Oral Health
and Pregnancy project, supported by Oral-B, which is now being
disseminated by 20 national member societies in their respective
languages and countries.
EFP Graduate Research Prizes in Periodontology
The first prize of the EFP Graduate Research Prizes in Periodontology, which is given to the best research from EFP-accredited
graduate perio programmes, was awarded to the study “At least
three phenotypes exist among periodontitis patients”, authored by
Dr Chryssa Delatola, Prof. Bruno Loos, Dr Evgeni Levin and Dr Marja
Laine from the Netherlands. The second prize was given to research
titled “Reduced platelet hyper-reactivity and platelet-leukocyte aggregation after periodontal therapy”, a paper written by Dr Efthymios
Arvanitidis, Dr Sergio Bizzarro, Dr Elena Álvarez Rodríguez, Prof.
Bruno Loos and Dr Elena Nicu, also from the Netherlands. The third
prize went to the study “Oral health in relation to all-cause mortality: The IPC cohort study” by Dr Nicolas Danchin from France,
Prof. David Batty from the UK and Prof. Philippe Bouchard from
France. Concerning personal recognition, Prof. Jan Wennström
received the EFP Distinguished Scientist Award, and Prof. Stefan
Renvert the EFP Distinguished Service Award.
Strengthening the message
“As the EFP reinforces its leadership and its role as the world benchmark in gingival health and periodontal disease, it is time for us to
strengthen the message that gingival health brings not only oral
health but also overall health, well-being and quality of life throughout a whole lifetime, and particularly among the population aged over
60,” highlighted Sculean. “I am deeply happy and honoured to lead
this exciting time for the EFP and for periodontology in Europe, as we’ll
keep working on promoting its acknowledgement as a recognised
dental specialty in all EFP countries, and on turning it into an area
of interest for dentists, dental students and patients across Europe.”
the
aim of
tackling the
hidden epidemic of periodontal
disease. Now I’m ready to continue to contribute to the success of exciting forthcoming EFP projects, starting with EuroPerio9 next June.”
Other major outcomes of the Vienna general assembly were the
launch of the EFP app for accessing key EFP content via smartphones and tablets, recognition of the Lithuanian periodontology
society as a full-member society and the decision to hold Perio
Master Clinic 2019 in Hong Kong next year.
EFP—The global benchmark in periodontology
The EFP is the driving force behind EuroPerio—the world’s
leading congress in periodontology and implant dentistry—and
Perio Workshop, a globally leading meeting on periodontal science. It is an umbrella non-profit organisation that brings together
30 national scientific societies of periodontology in Europe, northern Africa and the Middle East, which together comprise about
14,000 specialist dentists, researchers and other members of the
dental team focused on improving periodontal science and practice. The EFP also edits the Journal of Clinical Periodontology, one
of the most authoritative scientific publications in this field.
More information can be obtained at www.efp.org.
Wimmer said, “I am proud that this 2018 general assembly has
brought together here in Vienna many of the most brilliant periodontal scientists, clinicians and teachers in the world, to review
progress made over the last year and to prepare future action with
CAD/CAM
2 2018
53
[54] =>
| meetings
European Federation of Periodontology
Interview with Prof. Søren Jepsen, Scientific Chair of EuroPerio9
This year’s EuroPerio, the world’s leading congress in periodontology and implant dentistry, is expected to attract up to 10,000
periodontists and members of the dental team to learn about the
latest in periodontal research and clinical practice, in June in Amsterdam in the Netherlands. In this interview, Prof. Søren Jepsen,
past President of the European Federation of Periodontology (EFP)
and Scientific Chair of EuroPerio9, outlines the event’s scientific
programme, which features more than 100 top-level speakers
and many innovations. The detailed programme is available at
www.efp.org/europerio9/programme/scientific/index.html.
Prof. Søren Jepsen
Why should a dentist or a hygienist consider attending EuroPerio9?
Because EuroPerio9 is their opportunity to obtain the best insight
on periodontology and implant dentistry available in the world until
2021—when EuroPerio10 takes place. EuroPerio9 has gathered
the best pool of talented speakers from Europe and around the
world for an audience that is increasingly global too. We’ll enjoy a
great venue in a city as attractive and well-connected as Amsterdam. And then there are the events of the networking programme,
the fact that all happens in only four days and the choice between
four parallel tracks of presentations according to the attendee’s
interests. All in all, attending EuroPerio9 is the most enjoyable and
cost-effective way to be fully updated on the best in periodontology
and implant dentistry available today.
Will EuroPerio9 be similar to EuroPerio8 (London, UK, 2015) and
EuroPerio7 (Vienna, Austria, 2012)?
It will be definitely unique! We have created the Team Session
track, which is more inclusive than the previous separate track for
dental hygienists. We have added more sessions on the afternoon
of Wednesday, 20 June, to take better advantage of the time before
the official opening ceremony. We have arranged sessions in such
54 CAD/CAM
2 2018
a way that many more dental professionals will be able to present
their short oral presentations and posters for discussion. We have
included the well-established stars in the specialty and have more
women speakers and young speakers than ever before. We have
built on the best of our successful experiences and we have added
a number of new formats.
What are those new formats?
We have designed eight new formats. First, on the opening day,
we will have a special double session with the Japanese Society
of Periodontology, one on biofilm and anti-infective therapy, the
other on regenerative periodontal and implant therapy. Second,
the Perio Talks will offer fresh, TED Talk-style presentations given
at the first EFP Alumni Symposium. Third is a lively debate about
the use of antibiotics, led by Profs. Andrea Mombelli and David
Herrera, in which attendees will be able to use their smartphones as
voting devices. Fourth, for the first time, a live surgery session will
take place at a EuroPerio congress. A new, rarely performed procedure with implants will be carried out by Prof. Giovanni Zucchelli
and Dr Martina Stefanini at the Academisch Centrum Tandheelkunde Amsterdam dental school and broadcast in real time.
The fifth major innovation is the interdisciplinary treatment planning
session, in which cases will be shown and the audience will choose
between different options for treatment. Sixth is a 3-D session with Dr
Pierpaolo Cortellini and Prof. Stefan Renvert on reconstructive surgery
on teeth and implants, in a large auditorium. Seventh is the EFP Perio
Contest, for which presentations are being judged not only by an expert
panel but also by social media voting in the days before EuroPerio9.
The three final contestants will be invited to present their work on
stage on the last day of the congress. Eighth is the Nightmare Session,
in which Drs Mario Roccuzzo, Giulio Rasperini, Jean-Louis Giovannoli
and Caroline Fouque will explore treatments that went badly.
Being Scientific Chair of EuroPerio9 sounds like quite a
challenge. How has the experience been?
It is, indeed, an incredible challenge, but also an opportunity to work
with a wonderful team of periodontists and professional organisers. Together, we have worked hard to put together a high-quality
programme with the latest research in the field, the best professionals and the new formats I mentioned. I hope that EuroPerio9
will provide attendees with a fruitful and unforgettable experience!
[55] =>
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[56] =>
| meetings
International Events
LEARN THE
LATEST FROM
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EuroPerio9
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24-26 August 2018
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[57] =>
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2 2018
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[58] =>
| international imprint
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Publisher/President/CEO
Torsten R. Oemus
Director Content Creation
Claudia Salwiczek-Majonek
Editor-in-Chief
Dr Scott D. Ganz
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Schmid
Copy Editors
Sabrina Raaff
Ann-Katrin Paulick
Editorial Board
Dr Scott D. Ganz (USA)
Prof. Albert Mehl (Switzerland)
Prof. Gerwin Arnetzl (Austria)
Dr Stefan Holst (Germany)
Hans Geiselhöringer (Germany)
Dr Ansgar Cheng (Singapore)
International Administration
Chief Financial Officer
Dan Wunderlich
Chief Technology Officer
Serban Veres
Junior Business Development & Marketing
Alyson Buchenau
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Tom Carvalho
Junior Digital Production Manager
Hannes Kuschick
E-Learning Manager
Lars Hoffmann
Education Director Tribune CME
Christiane Ferret
Product Manager CME
Sarah Schubert
Sales & Production Support
Nadine Dehmel
Nicole Andrä
Executive Producer
Gernot Meyer
Advertising Disposition
Marius Mezger
International Offices
Dental Tribune International
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Copyright Regulations
CAD/CAM international magazine of digital dentistry is published by Dental Tribune International (DTI) and appears in 2018 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 aforementioned, and do not have to comply with the views of DTI. Responsibility for such articles
shall be borne by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information
published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply.
Legal venue is Leipzig, Germany.
58 CAD/CAM
2 2018
[59] =>
© MIS Implants Technologies Ltd. All rights reserved.
Open Frame Design
Access for Irrigation
and Anesthesia
Single Handed Procedure
MAKE IT SIMPLE. WE KNOW HOW!
The innovative design of the MIS MGUIDE and its surgical kits
simplifies digital dentistry. The use of CAD/CAM, allows for a
prosthetically driven, safe and accurate procedure. To learn more
about the MIS MGUIDE, go to www.mis-implants.com
®
P A R T
O F
T H E
M C E N T E R
G R O U P
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/ Editorial by Dr Scott D. Ganz
/ Content
/ Importance of 3-D printing in dentistry
/ Mastering the implant digital workflow
/ Treatment with digital planning and guided surgery of a fully edentulous patient
/ Restoring function and aesthetics with monolithic zirconia restorations
/ Immediate implantation with CAD/CAM and functional restoration in the aesthetic zone
/ Aesthetic Digital Smile Design: 2-D-/3-D-assisted communication and software design
/ Dynamic navigation by innovative registration
/ Patient preference fuelling transition in US$1.6 billion American and European overdenture market
/ Industry
/ Interview: “Dentsply Sirona offers dental professionals different workfl ow options”
/ Interview: MIS introduces new CONNECT abutment system
/ Meetings
/ Submission guidelines
/ International imprint
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