CAD/CAM international No. 3, 2012

Cover / Editorial / Content / Clinical digital dental photography / “Lecture theatre” —a new interactive concept— on chairside CAD/CAM dentistry; An interview with Dr Michael Dieter - Ivoclar Vivadent / The implant-retained bar overdenture: The SFI-Bar / CAD/CAM-based restoration of an edentulous maxilla / 3-D alveolar ridge reconstruction in a case with severe bone loss / Single-tooth implants in the aesthetic zone— Challenge and opportunity / The filter principle: Is every patient a finals patient? / Collaborating and connecting in the dental space / CAD/CAM systems market in Japan to gain momentum / Industry News / Subscription / Art nouveau—A Viennese Gesamtkunstwerk / Europerio 7—Perio experts from Europe met in Vienna / Smart dentistry: Digital practice and laboratories in focus at International Dental Show 2013 / International Events / Submission Guidelines / Imprint

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CAD0312_01_Title 19.09.12 11:02 Seite 1

issn 1616-7390

Vol. 3 • Issue 3/2012

CAD/CAM
digital dentistr y

international magazine of

3

2012

| special
Clinical digital
dental photography

| research
The implant-retained bar overdenture: The SFI-Bar

| case report
CAD/CAM-based restoration of an edentulous maxilla

[2] => CAD0312_01_Title

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[3] => CAD0312_01_Title

CAD0312_03_Editorial 19.09.12 13:26 Seite 1

editorial _ CAD/CAM

Dear Reader,
_It is my pleasure to welcome you to this year’s third issue of CAD/CAM!
As the organiser, I am pleased to invite you to the first Asia Pacific edition of the seventh
CAD/CAM & Computerized Dentistry International Conference in Singapore from 6 to 7 October 2012. I am very excited to be involved in the organisation of such an event, which has
built extremely important bridges between the dental team, dental technicians and industry.
We look forward to an amazing weekend at the Marina Bay Sands Hotel in Singapore.
The main scientific conference (6–7 October) and the dental technicians’ parallel session
(7 October) will cover the latest trends and developments in digital dentistry. The impressive
two-day programme will see 20 international speakers giving expert cutting-edge presentations to the 400 expected dentists, dental technicians and other dental professionals, all
hungry for knowledge from Asia Pacific, Europe and the Middle East. Participants will also
have direct contact with 25 industrial players in a networking environment, creating a forum
for discussions, questions and the exchange of valuable feedback, while viewing the latest
technologies at the exhibition.

Tzvetan Deyanov
Business Development Manager
CAPP Asia

Only six years ago, when the Middle Eastern market was still in its early stages we held the
first CAD/CAM & Computerized Dentistry International Conference in Dubai with enthusiasm
and confidence in this exciting field. We are confident that we will be able to transfer this
concept to the Asia Pacific region successfully and play a significant role in the development
and improvement of digital dentistry.
Similar to Dubai, Singapore is a commercial hub for the entire region. In addition, the
digital dental industry in Asia is growing tremendously rapidly. Increasing demand for higher
quality restorations, for example, has boosted purchases of CAD/CAM solutions. Continuous
growth in the privatisation of hospitals, the expansion of dental clinics and the ageing
population has resulted in CAD/CAM paving the way forward for dentistry, offering improved
accuracy and efficiency. These developments have created the need for dentists to further
develop their skills and knowledge in digital dentistry in order to keep up with the latest
tools provided by the industry for their benefit.
Looking to the future, it is inevitable that digital dentistry will become standard in all
dental clinics in both Asia and the rest of the world. Industry forecasts for Asia estimate
double-digit growth in the CAD/CAM market for the next few years.
For these reasons, I would like to invite all dental professionals to the largest annual
international event focused entirely on computerised dentistry. I look forward to seeing you
in the vibrant city of Singapore!
Yours faithfully,

Tzvetan Deyanov
Business Development Manager
CAPP Asia

CAD/CAM
3_ 2012

I 03

[4] => CAD0312_01_Title

CAD0312_04_Content 19.09.12 14:36 Seite 1

I content _ CAD/CAM

I editorial
03

I news

Dear Reader

40

| Tzvetan Deyanov

CAD/CAM systems
market in Japan to gain momentum

I special

I industry news

06

41

Clinical digital dental photography
| Dr Amit Patel

| Bausch

I feature
12

Bausch PROGRESS 100
and Arti-Fol 12 μ metallic shimstock

“Lecture theatre”—a new interactive concept—
on chairside CAD/CAM dentistry

42

3Shape’s Dental System offers CAD Design
of DENTSPLY Friadent customised abutments
| 3Shape

| An interview with Dr Michael Dieter

44

I research
14

| Planmeca

The implant-retained bar overdenture: The SFI-Bar

46

| Dr Tussavir Tambra

IADR/Straumann Award in Regenerative Periodontal
Medicine presented to Prof. Anton Sculean
| Straumann

I case report
20

New Planmeca iRomexis application

CAD/CAM-based restoration of an edentulous maxilla
| Dr Arnd Lohmann

I digital platforms
48

Course calendar

I user report

I feature

24

50

3-D alveolar ridge reconstruction in a case with
severe bone loss
| Prof Marcel Arthur Wainwright

I industry news
28

Single-tooth implants in the aesthetic zone—
Challenge and opportunity

Art nouveau—A Viennese Gesamtkunstwerk
| Annemarie Fischer

I meetings
52
54

| Dr Ata Anil

Europerio 7—Perio experts from Europe met in Vienna
Smart dentistry: Digital practice and laboratories
in focus at IDS 2013
International Events
CAD/CAM
issn 1616-7390

56

I opinion

international magazine of

34

The filter principle: Is every patient a finals patient?
| Simon Hocken

I practice management

I about the publisher
57
58

| submission guidelines
| imprint

Vol. 3 • Issue 3/2012

digital dentistry

3

2012

| special
Clinical digital
dental photography

| research
The implant-retained bar overdenture: The SFI-Bar

| case report

36

Collaborating and connecting in the dental space

CAD/CAM-based restoration of an edentulous maxilla

Cover image courtesy of Planmeca.

| Shane Hebel

04 I CAD/CAM
3_ 2012

[5] => CAD0312_01_Title

THE WORLD SPEAKS e.max.

*

From left: G. Ubassy, Dental Technician, France | M. Roberts, Dental Technician, USA | M. Temperani, Dental Technician, Italy | D. Hornbrook, Dentist, USA |
O. Brix, Dental Technician, Germany | U. Brodbeck, Dentist, Switzerland | G. Gürel, Dentist, Turkey | C. Coachman, Dentist, Ceramist, Brazil |
A. Shepperson, Dentist, New Zealand | A. Bruguera, Dental Technician, Spain | S. Kataoka, Dental Technician, Japan | S. Kina, Dentist, Brazil

SO DOES THE SCIENCE.

UP TO 10 YEARS OF CLINICAL EVIDENCE.
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2

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40 MILLION RESTORATIONS.
1 PROVEN SYSTEM:
IPS e.max
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* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is now available at:
www.ivoclarvivadent.com/science_e

mic
a
r
e
c
l
al
eed
n
u
o
all y

1

M. Kern et al. “Ten-year results of three-unit bridges made of monolithic lithium disilicate ceramic“;
Journal of the American Dental Association; March 2012; 143(3):234-240.
2
Mean observation period 4 years IPS e.max Press, 2.5 years IPS e.max CAD.
See the IPS e.max Scientific Report Vol. 01 (2001 – 2011).
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Based on sales.

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[6] => CAD0312_01_Title

CAD0312_06-10_Patel 19.09.12 12:47 Seite 1

I special _ digital photography

Clinical digital
dental photography
Author_ Dr Amit Patel, UK
Over the past decade, the availability of digital photography,
digital imaging systems and digital presentation software programs has revolutionised teaching and lecturing.

Fig. 1a

Fig. 1b

Figs. 1a & b_Canon EOS 40D 105 mm
lens with ring flash and dual flash
lighting systems (SLR).

Fig. 2_Nikon Coolpix 4500
(point and shoot).
Fig. 3_Nikon Coolpix 4500 with ring
light (point and shoot).

06 I CAD/CAM
3_ 2012

_In today’s environment of patient’s high expectations and increased litigation, especially with
regard to cosmetic dentistry, good record-keeping
is essential. Clinical photography is a very important
tool in general practice in documenting treatment,
especially in aesthetic and cosmetic cases.1

Before the advent of digital
photography, it was expensive
to purchase dedicated 35 mm
dental photographic equipment
and accessories, and it was more
likely to be dentists who were
also amateur photographers
who bought such equipment.3
Since the development of digital
cameras, the costs have been
brought down quite considerably. This has made it more accessible for most dentists in their everyday practice.
The main advantages of digital versus film photography are instant image acquisition, reduced costs
of film processing and a relatively easy learning
curve.

Clinical photography and academic presentation have undergone a transformation over the past
ten years.2 In the past, clinical slide photography and
carousel slide lecture presentations were the gold
standard in both dentistry and the medical fields.

It is very difficult to outrace technology, as it
is evolving daily at a rapid rate and one will always
be behind. So don’t plan on using your current digital equipment for the rest of your life; it is always
outdated within a couple of years. Over time as our
own skills and knowledge improve with digital pho-

Fig. 2

Fig. 3

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CAD0312_06-10_Patel 19.09.12 12:48 Seite 2

special _ digital photography

Fig. 4

tography, we will want to improve on our old images; therefore, reinvesting in technology is part of
the challenge in the pursuit of excellence.
One of the biggest advantages of digital photography is that the images can be viewed instantly
and can be edited in many ways, such as improving
brightness and contrast, cropping, changing hue
and saturation, adding text and symbols, using software.

_Types of cameras
Digital SLR (single-lens reflex) cameras are highend cameras designed for semi-professionals to
professionals (Figs. 1a & b). Recently, most of the
major camera brands have developed a range of
affordable DSLRs, allowing us to develop our clinical photography skills over time to achieve higher
standards in our practice.
DSLR cameras have the advantages of
interchangeable lenses, including macro
and telephoto, metered lenses, and ports
for accessory flashes, such as a ring flash or
a dual flash system. One can also choose
between manual focus and autofocus cameras. Although the modern camera can control a number of key settings relating to the
exposure and flash levels, these can normally
be set manually.
These types of cameras can be expensive
and bulky to use for clinical photography.
A good number of the point-and-shoot style
of digital cameras are available at reasonable prices and take excellent clinical photographs even at a macro level. I have been
using a Nikon Coolpix 4500 (Figs. 2 & 3) since
2003, which allows macro images up to 2 cm
from the object and with which I have obtained good results (Figs. 6–14).
The advantages of the smaller point-andshoot style cameras over DSLRs is that they
are less bulky, lightweight and compact, and
work well for most clinical cases. There is
also no need for multiple lens changes.

Fig. 5

_Digital camera jargon
Digital cameras capture images as elements,
known as pixels. A megapixel is equal to one million
pixels. The more pixels contained in an image, the
higher the image resolution. Resolution relates
primarily to print size and the amount of detail in
an image when viewed on a computer monitor at
100 per cent magnification.
Images with more megapixels yield better print
images. Many amateur and professional digital photographers crop their photographs, sometimes reducing them dramatically in size, to focus on the
key element of the image. Obviously, the more pixels
in an image, the more can be cropped while retaining
a useful image.
I consider that six megapixels is sufficient for
use in clinical digital photography. It gives one the

Fig. 6

Fig. 4_Small Aperture
gives a large depth of field.
Fig. 5_Large Aperture
gives a narrow depth of field.
Fig. 6_Front view.

Fig. 7_Right mirror view.
Fig. 8_Left mirror view.
Fig. 9_Upper occlusal mirror view.
Fig. 10_Lower occlusal mirror view.
Fig. 11a_Right side mirror view.
Fig. 11b_Right side, lips retracted,
no mirror used.

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11a

Fig. 11b

CAD/CAM
3_ 2012

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I special _ digital photography

Fig. 12

is more than sufficient. The smaller files
also make it easier to transmit electronically.
A TIFF file is also compressed but the file does
not lose quality upon being saved; therefore,
TIFF files are larger than JPEG files. TIFF format
images can be utilised in presentation software, the only drawback being that the software may run more slowly owing to a larger
file format. I am inclined to use the JPEG Fine
format to save the images, as they are easily
transferred to the computer and can be used
for presentation purposes.

Fig. 13

_Standardising images

Fig. 14a

Fig. 14b

Figs. 12 &13_The black background
improves image quality
and emphasises the translucent
regions of the teeth.
Fig. 14a_Images of film radiograph
taken from lightbox.
Fig. 14b_Same image manipulated
with GiMP software removing the
saturation making it black and white.
Fig. 15_Set the camera to black
and white setting and take photo
of film from lightbox.
Fig. 16_Using OpenOffice Impress to
present a case.
Fig. 17_Shade tab for laboratory
technician.

Fig. 15

ability to use the images for presentation to patients
and for lectures using software such as Microsoft
PowerPoint (www.microsoft.com) or open-source
software that can be obtained from the Internet,
such as OpenOffice (www.openoffice.org), and to
print reasonable size images (300 x 450 mm) for
poster presentations.
The images are stored on a CompactFlash card
(CF card) or Secure Digital card (SD card), for example.
There are many file types (RAW, JPEG and TIFF) that
all serve different purposes. A RAW file is comparable
to the latent image contained in an exposed but
undeveloped piece of film. This means that the photographer is able to extract the maximum image
quality possible, whether now or in the future. This
format is mostly used in professional photography.
A JPEG file is a file that is
compressed and when saved
loses its quality. This results
in a lower quality and smaller image file. For many applications, the image quality

It has never been easier to take standardised photographs and use high-quality controlled clinical images. Focal distance can be
standardised by securing a piece of dental
floss or chain to the bottom of the camera and
holding it near an appropriate area (chin) of
your patient.4 This ensures that you will be at the same
distance from the patient for all views.
For macro photography, a macro lens and ring
flash for a DSLR can be used for capturing close-up
images of the subject. Ring lights (usually a ring of
LEDs fixed to the lens) can also be obtained for most
point-and-shoot cameras (Fig. 3). It is not always essential to have all these accessories, as you do not
need to get close to the subject. These cameras automatically compensate for various lighting conditions
and some can compensate for macro distances.
Getting too close will overexpose some areas
and block the flash in other areas, causing shadows.
The best technique is to keep away from the subject
and use the optical zoom to get close to the area. By
doing this, you are far away enough for the flash to
disperse over a larger area. With digital editing, you
can crop any extraneous anatomy. If the image is
taken at a high resolution, your image will be of sufficient magnification after cropping the unwanted
structures (macro-like).5

_Basic functions
There are four exposure settings (modes) in the majority
of DSLR cameras and all employ
a through-the-lens metering
system:
Aperture priority

Fig. 16

Fig. 17

08 I CAD/CAM
3_ 2012

The aperture is the lens
opening. So the aperture control allows the photographer to

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special _ digital photography

control how far the lens is
opened when a picture is taken.
The farther the lens is opened,
the greater the amount of light
that is allowed into the camera
and the lighter the exposure.
Once the aperture value has
been selected, the camera automatically selects the correct
shutter speed to produce an
acceptable exposure. By setting the aperture value, the
photographer decides on the
depth of field (the plane of sharp focus) in the
image. One can select a small aperture value (a high
f-number) for a larger plane of sharp focus (Fig. 4) and
a large aperture value (a small f-number) for a narrow
plane (Fig. 5).
A depth of field problem is that the entire dentition can only be photographed completely in sharp
focus if the focal plane is positioned carefully. Therefore, do not focus on the anterior teeth (yellow circles
on Fig. 4). For a frontal view, the point of focus should
be around the canines (yellow circle on Fig. 5).
Shutter priority
The shutter speed controls the amount of light
that enters the lens when the picture is taken. The
more light desired, the slower the photographer
should set the shutter speed. Once the shutter speed
has been selected, the camera automatically selects
the correct aperture value to produce an acceptable
exposure. This mode is not used for the purpose of
intra-oral photography.
Program
The camera automatically selects both the aperture and shutter speed based on a built-in program.

Fig. 18

Fig. 19

teach and improve team involvement of all the staff.
I feel that it is important to delegate the process of
intra-oral photography to other members of staff;
therefore, it is essential to teach and emphasis the
standardisation of all the images taken so that any
member of staff trained will achieve the high standards required.

Fig. 18_Cropping tool using GIMP.
Fig. 19_The cropped image without
the retractors using GIMP.

Orientation of the image is important. The occlusal plane should run parallel to horizontal frame of
the photograph through the view-finder, as a photograph taken from below will distort and alter the
perspective of the teeth. Lateral photographs should
be taken perpendicular to the teeth using a mirror
(Figs. 7, 8 & 11a). Lateral photographs without mirrors will only show a few teeth, as the metered focus
will be on the canines and first premolars (Fig. 11b).
For occlusal views, the camera should be as near as
perpendicular to the occlusal mirror (Figs. 9 & 10).

Tips for dental photography
_Use cheek retractors;
_Use dental photography mirrors (warm using the three-in-one to remove fogging and saliva
bubbles);
_If the image if too bright, increase the f-number (reduce aperture size);
_If the image is too dark, decrease the f-number (increase aperture size);
_Take as many photographs as you like, as you can delete them later.
Table I

Manual
Tips for dental presentations
The photographer selects both the aperture and
shutter speed, but the camera’s built-in meter can
still be used to calculate the correct exposure.
For dental photography, it is important to be in
control of the exposure features. Therefore, either
the aperture priority or manual exposure settings
are preferable.

_Accessories for intra-oral photography
Cheek retractors and intra-oral photography
mirrors are essential tools for dental photography
(Table I). Using these tools allows us as clinicians to

_Use the crop tool to remove cheek retractors;
_When using presentation software, use a black or white background for your images;
_Don’t use too many transitions, as this can be distracting to the audience;
_Definitely don’t use any sound effects.
Table II

Recommended digital SLR cameras and their settings for intra-oral photography
Camera
Flash
Power setting
Aperture value
Shutter speed

Nikon DSLR
Nikon R1C1 flash
TTL
F22
1/160

Canon DSLR
Sigma ring flash or Canon ring flash
eTTL
F25
1/125

Nikon DSLR
Sigma ring flash
1/4
F25
1/160
Table III

CAD/CAM
3_ 2012

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I special _ digital photography
able to use the image to create a restoration with the correct shade and
characterisation. I also use the images
taken pre- and post-operatively of any
restorative and implant work and
supply the images to the dental technician, as rarely do technicians see
their own handy work in situ.

Fig. 20a

Fig. 20b

Fig. 20a–c_Tablet computers
can be used as an education
device for patients.

Fig. 20c

When taking images of isolated teeth, one way of
improving the image is by using a black background
(contrastor). The black background improves the
image quality and highlights the translucent regions
of the teeth (Figs. 12 & 13).

I also use another open-source
program (GIMP) to manipulate the images, that is to crop out any unwanted
distractions, such as the retractors
(Figs. 18 & 19; Table III). Using this software, it is possible to reorientate the image if not level with the horizontal plane using the rotation tool. The image is simply saved and imported into the presentation program.

_Conclusion
_Radiographs
Taking images of plain film radiographs can be
difficult. The film is placed on an X-ray viewer box and
the image is then taken. In most cases, there will be a
greyish green cast to the image. This is due to the fluorescent light in the X-ray viewer that produces flicker
at the mains frequency. Essentially, when the image is
taken, the fluorescent light may be flickering on or off,
thereby affecting the colour of the image (Fig. 14a).
There are many complicated ways of overcoming
the colour cast, but we have found two methods that
appear to achieve the desired results more easily.
The image can be manipulated to produce a black
and white image (Fig. 14b) using bought software such
as Adobe Photoshop (www.adobe.com) or using opensource software such as GIMP (www.gimp.org). The
second technique—and the easiest—is to set the digital
camera to capture images in black and white (Fig. 15).

_Presentation software
For presentations, I use OpenOffice. It is virtually the
same as Microsoft Office; the only difference is that
you can save the documents in any format available,
such as those used by Microsoft Word and Google
Docs. OpenOffice offers a program called Impress
that is equivalent to PowerPoint. I like to use a black or
a white background for my slides, as this makes the
images more prominent on the slides (Fig. 16; Table II).
These presentations are used both for patients
as an education tool and for lecturing purposes. I also
find it useful to take a photograph of the nearest shade
tabs to the adjacent tooth so that all information available can be sent to the laboratory technician (Fig. 17).
The image is sent as either a JPEG or an OpenOffice
Impress file to the laboratory. The technician will be

10 I CAD/CAM
3_ 2012

According to Moore’s law, the number of transistors in integrated circuits has doubled every year
since the invention of the integrated circuit. Moore
predicted that this trend would continue. It is thus
evident that by the time this article goes to print, camera technology will have made further advancements,
but the principles of capturing an image will remain
the same. Observing the simple rules to ensure standardised images will allow all members of the dental
team to obtain good quality images. An important
consequence of digital dental photography is the
ability to check and improve the images.
Interestingly, whilst writing this article, the World
Mobile Congress was held in Barcelona in February 2011.
Many tablet computers were showcased at this event
(Fig. 20a–c). The use of these newer tablets in everyday
practice is an important patient education tool. One’s
images can be archived on the tablet and imported into
presentation software, making it more patient friendly.
The tablet can then be used by the dental team to educate patients. It is important to be aware that dental
photography is an essential part of dentistry used not
only to document, but also to illustrate and educate._
Editorial note: A complete list of references is available
from the publisher.

_about the author

CAD/CAM

Dr Amit Patel
Specialist in Periodontics &
Implant Dentist, Associate
Specialist Birmingham Dental
Hospital, Honorary Clinical
Lecturer University of
Birmingham School of Dentistry

[11] => CAD0312_01_Title

... we make Occlusion visible ®

The correct physiological recovery of the occlusion poses a major challenge for every dentist and technician.
Even the smallest high spot, measuring just a few microns, can cause dysfunction in patient’s masticatory system.
,n restorative dentistry, occlusal proportions are constantly changing. ,t is therefore essential, for the bene¿t of
the patient to understand and monitor the function of teeth in static and dynamic occlusion. Functional occlusion
is important for the overall health of the patient. The interdisciplinary veri¿cation of symptoms and treatment
is an integral part of daily practice. Therefore, checking the occlusion
with the correct material during treatment is highly recommended. For
1st ASIA - PACIFIC EDITION
further information you are welcome to visit our website and our latest
7th CAD/CAM & Computerized
Dentistry
App „Dentalnavigator“ which is available for iPhone and iPad.

See us at:

International Conference
06 - 07 October 2012, Marina Bay
Sands Hotel
SINGAPORE

www.dentalnavigator.net
3D Dental Simulator

Dr.Jean Bausch GmbH & Co.KG
Oskar-Schindler-Str.4
xäÇÎÇÊÊUÊiÀ>Þ
Phone: +49(0)221 709360
Fax:
+49(0)221 7093666

email:

info@bauschdental.de

www.bausch.net

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I feature _ interview

“Lecture theatre”
—a new interactive concept—
on chairside CAD/CAM dentistry
An interview with Dr Michael Dieter, Ivoclar Vivadent, Liechtenstein

Dr Michael Dieter

_To be held for the first time in South-East Asia,
the seventh CAD/CAM & Computerized Dentistry International Conference in Singapore in October will
offer a detailed overview of the latest CAD/CAM technologies that are aimed at helping dentists achieve
aesthetic and long-lasting all-ceramic restorations
chairside. During a presentation in Cape Town, South
Africa, CAD/CAM had the opportunity to speak
with Ivoclar Vivadent’s Dr Michael Dieter, head of the
International Center for Dental Education, who will
be hosting the lecture theatre together with Jörg Vogt,
international CEREC trainer for Sirona.

demonstrate the main differences in terms of aesthetics, particularly for use in the anterior dentition,
and the physical properties or strength of the various
all-ceramic systems.

_CAD/CAM: Dr Dieter, your joint presentation
with Mr Vogt in Singapore will be held in form of a
lecture theatre. What is behind this concept?
Dr Michael Dieter: Jörg Vogt and I developed this
concept two years ago. When the organiser’s managing director, Dr Dobrina Mollova, saw our performance
at the sixth CAD/CAM & Computerized Dentistry International Conference in Dubai last year, she named
it a “lecture theatre” because of its truly interactive
nature. Jörg and I present in continuous dialogue with
each other, which makes the lecture more interesting,
not only for the audience but also for us. Additionally,
case demonstrations with the CEREC AC will be performed live on stage.

If we look at the increasing number of all-ceramic
systems on the market that manufacturers claim to
be aesthetic, we can in fact perceive significant differences. The questions remain: what does “aesthetic”
mean, and how suitable are these materials in clinical
reality? This is exactly what we will be discussing in our
lecture: translucency, opalescence and fluorescence
—these optical properties of the natural tooth can be
reproduced in the patient’s mouth with select modern
all-ceramic materials.

Primarily, our lecture is aimed at dentists who
are interested in minimally invasive aesthetic treatment solutions or who simply want to get into dental
CAD/CAM technology. Our goal is to provide a predictable guideline for the clinical treatment sequence
using chairside CAD/CAM technology. However, the
lecture is also suitable for any dentist who is interested in all-ceramics as a modern restorative treatment
option.
From my experience, I can say that many practitioners still have little knowledge of what all-ceramic
material they are supposed to use for various clinical situations. With our lecture theatre, we aim to

12 I CAD/CAM
3_ 2012

_What do you think the reason is for this lack of
knowledge?
Recently, we have seen the rapid development
of materials and technologies. For the practitioner, it
is sometimes difficult to keep up with all these new
developments. This is why continuous education is
becoming more and more important.

While I will focus on the treatment sequence from
a clinical perspective, Mr Vogt will provide insights
into the CAD/CAM process using the CEREC AC and
the latest software (version 4.03). He will demonstrate
live, step-by-step, how to design the restorations and
I will illustrate the related clinical cases.
_What are the most common mistakes when
choosing materials?
Selecting the right material is not the only difficulty. The correct tooth-preparation technique remains
a challenge for many dentists because all-ceramics
require an entirely different preparation design compared with the commonly used metal alloys or metal
ceramics. If mistakes are made at the beginning, fracture of the restoration becomes much more likely.
Therefore, preparation techniques for all-ceramics with
regard to CAD/CAM application will be in focus as well.

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feature _ interview

_What impact has CAD/CAM technology had
on the usage of aesthetic restorations in the dental
practice?
With CEREC, CAD/CAM technology has been
available for chairside application for more than
27 years. So this is a well-documented procedure with
long-term clinical success. Today, there are approximately 34,000 CEREC units in use, which demonstrates impressively that this technology is still driving
aesthetic dentistry in the clinical practice. The main
indications are inlays, onlays, partial crowns, full
crowns and veneers. In addition, up to four-unit posterior bridges are now possible, either as a temporary
solution with polymer blocks (e.g. Telio CAD, Ivoclar
Vivadent) or as a permanent restoration with a highstrength zirconium dioxide/lithium disilicate material
(e.g. IPS e.max CAD-on, Ivoclar Vivadent).
_What are the aesthetic limitations of chairside
CAD/CAM?
Generally, posterior restorations like inlays, onlays
and crowns can be realised with good aesthetic results. With anterior restorations like crowns and veneers, the aesthetic outcome largely depends on the
adjacent teeth that we have to match intra-orally.
Highly aesthetic colour gradients for CEREC restorations can be achieved with polychromatic blocks (e.g.
IPS Empress CAD Multi, Ivoclar Vivadent) or by shading
and staining monochromatic lithium disilicate blocks
(e.g. IPS e.max CAD, Ivoclar Vivadent).

which makes life easier for both the dentist and the
patient.
_What are the critical factors for achieving successful long-term clinical outcomes?
In addition to the factors described above, cementation, particularly for glass-based ceramic restorations, is a clinical step of paramount importance for
long-term clinical success, since it is directly linked to
the aesthetic outcome and the fracture strength of the
final restoration. Which ceramics have to be bonded?
Which ceramics can be cemented conventionally?
How does one prevent post-operative sensitivity after
cementation? All these questions will be answered in
detail during the lecture.
_Many speak of CAD/CAM technologies as the
next revolution in dentistry. Do you agree?
I would say that the revolution will continue. I am
still fascinated by the materials and the manufacturing process. All-ceramic restorations are not only
aesthetically pleasing but also minimally invasive.
Therefore, patients benefit not only from better looking teeth, but also from the fact that much less natural tooth substance has to be removed compared with
traditional restorative techniques and materials.

“...cementation is a very
important factor and still
All this can be carried out by the dentist chairside.
underestimated by many dentists.”
If the adjacent teeth show visible internal structures
like mamelons, dentists need the support of dental
lab technicians to optimise aesthetics—this represents
the aesthetic limitation of chairside CAD/CAM.
_Have restorations become more complex with
chairside CAD/CAM?
On the one hand, yes, the procedure has become
somewhat more complex because the dentist is also
responsible for the design, milling and surface finishing of the restoration. On the other hand, impressions and temporaries are no longer necessary,

The next few years will show what CAD/CAM manufacturers have kept in reserve, both chairside and
labside. Materials manufacturers like Ivoclar Vivadent
will continue to develop highly aesthetic and userfriendly all-ceramic systems that aim to further reduce the minimum material thickness—requiring even
less invasive tooth preparations—to the benefit of the
patient.
_Thank you very much for this interview.

CAD/CAM
3_ 2012

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I research _ SFI-Bar

The implant-retained bar
overdenture: The SFI-Bar
Author_Dr Tussavir Tambra, United Kingdom
This is mainly because a fixed bridge is provided and
treatment times are reduced from months to hours,
avoiding a conventional denture.

Fig. 1
Fig. 2a

Most edentulous patients can tolerate a complete
maxillary denture with few problems. The vast majority of problems arise in the mandible, where the
underlying supporting tissues are not designed to
function under this type of occlusal loading. Even
a properly constructed complete lower denture can
move as much as 10 mm in function. This continuous
movement of the prosthesis results in loss of the
supporting bone (or remodelling), further destabilising the denture. Poor ridge form increases denture instability and this produces more remodelling.
Edentulism fulfils the WHO definition of a physical
impairment.

_Treatment protocol
Fig. 2c

Fig. 2b

_Introduction

Fig. 3

14 I CAD/CAM
3_ 2012

The advent of CAD/CAM technology and the more
widespread utilisation of implants in modern dentistry have led to an explosion of treatment solutions
designed to address any situation encountered by
the general dentist. As patients have become more
aware of the benefits of implant therapy, they have begun to demand more immediate restoration of their
teeth. The provision of a fixed prosthesis has always
been the goal in dentistry; however, the cost of such
treatment is pricing the vast
majority of patients
out of the
implant
market. Immediate loading, avoiding
conventional grafting techniques by placing implants at various
angulations (All-on-4, Nobel Biocare;
Columbus Bridge, BIOMET 3i ), has resulted
in a significant uptake of treatment by edentulous patients and those with a failing dentition.

A simple treatment protocol was devised to treat
this problem. According to this protocol, two dental
implants are placed in the inter-foraminal area of the
mandible, to which either a bar or stud attachments
are connected to retain the lower denture. This treatment greatly improves both masticatory efficiency
and function in patients. Over the last two decades,
attempts have been made to render the implantretained overdenture the standard treatment for
edentulism,1 as demonstrated most recently by the
McGill consensus.2
Prosthetic failure, usually loss of retention, and
the technical difficulties encountered when relining
or changing stud attachments proved to be major
negative factors in dentists’ attitudes towards this
treatment modality. Several attempts were made to
redesign and improve the attachments; however,
owing to previous negative experiences, most dentists became reluctant to adopt implant-retained
overdentures as a routine treatment option. The push
to place more implants in an attempt to improve
the situation led to the bar- and clip-retained overdenture scenario. This technique was more successful but still encountered similar issues to the studattachment overdentures.3

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research _ SFI-Bar

Fig. 4b

Fig. 5

Fig. 4a

Poor stress transmission from the prosthesis to
the supporting implants results in bone loss around
the implants (especially the most distal implants in
the multiple bar scenario), in addition to prosthetic
and surgical complications.4 This resulted in implant
companies and clinicians moving away from the
two implant-retained overdenture treatment option
in favour of fixed solutions, such as round-house
bridges fixed on four or more implants. As a result,
the vast majority of patients cannot access implant
therapy owing to financial constraints. The McGill
consensus brought the implant-retained overdenture back into the spotlight as a way of increasing
access to implant dentistry and improving patients’
quality of life. Improved component manufacturing
techniques, and greater care and attention to both
surgical and restorative treatment planning have
significantly improved treatment outcomes using
overdentures.5

system, in which add-on kits (Fig. 3) can be used to incorporate multiple implants to create a round-house
bar. Implant adapter abutments are first torqued
onto the implants (Figs. 4a & b). They form one half of
a universal ball joint—the other half being incorporated into the bar element. The bar itself is formed by
a hollow tube bar that fits onto the end of each ball
joint (Fig. 5). This tube bar is cut to the correct length
using a specialised jig and cutting disc (Figs. 6a–c).
The jig is designed to mimic a ball joint connection,
ensuring a perfect section each time. The jig slides
along the tube bar until it reaches the implant
adapter, accurately sizing the bar. The tube bar is then
locked in place and cut to size with a cutting disc
(Fig. 6c). This process can be carried out either chair side
(two-implant bar) or in the laboratory (four-implant
bar or larger). An implant-level master cast will be

Recently Cendres+Métaux introduced the Stress
Free Implant Bar, or SFI-Bar, to the dental community.
This unique, implant-platform-independent restorative bar overdenture solution allows the fabrication
of a true passive-fit bar and clip system on two or
more implants (Fig. 1). Finite element studies and
clinical evaluation of the system have found minimal
stress transmission from the prosthesis to the implants under loading (Figs. 2a–c), with most stresses
being evenly distributed between the supporting implants. Vertical loads are transmitted effectively to
the supporting implants, while undesirable lateral
stresses are largely eliminated. More recent clinical
studies have also shown it to be a viable immediateloading treatment solution. The technique is in its
infancy, so long-term (five years or more) data is not
available. The SFI-Bar is a modular system that connects multiple dental implants with no soldered or
laser-welded joints.
The minimum inter-implant distance is 8 mm and
the maximum is 26 mm. This is an expandable bar

Fig. 6a

Fig. 6b

Fig. 6c

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3_ 2012

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Fig. 7a

Fig. 7b

Fig. 7c

Fig. 7d

required for cutting in the laboratory. The cutting of
the tube bar must always be carried out extra-orally.
Once the tube bar has been cut, the ball joints are
inserted into each end of the tube bar prior to seating
on the implant adapters (Figs. 7a–d) and torqued into
place. The SFI-Bar is now complete and the patient is
ready for the retentive element to be housed in the
denture. The ball joints can accommodate non-parallel implant placement up to a maximum of 15°
angulation correction. The absence of any soldered or
welded joints means that a greater length of the bar
can be engaged by the retentive clip. In conventional
techniques, the presence of a weld increases the bar
thickness, at that point preventing any retentive clip
engaging that area. In the SFI-Bar, the clip engages
the full length of the bar between the ball joints
(Fig. 8). The bar assembly must be parallel with the
occlusal plane; therefore, a selection of implant adapters of varying lengths should be available.
Most of the major implant companies offer CAD/
CAM-fabricated bar and clip solutions. However,

these bars are relatively expensive and are fabricated through
a conventional impression and
master cast technique. Studies
have shown that 50 per cent
of all errors during impression
making and cast fabrication
result in non-passive fit of bars
and frameworks. Thus, any bar
fabricated through an impression or cast technique cannot
be truly passive.6–8 A clinical
case will be presented below
in order to demonstrate the
direct chair-side method and
the use of the SFI-Bar on two
implants to restore an edentulous mandible. In addition, the
main points for use with the indirect method will be outlined.

_Case presentation
In 2006, a 60-year-old female patient initially
presented, complaining of an ill-fitting lower denture. The patient had worn a conventional complete
mandibular denture for over 20 years, opposing a
metal-based maxillary removable partial denture.
The patient had visited a denturist on several occasions to try to improve the situation. After multiple
relining procedures, the patient decided to seek expert help. An OPG radiograph revealed a severely
resorbed mandible that clinically presented as a classic bowl-shaped deficiency (Figs. 9a–c). Radiographic
examination revealed there was adequate bone
volume in the anterior region for the placement of
dental implants. However, a fixed solution would
only have provided a shortened dental arch, as the
mental foramen had become more mesial owing to
bone resorption. Placing implants distal to the mental foramen was not an option, owing to the proximity of the inferior dental nerve and lack of bone height.
The patient was not keen to have any nerve repositioning or complex bone grafting. Another important
factor negating the fixed solution was the size of the
volume defect. This would have been difficult both
to correct and to maintain and would have produced
a poor aesthetic result. The additional bulk of denture
flanges allowed proper facial support.
After discussing all the relevant issues, the patient
decided that the removable overdenture retained
with two implants was the best and least complicated
treatment option for her. The upper denture was not
an issue for the patient, as it was retentive and stable.
In order to limit costs, the upper denture was not
replaced. A surgical guide was fabricated after the
vertical dimension, aesthetic and phonetic parame-

Fig. 8

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research _ SFI-Bar

ters had been corrected in
the wax denture try-in. Two
4.1 mm RN connection dental
implants (Straumann), each
8 mm in length, were placed
in sites #32 and #42 (Figs. 7a
& 9b). These were allowed to
integrate for three months
prior to the provision of a ballabutment-retained overdenture. This denture functioned
without surgical or prosthetic
issues for a five-year period.
Unfortunately, the patient
revisited her denturist and
complications arose after an
attempted intra-oral relining
procedure. On examination, it
was determined that the ball
abutments were damaged and
needed to be replaced. The female housings needed to be replaced, as they were
no longer seated properly on the ball abutments.
The patient was then given the option of having
either another ball-abutment-retained overdenture
or a bar- and clip-retained overdenture instead. The
patient opted for the bar and clip overdenture. The
first step was to remove the damaged ball abutments
and seat the appropriate implant adapters on each
implant (H1 adapters of 1 mm in length; Figs. 4a & b).
The tube bar was then inserted into the cutting
tool and cut to correct length using the cutting disc
(Figs. 6a–c). The bar assembly was then connected
to the implant adapters and torqued into place. The
universal nature of the ball joint allows the tube bar
to be located in the horizontal plane in a truly stressfree alignment (Figs. 2a–c & 7b–c).
The implant adapters were chosen so that when
the bar is seated it is parallel to the occlusal plane,
with at least 1.0 mm clearance between the underside of the bar and the mucosal tissues (Fig. 7b). This
allows access for effective oral hygiene procedures
around the dental implants and reduces the risk of
tissue hyperplasia around the bar when the denture
is seated. From a surgical perspective, ridge reduction procedures may be required firstly
to aid ideal implant placement
and secondly to ensure there
is enough space to fabricate
the final denture to be seated
on the bar assembly. If multiple
implants are used, adapters
with a range of lengths should
be used. Multiple implants are
more difficult to place parallel

Fig. 9a

Fig. 9b

Fig. 9c

Fig. 10

to each other, but the ball joints can accommodate up
to 15° of implant divergence. Surgical complications
are seen more commonly in bar and clip overdentures
than stud-attachment overdentures. Clinically, the
whole procedure took six minutes, from removing the
ball abutments to torquing the bar assembly into
place.

The ball-abutmentretained denture was then hollowed out so that
it could be seated over the bar assembly and used
as a provisional while the new definitive denture
was being fabricated. A custom tray was used to make
a border-moulded final impression with Impregum
(3M ESPE), after blocking out the bar assembly (Fig. 10).
A wax occlusal rim was then used to determine the
vertical dimension of the occlusion and obtain a
CR record. This was followed by a full wax try-in to
ensure that all the aesthetic, phonetic and occlusal
parameters were correct. At this point, the denture

Fig. 11a

Fig. 11b

Fig. 12

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3_ 2012

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I research _ SFI-Bar

Fig. 13a

Fig. 13b

Fig. 13c

Fig. 13d

was ready to be processed. The denture is processed
in one of two ways:
_In the laboratory technique, the female part T
(made from pure Grade 4 titanium) is integrated
into the denture and a complete prosthesis is returned to the clinic. Part T is contra-indicated for
use on two implant bars (Figs. 11a & b).
_In the chairside technique, the denture is
processed and a window is cut in the denture,
through which the dentist can pick up the female
part E (made from Elitor—68.6 per cent gold alloy),
using self-curing acrylic resin in the patient’s
mouth after seating the spacer and blocking out all
undercuts (Fig. 10).
The total width of the bar with the E clip seated
is 4.3 mm (Fig. 12) and 3.6 mm with the T clip seated
(Fig. 11a). This is relevant for treatment planning, as
ridge reduction may be indicated to provide space
for the denture.
In the laboratory method, the denture is completed with the female part T integrated into the
denture. The dentist then chooses the level of retention required by selecting the appropriate plastic inserts and seating them in part T (Fig. 11b). The plastic inserts are designed to compensate for transfer
inaccuracies during the impression, master cast
fabrication and post-processing stages. The presence of a laboratory technician is recommended for
the chairside technique. A spacer is placed on the
tube bar prior to seating the E clip to ensure vertical
resilience. The spacer ensures a slight gap between
the E clip and the tube bar so that when the patient
bites down, the E clip does not overload or distort the
bar as the denture beds into the supporting mucosa.

18 I CAD/CAM
3_ 2012

All undercuts around the bar
assembly, especially between
the bar clip and tissues, were
blocked out with a silicone
material (Fig. 10). A window
was then cut into the lingual aspect of the denture to
expose the E clip (Fig. 13a).
A small bead of cold-cure
acrylic resin was then placed
on the E clip, covering the retentive element of the clip. The
E clip was then attached to the
denture with small increments
of resin (Fig. 13b). The resin
was allowed to cure fully before the denture with the E clip
was removed from the mouth.
The remainder of the void was
then filled with cold-cure resin
and allowed to cure outside
the mouth (Figs. 13c & d). Ideally, this process should
take place in a pressure pot.
A transfer jig that fits into the E clip and is effectively a tube bar replica can be utilised if a large
volume of acrylic has been used to house the E clip.
The denture with the transfer jig seated in the E clip
is bedded into a patty of fast-set plaster, similar to
a denture-repair scenario. Once the stone has set,
the denture is placed in a pressure pot with warm
water and the self-curing resin is allowed to polymerise. Once the acrylic has fully cured, it is separated from the stone base and the transfer jig and
all excess acrylic is trimmed.
At least 50 per cent of the lamellae of the E clip
must be clear of resin. Only the superior part of the
E clip with the attachment portion and shoulder
section is locked into acrylic (Fig. 13c). The lamellae
must be free to flex over the tube bar during insertion and removal of the denture. If the resin is in
direct contact with the lamellae, the denture may
not seat, as the E clip cannot flex. Finally, the definitive prosthesis was seated (Figs. 14a & b).
The level of retention of the E clip was adjusted
using the activation and deactivation tools provided
in the restorative kit. The occlusion was checked and
adjusted after verifying that the denture had been
properly seated, using pressure-indicating paste.
The bar assembly is required to retain the denture in
the two-implant scenario. Support is derived from
the conventional hard- and soft-tissue load, bearing areas like the residual ridge and the buccal shelf.
The patient was then instructed on appropriate care
of the implants and the prosthesis, and a routine
recall and maintenance programme was instituted.

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research _ SFI-Bar

_Discussion
It is imperative that the
block-out procedure around
the bar assembly is correct.
Otherwise acrylic will enter an
undercut area and cure, thus
locking the denture to the bar
assembly. As a consequence,
there would be no option but to
cut the denture from the bar to
free it. This will not only ruin the
denture, but may also damage the bar—a very costly
and time-consuming mistake. The E clip is designed for
use with the two-implant bar and should be picked
up with a self-curing resin as explained. The T clip is
for a laboratory-processed denture on four or more
implants, as the plastic inserts correct any processing
errors. It must not be used in a two-implant situation.
Several studies have shown that conventional
bar- and clip-retained overdentures transfer significant stress to the supporting peri-implant tissues
(mainly bone).9–11 The key to the SFI-Bar system is that
the bar is assembled in the patient’s mouth without
the use of soldering, laser welding or conventional
bonding techniques, thus reducing stress transmission to and bone loss around the implants. Studies
have demonstrated that any laboratory-based technique that requires a master cast made from a dental
impression will result in a bar that is not truly passive.8, 9 As a result, several authors have suggested
that the only way to achieve a passive fit would be
to assemble the framework intra-orally and then
bond the bridge pontic in place.12, 13 This is the method
employed with this system.

Fig. 14a

Fig. 14b

time and component costs result in reduced treatment
costs for the patient. In the case presented, for example, the bar assembly was completed in only six minutes. This is approximately the same time it takes for a
polyether impression material (like Impregum) to set!

_Conclusion
The SFI-Bar is relatively inexpensive compared
with conventional gold castings and CAD/CAM options. The overall cost of the prosthesis and treatment
time are significantly reduced compared with conventional and CAD/CAM techniques. Precision-milled
components provide an improved quality of fit. The
physical and mechanical properties of the component
materials can be controlled accurately, which is difficult to achieve with conventional casting methods.
The SFI-Bar can be connected to two or more implants
to create a full-arch bar if needed, while the SFI-Bar
system produces a bar assembly that seats passively
as demonstrated by finite element analysis. The passive-fit bar assembly can result in greatly reduced
stress transmission to the supporting implants.
Studies have demonstrated that this is also a viable
treatment option for immediate-loading situations
in the mandible, provided that the implants achieved
insertion torques exceeding 50 Ncm approximately._

There is no casting, soldering, laser welding or
bonding of components when fabricating the definitive bar. This, combined with the universal balljoint nature of the components, ensures a true passive fit when the bar is assembled. The finite element
analysis clearly shows the stress-free nature of the
bar when being assembled and when the prosthesis
experiences loading (Figs. 2a–c).

The finite element data and images were kindly provided
by Dr Ludger Keilig, Endowed Chair of Oral Technologies,
University of Bonn, Germany.

No laboratory time is required to fabricate the
bar and there are no costly implant components or
gold-alloy charges. Clinically, there is no need for the
bar sections to be soldered in an attempt to achieve
passive fit—a step that may need repeating—as with
the conventional method.

_contact

There are no soldered or laser-welded joints, so the
bar assembly has no inherent weak points that may
fracture or corrode. The bar is assembled by the clinician, who also attaches the E clip intra-orally. The
reduced number of clinical appointments, laboratory

Disclaimer: The SFI-Bar, implant adapters and E clips were
provided by Cendres+Métaux. The author did not receive
any financial inducements to write this article or payment
towards laboratory charges, nor was any other kind of
payment given or received.

CAD/CAM

Dr Tussavir Tambra
BDS, DDS, MS Prosthodontics (Michigan)
Wolverhampton
United Kingdom
dr.tambra@hotmail.co.uk

CAD/CAM
3_ 2012

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I case report _ restoration of edentulous maxilla

CAD/CAM-based
restoration of an
edentulous maxilla
Author_Dr Arnd Lohmann, Germany

Fig. 1

Fig. 2

Fig. 1_Orthopantomogram post
insertion of the XiVE TG implant.
Fig. 2_The FRIADENT MP abutments
transfer the working level from
the edge of the bone to
a supragingival level.

Fig. 3_Functional impression with
FRIADENT MP impression abutments.
Figs. 4 a–d _Screenshots of the
virtual bar construction with
various overlays.

Fig. 3

_Introduction
There is probably no other treatment method
that turns our patients’ quality of life for the better
so critically and predictably as the restoration of the
edentulous jaw using implant-supported dental replacements (Alfadda et al., 2009). An implant-based,
telescopic bridge should be viewed as the treatment
of choice for the rehabilitation of an edentulous
mandible (Abd El-Dayem et al., 2009). This is the
conclusion drawn from the results of an investigation
by Eitner and his colleagues in 2008, especially in
anatomically difficult situations, in which an implant-supported superstructure guarantees an ade-

Fig. 4a

20 I CAD/CAM
3_ 2012

quate prosthetic rehabilitation. Visser et al. showed
in 2009 that the implant-supported restoration of
the edentulous maxilla also represents a proven and
effective treatment method with predictable success.

_Connection elements
Various anchoring elements such as bars, double
crowns and a variety of prefabricated connection
elements for the replacement of teeth have been
discussed in the past (Alfadda et al., 2009; Eitner et al.,
2008). A bar connection and telescopic crowns are favored for the edentulous maxilla, since, in contrast to
flexible connections, these can prevent the denture

Fig. 4b

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case report _ restoration of edentulous maxilla

Fig. 4c

from tilting. Which of these two connection types
is to be preferred, however, seems unclear. Implants
supporting telescopic crowns exhibit a reduced sulcus fluid rate, which is interpreted as a sign of a slight
inflammation of the periimplant tissues. This, however, as Eitner and his colleagues showed, does not
lead to a reduced rate of implant loss in comparison
with implant-supported bars, even over a longer period. Bar-retained, implant-supported superstructures, on the other hand, are significantly less prone
to repair, with the result that, according to the working party under Eitner, no alternative restoration can
be identified as to be preferred. In each case, following extensive treatment, the patient treated expects—
for him, from a financial and, above all, an emotional
point of view—a substantially uncomplicated, mechanically “maintenance-free” rehabilitation. In this
respect, restoration using a bar-retained, removable
superstructure resembling a bridge is, for us, the first
choice. As a matter of principle, we include two interlocking mechanisms to improve the wearing comfort. This prevents a reduction in the retention of
the removable unit caused by abrasion. Furthermore,
the interlocking gives the patient the important feeling of confidence, since unwanted loosening of the
restoration is precluded.

_Materials
Individually milled bars are usually cast in a
chrome-cobalt or gold alloy. A recent option is the
central CAD/CAM fabrication of virtually designed

Fig. 6

Fig. 4d

bar constructions in accordance to a model scan.
This fabrication variant has numerous advantages:
on the one hand, the tension-free fit of the bar on
the implants is not affected by the shrinkage of the
metal caused by cooling. On the other hand, it is possible to manufacture the bar from titanium, which
may result in a reduction in gingival inflammation
(Abd El-Dayem et al., 2009), since there is a better
attachment of the tissues here. The team under Abd
El-Dayem further concludes that both advantages
together, the absolutely tension-free fit of the bar
and the material itself, could lead to even less periimplant bone resorption, which further improves
the long-term prognosis.

Fig. 5

Fig. 5_Working model with bars,
bar slides, tertiary structure
and inserted slides.

_Case presentation
A 73-year-old woman, a non-smoker with an
unremarkable medical history, was given six implants with two milled bars as anchoring elements.
Five XiVE S plus implants were inserted during a simultaneous sinus floor elevation and were allowed
to heal submerged over six months. When the implant was uncovered, a vestibular graft was performed with an apical transposition flap. Due to the
less favorable bone volume in region 16, an additional XiVE TG plus implant was inserted subsequently for the purposes of the procedure and was
immediately loaded (Fig. 1). The impression for the
fabrication of the CAD/CAM bars was made four
weeks later on the MP abutments inserted during
this consultation (Figs. 2 and 3).

Fig. 6_Titanium bars in situ.
Fig. 7_The metal base was
cemented intraorally.
Fig. 8_The finished tertiary
structure with open slides.

Fig. 7

Fig. 8

CAD/CAM
3_ 2012

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I case report _ restoration of edentulous maxilla
_Conclusion

Fig. 9

Fig. 10

Fig. 11

Fig. 9_Frontal view of the
finished superstructure.
Fig. 10_The incorporated restoration
in the patient’s mouth; excellent
translucence of the selected dentition
(Genios, DENTSPLY DeTrey).
Fig. 11_OPG for the follow-up;
stable conditions almost two years
after incorporation of
the prosthetic restoration.

The advantage of the Friadent MP abutments is
the transfer of the working level from the implant
shoulder—that is, the crestal edge of the bone—to
a supracrestal plane. Hence, the apposition of the
marginal tissues on the abutment components is
not affected by try-ins and other treatment steps.
Furthermore, a simple visual check of the bar seating can be made. Figure 2 shows the patient’s condition prior to impression making, with inserted
Friadent MP abutments. The model fabricated using
the MP analogs and a XiVE TG implant analog was
sent to the DENTSPLY Scan Center with the temporary construction.
The option of displaying and masking various
structures, such as the soft tissues, the dental
arrangement, the implants and the bar construction, allows a simplified check of the construction
proposal (Figs. 4a to 4d). This is adjusted to the
practitioner’s preferences as required. Galvanic
bar latches are manufactured on the titanium
CAD/CAM-fabricated bars, embedded in the openings for the slide axles. The tertiary structure is cast
from a chrome-cobalt alloy. In order to guarantee a
tension-free fit for the supported metal base, this
was cemented to the bar latches in the patient’s
mouth. The Genios dentition (DENTSPLY DeTrey)
was transferred to the manufactured framework
(Figs. 5 to 8).
The final restoration was adjusted to the patient’s mouth and inserted (Figs. 9 and 10). The
dentition showed excellent translucency. On followups 27 months after the implant insertion and
21 months after the incorporation, the tissue conditions were stable (Fig. 11). The crestal bone level was
still located on the implant shoulder. No resorption
was observed.

22 I CAD/CAM
3_ 2012

Because of its good primary stability, even in
marginal situations, the XiVE implant system is applicable in an augmentation of the maxillary sinus
with simultaneous implant placement. Where there
is little remaining bone volume, the prerequisite for
this is a classic, submerged healing phase without
pressure. The option of relocating the connection
level to an epigingival level following uncovering
reduces the risk of a deterioration of the bone in the
region of the implant shoulder due to manipulation. CAD/CAM fabrication of the bar constructions
markedly improves the fit of these constructions,
which a practitioner who has used this new technique
will immediately recognize. Together with the use of
titanium as the component material, the tension
reduction represents a further advance in the reproducible retention of marginal bone. Furthermore, the
bar construction with latches restores the desired
level of security and hence vitality to the patient.
Editorial note: A complete list of references is available
from the author.

_about the author

CAD/CAM

Dr Arnd Lohmann
got his Licensure in Hamburg,
Germany, in 2002 and worked
as assistant doctor in Oral and
Maxillofacial Surgery from
2002 to 2003. In 2003 he
completed his dissertation.
He has focused on Oral
Implantology since 2003 and completed his
Master of Science in Oral Implantology in 2007.
He is a member of the German Society of
Oral Implantology (Deutsche Gesellschaft fuer
Orale Implantologie, DGOI), the German Association
of Dental Implantology (Deutsche Gesellschaft
fuer Zahnaertzliche Implantologie, DGZI) and
the German Association of Oral Implantology
(Deutsche Gesellschaft fuer Implantologie, DGI).
He works in a partnership and medical practice
with Dr Rainer Lohmann in Bremen, Germany.
Dr Arnd Lohmann, MSc
Ostpreußische Str. 9
28211 Bremen
Germany
Tel.: +49 421 443868
mail@zahnarztpraxis-dr-lohmann.de
www.zahnarzt-dr-lohmann.de

[23] => CAD0312_01_Title

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[24] => CAD0312_01_Title

CAD0312_24-26_Wainwright 19.09.12 12:51 Seite 1

I user report _ alveolar ridge reconstruction

3-D alveolar ridge
reconstruction in a case
with severe bone loss
Author_Prof Marcel Arthur Wainwright, Germany

question the necessarity of iliac hip grafts for
intraoral bone augmentation.

_Materials and methods

Fig. 1

Fig. 2

Fig. 1_Presurgical aspect revealing
massive Periodontitis and bone
resorption in region 32, 42, 44.
Fig. 2_The CB-Scan exposing
region 32—with partial loss of the
buccal and lingual wall region 32–44.

_Introduction
A high clinical evidence of grafting procedures
from extraoral autologeous donor sites like i.e.
from the iliac crest in difficult bone loss sites
is still the practice in oral or oral-maxillofacial
surgery. However, the invasive surgery combined
with a prevalence of patients morbidity and suffer
is an issue to discuss the persisting legitimation
of this procedure. Since the appearance of reliable bone substitute materials with or without
any autologeous bone added, the positive results
concerning longterm stability of regenerated bone
even in difficult cases have become very predictable.
This article will point out in a case report the reliability of alternative and less invasive techniques
for 3-D bone reconstruction in the mandible and

24 I CAD/CAM
3_ 2012

A female patient aged 48 years old with a severe
and advanced periodontitis in the maxilla and the
mandible came into our clinic with the desire of a
complex treatment plan with an implant retained
denture in both jaws. This case report will pinpoint
the treatment of the mandible. A CBVT was revealing massive bone loss in height and width in the
mandible arch from canine to canine and apical
cyst at tooth 23, 26 and 28 (Figs.1 & 2). According
to our protocol we started with an initial scaling
and HELBO®-Laser decontamination prior to the
surgery to decrease the number of pathologic
germs and post op infections. Tooth 18 and 19 in
the left mandible were intended to maintain until
the finalization of the prosthetics to give some
comfort during temporization with an immediate
denture that was placed post op. Preoperative
the patient received 1,200 mg of Clindamycin. The
patient desired the surgery of tooth removal and
ridge augmentation persued under general sedation.
After nasal intubation and local anesthesia the
bridge in the lower was removed and the remaining teeth despite from 18 and 19 as mentioned
before (Figs. 3 & 4). After full flap preparation with
crestal incision, releasing incisions and exposure
of the mental nerve exit, the volume of the severe
bone loss was revealed as well as the minor soft tissue conditions due to inflammatory tissue proliferation (Figs. 5 & 6). The success of 3-D bone augmentation is bonded to primary wound closure
and tensionless flap adaptation. Thus, the periosteum is dissected with a scissor from the epiperiostal connective tissue before augmentation
procedures to reduce bleeding and guarantee a

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user report _ alveolar ridge reconstruction

Fig. 3

Fig. 4

Fig. 5

Fig. 6

flap flexibility without compromising soft tissue
and nutritive blood vessels.

augmentation material volume an allograft block
(Puros®, Zimmer Dental) was particulated and
added to the mixture. Before placing the material
a non resorbable titanium-reinforced membrane
(Cytoplast Ti-250, Sybron Implant Solutions) was
adapted lingually and folded to shape the augmentation complex according to the new and
desired crest volume (Fig. 8).

For bone augmentation a bone block was harvested via ultrasonic surgery from the retromolar region distal from 32 of the right mandible
(Piezotome II, Acteon France).
This bone block was devided into two halfs.
One was used for two “bone shields” to create a
mold for the grafting material, one was particulated with a bone mill and mixed with defect blood
and a ␤-TCP (Nanobone®, Artoss GmbH, Rostock,
Germany). The bone blocks were fixed with two
osteosynthesis screws (Fig. 7) and the mixture of
autologenous bone plus ␤-TCP in mixing ratio
50 : 50 was used to fill the gaps and increase
the rigde width and height. To increase the bone

Fig. 3_ Site before bridge
removal and extraction.
Fig. 4_Surgical Site after
bridge removal and extraction
of teeth 33, 32, 42, 43, 44.
Fig. 5_After Cystektomy the
dramatic severe horizontal
and vertical bone loss is visible.
Fig. 6_Frontal aspect of the
compromised bone situation.

Upon the non resorbable membranes three
xenogenous resorbable membranes (Tutodent®,
Zimmer Dental) were placed according to the
sandwich membrane layer technique to create a
better adaptivity to the flaps (Fig. 9) and enhance
wound healing. Primary wound closure (Fig. 10)
was achieved with a 4-0 metric suture (Gore-Tex®,
Gore). The patient carried a clamb retained provisional denture that was rebased with a soft

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 7_Fixation of the autologous
bone blocks which have been
harvested ultrasonically
from the retromolar region
of the right mandible.
Fig. 8_3-D crest reconstruction
with the “mold-technique”
with clearly visible horizontal
and vertical augmentation.
Fixation of a titanium reinforced
ePTFE- membrane with pins.
Fig. 9_Resorbable collagenous
membranes are placed upon
the non resorbable membranes.
Fig. 10_Wound closure with
4-0 metric GoreTex sutures
after flap mobilasation.

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3_ 2012

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I user report _ alveolar ridge reconstruction

Fig. 11a

Fig. 11b

Fig. 11a_Membrane exposure of the
non resorbable ePTFE membrane
after 4 weeks. Clearly visible is
the enhanced soft tissue situation.
Fig. 11b_6 months post surgical
the fully reconstructed bone
situation is obvious.

material and was instructed to have no solid food
for 10 days. Postoperative the patient continued with 1,800 mg Clindamycin, Ibuprofen 600 mg
and a decongestant enzyme based medicine
(Bromelain-Pos®, Ursapharm, Germany). The next
day the patient had an expected cheek swelling
but was not suffering from pain, after 10 days the

Fig. 13

The well vascularized bone was used to insert
4 dental implants (4 x 3.75 x 13 BEGO Semados®,
BEGO, Germany) for a later bar-retained denture,
the healing time is estimated with 8 weeks (Fig. 13)
and was not completed before publication, here
my apologies to that.

_Discussion
3-D bone augmentation in cases with severe
bone loss can be accomplished also with a less
invasive surgical protocol than the iliac hip graft.
The morbidity can be dramatically reduced with the
use of ultrasonic devices. Regarding the donor site,
which may be favorized with the retromolar region
patients have close to zero complains if a single
incision procedure is performed. Allograft materials may enlarge the volume of the augmentation
material and in addition to that the success of
␤-TCP is not to be questioned.

Fig. 12a

Fig. 12a_CBS of the pre-op region 44
with entire loss of the buccal plate
in region tooth 44.
Fig. 12b_Region tooth 44 after
6 months of healing with fully
reconstructed bone prior
to implant surgery.
Fig. 13_Inserted implants in the
fully reconstructed bone.

Fig. 12b

sutures were removed. However, 6 weeks later a
membrane exposure of the non resorbable membrane was evident, but due to the fact that this is
tollerable when the patient is instructed to maintain oral hygiene and re-called once a week, the success of the outcome was not threatened (Fig. 11a).
The titanium pins and the titanium reinforced
membranes were removed after 4 months.
Eight months after augmentation the 2-D aspect
of the CBVT showed clear evidence for entire ridge
reconstruction of the deficient sites (Fig. 11b) with
osteosynthesis screws in position. To emphasize
the efficiency and predictability of this technique
the pre-op scan of region 28 (Fig. 12a) and the reconstructed bone 8 months later (Fig. 12b) show
clear an increasement of bone height and width.

26 I CAD/CAM
3_ 2012

Regarding the long term stability the regenerated bone is superior to pure autologous bone from
the iliac crest, which resorption rate is much higher
compared to intraoral bone or ␤-TCP. Reduced
pain and postoperative complains should be reduced and enlarges the number of patients willing
to undergo oral augmentative procedures. _

_contact
Prof Marcel A. Wainwright
DDS, PhD
Dentalspecialists
Kaiserswerther Markt 25–27
40474 Duesseldorf, Germany
Weinrecht@aol.com
www.dentalspecialists.de
Universidad de Sevilla
Facultád de Odontologia
Calle Avicena s/n
41009 Sevilla

CAD/CAM

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I industry report _ single-tooth implants

Single-tooth implants in
the aesthetic zone—
Challenge and opportunity
Author_ Dr Ata Anil, Turkey

Fig. 1_Initial clinical situation
with fractured tooth 21.
Fig. 2_Corresponding X-ray with
conservable root remains.

Fig. 3_After atraumatic extraction
the alveolar cavity is closed
with a free gingival graft.
Fig. 4_The ovate pontic pre-forms
the soft tissue.

Fig. 3

Fig. 2

Fig. 1

_Single-tooth implants in the anterior region permit not only functional reconstruction at
the highest level, but also reconstruction for
aesthetic reasons. However, when providing cosmetically attractive treatment, a large number of
parameters need to be taken into account, and
experience and knowledge of physiological processes are essential. The following article will describe the implant-supported reconstruction of
an anterior tooth lost as the result of an accident.

Fig. 4

28 I CAD/CAM
3_ 2012

After extraction of the fractured root, we performed a reconstruction of the soft tissue to act
as a basis for a harmonious reconstruction of
red–white aesthetics. This was performed at the
same time as implant placement via bone augmentation and connective tissue transplant. The
surgical measures applied allowed optimisation
of the hard and soft tissue and, using a gingiva
former, the shape of the gingiva could be adapted
to the neighbouring teeth. Delivery of a ceramic

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industry report _ single-tooth implants

Fig. 5

crown completed the attractive final cosmetic
result.
In the case of completely or partially toothless
arches, implant-aided and -supported rehabilitation is a successful method of treatment in which
single-tooth implants are largely used to restore
function and aesthetics. Anatomically correct
positioning of the implant can, however, only be
realised, if the necessary bone level and soft tissue profile are considered in the planning and
treatment. Tooth shape and colour are equally
important for providing an aesthetically harmonious appearance. The anterior region of the maxilla is not referred to as the aesthetic zone without reason. After all, it is the most striking region
of the stomatognathic system and affects facial
appearance.
This is why special rules apply to implantsupported single-tooth restoration in this region
with regard to the choice of abutment: titanium
abutments may show through translucent ceramics, lead to dark colour effects or have a negative impact on the optical effect of the papillae.
In the course of time, the edge of the abutment
may even become visible owing to changes in
gingival profile. A number of established surgical

procedures can be employed to improve conditions for a natural appearance of the restoration,
but the healing of the soft tissue plays a major role
in ensuring long-term success of these measures.
Ideally, primary wound healing remains the objective. Any loss of bone after tooth loss is to
be compensated for with suitable augmentation
techniques.

Fig. 6

Fig. 5_Determining the ideal position
for the implant with an Iglhaut locator
and surgical suture materials.
Fig. 6_After insertion of the XiVE S
plus implant, a 1 to 2 mm wide gap
remains.

_Case report
A 50-year-old female patient with a non-contributory medical history presented to our dental
practice with complaints about tooth 21, which
had been fractured in a traffic accident (Fig. 1).
The X-ray showed no apical lucency in the area of
the destroyed tooth (Fig. 2). Clinical examination
showed a sufficient volume of attached gingiva
and that the frenulum was in a physiological
position. However, the vestibular soft tissue was
ruptured in the area of the fractured tooth. It
seemed as if the bone underneath the rupture
had also been involved.
Although most of the mesial and distal papillae were in their correct position and still connected to the root cement of the neighbouring
teeth, the distal papillae had receded by approxi-

Fig. 7_An absorbable membrane and
a connective tissue graft are placed
over the implant and the filled defect.
Fig. 8_The flap is repositioned
and sutured.

Fig. 7

Fig. 8

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I industry report _ single-tooth implants
Fig. 9_The X-ray after six months
demonstrates good bone
regeneration.
Fig. 10_The clinical situation after
removing interim treatment.

Fig. 9

Fig. 10

mately 1 to 1.5 mm. As the length of the remaining root was insufficient for a combined endodontic–prosthetic restoration and the crown
margin was to be positioned sub-gingivally to
provide an optimal aesthetic result, we decided
to extract the remaining part of the root and to
replace it with a XiVE S plus implant (DENTSPLY
Friadent).
The periodontal fibres in the root area were
loosened with a scalpel. The periodontal gap
was extended with a periotome and the subcrestal fibres separated. This was the most
atraumatic course of tooth extraction. Then,
the extraction alveolar was carefully debrided
to remove any remaining granulation tissue
completely. To avoid damaging the labial bone
lamella, no force was exerted in bucco-palatal
direction during root extraction. The soft tissue
remained undamaged by avoiding a vertical
incision.
Using palatal mucosa as a free gingival graft,
we ensured primary healing in the region of the
extraction alveolar. This was previously measured
with a periodontal probe, the corresponding
trimmed graft placed over the alveolar cavity and
stabilised with sutures (Fig. 3). To support the

Fig. 11_Uncovery of the
implant with a scalpel.
Fig. 12_The TempBase Abutment
is reinserted and fitted with a
TempBase Cap as temporary
treatment.

30 I CAD/CAM
3_ 2012

Fig. 11

mesial and distal papillae and to condition the
tissue, a temporary crown was constructed from
composite material and fixed to the neighbouring
teeth as an ovate pontic (Fig. 4). Implant placement was carried out six weeks later. Immediate
implant placement after tooth extraction is usual,
but in this case controlled bone regeneration was
also required, which made implant placement
directly after extraction of the remaining root
part inadvisable.
A para-crestal incision some 2 to 3 mm palatal
to the alveolar ridge was carried out under local
anaesthetic, and a mucoperiosteal flap was prepared using a periosteal elevator. The flap reached
buccally to the muco-gingival junction. This way,
the alveolar ridge could be exposed. The bone
was cleared of connective tissue. The implant
position was determined using a locator. In order
to avoid perforation of the labial bone safely,
the implant was not to be inserted directly into
the alveolar socket but shifted slightly in a palatal
direction.
To permit insertion of the implant within
the aesthetic window, we determined the ideal
bucco-palatal alignment using surgical suture
materials fixed to the neighbouring teeth (Fig. 5).

Fig. 12

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industry report _ single-tooth implants

Fig. 13_The temporary crown,
fabricated chairside and modified
on the basis of the TempBase Cap,
is pressed into position on the
surrounding soft tissues.
Fig. 14_Fitting of the laboratorycustomised CERCON abutment.

Fig. 13

This allows for adequate dimensioning of the
crown on the one hand, and provides sufficient
labial tissue volume on the other.
The implant site was prepared for a XiVE S plus
(3.8 mm in diameter, 15 mm in lenght) implant.
By involving the palatal cortical bone and bonespecific preparation afforded by XiVE and the
condensing thread of the implant, we achieved
a torque of 50 Ncm during insertion. After placing
the XiVE implant in its final position, an approximately 2 mm wide gap remained to the Lamina
vestibularis (Fig. 6). We mixed the drill cuttings
collected with a bone trap, which is standard procedure, with a xenogeneic bone grafting material
and filled the defect.
As a means of protection, we covered it with
a correspondingly trimmed absorbable membrane. This was covered with a gingival graft
from the palatal mucosa, and the flap was repositioned and sutured (absorbable sutures 4.0;
Figs. 7 & 8). As during the first intervention,
Amoxicillin (Augmentin 1,000 mg) was given as
antibiotic cover and chlorhexidine mouthwash
solution and naproxen sodium (Apranax 275 mg)
to be taken as required. Healing progressed without problems.

Fig. 14

Six months later and following successful osseointegration, uncovery was done using a scalpel (Figs. 9–11). The TempBase (DENTSPLY Friadent),
which was used as placement head and replaced
with a cover screw after insertion, was re-inserted
and temporarily restored with an appropriate
chairside-modified TempBase Cap (Fig. 12). The
transition between the plastic cap and the previously prepared temporary crown was filled with
composite material.
During placement of the temporary crown,
pressure was exerted on the underlying soft
tissue and the papillae until the region became
ischemic (Fig. 13). This condition needs to be
reversible, and it is essential to check that the
tissue regains its red colouring after a few minutes. In our experience, this method achieves
proliferation of the papillae coronally. After
four weeks, the temporary crown was removed
and replaced with a transfer coping and the
impression was made using a type I polyvinylsiloxane.
The resulting ceramic crown manufactured
in the laboratory was bonded to the matching
CERCON abutment (DENTSPLY Friadent) using
a light-cure adhesive after try-in (Fig. 14). After

Fig. 15

Fig. 16

Fig. 15_Final ceramic crown
in situ adapts harmoniously
to the overall picture.
Fig. 16_X-ray follow-up after three
years demonstrates largely stable
bone conditions.

CAD/CAM
3_ 2012

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I industry report _ single-tooth implants
three years, conditions remained stable with a
pleasing aesthetic appearance (Figs. 15 & 16).

_Discussion
Implants for single-tooth replacement are an
important and established treatment concept.
For this case, an implant was placed soon after
extraction of the traumatised tooth because this
appeared to be the most appropriate protocol,
also with regard to the good condition of the remaining teeth. A number of investigations have
found ridge atrophy during the first year of tooth
loss. As a rule, atrophy commences after the third
week and the Crista alveolaris decreases by 30 to
50 % within a year.
To protect the bone against increasing degeneration through physiological load, the implant
should ideally be placed directly after tooth extraction (immediate implant placement) or after
four to six weeks at the latest (delayed immediate
implant placement), once soft tissue healing is
complete. If the gingiva and bone are not involved, the implant can be placed immediately.
In cases in which the tooth has been lost for
endodontic reasons (owing to periodontal disease or following trauma with bone and gingiva
loss), augmentative procedures are usually also
required. To ensure secure healing of the membranes and soft tissue grafts used for augmentation, the surgical area should be covered
completely to allow primary healing. Ideally, the
soft tissue is given four to six weeks to regenerate
before placing the implant. Primary wound healing can be ensured by placing a free gingival graft
over the extraction wound.
To provide long-term success of the implant,
the endosseous part of the implant must be covered completely by bone. Here, the vestibular regions of the implants play a major role. After bone
reconstruction, it is also important to cover the
entire region with soft tissue. The combination of
bone reconstruction and grafting with autogenous bone, which can be collected using a bone
trap for example, has proven a highly practicable
method for augmentation. By covering with an
absorbable collagen membrane, the soft tissue is
isolated from the regenerative region. In this case,
as the vestibular soft tissue was of insufficient
volume despite the free gingival graft, a palatal
connective tissue graft was placed in addition to
the augmented region. The thickness of the soft
tissue affects the degree of recession. As a thick
gingiva is better nourished, a connective tissue
graft is often used in aesthetic regions.

32 I CAD/CAM
3_ 2012

In the case of single-tooth restorations, the
localisation of the implant is the most important
factor for achieving aesthetically pleasing reconstruction. Templates should be used for positioning. If this is not possible, the manual methods
in use for years can be employed. The length of
the papillae, measured with a periodontal probe,
bone thickness and the vestibular lamellae are
very important for long-term stable treatment. In
our case, we used the Iglhaut locator because the
implant was not placed directly into the alveolar
socket but into a more palatal-oriented position.
We know from the literature that soft tissue is
a mirror of the bone. Using a palatal connective
tissue graft, a thin gingival biotype can be converted into a thick biotype. In our case, we employed an envelope technique for transplantation
of the sufficiently dimensioned palatal-source
mucosa graft. If the soft tissue is thick enough,
it is possible to shape gingiva and papillae with
temporary crowns. In addition, if there is sufficient distance to the bone, the papillae can even
be extended. Pressure is exerted on the papillae
to profile them in the direction of the crown.
Sufficient connective tissue thickness prevents
the showing through of titanium, but a darker
discolouration is definitely avoided by using zirconium dioxide abutments.

_Summary
Additional bone and soft tissue constructions
are usually necessary to provide a long-term
appealing reconstruction with single implants in
the aesthetic zone, and localisation of the implant
must be planned accurately. The implant should
be placed as soon as possible after tooth loss.
Zirconium dioxide is a proven material for abutments._
Editorial note: This article was first published in IDENTITY
2/11. A complete list of references is available from the
author.

_contact

CAD/CAM
Dr Ata Anil
Ardent Dental Clinic
Teşvikiye Cad. 49/10
34365 Nişantaşı
Istanbul
Turkey
ataanil@ar-dent.com
www.ar-dent.com

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Anzeigen Stand DIN A4_Anzeigen Stand DIN A4 10.04.12 11:33 Seite 1

Dental Tribune for iPad –
Your weekly news selection
Our editors select the best articles and videos from around the world for you
every week. Create your personal edition in your preferred language.

ipad.dental-tribune.com

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CAD0312_34-35_Hocken 19.09.12 12:52 Seite 1

I opinion _ patient communication

The filter principle: Is every
patient a finals patient?
Author_ Simon Hocken, UK
“Your work is going to fill a large part of your life,
and the only way to be truly satisfied is to do what
you believe is great work. And the only way to do
great work is to love what you do. If you haven’t
found it yet, keep looking. Don’t settle.
As with all matters of the heart, you’ll know when
you find it. And, like any great relationship, it just
gets better and better as the years roll on. So keep
looking until you find it. Don’t settle.”
Steve Jobs, CEO of Apple Inc.
in 2005
_You remember finals, don’t you? Of course
you do. Your examiners carefully selected a patient(s) for you to examine and diagnose and for
whom to present a treatment plan. The finals patients were unlucky enough to have more than one
dental problem and you were marked on finding
all of them and your ability to determine a set of
solutions for the patient.
Afterwards, most of us headed off into practice,
where a series of finals patients are paraded in front
of us on a daily basis. Now these patients willingly pay
us to make our professional judgements, offer our best
solutions and suggest a fee for doing the dentistry.

34 I CAD/CAM
3_ 2012

However, that’s not always what happens, is it?
There’s something that happens in general dental
practice (be it public like the National Health Service
[NHS] here in the UK, mixed or private practice) that
is rarely spoken about in dental magazines, online
forums or even at the bar at dental conferences. And
it’s this: many dentists consult with, examine, diagnose and treatment plan their patients, not in the way
that they did for their finals patient, but by applying
some sort of filter—a filter of which the patients are
completely unaware. Such filters have several elements and in my 25 years of being a dentist, followed
by ten years of coaching dentists, I think I’ve probably
heard or seen them all, or at least their effects.
The filter may have some or all of these components:
1. Will the patient like me if I tell him about all of this?
2. Will the patient come back if I tell him about all
of this?
3. Will the patient think I am overprescribing?
4. (For returning patients) If I tell the patient about
all of this now, will he wonder why on earth I
haven’t mentioned it before?
5. Will the patient be willing to pay for all of this?
6. If I persuade the patient to have the big treatment
plan, what happens if it goes wrong?

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opinion _ patient communication

7. As long as I make a note on the records, I am
keeping myself within the legal rules.
The enemy within here is fear, and not the patient’s but the clinician’s. And so the filter is applied
and the patient is offered the treatment plan that
the clinician believes is absolutely necessary or the
one he feels the patient needs. Presumably, he
leaves the rest until such treatment becomes (as he
deems it) necessary or needed. An additional filter,
of course, is the one that pushes the dentist towards
offering treatments that are well paid or earn the
most number of units of dental activity.

exactly what the garage has found wrong with your
car. So what’s really going wrong when a patient
leaves a dental surgery with half a treatment plan?
In my opinion, this happens because we’ve lost
the simple, straightforward, trusting relationship
between patient and clinician that we had as a finalyear student. External circumstances such as insurance companies, the economy, the practice finances
and, probably most importantly, our lack of confidence and self-esteem have filtered our behaviour
so that we agree to compromise our professional
skill set and integrity in order to be liked, keep the
patient or stay within our comfort zone.

Let me run this analogy past you.
Imagine taking your three-year-old, £25,000 car
in for a 30,000-mile service. During the course of
this, the technician discovers that as well as the
regular service items needed, your car also has two
sets of worn brake pads. In addition, the front brake
discs are warped, the rear dampers are leaking and
two tyres are nearly at their worn-tread marks.
As a customer, which of these phone calls would
you like the garage to make?
1. The call that lists the faults, your options and the
costs for having everything put right?
2. The call that tells you about the faults they think
you will want to hear?
3. The call that tells you about the faults that you
will be able to see?
4. The call that tells you about the faults they think
you will be willing to have fixed?
5. The call that tells you about the faults that will
earn them the biggest margin?
And what will the garage do about the faults they
don’t tell you about? Perhaps, put a ‘watch’ on their
records and consider telling you at the next service?

_Duty of care
I know that some of you will be wincing already
at my comparison between a clinician and a mechanic but there’s more mileage in this analogy
still to come. After paying for just the service,
you drive off from the garage with the faults left
unreported. A child runs out in front of your car
and you fail to stop in time because of the worn
tyres/brake pads/discs/dampers. In the investigation that follows, these things come to light and
spark a witch-hunt.
A good garage owner dare not risk this and the
inevitable damage to the garage’s reputation. He
takes his duty of care seriously and must tell you

“We agree to compromise
our professional skill set
and integrity in order to be liked.”
So, how does that sound? Not so great from
where I’m sitting and let’s not tell the national newspapers. When I left the NHS in 1992, I decided to
get rid of all the filters I had acquired, and simply
show and tell my patients what I could do for them
as if they were one of my family and money and
time weren’t an issue. I’ve used exactly the same approach in my coaching practice. I was lucky enough
to be mentored by some great coaches on the idea
that you often do your best coaching just before
you get fired (for telling it like it is). And that’s what
I do for our clients.
In my view, you have to decide what sort of
dentist you want to be: either an anxious singleunit, one-tooth-at-a-time dentist, forever destined
to gross a thousand pounds a day, whilst complaining that patients don’t want your treatment; or a
dentist who communicates clearly and straightforwardly with your patients about what you can
see in their mouths and the best way to fix it, thereby giving them back their responsibility for their
health and leaving the decision about whether to
proceed with them._

_about the author

CAD/CAM

Simon Hocken is Director of
Coaching at Breathe Business,
a business-coaching
consultancy based
in Kingsbridge in the UK.
He can be contacted at
info@nowbreathe.co.uk.

CAD/CAM
3_ 2012

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CAD0312_36-39_Hebel 19.09.12 12:53 Seite 1

I practice management _ communication

Collaborating
and connecting
in the dental space
Author_ Shane Hebel, Canada

_Communication skills are an integral part
of our daily lives. How we communicate defines
who our friends are, what our families think of us,
and how our businesses are perceived by the community at large. Typically, when you think about
communicating, you think about it in relation to
your friends and family. We spend countless hours
thinking about how we speak to other people,
what effect it has on them, whether we should have
said something or not, or if other people think we’re
upset with them or frustrated based on our words
and actions.

_Oh wait!
Actions. That’s another part of communicating
that many people don’t think about. How your body
moves in rhythm with the way you’re talking can
have a major effect on what people perceive you
to be saying. Our bodies and mouths move in a
dynamic that we don’t yet really understand, but our
subconscious selves do. Have you ever gotten that
feeling that even though someone was apologising
to you, they didn’t really mean it? Or that someone

36 I CAD/CAM
3_ 2012

was really upset when they told you that everything
was fine? Why do you think that you get those
feelings? Something about the way that that person
is communicating with you—other than with their
words—is telling you that.
A second aspect of actions is your actual actions.
We’ve all heard the saying “actions speak louder
than words”. Well, it’s true. If you say one thing and
do something completely different, that’s a form of
communicating. If you’re always consistent in the
way you approach a problem, or situation, that’s
also a form of communicating. How you conduct
yourself both personally and professionally is a way
to communicate the person you are and what you
stand for. The most important part of that is that
people actually take notice.

_When bad goes good
In 1995, Tylenol had a problem. Many bottles of
its medication had been tampered with and would
prove to be dangerous or fatal if ingested. Right
away, the company recalled its entire product and

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practice management _ communication

spent a huge amount of time and money figuring
out what went wrong and in making sure that no
one became ill—all at the expense of its brand image.
The company did the right thing and stood by its values. Here’s the kicker—while it thought that posting
this recall would destroy its company image, it actually bolstered it. People found it extremely admirable that the company was more than willing to
tarnish its own reputation and spend huge amounts
of money to stand by its values. They stood by
Tylenol. Tylenol had communicated to people that it
was an ethical company and that communication
was heard loud and clear.
Some people and companies don’t care what
other people think of them. In fact, some actually
thrive on their inability to communicate and the dislike people feel for them as a result. Take Paris Hilton,
Lindsay Lohan or Kim Kardashian. These three women
are all celebrities who communicate a terrible image
and are famous for it. They succeed because people
don’t like them and are just itching to figure out
what they’re going to do next.

_How?
Let me break each of those aspects down for you
to show how increased communication skills can
help you in each of those areas.
The first major area that is going to affect how
you communicate is your internal business processes. How you communicate internally within
your office can have a huge impact on how smooth
your operations are, how happy your staff are, or
even what your monthly expenses are. All of these
things can be improved by communicating more
efficiently and effectively within your organisation.
Huge mistakes can be made in business through a
failure to communicate or a lack of understanding
among team members. Take Morgan Stanley as an
example. Recently, they made a US$2 billion blunder
that has led to increased surveillance of all US banks
by the government, an investigation into the company, a huge drop in their stock price, and the resignation of some of the top performers and managers
at the company. Why was this mistake made? Someone messed up because of a lack of communication.

_Communicating
However, a terrible image is not what most people (and especially companies) want. People naturally want other people to like them. They want to
be seen as people who stand by their values, can get
their point across, and can do so without projecting
the image of being mean, frustrated or impatient.
As something that many people strive to do, communicating effectively has been discussed extensively in our society. Countless seminars and training programmes have been conducted that deal
with communicating with people. Even more books
have been written on the subject.
So why is how we communicate so important?
Good question. Communication is important because it gives others an idea of what we think, who
we are, and what we stand for. This is extremely
important in your personal life. It’s even more important in your professional life. How others perceive you can have a huge impact on how smoothly
your office runs, how many new patients you get,
and how easy doing business with other people is.
Communicating is at the crux of how we function as
a society and your ability to function well from a
communication standpoint will have huge impacts
on your personal and professional life.
One thing that has already been mentioned is
how solid communication leads to a smoother internal business process, bringing in more patients
(or retaining returning patients), and working together more efficiently with others in the dental space.

CAD/CAM
3_ 2012

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I practice management _ communication
the office. Let me review some of the more common ones briefly.
In person

Think about how you communicate with others
within the office on a daily basis. The key is to recognise that not all communication is verbal. Reflect on
how information is processed, received, transferred,
and stored within your company. Then reflect on
whether those processes are effective and if everything is being communicated the way it should be.
With patients, think about how you and your staff
come across. Do patients generally have a good
sense of what they’re getting into when they come
to your office? Are they aware of after-care procedures and processes? Do they ever seem confused?
Ask yourself these questions and consider asking
patients how they feel about your office. If you’re
not communicating what you’d like to with your
patients, there are definitely things you could tweak
in order to be more effective on that front.
There is a well-known theory in the businessmarketing world regarding how information is
communicated in a business context. Let’s say you
have a certain concept you want to communicate
to someone. You communicate it to them. They
hear a certain concept and act upon it. Those are
the three main parts of the communication of a
message. The interesting thing is that the message
that you intended to communicate is not always
the same message that is received. How closely
these two align is determined by the medium and
mode of communication that you use. Information
can be communicated in a variety of ways within

38 I CAD/CAM
3_ 2012

Offices are fast-paced environments and, frankly, written communication is slow. One of the most
common forms of communication in the office
environment is oral communication. Speaking with
your reception staff, hygienist, or assistant is usually the fastest way to get information across.
However, there is one problem with relying on oral
communication alone: it’s notoriously unreliable.
People mumble, mishear things, tune out, don’t
write things down, and forget. Oral communication
can thus lead to misunderstandings moreso than
any other form of communication. Another concern
is that oral communication isn’t recorded. Unless
someone writes down what is said, there is no record
of it. This can play havoc in internal work relationships and can lead to an ineffective process in some
cases. Of course, there are times when oral communication works better than anything else (for
example, in the operatory), but there are a number
of cases in which oral communication should be
converted to something more permanent or at least
written down. An example would be asking your
reception staff to refer a patient to a specialist. If
the request is made orally, staff may forget, the
doctor may think that he’s made the request when
he hasn’t, and the request could fall through the
cracks of the endless stream of office paperwork.
An alternative may be to use e-mail or have a written note taken on the spot. This is just one example
of how communication in your office could be made
more efficient. It also leads us to the next type of
office communication.
Written communication
Written communication can take on many different forms. Paper notes, e-mails, faxes, various
feedback and consent forms, and even Post-it notes
are all examples of written communication that you
may see in your office space. Unlike oral communication, written communication is more permanent
and provides a record of what was communicated
throughout the office, making it a desirable communication form. The only problem with it is that it’s
slow and can easily be misinterpreted. Messy handwriting, short-forms, and absence of tone and body
language can all lead to a written note being misinterpreted. However, this happens far less often than
with oral communication because there is a paper
trail. People can ask for clarification, check things
that happened previously, and gain a better sense of
what the note is about from supporting documents,
other staff or other notes. This is the form of com-

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practice management _ communication

munication desired for most official communication. Staff records, patient records, to-do lists, etc.
are typically all in a written format because they can
then be tracked. So what do you want to keep in this
type of format? You want to write down anything
that you want to be able to refer back to at a later
date. A not-so-typical form that you may want to
consider using is writing down what occurred in
meetings with office staff. This will allow you to
look back at what was discussed, what items are
outstanding, and what you should expect at an
upcoming meeting. None of our memories is perfect and writing things down is a huge help in keeping records and helping your practice to run more
smoothly.
Body language
The third type of communication (and possibly
the most important) is what your body language/
appearance and that of your staff says. While not
explicit, what your body says can have a huge effect
on how people perceive you, what people think of
what you say, and even whether people believe what
you’re saying to them. There isn’t much to be said
about body language other than to be aware of how
you’re coming across to others and whether there
is anything that you’re doing that you could change
that would make you appear more genuine, approachable, honest, or any other quality that you
wish to demonstrate. In terms of appearance, do
you seem approachable and trustworthy? Do you
present yourself in a professional manner? Do other
people think that you come across as someone to
respect? These are all questions that you can ask
yourself that deal with your body language and how
you present yourself to other people. This matters
in all of the interactions that you make—with your
staff, clients and partners.

installed into cars before they left the sales floor.
By working together, participating car companies
got a new gadget to use to entice buyers to purchase their vehicles and Sirius Radio got access to
a brand new market that proved to be extremely
profitable.
Collaborating and communicating go hand in
hand. If you’re lacking in how you communicate
with others, your ability to collaborate with others
will also be lacking. Collaboration is all about working together with others to generate returns that
are greater than what either party could produce on
its own. There are many collaboration opportunities
for your practice. One of the most common examples is collaborating with other dentists using circular referral systems. This can result in huge returns
for your practice, simply because you were able to
collaborate with someone else. Think of other ways
you could collaborate in your industry. How can you
work with someone and mutually help each other
in a way that neither could do on their own? Most
of the biggest innovations in the world arose from
some form of collaboration, so this is definitely
something that you want to think about.

_Conclusion
Always be aware of how you’re communicating
with other people and always be looking for opportunities to collaborate. Simply being aware can
do wonders, as you can change things that aren’t
working, enhance things that are, and generally
make your practice more efficient both internally
and in the image that is presented to the outside
world. Decide what you want to communicate as
your brand and start doing it!_

_about the author

CAD/CAM

_Collaborating
Now that you’re aware of the different types of
methods of communicating, there is one more area
in which they can be applied that can result in huge
changes in your business: collaboration with others.
When most people think of collaborating and working together, they think internally. Most will think
about working together with their family or with
their office staff. Very few think about how they can
collaborate with others outside of their immediate
circle. Yet, this type of collaboration can have a huge
impact on your business. Throughout business history, companies have collaborated in order to come
up with big ideas and profitable ventures. Think
about Sirius Radio; that’s a company that knows
collaboration. It only really took off after collaborating with car companies and having the system

Shane Hebel is currently a
student studying Finance and
Accounting at the Schulich
School of Business. He is a
sales and marketing executive
for My Dental Hub. He is
involved in a number of
organisations that promote
collaboration, connectivity and education, including
Impact Entrepreneurship Group, Standard
International and, of course, My Dental Buddies.
shane@mydentalhub.com
www.about.me/shane.hebel
www.linkedin.com/in/shanehebel
www.twitter.com/shane_hebel

CAD/CAM
3_ 2012

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CAD0312_40_Japan 19.09.12 12:54 Seite 1

I news _ CAD/CAM

CAD/CAM systems market
in Japan to gain momentum

CAD/CAM systems like this
NobelProcera optical scanner from
the Swiss manufacturer
Nobel Biocare will see extensive
growth in countries like Japan.
(DTI/Photo courtesy of
Nobel Biocare, Switzerland)

_Manufacturers of dental CAD/CAM systems
will have to look towards the Far East, as growth
in this industry segment in countries like Japan is
expected to outpace traditional markets in Europe
and North America, a new report by the Millennium
Research Group suggests.
According to the paper released by the Canadian
market intelligence provider on Thursday, CAD/CAM
markets in Europe will not show improvement
before 2014, while Japan will see dramatic growth
owing to under-penetration in dental offices and
increasing interest by dentists in investing in the
technology.
In addition, decreased reimbursement for conventional metal restorations by national health insurance will increase the competiveness of new materials for manufacturing prosthetics, the report states.

40 I CAD/CAM
3_ 2012

Despite its recent economic troubles, Japan is
currently the largest market for dental CAD/CAM
and prosthetics in the Asia Pacific region after Australia and South Korea. Since the country has to import much of its CAD/CAM technology from abroad,
the field is largely dominated by European and US
manufacturers, such as Sirona Dental Systems, Nobel Biocare or 3M Espe. A few domestic companies
have launched their own systems in recent years,
such as Kuraray Noritake Dental’s KATANA system,
which is now distributed worldwide.
Millennium Research Group predicts that the
global market for dental CAD/CAM will exceed
US$540 million by 2016, to constitute over one
tenth of the overall market for dental equipment.
With over 60 per cent, chairside systems like intraoral scanners will most likely have the largest share
in this segment, the company said._

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CAD0312_41_Bausch 19.09.12 12:55 Seite 1

industry news _ Bausch

Bausch PROGRESS 100 and
Arti-Fol 12μ metallic shimstock
_Bausch PROGRESS 100 is a smooth
fibre-reinforced paper with high colouring capacity that adapts perfectly to
occlusal surfaces. The occlusal contact
points or centric contacts are marked
very precisely because of the paper’s
progressive colour transfer.
This 100 µ paper is impregnated with
hydrophilic waxes, pharmaceutical oils
and the Transculase bonding agent. This
unique combination enhances detection of high
spots on surfaces that are difficult to measure,
such as highly polished metals or ceramics. In
addition, its hydrophilic properties make it advantageous for use on moist occlusal surfaces—
a highly desirable attribute.

Arti-Fol 12 µ metallic is a high-tech test film
with distinctly improved features. It is made of
metallic polyester film (shimstock film) of only
12 µ in thickness. This film possesses excellent
colour transfer. High spots can easily be detected, especially on ceramic or highly polished
metal surfaces. Arti-Fol has a high tensile
strength and is ideal for checking approximal
contact points when fitting dental bridges and
crowns.
In contrast to the conventional shimstock film,
Arti-Fol marks high spots precisely. Since the back
of the film is metallic, it is obvious which side is
colour coated and which is not.

The combination of Bausch PROGRESS 100
and Arti-Fol 12 µ offers considerable advantages,
especially for measuring occlusal surfaces such
as highly polished metal surfaces or highly
glazed ceramics that are difficult to examine.
Bausch PROGRESS 100 is used first, transferring

the pigments and a thin coat of Transculase
bonding agent to the occlusal surface. Contacts
are immediately evident._

_contact

CAD/CAM

Dr Jean Bausch GmbH & Co. KG
Oskar-Schindler-Str. 4
50769 Cologne
Germany
info@bauschdental.de
www.bauschdental.com

CAD/CAM
3_ 2012

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CAD0312_42_3shape 19.09.12 12:55 Seite 1

I industry news _ 3Shape

3Shape’s Dental System offers
CAD Design of DENTSPLY
Friadent customised abutments
DENTSPLY Friadent’s abutments,” according to
Rune Fisker, Vice-President of Product Strategy at
3Shape. “Now they can design virtually and provide
highly aesthetic two-piece customised abutments,
thereby introducing better choices for dentists and
their patients.”
“Optimal clinical results and long-term stability
can be achieved best by using original components
like implant, titanium base and implant library
throughout the workflow,” recommended Frank
Beckerle, Digital Dentistry Global Brand Manager
at DENTSPLY Friadent. “To determine the correct
position of ANKYLOS and XiVE we also provide the
matching scan bodies.”

_3Shape, a global leader in 3-D scanners and
CAD/CAM software solutions announces the official release of new capabilities in its Dental System,
allowing the design of two-piece customised abutments using DENTSPLY Friadent pre-manufactured
titanium bases.
3Shape has incorporated a complete and original DENTSPLY Friadent library into its Dental
System software, supporting DENTSPLY Friadent’s
ANKYLOS and XiVE implant systems.
The new library enables dental technicians to use
3Shape’s Abutment Designer to model two-piece
abutments using a pre-manufactured titanium
base with a customised zirconia abutment top. In
order to manufacture the designed restoration,
the original titanium base must be obtained from
DENTSPLY Friadent and the customised zirconia
part can be milled locally by the lab or milling
centre.
“DENTSPLY Friadent is a leading implant manufacturer, and many labs are steadfast users of
both the 3Shape CAD/CAM Dental System and

42 I CAD/CAM
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“The DENTSPLY Friadent library gives me even
more options in solving implant cases with individual zirconia abutments on titanium bases,” stated
Björn Roland, Dental Design Schnellbächer &
Roland. “Using these libraries with the 3Shape CAD
Design software, I can achieve optimal aesthetic
results easily and quickly in a few clicks.”
The DENTSPLY Friadent library was released on
3 July 2012. Users who wish to benefit from this
opportunity should contact their 3Shape distributor for more information on how to obtain the
library. The original implant and titanium base must
be obtained from the DENTSPLY Friadent distributor, and scan bodies can be ordered from international customer service on +49 6181 595694 or at
customerservice.degudent-de@dentsply.com._

_contact
3Shape A/S
Holmens Kanal 7
1060 Copenhagen K
Denmark
www.3shape.com

CAD/CAM

[43] => CAD0312_01_Title

Dental Tribune A4 CAD_CAM Singapore Ad.pdf 6/3/2012 4:48:35 PM

1ƗƘ A S I A

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E D I T I O N

7 CAD/CAM & Computerized Dentistry
th

International Conference
06 - 07 October
October 2012,
2012, Marina
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NGAPO
ORE

T H E

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I N C OM PU T E R I ZE D D E NT I S T R Y
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E
NTheatre Presentation

C

One-visit chairside dentistry:
How to make CAD/CAM
Restorations Esthetic
and Durable in Clinical Practice

M

Y

CM

MY

Dr. Michael Dieter,
Germany

CY

Joerg Voegt,
Germany

CMY

K

Dr. Andreas Kurbad,
Germany

Dr. Simon Smyth,
UK

Dr. med. dent. Peter Gehrke,
Germany

•Computer Navigated
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•Everyday CAD/CAM Usage: Preparation,
Practicality & Possibilities, What Benefits
You and Your Practice
•Further Possibilities of CAD/CAM:
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[44] => CAD0312_01_Title

CAD0312_44_Planmeca 19.09.12 12:55 Seite 1

I industry news _ Planmeca

New Planmeca
iRomexis application
for viewing. The images can then be downloaded
to the mobile device.
Planmeca also introduces Planmeca Online, a
free secure service that allows sharing of images
between clinics that use Planmeca Romexis. For
example, a radiology centre can send images directly to its customer clinic automatically. When
using the Planmeca iRomexis over a public Internet
connection, the free Planmeca Online account ensures secure delivery of images to the user’s device.
Please visit http://online.planmeca.com for more
information.

_Planmeca introduces Planmeca iRomexis, an
advanced mobile image-viewing application for
Apple iPhone and iPad devices. This application offers comprehensive features for 2-D and 3-D image
viewing and is designed to allow users of Planmeca
X-ray units to realise the full extent of their investment. The Planmeca iRomexis application allows
users to access images from anywhere in the world
using Wi-Fi or 3G networks.
Planmeca is the first to introduce a free native
Apple iPhone and iPad application with an integrated 2-D and 3-D image viewer with true 3-D surface model rendering and the capability to access
images over 3G networks. All images acquired with
Planmeca X-ray units, including Planmeca ProMax
3D volumes and ProFace 3-D facial scans, can be
viewed, enhanced and studied.

“This new service emphasises our commitment
to R & D and best practices in dentistry. Planmeca
provides the most advanced tools—3-D imaging
units and software—for acquisition and sharing of
images and information for the benefit of patients.
This concept also opens interesting future possibilities in communication and sharing of medical
information between Planmeca’s customer clinics,
while taking into consideration HIPAA and other
patient safety requirements,” explained Helianna
Puhlin-Nurminen, Vice-President of the Digital
Imaging and Applications division at Planmeca.
The product is based on the recognised Planmeca
Romexis desktop software suite that supports both
MS Windows and Apple Mac operating systems,
and includes processing of all dental imaging modalities: intra-oral, panoramic, cephalometric, and
3-D imaging. Planmeca iRomexis is now available
for use with all new and existing installations.
Planmeca iRomexis and the Planmeca Online service are compatible with Planmeca Romexis version
2.6.R or newer._

_contact
In addition, the operating status of a clinic’s
Planmeca Sovereign and Compact i dental units
can be monitored in real time. Images from Planmeca Romexis software can easily be sent through
a Planmeca Online account to Planmeca iRomexis
device users anywhere in the world. The account
holder will be notified automatically on his or
her Apple device when new images are available

44 I CAD/CAM
3_ 2012

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

CAD/CAM

[45] => CAD0312_01_Title

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([KLELWLRQ&RQJUHVV
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MARK YOUR CALENDAR
ScienƟĮc MeeƟng:
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Exhibit Dates:
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FOR MORE INFORMATION:
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[46] => CAD0312_01_Title

CAD0312_46_Straumann 19.09.12 12:56 Seite 1

I industry news _ Straumann

IADR/Straumann Award in
Regenerative Periodontal Medicine
presented to Prof. Anton Sculean
output over the past ten years, the PRG board was
unanimous in its decision to nominate him for this
highly prestigious award,” he added.
Worth US$5,000, the IADR/Straumann Award
in Regenerative Periodontal Medicine is sponsored
by Straumann and administered by the Periodontal
Research Group. Straumann is a leading contributor to R & D in implant and regenerative dentistry
and this award is an example of the group’s commitment to fostering and recognising excellence
in dental research.

_About the International Association
for Dental Research
Based in Alexandria, Virginia, USA, the IADR is
a non-profit organisation with more than 12,000
individual members worldwide, dedicated to
Prof. Michel Dard (Head of
Preclinical Research at Straumann),
Prof. Anton Sculean (winner) and
Prof. Alpdogan Kantarci (President of
the IADR Periodontal Research Group).

46 I CAD/CAM
3_ 2012

_At the general session of the International
Association for Dental Research (IADR), held at
Iguaçu Falls in Brazil, the 2012 IADR/Straumann
Award in Regenerative Periodontal Medicine was
presented to Prof. Anton Sculean from the University of Bern, Switzerland, in recognition of his
outstanding work and achievements in periodontal medicine.

_advancing research and increasing knowledge to
improve oral health,
_supporting the oral health research community,
and
_facilitating the communication and application
of research findings for the improvement of oral
health worldwide.

The objective of the award is to recognise significant contributions to basic and/or clinical research in regenerative periodontal or peri-implant
medicine. This year’s award was presented by
Prof. Alpdogan Kantarci, President of the IADR
Periodontal Research Group, and Prof. Michel Dard,
Head of Preclinical Research at Straumann.

For more information on the IADR, see
www.iadr.org. Within the IADR, the Periodontal
Research Group is the forum for members who
are active in periodontology. Its aim is to improve periodontal health by encouraging research
activities._

“Prof. Sculean has contributed significantly
to our understanding of oral tissue regeneration
throughout his career,” noted Kantarci. “As a preclinical and clinical investigator, he has evaluated
all major approaches to periodontal regeneration.
Furthermore, he has been an outstanding educator, a respected leader and a strong advocate of
evidence-based regenerative medicine. In view of
his continued active involvement and impressive

_contact
Institut Straumann AG
Peter Merian-Weg 12
4001 Basel
Switzerland
www.straumann.com

CAD/CAM

[47] => CAD0312_01_Title

George Goumenos,
Periodontist
Faculty Session III

Prosthodontist
Faculty Session I

Master Program Schedule:

Program Fee: 11.900 EUR

Session 1: November 10 - 13, 2012 (Athens, Greece)
Session 2: March 14 - 17, 2013
(Athens, Greece)
Session 3: June 2 - 5, 2013
(Santorini, Greece)
Session 4: August 26 - 30, 2013
(UCLA, Los Angeles, USA)

1st payment EUR 4.900€, before 5th OCT ‘12
2nd payment EUR 3.000€, before 1st JAN ‘13
3rd payment EUR 3.000€, before 1st MAY ‘13

Contact in Athens:
e-mail: info.fidentalmed@gmail.com
Tel.: +30 210 22.22.637 , +30 210 21.32.084
website: www.gidedental.com,
www.omnicongresses.gr

Initial deposit payable upon registration EUR 1.000€

Main Sponsors:

“Put on your seatbelt. This program dives right in, and immerses you into the world of dental implants, grafting
and restorative excellence. No matter what your experience level is, you will gain confidence and improve your
skills.”
Dr. Jeffrey Rohde, Santa Barbara, CA, N. America_Master Clinician Program 2008-2009
“We improved our original techniques. We learned new concepts, new materials and new procedures. But, the
most important for me was the diagnosis. It means a great deal that I can now diagnose a case much better than
before. And, much better is an understatement. I feel more confident now.”
Dr. Michalis Kalaitzakis, Athens, Greece, Mediterranean_Master Clinician Program 2007-2008

¥QOLQHUHJLVWUDWLRQZZZJLGHGHQWDOFRP&RQWDFWLQIR#JLGHGHQWDOFRP

[48] => CAD0312_01_Title

CAD0312_48_Platforms 19.09.12 12:56 Seite 1

I digital platforms _ course calendar

Announce your courses
in CAD/CAM!

LIVE EDUCATION SYMPOSIUM AT GREATER NEW YORK DENTAL MEETING
25–28 November 2012

Jacob K. Javits Convention Center, New York, USA

The Dental Tribune Study Club would like to invite you to participate at our Live Education Symposium at Greater
New York Dental Meeting. Each day will feature a selection of lectures led by experts in the field, providing an invaluable
opportunity to learn from opinion leaders, while earning ADA CERP C.E. Credits. We have developed a program that is both
diverse and engaging, with every lecture offering you the practical guidance you seek to take back to the practice and
put to immediate use.
Dental Tribune America, LLC
c/o Christiane Ferret
116 West 23rd Street, Ste. 500, New York, NY 10011, USA
+1 424 744 0608
c.ferret@dtstudyclub.com

For more information and to reserve a spot for your course(s) in the upcoming issues, please contact
Vera Baptist, Product Manager CAD/CAM, at +49 152 29929405 or v.baptist@dental-tribune.com.

48 I CAD/CAM
3_ 2012

[49] => CAD0312_01_Title

CADCAM_Abo_A4_Implants_Abo_A4 19.09.12 13:29 Seite 1

CAD/CAM
digital dentistry

international magazine of



Subscribe now!

I would like to subscribe to CAD/CAM (4 issues per year) for
€44 including shipping and VAT for German customers, €46 including shipping and VAT for customers outside Germany, unless a
written cancellation is sent within 14 days of the receipt of the
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Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-302, Fax: +49 341 48474-173, E-Mail: n.dehmel@dental-tribune.com

[50] => CAD0312_01_Title

CAD0312_50-51_Klimt 19.09.12 12:57 Seite 1

I feature _ art nouveau

Art nouveau—A Viennese
Gesamtkunstwerk
Author_Annemarie Fischer, Germany

_Blossoming colours, golden ornaments, structuralist style, and sensual representation—this year
marks the 150th anniversary of the artist Gustav
Klimt. This is the time to indulge in this art nouveau
style, and the place to enjoy his oeuvre is Vienna:
Klimt’s native Vienna is celebrating the distinguished painter with the Klimt Year 2012 jubilee.
Luscious flowers merging into elegant female
figures and organic ornaments crafted into luxurious jewellery epitomise art nouveau (Jugendstil
in German and Modern in Russian) at the end of
the 18th century, fin de siècle. Its style, which has a
variety of names, constitutes a global movement,
and its spirit is as colourful as its style. Its oeuvres
still dazzle the global art scene with record-breaking prices, and even centuries after its peak period,
its style is still copied in interior design and jewellery.

Fig. 1_Secession building of the
Association of Visual Artists.
Fig. 2_Post office at the Leopold.

Fig. 1

The art nouveau concept combines the arts into
a form of “syn-arts”, truly in the spirit of breaking
and merging boundaries—merging arts and crafts
from high culture to the everyday, combining the
sensual and the crafted, connecting the organic

Fig. 2

50 I CAD/CAM
3_ 2012

earthiness to the artistically elevated, and striving
for the creation and the realisation of the synaesthetic Gesamtkunstwerk.
Gustav Klimt spent most of his life in Vienna, and
a trip to Vienna offers a synaesthetic experience:
the city not only celebrates the extraordinary, but
also appreciates the art of the ordinary—with architecture and artworks to enjoy, and cuisine in which
to indulge.
There are several museums now offering special
exhibitions, notably the Belvedere and the Albertina,
as well as the Leopold Museum in the avant-garde
MuseumsQuartier—explore the quarter’s designer
shops for unique souvenirs.
Moreover, one can trace Klimt’s influential artwork in the numerous cityscapes and in a variety of
monuments, notably in the Viennese Secession art
house—the ideal starting point for a Klimt journey.
The golden-green Secession art house still hosts the
Beethoven Frieze [Beethovenfries]—a wall painting
that is part of the “Close-up” exhibition. During the

[51] => CAD0312_01_Title

CAD0312_50-51_Klimt 19.09.12 12:57 Seite 2

feature _ art nouveau

Fig. 3

former Austro-Hungarian era, the name “Secession”
served as a synonym for “art nouveau”, and its motto is still engraved above the entrance: “To every
age its art. To art its freedom.” [Der Zeit ihre Kunst.
Der Kunst ihre Freiheit.]
Within walking distance to the Secession, the
Albertina impresses with its astonishing architecture and permanent collections. The special Albertina exhibition “The Drawings” frames the Klimt with
an exploration of his artistic methodology and mediums. Klimt created fascinating effects with various means, and the exhibition features drawings
created with pencil, chalk, or coloured pencils, and
painted with feathers, watercolours, or gold paint.
The Leopold Museum offers the most avantgarde and audience-oriented perspective display,
and sets out to understand the painter, as well as
the human being, in its exhibition “Klimt: Up Close
and Personal”. Paintings, including the vital Death
and Life, drawings and correspondences explore
both the artistic and artist’s life in an innovative
setting, offering novel and holistic perspectives.
The Leopold Museum illuminates Klimt’s artistry
with his own reflections on his working methods.
Vivid photographic images of his typical artistic
attire and the reconstruction of his studio support
the museum’s theme impetus of “up close and
personal”—whilst avoiding myths and clichés.

of human emotion. Klimt’s famous canvas is part
of the Upper Belvedere, and the Belvedere gardens
offer an ideal setting for wandering around.

Fig. 4

Fig. 3_The Upper Belvedere, Vienna.
Fig. 4_The aura of Klimt’s The Kiss
(Der Kuss, 1908) at the Belvedere.

If you would like a holistic perspective on art
nouveau for your personal library, the recently published Jugendstil [Art Nouveau] by Norbert Wolf
(2011) is a true Gesamtkunstwerk. The book is gold
framed in a larger-than-life-format, and even its
font is adapted to the art nouveau style. The author
offers a multi-perspective and global view on the art
movement. From everyday objects to haute couture
and high culture, the book offers a holistic insight
into the global movement and places a special focus
on Gustav Klimt and Viennese architecture from its
opulent beginnings to contemporary designs._
_The Secession, Association of Visual Artists, Friedrichstraße 12, open Tuesdays to Sundays, from
10:00 to 18:00, www.secession.at
_Leopold Museum, Museumsplatz 1, open daily
(except Tuesdays) from 10:00 to 18:00, Thursdays
from 10:00 to 21:00, www.leopoldmuseum.org
_“Gustav Klimt. The Drawings” exhibition, Albertina,
Albertinaplatz 1, open daily from 10:00 to 18:00,
Wednesdays from 10:00 to 21:00, www.albertina.at
_Belvedere, Prinz Eugen-Straße 27, open daily from
10:00 to 18:00, www.belvedere.at

Fig. 5_A collection of Klimt books.

The museum offers a vintage-communication
experience to the visitor: from the museum’s own
post office, one can send reproduced postcards
to loved ones at home—Klimt himself was an avid
letter writer.
Gustav Klimt’s artistry was avant-garde for his
time and his most famous oeuvre, The Kiss, advanced as an epitome of the fin de siècle ambiance
and emerged as one of the art nouveau icons. In the
image, gold is not only employed as a mere luxury
material; the usage of the material reflects the aura

Fig. 5

CAD/CAM
3_ 2012

I 51

[52] => CAD0312_01_Title

CAD0312_52-53_Europerio 19.09.12 12:58 Seite 1

I meetings _ Europerio 7

Europerio 7—Perio experts
from Europe met in Vienna
_At the beginning of June, dental professionals from all over Europe gathered at the Reed Exhibitions Congress Center in Vienna for the Europerio
7 congress. The scientific event, organised by the
Austrian Society of Periodontology on behalf of
the European Federation of Periodontology (EFP),
presented the latest research and technology in the
fields of periodontology and dental implantology
over the course of three days.

presented on stage with their respective flags during
the welcome ceremony. Among others, the delegates
were addressed by EFP General Secretary Stefan
Renvert (Sweden) and Chairman of the Europerio 7
Organising Committee Dr Gernot Wimmer (Austria),
who also paid tribute to several members of the Vienna
School and pioneers in oral biology, including Rudolf
Kronfeld and Bernhard Gottlieb, after whom the Medical University of Vienna’s dental school was named.

The congress was opened in the presence of representatives of 26 member associations of the EFP, who

“Thanks to the work of many, we have a fantastic
congress ahead of us,” Renvert said in the lead up
to the conference.
According to the organiser, Europerio 7 was
aimed at both general
practitioners and specialists. Over 100 speakers
from Europe and overseas
presented the latest insights into the management and treatment of periodontal disease, as well
as aspects of dental implant therapy, in over 60
lectures and workshops.
A large number of sessions
were dedicated to pre-existing medical conditions.
In two of the main sessions
(periodontal medicine, and
risk factors and their management), reference were
made to important associations with diabetes,
obesity and cardiovascular disease, the organiser
said.

52 I CAD/CAM
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[53] => CAD0312_01_Title

CAD0312_52-53_Europerio 19.09.12 12:59 Seite 2

meetings _ Europerio 7

The scientific programme started with presentations on periodontal plastic surgery and new
insights into the host response in periodontitis,
alongside sessions on computer-guided treatment
in dental implantology and dental hygiene. In addition, posters were presented throughout the day.
According to the organiser, over 1,300 abstracts
were submitted for Europerio 7, a 60 per cent increase compared with the last congress.
The event received support by a number of major industry players, including Straumann, Philips,
Acteon, MIS and Nobel Biocare, which sponsored
a number of seminars and corporate workshops
during Europerio 7. New products and technologies
were on display during the trade exhibition, which
was joined by over 100 companies from around the
globe.
“With its particular emphasis on research that
will address the global scientific community and
give them a forum, my expectations for this conference and its reception are especially high,”
Dr Gernot Wimmer told Dental Tribune Austrian
Edition. “From a professional viewpoint, I am eager
to see the results of the attendance at our different events, as these evaluations will be vital for the
planning of future congresses.”

This year was the seventh time that the EFP had
organised the congress in collaboration with one
of its member periodontal societies. The federation,
which is based in Madrid, was founded in 1991 in
order to facilitate research in periodontology and
dental implantology. Its main congress is held every
three years in different host cities in Europe. The last
congress in Stockholm in 2009 saw the attendance
of over 6,600 visitors from 82 countries.
The next Europerio congress will be held in 2015
in London._

All images courtesy of
AMFORT/Christian Lendl.

CAD/CAM
3_ 2012

I 53

[54] => CAD0312_01_Title

CAD0312_54-55_IDS 19.09.12 12:59 Seite 1

I meetings _ IDS 2013

Smart dentistry: Digital practice
and laboratories in focus at
International Dental Show 2013
_Digital technologies in use in the dental practice and laboratory, new CAD/CAM processes, modern software for networking and work processes
will be some of the main topics during IDS.
Its presence in the media, the expectations of
patients, and not least its record of success in the
dental practice and laboratory demonstrate that
there is now no avoiding digital technology in the
world of dentistry. Information about CAD/CAM
systems and intra-oral scanners fill whole special
editions in the dental press. Beyond treatmentrelated applications, software for accounting, purchases and documentation is also gaining in importance. Ever since dentists have been legally required
to practise systematic quality management, computer-supported solutions have been increasingly
in demand in that area as well. There is already brisk
competition in the relatively young digital marketplace. Many companies are therefore continually
increasing their efforts when it comes to development, especially in this sector. As a result, large

54 I CAD/CAM
3_ 2012

numbers of innovations, new programs and more
effective interfaces are keeping the area of digital
technology on the move. In order to keep up with the
fast pace of development, it is essential to establish
direct contact with manufacturers and their products—and that is most easily achieved at the world’s
leading and largest dental medicine and technology
trade fair, the International Dental Show (IDS) in
Cologne.
An excellent example of the strength of innovation in the dental industry is provided by the
CAD/CAM-assisted production of dental prostheses.
Among other factors, increasingly precise processes
for centralised production lead to results that fit
well and that save time and money. Modern programs can also help to make communicating with
patients easier by providing a means of demonstrating the results before treatment begins. In this
situation, these programs can help to noticeably reduce the time it takes to motivate patients and get
them involved in the planning of their prostheses.

[55] => CAD0312_01_Title

CAD0312_54-55_IDS 19.09.12 12:59 Seite 2

meetings _ IDS 2013

In order to serve the needs of patients even
better, many dentist/dental technician teams use
intra-oral scanners nowadays. Scanning replaces
traditional impression taking and speeds up the
workflow because information can be passed on
digitally. Additionally, the problem of a sensitive gag
reflex is eliminated. This reflex, which some patients
find uncomfortable, often occurs when an impression material is used.
The transition to a digital practice and laboratory
also includes areas beyond actual treatment. Modern IT systems provide for seamless networking. Useful software for ensuring data integrity, inventory
control and billing, for example, is included in complete solution packages—as are indispensable tools
for quality assurance and digital documentation.
Those interested in the many new developments
in this sector would be well advised to consult
directly and personally with the manufacturers at
IDS 2013 in Cologne. From 12 to 16 March 2013,

dentists and dental technicians will be offered the
unique opportunity to not only experience all the
latest innovations live, but also take advantage of
the expertise of the dental industry during extensive
technical discussions.
“The fact that the future will be digital was already clear at the last IDS,” according to Dr Martin
Rickert, Chairman of the Association of German
Dental Manufacturers (VDDI). “Anyone who doesn’t
want to miss out on the latest trends should talk to
specialist exhibitors, experts and experienced users
at the coming International Dental Show. There’s
no better way to become well informed about the
range of modern digital methods and the newest
high-tech developments.”
IDS takes place in Cologne every two years and
is organised by the Society for the Promotion of
the Dental Industry (Gesellschaft zur Förderung der
Dental-Industrie) and the commercial enterprise
of the VDDI, and staged by Koelnmesse, Cologne._

All images courtesy of
Koelnmesse GmbH.

CAD/CAM
3_ 2012

I 55

[56] => CAD0312_01_Title

CAD0312_56_Events 19.09.12 13:00 Seite 1

I meetings _ events

International Events
2012
XXI Congress of the European Association
for Cranio-Maxillo-Facial Surgery
11−15 September 2012
Dubrovnik, Croatia
www.eurofaces.com
AAID Annual Meeting
3–6 October 2012
Washington, USA
www.aaid-implant.org
CAD/CAM & Computerized Dentistry
International Conference
6 & 7 October 2012
Singapore
www.cappmea.com

EAO
10–13 October 2012
Copenhagen, Denmark
www.eao.org/eao-congress
SA Society of Maxillofacial Oral Surgery
11–14 October 2012
Cape Town, South Africa
www.sasmfos.org
Nobel Biocare Symposium 2012
19 & 20 October 2012
Toronto, Canada
www.nobelbiocare.com
Nobel Biocare Symposium 2012
19 & 20 October 2012
Rimini, Italy
www.nobelbiocare.com
AAMP (joint meeting with ISMR)
27–30 October 2012
Baltimore, USA
www.res-inc.com/AAMP-ISMR-Meeting/
National Osteology Symposium Brazil
8–10 November 2012
São Paulo, Brazil
www.osteology.org
Greater New York Dental Meeting
23–28 November 2012
New York, USA

2013
International Dental Show
12–16 March 2013
Cologne, Germany
www.ids-cologne.de
FDI Annual World Dental Congress
28–31 August 2013
Istanbul, Turkey
www.fdiworldental.org

56 I CAD/CAM
3_ 2012

[57] => CAD0312_01_Title

CAD0312_57_Submission 19.09.12 13:00 Seite 1

about the publisher _ submission guidelines

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

I

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

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

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

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

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

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

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

CAD/CAM
3_ 2012

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[58] => CAD0312_01_Title

CAD0312_58_Impressum 19.09.12 13:00 Seite 1

I about the publisher _ imprint

CAD/CAM
digital dentistry
international magazine of

Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com

International Media Sales
Matthias Diessner
m.diessner@dental-tribune.com

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

Europe
Vera Baptist
v.baptist@dental-tribune.com

Product Manager
Vera Baptist
v.baptist@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
Franziska Dachsel
f.dachsel@dental-tribune.com
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Marketing & Sales
Nadine Dehmel
n.dehmel@dental-tribune.com
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com

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

Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
The Americas
Jan M. Agostaro
j.agostaro@dental-tribune.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Nadine Dehmel
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185

Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany

www.dental-tribune.com

Copyright Regulations
_CAD/CAM international magazine of digital dentistry is published by Dental Tribune Asia Pacific Ltd. and will appear in 2012 with four issues. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.

58 I CAD/CAM
3_ 2012

[59] => CAD0312_01_Title

®

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3D X-ray • 3D photo • panoramic • cephalometric
Romexis® software completes 3D perfection
Scan™  ProMax®
Plan bination for op 3D  Pr
®
en C oFa
xis D com
AD ce
e
3
m e
/CA ™
Ro iqu
M
n
U

More information

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

[60] => CAD0312_01_Title

Experience precision engineering.

Join the brand that reaches
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Choose from a wide variety
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and attachments.

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Now available for Straumann®
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and Bone Level
NobelProcera Titanium Implant Bar Overdenture

It’s called NobelProcera. A complete system with the
power to give you peace of mind working with one, secure,
full-service provider. Its CAD/CAM system lets you scan,
design and send your production orders to us for qualityassured centralized manufacturing. Take comfort in having
more than just products. Find value in a solid relationship
with one partner that focuses on you with customized local

support. Choose the predictability of a premium brand and
enjoy a wide range of certified materials and products with
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Their smile, your skill, our solutions.

nobelbiocare.com/nobelprocera
© Nobel Biocare Services AG, 2012 All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of
Nobel Biocare. Straumann® is a trademark of Straumann Group. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales ofﬁce for current
product assortment and availability.

NP Bars LAB Master Straum CADCAM.indd 1

2012-07-17 13.01

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[cover] => CAD/CAM international No. 3, 2012

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Table of contents

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