CAD/CAM international No. 4, 2013
Cover
/ Editorial
/ Content
/ Projecting a new smile from a facial photograph: A new way to plan multidisciplinarydental treatments
/ CAD/CAM dentistry and the laboratory technician: Partners in success
/ Digital implant dentistry —a workflow in five steps
/ Restoring implants using lithium-disilicate - CAD/CAM fabricated restorations
/ The finesse of the pink and the power of IPS e.max
/ Diode laser application optimises the clinical outcomes of digital workflow
/ MIS Dental Implants: When virtual becomes reality with the MGUIDE MORE
/ New open CAD/CAM solutions for dentists and dental laboratories from Planmeca
/ Compact 5 axis table-top machines for milling metal - zirconium dioxide - acrylics and wax
/ Straumann presents data and innovations that may change paradigms in implant dentistry
/ Dublin conference discussed future concepts in dental implant rehabilitation
/ Meetings: 5th International CAMLOG Congress —the first CAMLOG Congress based on the new Consensus Reports
/ International Events
/ Submission guidelines|
/ Imprint
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CAD0413_01_Title
CAD0413_01_Title 13.12.13 15:25 Seite 1
issn 1616-7390
Vol. 4 • Issue 4/2013
CAD/CAM
digital dentistr y
international magazine of
4
2013
| special
Projecting a new smile
from a facial photograph
| case report
Digital implant dentistry
—a workflow in five steps
| industry report
Diode laser application optimises
the clinical outcomes of digital workflow
[2] =>
CAD0413_01_Title
GMT 32593 GB 1307 © Nobel Biocare Services AG, 2013. 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.
Product images are not necessarily to scale. 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.
Gain direct access to
unrivaled products.
Be more efficient in your work with the new
NobelProcera 2G Scanner. Ultimate precision
enables you to process even advanced cases
with confidence.
Learn more
nobelbiocare.com/2G
[3] =>
CAD0413_01_Title
CAD0413_03_Editorial 12.12.13 14:17 Seite 1
editorial _ CAD/CAM
I
Digital dentistry,
our future?
_What does the term “digital dentistry” mean for the future of dentistry today? In my opinion, digital
dentistry has become all-encompassing and without question represents the most important technology
that will drive our industry for the next 25 years. Many clinicians think of digital dentistry only as the
ability to create a virtual model of a patient’s dentition with an intra-oral scanner. While intra-oral
scanning was one very important innovation, it is not new, having been developed and utilised for more
than 25 years already!
Dr Scott D. Ganz
Perhaps other clinicians relate the term “digital dentistry” to restorations that are fabricated utilising
CAD/CAM technology rather than conventional techniques in laboratory-intensive wax-ups and casting,
whether for natural teeth or for dental implants. Certainly, this methodology has also been around for many,
many years. As machining technologies have improved, software applications have become exponentially
more powerful and equipment costs have declined. Most major dental laboratories now speak the language
of digital workflow and have invested in the proper hardware, software, and training to deliver CAD/CAM
restorations for their clinician clients.
Yet, perhaps we are just discovering what digital dentistry really means and the way in which technology
will continue to be fuelled by innovation. The advent of computed tomography, and now cone-beam
computed tomography, scan devices has allowed clinicians an unparalleled ability to visually inspect
a patient’s individual 3-D anatomy, yielding information that can be utilised for preoperative diagnosis
and treatment planning. The uses are limited only by our imagination. Patients who require orthognathic
surgery, bone grafting, dental implants, third molar extractions, orthodontic intervention or endodontic
therapy will all benefit from a more complete and accurate assessment of bone, soft tissue and adjacent
vital structures, all provided by digital information.
Can we create a synergy between all facets of digital dentistry? As an example, intra-oral optical
scanning data can now be merged with 3-D CBCT data, allowing dental implants to be planned with greater
precision through interactive treatment planning software applications. The concepts of virtual teeth,
virtual occlusion, virtual articulation and implant planning can now be directly married to CAD/CAM
of custom abutments and restorations in zirconia, titanium or other materials. The same technology
is now being applied to bone grafting through rapid prototyping manufacturing by creating either an
anatomical model or virtual model of the defect, and milling or printing the donor graft from a variety of
biocompatible materials.
Just as the smartphone revolutionised the manner in which we communicate, the digital workflow will
serve as the foundation for improved methods to treat our patients. The industry is now moving toward
a common vision, but we are only at the tip of the iceberg in our use of digital technology worldwide
currently. Publications such as this provide a valuable service by showcasing the manner in which all phases
of digital dentistry will continue to evolve and affect our industry in the next 25 years.
Keep reading these pages to witness the continued evolution!
Dr Scott D. Ganz
CAD/CAM
4_ 2013
I 03
[4] =>
CAD0413_01_Title
CAD0413_04_Content 13.12.13 15:25 Seite 1
I content _ CAD/CAM
I editorial
03
I industry news
Digital dentistry, our future?
36
| Dr Scott D. Ganz
MIS Dental Implants:
When virtual becomes reality with the MGUIDE MORE
| MIS
I special
06
38
Projecting a new smile from a facial photograph:
A new way to plan multidisciplinary dental treatments
| Drs Marco Del Corso, Italy, & Alain Méthot, Canada
12
| Planmeca
40
CAD/CAM dentistry and the laboratory technician:
Partners in success
I case report
16
Compact 5 axis table-top machines for milling metal,
zirconium dioxide, acrylics and wax
| Schütz Dental
42
| Lee Culp, USA
New open CAD/CAM solutions for dentists and
dental laboratories from Planmeca
Straumann presents data and innovations that
may change paradigms in implant dentistry
| Straumann
Digital implant dentistry—a workflow in five steps
I meetings
| Dr Tim Joda & Prof. Daniel Buser, Switzerland
22
44
Dublin conference discussed future concepts
in dental implant rehabilitation
46
5th International CAMLOG Congress
—the first CAMLOG Congress
based on the new Consensus Reports
Restoring implants using lithium-disilicate,
CAD/CAM fabricated restorations
| Dr Walter G. Renee, USA
I industry report
issn 1616-7390
Vol. 4 • Issue 3/2013
CAD/CAM
digital dentistry
international magazine of
26
The finesse of the pink and the power of IPS e.max
| Rafael Santrich & Dr Larry Grillo, USA
48
International Events
I about the publisher
4
2013
| special
Projecting a new smile
from a facial photograph
| case report
32
Digital implant dentistry
—a workflow in five steps
Diode laser application optimises the clinical outcomes
of digital workflow
49
| submission guidelines
| Drs Frank Liebaug & Ning Wu, Germany
50
| imprint
04 I CAD/CAM
4_ 2013
| industry report
Diode laser application optimises
the clinical outcomes of digital workflow
Cover image courtesy of
Planmeca (www.planmeca.com).
[5] =>
CAD0413_01_Title
Planmeca’s open CAD/CAM solutions
Your ideal combination
Scan.
• Open solutions for all digital dentistry
• High precision for prosthetic works
• Integrated workflows for dentists and dental labs
Planmeca PlanScan™
Planmeca PlanScan™ Lab
Design.
Planmeca PlanCAD™ Easy
Planmeca PlanCAD™ Premium
Manufacture.
Planmeca PlanMill™ 40
Planmeca PlanMill™ 50
PlanEasyMill™
Find more info and your local dealer
www.planmeca.com
Planmeca Oy Asentajankatu 6, 00880 Helsinki, Finland
Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com
[6] =>
CAD0413_01_Title
CAD0413_06-10_DelCorso 12.12.13 14:18 Seite 1
I special _ digital smile design
Projecting a new smile
from a facial photograph:
A new way to plan
multidisciplinarydental treatments
Authors_ Drs Marco Del Corso, Italy, & Alain Méthot, Canada
without any significant advances in technique or
case presentation.
Many options are now available to predesign
the most appropriate smile for the patient, such as
computer imaging, diagnostic wax-ups on models
or simply drawing on a patient photograph.4 For
decades, dentists have been using various forms
of software to preview, predict, and plan aesthetic
procedures. Many of these programs lapsed into
obsolescence because it took too long to develop
proper diagnostic marketing or clinical guides.
Fig. 1
Fig. 1_An example of a smile design
simulated in a few minutes
and shown to the patient using
Dental GPS software.
_Introduction
Aesthetic dentistry relies on professional trust,
traditional wax-ups and artistic modifications of
provisional restorations in the mouth to achieve the
desired final result. Many of the published articles
in aesthetic dentistry discuss the same principles in
smile design: Golden Proportion, gingival architecture, emergence profile, and shape related to facial
anatomy.1–3 These principles have been followed
In this article, we demonstrate the use of Dental
GPS software, developed and proven over the last
five years.5 The system uses the parameters captured
by one digital preoperative full-face photograph to
help clinicians with aesthetic diagnosis and automatically generates the best smile virtual wax-ups
in only minutes. The smile prescription is then sent
to the laboratory for technicians to create or transform a new aesthetic smile with precision (Fig. 1).
_From diagnosis to the smile project
Fig. 2a_Clinical case: A young
female patient previously suffering
from gastric reflux came to the clinic
with enamel erosion, gingival
recession and aesthetic demands.
Figs. 2b–d_The restoration of both
maxillary and mandibular arches
aimed at preserving tissue and
improving the aesthetic outcome.
06 I CAD/CAM
4_ 2013
The system generates the virtual wax-up and
laboratory prescription within minutes with the
digital facebow, which captures the exact position
of the dental and facial midline with the occlusal
plane to prevent canting and shifting of patient
cases. The diagnosis and treatment planning system
also uses the M Ruler, an algorithm that analyses
the best position of all maxillary teeth on a digital
image to design the smile.5 Compared with the
Golden Proportion, which offers only one ratio,
1: 618, the M Ruler determines the patient’s own
unique ratio for smile design.
Fig. 2a
The program is used for diagnosing, planning
and executing changes in the position, shape, di-
[7] =>
CAD0413_01_Title
CAD0413_06-10_DelCorso 12.12.13 14:18 Seite 2
special _ digital smile design
Fig. 2b
mension, and proportion of the teeth. The first advantage of this tool is the rapidity in sharing the
aesthetic proposal with the patient, making him
or her an active participant in the treatment plan.
The precision in transferring all the co-ordinates of
the computer-simulated 2-D proposal into a 3-D
wax-up allows the lead dentist, all associated specialists and the laboratory technician to access and
share information regarding the treatment plan,
ongoing procedural status, and the final results of
the case. Should any midstream correction be necessary, it is relatively simple to inform and receive
consent from all involved.
_Diagnosis
Diagnosis is simply achieved by importing a
facial photograph into the GPS software and the
program then establishes the best smile parameters
for the patient.
Fig. 2d
Fig. 2c
A full-face photograph of the patient is taken
directly from the front by placing the lens in line
with the patient’s nose (Fig. 2a). The facial photograph is taken with the patient’s Frankfurt horizontal plane parallel to the floor. The inter-pupillary line
is not important in this process because often one
eye is lower than the other. The long axis of the face
and the upper lip line are the reference planes for
diagnosis and treatment planning.
The digital facebow provided by the software is
adjusted by the operator to fit along the incisal
edges and the dental midline of the patient. Then,
the digital facebow is rotated to fit the long axis
of the face on the vertical axis and the upper lip on
the horizontal aspect (Fig. 3).
The photograph is automatically zoomed out to
place the M Ruler over the face. This helps the clinician to diagnose facial or maxillary asymmetries,
I
Fig. 3_The digital facebow of the
program is adjusted to fit along the
incisal edges and the dental midline
of the patient.
Fig. 4_When the digital facebow has
been set, the system automatically
zooms in on the mouth with the
M Ruler over the patient’s teeth.
Fig. 5_The M Ruler helps to diagnose
facial and dental asymmetries
to provide the most aesthetic tooth
position, shape, and smile design
for the patient’s facial frame.
Fig. 6_The M Ruler guides the
clinician in creating a virtual wax-up
for the best smile design using
specific libraries. The result
is precise because the image
is calibrated to maxillary
incisors dimensions.
Fig. 3
Fig. 4
Fig. 5
Fig. 6
CAD/CAM
4_ 2013
I 07
[8] =>
CAD0413_01_Title
CAD0413_06-10_DelCorso 12.12.13 14:18 Seite 3
I special _ digital smile design
These vertical lines guide professionals in determining the best position of the maxillary arch and teeth
in relation to the patient’s face and in relation to the
patient’s lips and gingiva for smile design.
Fig. 7_The M Ruler.
Fig. 7
malpositioned teeth, gingival architecture discrepancies, improper axial inclination, dental midline
deviation, or indications for maxillofacial surgery
and/or orthodontic treatment (Fig. 4).
Without the patient’s facial data, it is impossible
to evaluate the smile and its harmony within the
patient’s face properly. As part of the diagnosis, it
is necessary to evaluate facial and dental asymmetries. As practitioners, we need to keep global
aesthetics in mind by using a full facial view in the
laboratory (Fig. 5). Close-up photographs of the
patient’s smile aid smile design, but the complete
facial photograph is required to evaluate the smile
on the patient’s face.6
_Simulation
Fig. 8_The before and after
simulation usually shown
to the patient at the end
of the first consultation.
Figs. 9a & b_The prescription
resulting from the software
(a) gives the laboratory the
co-ordinates necessary to mount
the model on to the articulator
and to wax up the final work.
Specific guidelines help the
technician to create a very precise
wax-up of the future smile (b).
Fig. 8
Computer software creates a simulation as a
virtual wax-up. The practitioner uses the virtual
wax-up in the diagnostic process to determine the
treatment options appropriate for the patient, such
as orthodontics, crowns, implants, bridges, or full or
partial dentures. This process aids the practitioner
in presenting and discussing different options with
the patient during a consultation (Fig. 6).
The diagnosis and treatment planning use the
M Ruler. This diagnostic tool for smile design uses
an algorithm based on maxillary central incisors
width and the width of the patient’s maxillary
arch to display an ideal arrangement of all the
teeth shown in the smile (Fig. 7). Each patient has
a unique maxillary arch width and upper central
width. Maxillary teeth best position should be disposed between those lines in respect of the width of
the upper arch and the width of the central incisors.
The computer software simulation or virtual
wax-up can be generated within minutes, and helps
(or guides) the clinician in determining treatment
options, which can be discussed with the patient
during the same consultation.
In this particular clinical case, the simulation
suggested longer central incisors to create a smile
line that would follow the lower lip and lend a more
pleasing proportion to the smile. Tooth whitening
was also indicated (Fig. 8).
_Communicating with the laboratory
After the virtual diagnostic wax-up, the patient
was informed of the treatment options, including
no treatment at all, and the risks, benefits, and costs
of treatment. Informed consent was obtained for
the treatment, which entailed placing ten veneers
from the second premolar to the opposite second
premolar on the maxillary arch and ten veneers on
the mandibular arch.
Once the simulation (Fig. 8) had been accepted
by the patient, alginate impressions of the maxillary
and mandibular arches were poured with white
stone and sent to the laboratory with a bite registration6, 7 taken using LuxaBite (DMG America).
The aesthetic prescription was sent to a certified
dental laboratory, which mounted the 3-D model on
to an articulator in accordance with the GPS smile
prescription and waxed up the final work following the future smile line (Figs. 9a & b). Because of
the image’s calibration, the wax-up coordinates are
very precise (Fig. 10).
Laboratory communication is a critical factor in
the development of a diagnostic wax-up. In order
to reproduce the simulation (virtual wax-up), the
laboratory technician requires the position of soft
Fig. 9a
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Fig. 9b
Fig. 11a
tissue on the articulator. After simulating the final
outcome with respect to the rest of the face, the
GPS digital facebow will position the maxillary cast
on the articulator with the exact pitch, yaw and row
of the photograph to reproduce the virtual wax-up
on provisional and final restorations. The M ruler
guides the wax-up of the future smile. This process
is actually the easiest way to transmit the entire
aesthetic data concerning the facial soft tissue to
the laboratory.
_Project realisation
The model’s wax-up was used to fabricate a
preparation guide8 to perform minimally invasive
preparation, controlling ceramic thickness and
maintaining the structural integrity of the tooth.8, 9
A silicone impression of the wax-up was taken with
Sil-Tech Putty (Ivoclar Vivadent) and the impression
was filled with Luxatemp provisional material in
shade A2 (Luxatemp, DMG, USA) and then relined to
the prepared teeth in order to create a mock-up.
Once the wax-up had been used to create a
precise mock-up, the mock-up was scanned and
constituted the ghost guide for the CEREC system
(Sirona) to project (Figs. 11a–c) and produce chairside ten maxillary and mandibular veneers using IPS
Empress CAD blocks (Ivoclar Vivadent). The final
restorations were successively stained, glazed and
cemented with shade A3 Variolink (Ivoclar Vivadent;
Figs. 12a & b).
At the end of treatment, the smile line had been
corrected to follow the lower lip line contour, and
the final smile results were in harmony with the
patient’s face. Both maxillary central incisors were
dominant and had been designed to the specific
width and length by the GPS program to suit the
I
Fig. 10
Fig. 11c
Fig. 11b
patient’s face. The final aesthetic outcome fulfilled
the patient’s expectations, and an improved smile
and facial appearance were achieved (Figs. 13a & b).
_Discussion
By using a simple preoperative facial photograph of the patient, the dental practitioner can
diagnose, create a treatment plan, and produce
with precision a virtual wax-up and laboratory
prescription in less than 10 minutes. The software
in this case uses the M Ruler to determine the
best smile for the patient.
The Golden Proportion Rule, or Divine Rule, represents a ratio of 1:1.618. This ratio has been used in
a multitude of applications for many years, and is
well known in the arts and architecture, dating back
many centuries. Over the course of time, this Golden
Proportion Rule has been applied to facial aesthetics and dentistry to provide mathematical guidelines for the creation of pleasing and aesthetic
smiles by the determination of the appropriate
proportions of the central and lateral incisors, and
the canines in the smile. However, many authors
have observed that natural teeth do not follow the
Golden Proportion Rule for the display of teeth8, 10, 11
and this rule cannot be universally applied to all
patients. In order to achieve a good aesthetic result,
the ratio of the Golden Proportion Rule must be
changed or adapted for each patient.
Fig. 10_Once the wax-up has been
calibrated to the 2-D virtual
simulation, the realisation of the
project is very easy and will respect
the preprogrammed aesthetics.
Individualization of the final
ceramics is possible.
Figs. 11a–c_Prepared teeth and
project (a) are scanned using the
chairside CEREC Software 4.2.
The wax-up (b) is scanned and used in
“ghost” modality to guide the creation
of the definitive restorations (c).
These are milled with the
CEREC MC XL milling unit.
This modified Golden Proportion Rule is achieved
by application of a mathematical formula relating
to the inter-molar distance of each patient, representing the width of the arch and the width of the
central incisors to determine the correct balance
for the teeth displayed within that arch to create
a pleasing smile.5
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4_ 2013
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I special _ digital smile design
Fig. 12a
Fig. 12b
Fig. 13a
Fig. 13b
Figs. 12a & b_The final restorations
were realised with a CAD/CAM
technique using IPS Empress
CAD blocks milled with
the CEREC system.
Figs. 13a & b_The final smile
and facial improvement.
The smile design contributes
to the changed facial appearance.
The virtual wax-up generated by the computer
generates an electronic prescription that can be
sent to the laboratory to create an accurate wax-up
of the proposed smile. Once the position of the maxillary cast correlates to the smile prescription and
the articulator, it is possible to fabricate provisional
and final restorations that match the virtual wax-up
with the software. This guides the laboratory technician in arranging each final restoration according
to length, width and position to establish the new
smile line, occlusal plane, and vertical dimension of
occlusion (Figs. 13a & b). The ceramist simply follows
the GPS digital prescription to create the final
restorations.
This new concept allows practitioners to increase their cosmetic workflow in their practice. The
visual simulation allows the patient to understand
the treatment plan from the preoperative image
through to the final cementation of the restorations. Several aesthetic projects can be simulated
and discussed with the patient in the first consultation, whereas traditional laboratory wax-up allows
the patient to visualise only one smile design possibility, often with no idea of the final aesthetic result
with respect to the rest of the face. Traditional
mock-ups also help practitioners and patients to
evaluate the smile design; however, in many cases
10 I CAD/CAM
4_ 2013
with diastemas or malpositioned teeth, the mockup itself—derived from
the traditional wax-up—
still gives only one alternative and cannot simulate the final result accurately without reducing
teeth. In addition, it entails a great deal of work
to take an impression,
create a wax-up and try
the mock-up in the patient’s mouth for an evaluation. Even if a diagnostic wax-up is made by
the dental laboratory and
shown to the patient, or if
a provisional is made from
the wax-up and tried as
a mock-up in the patient’s
mouth, this single proposed wax-up may not
be the optimal aesthetic
solution for that particular patient.12
_Conclusion
This article demonstrates the accuracy of imaging using the digital
facebow, a 3-D cast positioning system that requires a single facial photograph of your patient,
and the M Ruler, a diagnostic device for smile design.
Practitioners are able to fit the best possible smiles
in minutes to the patient’s face by trying different
simulated smiles using morphing technology to
create predictable and pleasing smiles for their
patients. This simple protocol saves significant
time and chairside adjustments. Moreover, patients
receive better cosmetic dental treatment by seeing
their best custom smiles, and can actively participate in the smile design process._
Editorial note: A complete list of references is available
from the publisher.
_about the authors
CAD/CAM
Dr Marco Del Corso (DDS, DIU) is in private
practice in Turin in Italy. He can be contacted at
marco.delcorso@fastwebnet.it.
Dr Alain Méthot (DDS, MSc) is in private practice
in Laval in Canada. He can be contacted
at alain@drmethot.com.
[11] =>
CAD0413_01_Title
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in Aesthetic and Restorative Dentistry
13 days of intensive live training with the Masters
in Santorini (GR), Geneva (CH), Pesaro (IT)
Three on location sessions with live patient treatment,
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mentoring under the Masters’ supervision.
Learn from the Masters of Aesthetic and Restorative Dentistry:
Registration information:
13 days of live training with the Masters
in Santorini, Geneva, Pesaro + self study
Curriculum fee: € 9,900
contact us at tel.: +49-341-48474-302 / email: request@tribunecme
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C.E. CREDITS
Tribune America LLC is the ADA CERP provider. ADA CERP is a service of the American Dental Association to assist dental professionals
in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors,
nor does it imply acceptance of credit hours by boards of dentistry.
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I special _ digital age
CAD/CAM dentistry and
the laboratory technician:
Partners in success
Author_ Lee Culp, USA
gical and prosthetic techniques, allow the dental
team predictable, consistent results in implant rehabilitation. MicroDental is involved as a beta test
area for many of these emerging technologies.
As dentistry evolves into the digital world, the
successful incorporation of computerization and
new technology will continue to provide more efficient methods of communication and fabrication,
while at the same time retaining the individual creativity and artistry of the skilled dentist and dental
technician. The utilization of new technology will
be enhanced by a close cooperation and working
relationship of the dentist/technician team.
Fig. 1
Photos courtesy of Lee Culp,
CDT/CTO.
_The concept of digital dentistry is one that
started out small and has progressively increased
in momentum until its boundaries appear to have
become endless. New technologies in dentistry will
only be successful if they are combined with a complete understanding of basic comprehensive dentistry. While new technology and computerization
can make procedures more efficient, less laborintensive and more consistent, it will not replace
education, practical experience and clinical/technical judgment.
The most exciting factor surrounding these technologies is not, however, only in the potential applications of the technology that are being hypothesized by dental professionals. The excitement truly
lies in the fact that these “hypothetical” applications
are currently being developed today, and some are
even in the final stages.
In a relatively short time period, distal technology
will revolutionize the quality of dental care that is
being delivered in modern practice. Implants are
now well documented for fulfilling the functional
requirements in prosthetic tooth replacement. These
new technologies, along with the evolution of sur-
12 I CAD/CAM
4_ 2013
The evolution from hand waxing to “digital waxing” using the diagnostic wax-up and provisional
restorations, as well as their digital replicas to guide
us in the creation of CAD/CAM restorations, will be
presented. The utilization of these new technologies, along with the evolution from “hand” design
to “digital” design—with the addition of the latest
developments in intra-oral laser scanning, materials and computer milling/printing technology—will
only enhance the close cooperation and working
relationship of the dentist/dental laboratory team
(Fig. 1).
The dental laboratory’s primary role in restorative dentistry is to perfectly copy all of the functional
and aesthetic parameters that have been defined
by the dentist into a restorative solution. Throughout the entire restorative process, from the initial
patient consultation, diagnosis and treatment planning to final restoration placement, the communication routes between the dentist and the laboratory technician require a complete transfer of
information.
Functional components, occlusal parameters,
phonetics and aesthetic requirements are just some
of the essential types of information that are nec-
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special _ digital age
I
essary for the technician to complete the fabrication
of successful, functional and aesthetic restorations.
Today, as in the past, the communication tools
between the dentist and the technician are photography, written documentation and impressions of
the patient’s existing dentition. The clinical models
from these impressions are created and mounted on
an articulator that simulates the jaw movements of
the mandible (Fig. 2).
_The digital laboratory
As restorative dentistry evolves into the digital
world of image capture, computer design and the
creation of dental restorations through robotics,
the dental laboratory must evolve as well. To fully
understand this concept, a laboratory must be clearly
defined.
At first thought, it may seem that a laboratory is
the place where a dentist sends his or her patient’s
impressions to (Fig. 3) be processed into restorations,
which are sent back to the dentist for adjustment and
delivery. This definition fits well with the traditional
concept of a laboratory/dentist workflow.
However, just as the Internet has forever changed
the landscape of communication through related
computer technology, the possibility to use CAD/
CAM restoration files electronically has provided the
catalyst for a significant change in the way we view
and structure the dentist/laboratory relationship.
Imagine that the laboratory is not a physical
place, but exists only in (Fig. 4) the talents of those
performing the restorative process: the dentist and
the technician. The equipment used to create the
restoration may be located centrally, remotely or
both. The laboratory is essentially a workflow, which
is as flexible as the abilities of the dentist, the technician and the equipment will allow.
Fig. 2
as the E4D Sky network enable E4D clinical operators
to communicate and facilitate the transfer of data
to technicians whenever laboratory involvement is
required. With just a click, the entire case (whether
scanned or completely designed) can be sent from
chairside to the laboratory for fulfilment of the online
prescription (Fig. 4).
_The digital process
The new millennium has brought with it a change
in digital dentistry as more than 20 different CAD/CAM
systems have now been introduced as solutions for
restorative dentistry. The introduction of digital laboratory laser scanning technology along with its
accompanying software allowed the dental laboratory
to create a digital dental environment to accurately
present a real 3-D virtual model that automatically
takes into consideration the occlusal effect of the
opposing and adjacent dentition.
As well as the ability to design 16 individual fullcontour, anatomically correct teeth at the same
time (Fig. 5). It essentially takes a complex occulsal
scheme and its parameters and condenses the information, displays it in an intuitive format that allows
The primary decision becomes where the handoff from one partner to another should occur. The
dentist, who has the ability to optically scan teeth
for impression making and chooses CAD/CAM restorations as the best treatment option for his or
her patients, has enhanced freedom as to where the
hand-off to the technician should occur. As a result,
the laboratory is no longer a place, it is rather to
a great degree, virtual.
_Communication is key
The ability to facilitate communication between
the dentist and the lab is of utmost importance and
what makes the E4D system stand out. Tools such
Fig. 3
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I special _ digital age
Fig. 4
Fig. 5
dental professionals with basic knowledge of dental
anatomy and occlusion to make modifications to the
design, and then sends it through to the automated
milling unit.
For the dental lab profession, the introduction of
digital technology effectively automated or even eliminated some of the more mechanical and labor-intensive procedures (waxing, investing, burnout, casting,
and/or pressing) involved in the conventional fabrication of a dental restoration, allowing the dentist
and technician the ability to create functional dental
restorations with a consistent, precise method.
_Linear versus vertical manufacturing
The successful laboratory of the future will need
to focus not just on the quality of the end product,
but also more efficient production methods to reduce
turnaround time within the laboratory process. Digital
technology will allow the laboratory production to
become vertical rather than linear.
The current laboratory fabrication process follows
a very linear progression: model fabrication, day one;
waxing, day two; finishing, day three; ceramics, day
four, etc. Average production time for an all-ceramic
or porcelain-fused-to-metal restoration is approximately five to seven working days based on this
fabrication method.
In the digital laboratory, impressions will still be
received from the client. Instead of taking days or
weeks to go through several processes, we will be able
to accomplish the same process in two to three days.
Once the impression is received at the laboratory,
the impression can be scanned and data sent to
several digital production stations at the same time.
This will potentially allow the model, the restorations
(both framework and waxup) and the final ceramic
restoration to be completed at the same time (Fig. 6).
14 I CAD/CAM
4_ 2013
_Digital diagnostic
and treatment planning
The basis for all long-term success in restorative
dentistry is a comprehensive diagnosis and treatment plan. The ability to preview a case from start
to finish, communicate and co-diagnose with other
specialists and specialties about dental patients via
the virtual world is the true power and capability
of digital dentistry._
_about the author
CAD/CAM
Lee Culp, CDT, is the
chief technology officer at
DTI Technologies, where he
guides the development of
the DTI digital technologies
program and its applied
applications to restorative
dentistry. Lee is also the editor
in chief of Teamwork and associate editor of
Spectrum. He is also on the editorial boards of
Practical Procedures and Aesthetic Dentistry,
Compendium and Inside Dentistry. Culp’s
professional memberships include the American
College of Prosthodontics, American Equilibration
Society, American Academy of Cosmetic Dentistry,
Academy of CAD/CAM Dentistry and the American
Prosthodontic Society. Culp is an accredited
member of the American Academy of Cosmetic
Dentistry. He is a leading resource/inventor for
many of the materials, products and techniques
used in dentistry today and holds numerous patents
for his ideas and products. Culp writes many articles
per year, and his writing, photography and teaching
style have brought him international recognition as
one of today’s most exciting lecturers and innovative
artisans in the specialties of digital dentistry,
dental ceramics and functional aesthetics.
[15] =>
CAD0413_01_Title
P R O F E S S I O N A L
M E D I C A L
C O U T U R E
EXPERIENCE OUR ENTIRE COLLECTION ONLINE
WWW.CROIXTURE.COM
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I case report _ guided surgery
Digital implant dentistry
—a workflow in five steps
Authors_ Dr Tim Joda & Prof. Daniel Buser, Switzerland
_Interdisciplinary Planning
CoDiagnostiX ensures the planning of the implant position using Cone Beam Computed Tomography (CBCT) with DICOM data (Digital Imaging
and Communications in Medicine) and the subsequent transfer of the virtual situation into reality
with an interdisciplinary team approach including
the restorative dentist, the implant surgeon and
the dental technologist.
Fig. 1
_Introduction
Restoration-driven implant placement is a key
factor for successful implant therapy. In this
context, Computer-assisted Implant Surgery (CAIS)
offers an additional instrument for treatment
planning, surgical placement and prosthetic rehabilitation in an interdisciplinary team approach.
The continuous technological progress in both
the computer-based development and the dental manufacturing process ensures new opportunities in the clinical workflow. DWOS, in association
with Straumann, offers a powerful combination of
CAIS with the established GonyX System. In addition, a fully digital pathway in a model-free approach or a combination of these workflows is now
possible.
This case presentation displays insights into the
current processes of CAIS with an outlook on future
improvements in the digital implant workflow.
Fig. 2a
Fig. 2b
16 I CAD/CAM
4_ 2013
The conventional workflow includes the fabrication of a dental set-up, a radiographic template
and the secondary adaptation to a surgical template. Here, the fully digital process represents a
further development: computer-assisted planning
of the implant position by means of a virtually constructed prosthetic set-up and on-screen designing
of an implant-guided template. The number of operational steps is shortened significantly compared
to the conventional workflow.
Moreover, costly and time-intensive preparations can be avoided for the patient in advance of
the CBCT. In addition, existing 3-D radiographic
images should already be used, if possible.
The clinical case presentation demonstrates
step-by-step the fully digital implant workflow with
CAIS, including intraoral surface scanning and
prosthetic rehabilitation in a five-step approach
(Fig. 1).
Fig. 2c
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case report _ guided surgery
Fig. 3
Fig. 4a
Step 1
3-D radiographic diagnostics are performed
without any template. An intraoral surface scan
(iTero™) supplements the imaging sequence. The
scan allows the generation of a high-resolution
portable STL file (Surface Tesselation Language) of
the intraoral patient situation (Figs. 2a–c).
I
Fig. 4b
Once the planning phase is finished in
CoDiagnostiX, a 3-D printer can plot the virtual
construction of the surgical template with the rapid
prototyping technique without the need of any physical model. Finally, CoDiagnostiX delivers an individual drilling protocol with sequenced CAIS instruments for a safe 3-D implant placement (Fig. 4a & b).
_Surgery
Step 2
Step 3
The DICOM data and the STL file are implemented
and superimposed in the CoDiagnostiX planning
software. A virtual set-up of the prosthetic reconstruction, as well as a surgical template with
optimal 3-D implant positioning can be realized
using a restoration-driven backward planning concept, whilst considering the individual anatomical
situation (Fig. 3).
Prior to implant surgery, the plotted template is
checked for a gap-free fit in the patient’s mouth.
Built-in viewing windows adjacent to the implant
site and in contralateral position improve the level of
control that can be clinically achieved (Figs. 5a & b).
After anesthesia and soft tissue punch, the cortical
bone is perforated with a round bur in central position.
Fig. 5a
Fig. 5b
Fig. 6a
Fig. 6b
CAD/CAM
4_ 2013
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I case report _ guided surgery
Fig. 7a
Fig. 7b
Afterwards, the preparation of the implant bed is
made, successively using specialized guiding tools
and corresponding spiral drills that could clinically
be inserted into the slots of the sleeves. A flapless
approach is only recommended if the local bone
anatomy is adequate in volume, and if a wide band
of keratinized mucosa is present at the implant site
(Figs. 6a & b).
be inserted manually by guidance of the finalized
drill bed. The post-operative radiograph shows the
correct prosthetic positioning of the implant with
sufficient safety distance from the Nervus alveolaris
interior and the adjacent dentition (Figs. 9a–c).
_Prosthodontics
Step 4
An implant depth gauge is placed after the
first drilling to confirm accurate positioning of the
osteotomy. Early error detection can be noticed at
this initial stage and a possible deviation of the proposed implant position must be corrected manually
(Figs. 7a & b).
Afterwards, the guided drill sequence can then be
continued. The present bone density will determine,
if thread cutting is necessary, or not (Figs. 8a–c). The
placement of up to RN/RC-diameter-implants can
be made directly, guided via the integrated 5 mm
drill sleeve. Implants with larger diameters must
Based on an additional intraoral optical impression using an implant scanbody, a second
STL file can be created immediately after implant
placement. This STL file is then also implemented
into CoDiagnostiX. Differences between the actual
implant location and the virtually planned position
can be correlated and compared (Figs. 10a–c).
Moreover, the implant-supported prosthetic
suprastructure can be designed and fabricated during the healing period. All the necessary information
of the actual implant position is still included in
Fig. 8a
Fig. 8b
Fig. 8c
Fig. 9a
Fig. 9b
Fig. 9c
18 I CAD/CAM
4_ 2013
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I case report _ guided surgery
Fig. 10a
Fig. 10b
Fig. 11a
Fig. 11b
the second STL file at this time. The CAD/CAM-fabricated monolithic implant crown can be finalized
based on the virtually generated patient situation
in a model-free technical approach.
Step 5
The full-contour reconstruction is tried out and
reveals a functional treatment outcome without the
need for any interproximal or occlusal corrections
and a pleasing clinical appearance (Figs. 11a–c).
_Summary
Further development in digital implant dentistry
approximates the interfaces of surgical and prosthetic treatment steps: from the virtual planning,
plotted on a guidance template manufacturing, to
the CAD/CAM-based design, including production
of the final prosthetic reconstruction.
As a part of the whole digital sequence, CAIS
offers an additional tool in the interdisciplinary treatment planning. Precise and predictable
treatment results can be implemented with this
approach under consideration of the individual
patient situation. In the full digital workflow, the
overall treatment time is shortened and technical
work steps can be saved in advance in a total of
five stages with only three patient appointments.
This novel process ensures the virtual construction
and fabrication of surgical templates with a 3-D
printer as well as the fabrication of monolithic implant-supported reconstructions using CAD/CAMtechnology without the need for any physical mod-
20 I CAD/CAM
4_ 2013
Fig. 10c
Fig. 11c
els. This approach has the potential to further
simplify clinical procedures in implant patients. The
technique needs to be examined in clinical studies.
In addition, clinical experience will demonstrate
what percentage of the patient pool will benefit
from this exciting technology.
_Acknowledgements
The authors would like to thank the dental technologist Isabell Wiestler for the manufacturing of
the implant-supported reconstruction and Albrecht
Schnappauf for his technical support._
iTero is a trademark of Align Technology Inc., San Jose/USA
_about the authors
CAD/CAM
Dr Tim Joda, DMD, MSc
Division of Fixed Prosthodontics
School of Dental Medicine,
University of Berne,
Switzerland
Prof. Daniel Buser, DMD, PhD
Department of Oral Surgery
School of Dental Medicine,
University of Berne,
Switzerland
[21] =>
CAD0413_01_Title
2013 - 2014
ALL EVENTS ACCREDITED BY
UPCOMING EVENTS
MIDDLE
EAST
Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP is a service
of the American Dental Association to assist dental professionals in identifying quality providers of continuing
dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
5th DENTAL - FACIAL COSMETIC INTERNATIONAL CONFERENCE
Joint Meeting with
American Academy of Implant Dentistry, 2nd Global Conference
JUMEIRAH BEACH HOTEL
08-09 NOVEMBER 2013
DUBAI, UAE
www.cappmea.com/aesthetic2013
DENTAL TECHNICIAN FORUM part of IDEM SINGAPORE 2014
in cooperation with Koelnmesse
SUNTEC INTERNATIONAL CONVENTION & EXHIBITION CENTRE
05-06 APRIL 2014
SINGAPORE
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CAD/CAM & DIGITAL DENTISTRY INTERNATIONAL CONFERENCE
9th EDITION
09-10 MAY 2014
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www.cappmea.com/cadcam9
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4
4 th IRAQI DENTAL REUNION ANNUAL CONFERENCE
Breaking New Opportunities in cooperation with
The 5th International Healthcare Exhibition & Conference Serving Iraq
MAY 2014
ERBIL IRAQ
36 th ASIA PACIFIC DENTAL CONGRESS 2014
Event Supporter
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I case report _ CAD/CAM restoration
Restoring implants using
lithium-disilicate, CAD/CAM
fabricated restorations
Author_ Dr Walter G. Renee, USA
_Today’s consumers are
always searching for the
ultimate bargain, even when
it comes to their dental care.
They want high-quality results and minimally invasive
treatments. The majority of
modern dental procedures
and techniques are trending toward satisfying these
demands.
As a result, CAD/CAM
technology has been incorporated into an increasing
number of dental procedures,
enabling dentists and their
teams to offer state-of-theart care to patients in half the
time of traditional methods.
Fig. 11
(Photos courtesy of Dr Walter J. Renee)
Fig. 1_Patient presented with
retained primary molars 55 and 65.
Moreover, when it comes to implant-supported
restorations, CAD/CAM technology efficiently and
effectively produces restorations that demonstrate
high-strength properties for durable, long-lasting
results that can withstand implant forces.
Research has shown that aesthetic, ceramic,
CAD/CAM-fabricated molar crowns supported by
implants gained high strength values when used
in conjunction with adhesive cements, particularly in cases with titanium and zirconia implant
abutments.1, 2
One of the most challenging aspects of a restorative case, however, is matching the abutment, restoration and adjacent dentition in perfect harmony.
This is especially difficult with single-unit restoration
cases because human dentition exhibits different
colours, shades, tones and hues. It never presents one
simple colour found on the standard shade guide.
Yet, using highly aesthetic lithium-disilicate
value blocks (IPS e.max CAD, Ivoclar Vivadent) milled
in the E4D in-office CAD/CAM system, dentists
can create restorations that are durable, strong and
indistinguishable from surrounding dentition, facilitating the highest level of aesthetics and function.
_Material selection/fabrication
The E4D in-office CAD/CAM system enables
clinicians to design, fabricate and place first-rate
aesthetic restorations in a single visit. The highquality ceramic restorations also demonstrate
excellent strength, fit and longevity suitable for
a broad range of indications and contribute to
predictable outcomes.3, 4
Among the benefits of utilizing the E4D in-office
CAD/CAM system to design and fabricate lithiumdisilicate restorations is the ability to capture state
of-the-art, powder-free digital impressions. These can
be taken from multiple angles for customized accuracy
and optimal efficiency. Additionally, both hard and
soft tissues can be scanned, depending on the case.
Preparation and margin assessment are completed simultaneously, and high-tech software fab-
Fig. 1
22 I CAD/CAM
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case report _ CAD/CAM restoration
Fig. 2
ricates multiple digital models at once. If needed,
sculpting tools facilitate corrections by reimaging,
eliminating the need for constructing multiple
models or placing temporaries.
During the milling process, the unit’s robust
design minimizes vibrations, resulting in micronprecise accuracy for enhanced fit and function of
the final restoration.4
As dental practices have moved toward inoffice CAD/CAM, innovative ceramic materials have
been developed that address material issues regarding strength and aesthetics. These new and improved ceramics are designed to endure CAD/CAM
processing without chipping or fracturing. They
can be milled to full contour for improved fit and
function.5
I
Fig. 3
For example, there are many advantages to
placing monolithic lithium-disilicate restorations
(IPS e.max CAD). These restorations exhibit the
same structural and esthetic properties of ceramic,
yet demonstrate high-strength resistance to longterm mastication forces.4 They also blend seamlessly
with natural dentition.
Fig. 2_Pre-operative right buccal
view of retained primary molars
55 and 65.
Fig. 3_Pre-operative mesial view of
retained primary molars 55 and 65.
Additionally, these restorations are indicated
for full-coverage posterior and anterior crowns,
although the material itself may be milled for cases
requiring thin veneers, minimally invasive inlays
and onlays, partial crowns, implant superstructures
and three-unit bridges.5, 6
Research shows that restorations fabricated
with CAD/CAM perform better and are more durable
compared to other available restorative options.4
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 4_The zirconium abutments
(Astra OsseoSpeed, DENTSPLY)
were placed and scanned
using the E4D intraoral scanner.
Fig. 5_The zirconium abutment
margins were marked
in the buccal area.
Fig. 6_Viewing zirconium in
subgingival locations was simplified
using the E4D ICE system.
Fig. 7_Image of the final restoration
design proposed by the E4D design
software for milling using
lithium-disilicate material.
CAD/CAM
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I case report _ CAD/CAM restoration
Fig. 8_The restoration’s material
thickness was verified using
the E4D Autogenesis software.
The blue areas equalled 2 mm and
the green 1.5 mm, which was ideal
for the selected IPS e.max CAD
lithium-disilicate material.
Fig. 9_The E4D Autogenesis
software resulted in appropriate
anatomical contours.
Fig. 10_The IPS e.max CAD Value 1
Impulse blocks were milled
and fired in one cycle, producing
highly aesthetic monolithic
crown restorations.
Fig. 11_Postoperative view
of the milled restorations.
Fig. 8
Fig. 9
Fig. 10
Fig. 11
The lithium-disilicate crystals in the IPS e.max material, in particular, deflect, branch or blunt cracks,
increasing the flexural and overall strength of the
material to a range of 360 to 400 MPa.3
be extracted and replaced with implant-supported crown restorations fabricated in-office using
the E4D CAD/CAM system and a lithium-disilicate
(IPS e.max CAD) material. The Value 1 Impulse
blocks were selected because they are ideal for
implant crowns, providing the ideal level of translucency.
These high-strength characteristics, capacity
for milling to full-contour and placement with
adhesive bonding or conventional cementation
render IPS e.max CAD monolithic restorations practical for restoring in-office implant restorations.4
Additionally, a strong bond between the restoration
and underlying tooth substrates can be achieved.5
Fig. 12_Postoperative facial view
of the completed restorations.
Fig. 13_Postoperative view
of the final monolithic crowns on the
abutments to replace the retained
primary teeth 55 and 65.
24 I CAD/CAM
4_ 2013
_Case presentation
Implants were placed and the patient was provided with zirconium abutments (Astra OsseoSpeed,
DENTSPLY). To fabricate the crown restorations,
the abutments were scanned using the E4D intraoral scanner (Fig. 4), and the zirconium abutment
margins were marked (Fig. 5).
A 28-year-old patient presented with retained
primary molars 55 and 65 (Figs. 1–3). These would
The E4D ICE software enabled easy viewing of the
zirconium margins in subgingival locations (Fig. 6).
Fig. 12
Fig. 13
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case report _ CAD/CAM restoration
The E4D design software was used to virtually
create the lithium-disilicate crown restorations for
the two premolars (Fig. 7). The software also enabled
verification of material thickness (Fig. 8). In particular, the E4D Autogenesis software was used to
create ideal tooth anatomy and contours, with the
buccal area 2 mm thick and the distal area 1.5 mm
thick, which was perfect for the lithium-disilicate
(IPS e.max CAD) material (Fig. 9).
I
Fig. 14_Postoperative close-up view
demonstrating the excellent colour,
function and aesthetic properties
of the Value 1 Impulse block.
The monolithic crowns seamlessly
match surrounding dentition and
blend with perfect translucency
to mask the underlying zirconium.
The Value 1 Impulse blocks (IPS e.max) were
milled and fired in one cycle, resulting in highly
esthetic and monolithic crown restorations (Fig. 10).
The implant screw access canals were sealed
using a provisional inlay material (Systemp.inlay,
Ivoclar Vivadent). To prepare the lithium-disilicate
crowns for placement, the internal aspects were
etched with 5 per cent hydrofluoric acid (IPS Ceramic
Etching Gel) for 20 seconds, then rinsed and dried.
Then, a silane primer (Monobond Plus) was placed
inside the crowns for 60 seconds and also on the zirconium abutments as a zirconium primer for 60 seconds, using the phosphoric acid methacrylate and
sulfide methacrylate to bond to zirconium. The restorations were then cemented using a universal resin
cement, without primers (Multilink, Ivoclar Vivadent).
Fig. 14
5. Buehler B. Simple and efficient crown fabrication with
an advanced CAD/CAM system. 2012; Dental Tribune.
6. Thompson VP. Durability (reliability) of all-ceramic
crowns (Web cast); event.on24.com/eventRegistration/
EventLobbyServlet?target=lobby.jsp&eventid=
163956&sessionid=1&key=B2F0098B49AAEA431E78
38ECF9721EFB&eventuserid=28400352. Accessed
April 21, 2010.
_Conclusion
IPS e.max CAD restorations provide predictable
results for restoring implants (Figs. 11–14). The
Value Impulse blocks lend to the creation of restorations that blend seamlessly with the adjacent
natural dentition, yet they provide the ideal level
of translucency to mask zirconium abutments.
In this case, the patient was pleased with the natural looking treatment results that were achieved
by combining the IPS e.max CAD material with E4D
in-office fabrication technology._
_References
1. Wolf D, Bindl A, Schmidlin PR, Lüthy H, Mörmann WH.
Strength of CAD/CAM-generated esthetic ceramic
molar implant crowns. Int J Oral Maxillofac Implants.
2008 Jul-Aug;23(4):609–17.
2. Guess PC, Att W, Strub JR. Zirconia in fixed implant
prosthodontics. Clin Implant Dent Relat Res. 2012
Oct;14(5):633–45.
3. Shenov N, Shenov A. Dental Ceramics: An Update.
J Conserv Dent. 2010 Oct-Dec: 13(4):195–203.
4. Poticny D, Potincy J, Klim J. CAD/CAM in-office technology innovations after 25 years for predictable,
eesthetic outcomes. The Journal of the American
Dental Association. 2010;141:55–95.
_about the author
CAD/CAM
Walter G. Renne, DMD,
is a 2003 graduate of the
College of Charleston and a
2008 graduate of the Medical
University of South Carolina
College of Dental Medicine.
He is active in undergraduate
dental education and holds
a full time faculty position in the Department of Oral
Rehabilitation at MUSC. He is the course director for
CAD/CAM technologies and ceramics and runs the
E4D CAD/CAM clinic at MUSC. Renne maintains an
active general dentistry practice utilizing both the
CEREC AC and E4D systems. His special interests
in patient treatment include advances in CAD/CAM
dentistry, adhesive dentistry and conservative
dentistry. He is active in dental research and
currently has a patent pending for a new dental
adhesive that is permanently antimicrobial in
addition to having revolutionary bond durability
components that prevent enzyme degradation of
the hybrid layer. This bonding agent may prevent
recurrent caries and bond breakdown in the long
term. You may contact Renne at renne@musc.edu.
CAD/CAM
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I industry report _ aesthetic dentures
The finesse of the
pink and the power
of IPS e.max
Authors_Rafael Santrich & Dr Larry Grillo, USA
_Introduction
When damage to dentition is too severe for
restorative treatment to be feasible, conventional dentures have been the treatment of
choice. Conventional dentures, however, can be
foul smelling and uncomfortable.1 Additionally,
jawbone resorption causes the dentures to become loose over time requiring readjustment
of the jaw to ensure a proper fit.2
In some cases, if resorption has already occurred, the patient will no longer have sufficient
bone structure to support dentures.2 To overcome the disadvantages associated with conventional dentures, new implant materials and
techniques have been developed, providing the
growing edentulous population with more opportunities for functional, stable and comfortable treatments as well as decreased bone loss.3
Due to the amount of masticatory forces placed
on the prostheses as a result of implant support, stronger, more durable substructures and
denture teeth are necessary to accommodate
wear.3
Zirconia is one of the strongest materials
available in the dental industry today demonstrating a flexural strength of approximately
900–1,100 MPa.4 Ideal for high-stress restorations,
including implant dentures, zirconia restorations boast a failure-free reputation according
to current research.5 Designed and fabricated
using CAD/CAM technology, zirconia substructures are stronger and more durable than traditional denture prostheses.6 Innovative tech-
26 I CAD/CAM
4_ 2013
niques provide long-term and patient-pleasing
results.
When fitted with customised lithium disilicate dentition, fixed implant prosthetics will not
develop a foul smell, require no realignment and
provide a predictable, highly aesthetic and lifelong solution. In addition, CAD/CAM technology
can be used in the office or laboratory for indications including full-mouth restorations, fixed
partial dentures, implant abutments, crowns, veneers, inlays, and onlays,7 contributing to faster
and easier restorative treatments.
Suitable for restorations requiring high strength
and exceptional durability, IPS e.max ZirCAD
(Ivoclar Vivadent) is a yttrium-stabilised zirconia
demonstrating a flexural strength of more than
900 MPa, and a fracture toughness of more than
twice that of glass-ceramic materials.8
With approximately 50 per cent porosity,
the pre-sintered blocks allow easy processing.
Yet, once sintered to full density, its superior
strength and inertness make it an ideal material for dental restorations.8 IPS e.max ZirCAD
blocks (Ivoclar Vivadent) meet the functional requirements demanded by posterior masticatory
forces.
Despite the use of different IPS e.max framework materials (lithium disilicate or zirconium
oxide), aesthetic results can still be achieved due
to a selection of natural and shaded pre-sintered
zirconium oxide blocks for colour versatility, and
when layered with aesthetic ceramic materials,
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I
Fig. 2
Fig. 1
Fig. 3
Fig. 5
Fig. 4
Figs. 1 & 2_Preoperative images of the patient’s dentition.
Fig. 3_Panoramic X-ray of the patient’s mouth.
Fig. 4_Immediate dentures were placed the day of surgery.
Fig. 5_A face-bow transfer was performed.
Fig. 6_A zirconia-hybrid prosthesis would be fabricated for the upper arch
and an acrylic prosthesis for the lower.
Fig. 7_Image of the duplicate denture.
Fig. 8_Plastic temporary abutment placed over the multi-unit abutment.
Fig. 9_Part A and B of the resin is mixed together.
Fig. 6
Fig. 7
Fig. 8
Fig. 9
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Fig. 10_The resin is applied
to the denture.
Fig. 11_Image of the resin denture.
Fig. 12_The frame was designed
and scanned.
Fig. 13_The zirconia frame
was tried in.
Fig. 14_IPS e.max Ceram pink
colours were chosen from the
shade guide.
Fig. 15_The frame was
characterised with Zirliner 1
and fired.
Figs. 16 & 17_A full-contour
wax-up was completed.
Fig. 18_The frame was masked by
layering IPS e.max Ceram in
intensive pink porcelain, opal enamel
white and opal violet.
Fig. 19_Characterisation of the
porcelain was finalised using
Essence stains.
Fig. 11
Fig. 10
Fig. 12
Fig. 14
Fig. 13
Fig. 15
Fig. 16
Fig. 18
Fig. 17
Fig. 19
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industry report _ aesthetic dentures
such as IPS e.max Ceram (Ivoclar Vivadent), good
aesthetics can be attained.9
The lithium disilicate ingots are specifically
designed for press-on procedures indicated for
zirconium oxide-supported gingiva portions,
single-tooth restorations, anterior and posterior
bridges, inlay-retained bridges, and implant
superstructures.10
Manufactured in nine block sizes, the larger
ones suitable for long-span bridge frameworks
or for stack milling and the smaller ones for copings, zirconia substructures can satisfy patient’s
demands for high-strength, highly aesthetic,
functional, fixed prosthetic results.10
The All-on-4 treatment concept (Nobel Biocare)
includes fixed and removable prosthesis and
can be used in combination with a full-arch zirconia substructure as well as a variety of implants
(Nobel Active, Nobel Biocare). The ability to screw
a provisional prosthesis onto the implants directly after surgery provides edentulous patients
with an immediate implant-supported restoration.11-15 Accommodating a wide range of abutments and prosthetics, this technique benefits
patients by providing an aesthetically pleasing,
comfortable, stable and functional prosthesis.11-16
_Clinical Protocol
The patient presented with severely worn and
damaged dentition (Figs. 1 & 2). After performing a panoramic X-ray of the patient’s mouth,
it was decided that the complete removal of
all remaining teeth was necessary (Fig. 3). The
treatment agreed upon was the application of
the All-in-4 technique (Nobel Biocare).
Therefore, the first step was to guide the
placement of the four RP Nobel Active implants,
and the multi-unit transmucosal abutments
used to facilitate tissue level emergence by creating a precision surgical implant guide. Once
the implants were placed, impression copings
were inserted, an impression was taken from
which to create the master cast and immediate
dentures were placed (Fig. 4).
A face-bow transfer was performed to idealise the parameters for a precision restoration
(Fig. 5). At this point, the decision was made
to fabricate a zirconia-hybrid prosthesis for
the upper arch and an acrylic prosthesis for the
lower (Fig. 6). A laboratory verification jig was
created from the master cast to guarantee the
accuracy of the final fit. To set tooth arrange-
I
ment and function, an occlusal wax rim was
created. The set-up was then screwed in, the bite
verified, and phonetics, function, and aesthetics
approved.
_Laboratory Protocol
The patient-approved immediate denture
was duplicated and mid-line smile design and
curve positions, i.e., Wilson spee, incorporated
(Fig. 7). The plastic temporary abutment was
placed over the multi-unit abutment (Fig. 8) and
parts A and B of the resin were mixed and
applied over the plastic abutment (Figs. 9 & 10),
creating the resin denture (Fig.11). The frame was
designed and the scanning process performed
(Fig. 12). The zirconia frame was tried in (Fig. 13).
A variety of samples of IPS e.max Ceram were
chosen from the shade guide to produce natural
colouration and mask the white zirconia frame
(Fig. 14). The colour was tested with the same
background as the frame colour to evaluate the
shade intensity of intensive dentin and dentin.
The frame was characterised with Zirliner 1 and
baked at 1,060 °C to create a bond between the
zirconia and ceramic (Fig. 15).
A full-contour wax crow design was completed (Figs. 16 & 17). Intensive pink porcelain
(IPS e.max Ceram) was built up to mask the frame
and mixed with opal enamel white (OE4) and
opal violet in specific areas to create a natural
look. The bake speed was lowered to 35 °C per
minute, held for one minute at 760 °C, cooled
at a rate of 25 °C per minute and held at 350 °C
for 15 minutes (Fig. 18).
Characterisation of the pink porcelain was
finalised using Essence stains (Ivoclar Vivadent).
Low speed rates were used to fire the glaze.
Fired at 35 °C to 730 °C for one minute, the glaze
was then slowly cooled at 25 °C per minute
and finally held at 350 °C for 15 minutes (Fig. 19).
Next, the crowns were glazed with shades one
and two of copper, white, cream, profundo, mahogany, ocean and sunset, then baked at 775 °C
per one minute hold (Figs. 20–25).
_Seating
Once the patient was satisfied with the colour, phonetics, and smile line (Fig. 26), the case
was prepared for bonding. The zirconia and titanium were primed (Monobond, Ivoclar Vivadent)
to create mechanical and chemical retention
in both materials. The case was then cemented using universal adhesive implant cement
(Multilink Implant, Ivoclar Vivadent, Figs. 27–29).
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I industry report _ aesthetic dentures
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Figs. 20–25_The crowns were
characterised with shades one
and two of copper, white, cream,
profundo, mahogany, ocean
and sunset, then fired.
Fig. 26_The case was ready
for bonding.
Figs. 27–29_The case was primed
with Monobond.
Fig. 30_The IPS e.max crowns were
etched with 5 per cent hydrofluoric acid.
Fig. 31_The crowns were cemented
into place, leaving the
screw holds vacant.
Fig. 32_Image of the healthy soft
tissue and the angulation
of the multiunit abutments.
Fig. 33_The case was torqued into place.
Fig. 34_Image of upper arch with
IPS e.max crowns and the Phonares
acrylic teeth in the lower arch.
Fig. 35_Postoperative occlusal view
verifying balance and occlusion.
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
Fig. 31
Fig. 32
Fig. 33
Fig. 34
Fig. 35
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industry report _ aesthetic dentures
Prior to cementing the crowns in place, they
were etched with a 5 per cent hydrofluoric acid
for 20 seconds (Fig. 30). All crowns were cemented into place except those that fit over the
screw holds (Fig. 31), which would be cemented
once the case was seated (Fig. 32). Finally,
the dentures were torqued into place (Fig. 33).
IPS e.max crowns were used in the upper arch
and Phonares acrylic teeth in the lower (Fig. 34)
to equipoise the forces and achieve a balanced
occlusion providing the patient with the highest
quality of function and phonetics (Fig. 35).
I
Newly developed, innovative alternatives are
more durable, aesthetic and last longer compared to conventional options. Implant-supported dentures fabricated with materials such
as zirconia and IPS e.max ZirPress not only
demonstrate superior characteristics, but are
stronger and more durable.3,17 Modern procedures and materials can satisfy patient demands
by providing denture treatments that are longlasting, strong and aesthetically pleasing._
Editorial note: A complete list of references is available
from the publisher.
_Conclusion
_contact
Previously limited to sometimes ill-fitting
and painful false teeth, edentulous patients today have a variety of sophisticated treatment
options. Due to their ease of use, predictability
and its many advantages, CAD/CAM technology,
pressable and milled ceramic materials and new
implant structures enable dentists and laboratories to provide comfortable, stable and aesthetic
treatments to edentulous patients.7
CAD/CAM
Rafael Santrich
Dental Designer
VM Lab Technologies
Advancing in Science
& Art of Restoration
vmlab@me.com
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CAD/CAM
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I industry report _ diode lasers
Diode laser application
optimises the clinical
outcomes of digital workflow
Authors_Drs Frank Liebaug & Ning Wu, Germany
_Introduction
Fig. 1a_Laser HF (Hager & Werken
GmbH & Co.KG, Duisburg, Germany):
The only device combining two lasers
975 nm/6 W and 66 nm/25–100 mW
and HF surgical component 2.2 mHz
for easy, fast and precise
cutting of soft tissues.
Fig. 1b_The preparation margin
can be traced ergonomically via
the laser hand piece like
holding a fountain pen.
Fig. 2_Blood and saliva make the
depiction of the prosthetic
preparation margin more difficult.
Fig. 1a
“Digital Workflow” has become an established term
in present-day dentistry, helping to solve problems
in dental technology which would have been rejected
due to an unwarranted high analogous effort some
years ago.
With digital procedures entering the realms of diagnosis, therapy and production, the workflow of dentists and dental technicians has changed considerably
over the past years. Today, all dental disciplines rely on
digital technologies to achieve exact diagnosis, modelling and production. The broad spectre of technologies
reaches from intraoral scanners for three-dimensional
scanning of the stomatognathic system to the production of models via CAD-data by 3-D printers. Dentists
and dental technicians make use of these technologies
as well as of manual procedure steps. Digital technologies have improved the highly demanding work of
Fig. 1b
32 I CAD/CAM
4_ 2013
today’s dental technicians in terms of reliability in planning and treatment. Now, neighbouring teeth, roots
and nerves can be captured precisely via digital volume
tomography, with the data being visualised threedimensionally. These options result in a significant risk
reduction of implant placement in the jaw bone. Furthermore, digitalisation has achieved a fundamental
change in patient communication. Dental technicians
and dentists are thus no longer demanded exclusively
as clinicians and craftsmen. For instance, CAD/CAM
technology and intraoral cameras allow for presenting
transparent solutions for an improvement of the aesthetic situation to the patient already in the practice.
Therefore, the patient is informed more soundly and
can be included in decisions on treatment planning.
The production of restorations has undergone a
tremendous change in the past years. All-ceramic
crowns have replaced porcelain fused to metal as the
standard. The properties of materials such as zirconium
Fig. 2
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industry report _ diode lasers
I
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
oxide have been improved to deliver perfect aesthetic
results.
_Exact transfer of the oral situation
as the base
Dentistry without digital technology and CAD/
CAM procedures has become inconceivable. Intraoral
and extraoral measurement, scanning of antagonists
and registration, three-dimensional construction on
screen (Fig. 7), applying a large variety of tooth shapes
from the data base, designing anatomical occlusal surfaces, the functional articulation in the virtual model,
the subtractive processing of high-performance ceramics—all of this would be impossible without computers.
Without an impression of the actual patient situation, modern dentistry is unthinkable. For decades,
not much has changed with regard to impression
technique, except for the development of impression
materials. Already in the 1980s, the first trials in digital
impression taking were conducted in the form of intraoral optical scans and then introduced as a new technique. By now, this technique is so well-developed that
it can be applied in a multitude of indications.
New procedures influence established steps of
the process, and advances simplify workflows. Thus,
virtual construction models, the articulation via Windows interface, biogeneric design of occlusal surfaces
via intelligent software, rapid-prototyping and 3-D
printing are only a small sample of the topics which are
discussed in scientific publications with regard to
CAD/CAM dentistry. Small and medium-sized dental
laboratories or, as in my case, larger practice laboratories will acknowledge their core competence of
producing high-class aesthetic restorations as well as
individually designed partial dentures and implant
dentures.
It has thus become a prevailing trend to produce
inlays, onlays, partial dentures and single-tooth restorations as well as large-span bridges and suprastructures assisted by computer. In addition, the computer-assisted production of long-term temporary
restorations according to functional criteria has become an established method in our practice for implantology and its suprastructures.
However, an exact transfer of the oral situation on
the virtual or physically present model is the foundation and the beginning of digital workflow. Whether
analogous impression taking or digital scanning by
optical procedures is applied, the mode of preparation,
especially the preparation margin, must be depicted
exactly.
Although sometimes the soft tissues can be pushed
away from the subgingival preparation margin because of the viscosity of the impression material, opti-
Fig. 9
Fig. 3_Working tip of the diode laser
for haemostasis.
Fig. 4_Excision of interfering soft
tissue can be done fast and
effectively via laser.
Fig. 5_After laser application, the
preparational margin is depicted
clearly. This is mandatory for
analogous as well as optical
impression taking in order to achieve
optimum results in the patient’s
prosthetic rehabilitation.
Fig. 6_Detail of the polyether impression
taking (Impregum Penta Soft,
ESPE Company, Seefeld, Germany)
with individual impression tray
confirms the exact depiction of the
oral situation, especially the
preparational margin at the
cavity margin.
Fig. 7_Milling machine M5 with
strip light scanner S600 ARTI as
a component of the CAD/CAM system
5-TEC in Ferrari red by
Zirkonzahn GmbH, Italy.
Fig. 8_Model under strip light
(inside the scanner S 600 ARTI).
Fig. 9_Articulator with model
of upper and lower jaw in the strip
light scanner S600 ARTI.
CAD/CAM
4_ 2013
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I industry report _ diode lasers
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 10_Depiction of the form of the
preparation, especially the level
ranges on the monitor, after cutting
less relevant aspects of the model
situation image digitally.
Fig. 11_Checking of the minimum
layer depth for the future ceramic
restoration is more practical than via
the analogous model.
Fig. 12_Articulation can be checked
from various perspectives.
Fig. 13_Production and checking of
the optimum occlusal configuration.
Fig. 14_Okklusal view of the digitally
planned partial crowns.
Fig. 15_In the end of the digital
planning phase, the restoration
can be checked from all special
dimensions even before the
milling process.
cal impression taking via scanner systems does not
allow for this option.
iaries, a good result is hard to achieve from impression
taking. Or is it?
While optical impression taking systems make a
contribution to standardization, direct control of the
preparation outcome and thus to the quality of the
impression, conventional as much as digital optical
impression taking can only capture structures which
are visible to the human eye. Optical impression taking
cannot replace conventional impression taking techniques completely. This holds true especially for removable and complete dentures as well as circular
implant suprastructures. In addition, the transfer of
virtual data into real-life working models, which is
often mandatory, has not yet been perfected.
Twenty years ago, I have introduced high-frequency technology and shortly afterwards dental
lasers to our praxis because of the high quality standards in solving prosthetic problems by our team of
clinicians and dental technicians. Especially the compact diode lasers can be applied effectively in this
field.
However, the current trend is digital impression taking, although many obstacles have yet to be overcome.
A review of the literature and published reports
shows that in most cases supragingival preparation
margins are treated, which some colleagues might be
able to take an impression from without any retraction cords. Extensive haemostasis measurements and
tissue suppression can cause more trouble, since a
camera will only be able to scan areas optimally which
are easily accessible.
No optical system has been able to see through
a pooling of saliva or offer usable data for an exact
rendering of the preparation margin. Imprecision can
accumulate between impression taking and final
prosthesis. Thus, both the advantages and the precise
results produced by digital workflow would be taken
ad absurdum.
But the clinical, deeply subgingival preparation
margin with bleeding of the adjacent gingiva (Fig. 2)
can be a severe challenge for experienced clinicians
using the traditional analogous impression technique. Without cord techniques or astringent auxil-
34 I CAD/CAM
4_ 2013
_Laser radiation
Not only is laser radiation absorbed by the tissue
and then transformed into heat, but it is also partly
transmitted through the tissue. This takes place independently from the respective dental laser and determines the indication. The cutting speed of the laser
radiation is limited by the tissue, which can only be
ablated in layers. Laser radiation produced by the dental laser is led to the application site in the oral cavity
by fibre optic systems consisting of mirror joint arms
and flexible glass fibres. Here, laser radiation from
the anterior fibre heats the surface layer of the tissue
in a closely-defined area, thus ablating the tissue.
In order to reach deeper layers, the tissue must be
ablated layer by layer. Although some authors see
this as a disadvantage1, this minimally invasive and
tissue-conserving procedure is especially helpful in
the sensitive cervical areas and in sulcus extension
previous to impression taking.2
_Clinical Procedure
The handpiece of the diode laser device (Fig. 1) is
placed in the hand like a fountain pen (Fig. 1 a). With the
thin fibre tip, the preparation margin is traced circularly
around the anchor tooth, either over its total circumference or only the gingival level range of the partial
crown (Figs. 3–5), by using it like a fine fibre pen of
a diameter of only 0.3 mm.
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industry report _ diode lasers
Thus, uneven gingival areas or gingival areas damaged iatrogenically during abutment preparation are
removed and haemostasis is achieved. If light oozing
bleeding occurs, haemostasis is achieved punctually
via laser fibre by increasing the pulse energy (Fig. 4). For
this, only little anaesthesia is necessary and the procedure is much more pleasant for the patient. If a scanning system demands the use of powder in order to improve optical impression taking, special care must be
taken to ensure that the powder does not bind with
blood or cervicular fluid. Otherwise, optical impression
taken could provide imprecise results and thus cannot
be used as the starting point of the digital process chain.
After the working field was prepared as described
and the complete preparation level range is easily
accessible by the clinician and can be prepared dryly
(Fig. 5), the impression taking technique favoured by
the dentist can be performed.
Laser application is seen as part of the prosthetic
quality management in my practice and is thus a standardised aspect of every preparation. Immediately before
the drainage, precision impressions are taken. For this,
I often use individual impression trays and Impregnum
(3M ESPE, Seefeld, Germany), as can be seen from Figure 6. The dental technicians in our team check the impression by stereo magnifying glasses and release it for
further processing. After the classical production of the
model from superhard plaster, the digital process chain
starts with the strip light scanner S600 ARTI (Fig. 7).
_Strip light scanner S600 ARTI
The all-automatic, optical strip light scanner S600
ARTI (Zirkonzahn) with two cameras, precision gears
without tooth belt and 360° rotation and 100° swivel
axis, digital model scanning of almost any object is possible with a precision of about seven micron. Differences can thus be registered easily. The oversized measuring field of 95 x 75 x 100 mm allows for complete
scans of the articulator or the whole arch (Figs. 8 & 9).
Combined with the software Zirkonzahn.Scan, it is the
only scanning system by which the dental technician
can register his own laboratory articulator with the
scanner und measure its axes. This is necessary for rendering realistic articulator situations with regard to the
facial arch in the three-dimensional system of coordinates of the software. When the model situation is
depicted on the monitor, the result of the dental preparation after exposure of the levels via laser can be depicted in detail (Fig. 10). This is another opportunity for
the treatment team to check for errors. Articulation and
layer depths of the planned ceramic restoration can be
depicted as seen in Figures 11 and 12. Then, the optimum occlusal planes as well as the form of crown or
partial crown can be planned (Figs. 13 & 14). In addition
to the milling machine M5, the scanner S600 ARTI
I
forms a component of the CAD/CAM system 5-TEC
(Zirkonzahn) that we use in our practice laboratory.
Of course, every step of the process is guided by
know-how and expertise in dental technology, which
must not be underestimated during sintering process,
individualization or veneering.
_Laser light in the placement of the
prosthetic restoration
After the dental laboratory fabrication, we have come
the full circle with the placement of the full ceramic
restoration, for again we need cleanliness and a dry
working field free of bleeding for this final dental treatment step. Often, localized gingivitis with an increased
bleeding propensity can occur postoperatively or due
to the temporary restoration, which often interlocks a
number of prepared teeth to achieve stability. Furthermore, personal oral hygiene of the patients, especially
flossing, is limited at this stage, which can cause localized gingivitis. Gingival hyperplasia also sometimes occurs, but it can be removed precisely and within seconds
by diode laser. This holds especially true for the haemostasis of capillary bleeding and the drainage of the gingival sulcus in close proximity to the preparation margin.
This is the only way to make sure that the various
bonding cements or bonding systems are applied
according to the manufacturer’s instructions.
_Conclusion
Diode lasers are mandatory for an effective quality
improvement in the beginning and at the end of the
digital process chain. The form of the preparation,
especially the preparation margin, must be depicted
precisely, whether in analogous impression taking or
digital scanning via optical techniques. The routinely
application and consequent use of laser technique are
the basis for clinical long-term success of the prosthetic restoration. It can therefore help to meet the
high demands of the patients._
Editorial note: A complete list of references is available
from the publisher.
_contact
CAD/CAM
Prof. (Univ. Shandong) Dr Frank Liebaug
Praxis für Laserzahnheilkunde und Implantologie
Arzbergstr. 30
98587 Steinbach-Hallenberg, Germany
Tel.: +49 36847 31788
frankliebaug@hotmail.com
www.laserzahnarzt-liebaug.de
CAD/CAM
4_ 2013
I 35
[36] =>
CAD0413_01_Title
CAD0413_36_MIS 12.12.13 14:27 Seite 1
I industry news _ MIS
MIS Dental Implants:
When virtual becomes reality
with the MGUIDE MORE
DICOM data is then uploaded for a 3-D clinical evaluation. Next comes the implant planning and template design stage. Integration of a scanned wax-up
and stone models enable virtual top-down planning
as well as the template design. Then the stereolithographic templates are produced. The open wireframe templates are made using advanced 3-D
printing technologies to ensure optimum fit. Now
the guided surgery can be performed. Restoration
can be done via immediate provisional prosthetic
solutions produced in advance, using MGUIDE
MORE prosthetic tools for laboratory technicians.
_The MGUIDE MORE is an advanced virtual
implant planning and guided implantology system
developed by MIS to accurately transform DICOM
data into 2-D and 3-D images that depict real cases
in a virtual environment; enabling real-time 2-D
and 3-D visualization for perfect implant planning.
The MGUIDE system features user friendly
software, and incorporates the production of a
fully validated drilling template; assuring accurate
guided implantation with predictable prosthetic
outcomes. The prosthetic-driven planning can be
done either by the clinician, using simplified stateof-the-art MGUIDE software, or through the MIS
network of MCENTERS, well-equipped facilities in
over 20 countries and five languages that provide
full technical support and guidance.
Implantology professionals using the MGUIDE
software become members of an important online
information hub that connects all software users; doctors, dental laboratories, periodontists, prosthodontists and the MCENTER. Users can share cases, take part
in demonstrations, discussions or consultations, and
use a remote access feature for direct interaction with
another member’s MGUIDE MORE planning process.
How does the MGUIDE process begin? First
a single patient Cone Beam CT scan is done. The
36 I CAD/CAM
4_ 2013
There are many clear advantages to the MGUIDE
MORE open wire-frame template. It allows an open
field of view during surgery, where anaesthesia and
irrigation are accessible from all angles without removing the template. Raised flap surgery can also be
more easily performed. The template is constructed
from a strong, durable biocompatible material and
the 3-D CAD/CAM design ensures the highest level
of accuracy. The lightweight template is an added
benefit for patient comfort as well.
The MGUIDE MORE surgical kit not only enhances
accuracy and safety for a smoother guided procedure, it also simplifies the implantology process by
eliminating the need for traditional guidance keys.
Specially designed sleeves and drills stop at the precise position and depth planned, freeing-up hands
and saving valuable time. The MGUIDE MORE has
been specially engineered to deliver a more accurate
and streamlined minimally invasive implant placement and restoration procedure, resulting in less
chair time and fewer patient appointments._
_contact
MIS Implants Technologies Inc.
P.O. Box 7
Bar Lev Industrial Park
20156 Israel
www.mis-implants.com
CAD/CAM
[37] =>
CAD0413_01_Title
[38] =>
CAD0413_01_Title
CAD0413_38_Planmeca 12.12.13 14:27 Seite 1
I industry news _ Planmeca
New open CAD/CAM solutions
for dentists and dental laboratories
from Planmeca
The ready design can
then be sent to Planmeca
PlanMill 40, a new milling
unit targeted for dentists and
designed for glass ceramic
and other material works. The
4-axis milling unit is quick
and accurate.
_Integrated workflow
for dental labs
_Planmeca now introduces a full range of open
CAD/CAM solutions for dentists and dental labs
to complete its offering in industry-leading dental
equipment and software. The dentist or lab can
choose either the entire workflow solution or only
certain parts, according to their needs. This is made
possible with Planmeca’s unique and open interfaces between devices and software. From highprecision desktop milling units to sophisticated CAD
software, this unique solution includes all necessary
tools for open CAD/CAM dentistry.
_Integrated workflow for dentists
Planmeca PlanScan is a digital impression scanner
for ultra-fast, powder-free 3-D scanning. The quick
and accurate scanner provides real-time digital
impressions from one-tooth to full-arch scans. The
open STL data output means that the scanned data
can be sent to any dental lab for CAD work. Planmeca
PlanScan is the first dental unit integrated impression
scanner. Alternatively, it is available as a standalone
version and can be connected e.g. to a laptop.
Planmeca also offers dentists a new open
CAD software suite for easy 3-D design. Planmeca
PlanCAD Easy is integrated in the Planmeca Romexis
software and is a perfect tool for designing prosthetic works from individual inlays to full-arch
bridges and abutments.
38 I CAD/CAM
4_ 2013
For dental laboratories,
Planmeca offers Planmeca
PlanScan Lab, a fast and
maintenance-free desktop lab
scanner for scanning plaster
casts. The design phase is done in the open Planmeca
PlanCAD Premium lab software, after which the
ready design is sent to Planmeca PlanMill 50,
an accurate 5-axis milling machine designed for
dental labs.
Alternatively, the laboratory can order fast and
reliable milling services from Planmeca’s CAD/CAM
milling centre PlanEasyMill, which offers a wide
range of materials and fast deliveries.
“Our CAD/CAM solutions are truly unique, as
the system is completely open and flexible”, explains
Mr Jukka Kanerva, Director of Dental care units and
CAD/CAM division at Planmeca Oy. “Dentists and
laboratories can choose either the entire solution
and benefit from the integrated workflow, or just
pick the necessary parts and send the open data
to their partners. This is truly digital perfection.”_
_contact
Planmeca Oy
Asentajankatu 6
00880 Helsinki
Finland
www.planmeca.com
CAD/CAM
[39] =>
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[40] =>
CAD0413_01_Title
CAD0413_40_Schuetz 12.12.13 14:27 Seite 1
I industry news _ Schütz Dental
Compact 5 axis table-top machines
for milling metal, zirconium dioxide, acrylics and wax
Fig. 1
Fig. 2
Fig. 1_The compact five-axis CNC
table top machine, Tizian Cut 5 smart
from Schütz Dental mills metal,
zirconium dioxide, acrylics and wax.
Fig. 2_Cobalt chromium milling
blanks in the milling chamber
being milled into a 14 unit bridge.
Fig. 3_The automatic 8-fold blank
changer in the Tizian Cut 5 smart plus
milling machine.
(Pictures courtesy of Schütz Dental)
_Schütz Dental introduces the new Tizian Cut 5
smart milling machine which measures just 50 cm
wide. It can master almost every milling task, almost
any undercut with almost any material—even final
non-precious metals.
Five simultaneous axes with an angle of up to
thirty degrees make for a huge range of indications.
With its separately available and retrofitted water
cooling system, this machine becomes a milling
machine for glass ceramics.
The automatic tool changer can take up to
16 milling and grinding tools. Adding to the basis
machine Tizian Cut 5 smart, the model Tizian Cut 5
smart plus is available with a fully automated,
8-fold blank changer. Both machines can be fitted
with a tool administrating module. With the help of
this module, the user will always know when a tool
needs replacing. All Tizian machines are licensefree and import open STL data. This creates the core
of a complete digital chain of work, which already
begins for Schütz Dental from the first digital TMJ
measurement.
The CAM family Tizian Cut 5 has been extended
with the “smart” and now the new “smart plus”
models (Fig. 1). In both simultaneous five-axis
machines, the newest innovations in hardware and
software ensure more precision, diversity, speed
and comfort than ever before. Particularly impressive is how such a compact machine can be used for
dry-machining of non-precious metals (Fig. 2). Due
to the sinter-less process, precise fitting and high
40 I CAD/CAM
4_ 2013
Fig. 3
quality of materials, this machine produces bridges
of up to 14 units and is also suitable for implantsupported objects with a passive fit. Production
of frameworks is precise and time saving with the
advanced construction software Tizian Creativ RT:
Following a virtual design, the Tizian machine mills
a framework in a modelling acrylics or wax. Thanks
to an axis angle of up to 30 degrees, undercuts can
be seamlessly produced.
Inside the Tizian Cut 5 smart plus machine, there
is an additional automatic 8-fold blank changer
(Fig. 3). Together with the previously integrated tool
changing device, this gives you the opportunity
for continuous operation. Both CNC versions can
be upgraded with a water cooling system and a
collecting tank. This means that lithium disilicate
as well as zircona reinforced glass ceramics can
be milled using the wet-machining feature. This
quick working, compact all-rounder and its „made
in Germany“ quality makes this machine truly stand
out. Take the example of a three-unit metal bridge,
milled in just 50 minutes._
_contact
Schütz Dental GmbH
Dieselstr. 5–6
61191 Rosbach, Germany
export@schuetz-dental.de
www.schuetz-dental.com
CAD/CAM
[41] =>
CAD0413_01_Title
CADCAM_Abo_A4_Implants_Abo_A4 12.12.13 12:09 Seite 1
CAD/CAM
digital dentistry
international magazine of
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[42] =>
CAD0413_01_Title
CAD0413_42-43_Straumann 13.12.13 15:28 Seite 1
I industry news _ Straumann
Straumann presents data and
innovations that may change
paradigms in implant dentistry
together with the SLActive surface for accelerated
osseous healing and the new Loxim Transfer piece
for improved handling convenience.
Straumann’s new Roxolid 4 mm Tissue Level
“Short Implant” was also presented in Dublin. This
is the shortest implant Straumann has ever sold and
it is designed to avoid extensive augmentation procedures in patients with insufficient vertical bone
for conventional implants. It is backed by long-term
clinical data, showing excellent performance over
five years.
Speaking about Roxolid and SLActive at the
Straumann Corporate Forum, Prof. David Cochran,
Chairman of the Department of Periodontics at
the University of Texas Health Science Center at
San Antonio Dental School, noted: “These technologies will increase the clinician’s confidence to
use shorter and narrower implants that reduce the
invasiveness of implant treatment”.
_New ceramic implant—an innovative
evidence-based alternative
Straumann’s new ceramic implant.
_At the 22nd Annual Scientific Meeting of
the European Association for Osseointegration in
Dublin, Straumann provided an update on several
initiatives that may lead to paradigm shifts in implant dentistry.
_Roxolid SLActive—setting new
standards, reducing invasiveness
The Group has just launched its Roxolid SLActive
implants in a full range of sizes to help avoid
bone augmentation procedures—saving patients
trauma, discomfort, time and money, and thus
increasing patient acceptance. Until now, only
Straumann’s smallest diameter implants—which
are designed for use in narrow spaces or where
bone is limited—have been produced in Roxolid. But,
based on extensive clinical evidence and with the
goals of reducing invasiveness and making treatment possible for patients with insufficient bone,
Straumann now offers all its implants in Roxolid
42 I CAD/CAM
4_ 2013
Clinical results were also published on Straumann’s new ceramic implant, which has now entered a controlled market release.
In terms of aesthetics, ceramic materials offer
a significant advantage to metals in dental applications. Furthermore, ceramic provides a good biocompatible alternative for patients who ask for metalfree implants. However until now, the main drawback
has been concern about mechanical predictability.
Straumann has overcome this hurdle through
an innovative manufacturing process followed by
a “proof-test”, in which every implant is tested
mechanically—a level of quality checking that is
exceptional in the dental implant industry.
The aesthetic properties are also exceptional:
unlike pure white ceramics, Straumann’s implant has
a translucent ivory colour like natural tooth roots.
[43] =>
CAD0413_01_Title
CAD0413_42-43_Straumann 13.12.13 15:28 Seite 2
industry news _ Straumann
To further ensure reliability, Straumann has used
a one-piece design (monotype), which integrates
the implant and the abutment. In addition, the company has succeeded in creating a ceramic surface
texture that is similar to, and performs like, the SLA
surface used on its titanium implants to enhance
and shorten the healing process.
The new implant is the result of a 7-year development program that has been driven by Straumann’s
unique expertise in implant design and its 60 year
heritage of material innovation. Typically, the company has chosen to test the product clinically before
introducing it to the market. Initial results from
the clinical program were published at the EAO:
in a multicenter study with 41 patients, success
and survival rates of 98 % were reported with zero
implant fractures after one year. Clinicians also reported pleasing aesthetic results and excellent gum
tissue condition around the implant.
Based on the very positive results to date, a further 500 implants have been issued to clinics in a
controlled market release. Providing the reports
continue to be favourable, Straumann expects to
launch the product on a broader scale in 2014.
I
Roxolid.
restorations for Straumann Bone and Tissue Level
implants with an original Straumann connection.
To do this, 3Shape has integrated a Straumann
library in its software, enabling dental technicians
to model two-piece abutments using a pre-manufactured Straumann Variobase and a customized
restoration that can be milled in the lab or a local
milling centre.
Roxolid SLActive implants.
Although the requirement for metal-free alternatives is not generally considered to be a major driver of
the market, the availability of highly aesthetic ceramic
implants with similar performance, flexibility and
predictability to their metal predecessors would undoubtedly change implant dentistry. Straumann’s new
ceramic implant may be a first step in this direction.
_Scientific update on new fullysynthetic bone regeneration material
With the goal of developing an enhanced bone
augmentation material that converts rapidly into
vital bone and preserves volume, Straumann has
been conducting research into synthetic bone
substitutes focusing on innovative biphasic calcium
phosphate ceramics. Good progress has been made
in tailoring the composition to achieve optimal
regenerative characteristics. Very encouraging preclinical results were presented in Dublin and clinical
evaluation is underway.
Straumann firmly believes that using original
components is in the patient's best interest and its
guarantee becomes invalid if systems are mixed.
The Variobase implant kit offers labs a precise, reliable solution for producing their own abutments
with an original Straumann connection. The agreement reflects Straumann’s efforts to offer the
broadest range of prosthetic possibilities and flexibility with guaranteed precision and reliability._
_Collaboration agreement
with 3Shape for CAD/CAM abutments
with original Straumann connections
_contact
Apart from the EAO news, Straumann announced a collaboration agreement with 3Shape,
a leader in 3-D scanners and CAD/CAM software
solutions, which makes it possible for users of
3Shape’s Dental System to produce customized
CAD/CAM
Institut Straumann AG
Peter Merian-Weg 12
4002 Basel
Switzerland
www.straumann.com
CAD/CAM
4_ 2013
I 43
[44] =>
CAD0413_01_Title
CAD0413_44-45_EAO 12.12.13 14:29 Seite 1
I meetings _ EAO
Dublin conference discussed
future concepts in dental
implant rehabilitation
cussed when the Convention Centre Dublin
opened its doors last October for the 22nd Annual
Scientific Meeting of the European Association
for Osseointegration (EAO).
According to the organiser, over 2,000 dental
professionals participated the three-day event,
which was held in the Irish capital for the second
time. In addition to current issues in the field,
like peri-implantitis and the challenges linked to
the treatment of an increasing elderly population,
the congress reflected on new developments
and methods, such as computer-assisted implant
rehabilitation and tissue regeneration.
Moreover, a number of sessions focused on risk
factors, treatment planning and the possibilities
of virtual learning techniques.
_Dental rehabilitation using implants has
seen significant advancements in the last decade.
Trends for the future of the specialty were dis-
44 I CAD/CAM
4_ 2013
Up to 70 experts from Europe and around the
globe were speaking at the meeting. The latest
research were presented in the form of short oral
[45] =>
CAD0413_01_Title
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meetings _ EAO
sessions and poster presentations took place
between the scientific sessions.
New products for treatment outcomes that are
more predictable and an improved workflow in
dental practices and laboratories were presented
at the industry exhibition, which was supported by
87 sponsors this year. Among others, MIS and Henry
Schein presented their latest tools for a complete
digital workflow. Furthermore, Danish dental solutions provider 3Shape had its recently launched
TRIOS intra-oral scanning system on display. New
and improved implant systems were presented by
Implant Direct and a number of other companies.
In 1995, the EAO held one of its earliest meetings in Dublin. Since then, the prestigious event
has taken place at 17 locations in 15 countries
throughout Europe. Last year’s anniversary meeting in Copenhagen saw more than 2,500 professionals participating, the number expected for the
2013 edition in Ireland. In addition to the Royal
College of Surgeons in Ireland and the Oral Surgery Society of Ireland, the meeting has received
support from the Irish Society of Periodontology
and the Prosthodontic Society of Ireland.
I
“In 1995, implant treatment was provided by
a fairly small number of specialists and access
for patients was limited,” commented Dr Brian
O’Connell, congress chairman and Professor of
Restorative Dentistry at Trinity College Dublin’s
dental school and hospital.
“Now implant treatment is available in every
part of the country and is provided by a wide
range of practitioners. As a result, awareness has
really grown among the population. (…)Europe
has a generally ageing population, who may have
the greatest demand and need for dental implant
treatment in the future. Evidence suggests that
the majority remain healthy and active for much
longer than we may have believed. We need to
learn much more about the specific requirements
of the older population and be aware of the risks
as well. Often assumptions about older people are
inaccurate. Although they may less demanding
about their needs, they frequently respond well
to implant treatment.”
Next year’s EAO annual congress will be held
from 16 to 19 October in Rome. For details please
visit EAO website._
All photos courtesy of EAO.
CAD/CAM
4_ 2013
I 45
[46] =>
CAD0413_01_Title
CAD0413_46_Camlog 12.12.13 14:29 Seite 1
I meetings _ CAMLOG Congress
5th International CAMLOG Congress
—the first CAMLOG Congress
based on the new Consensus Reports
The finishing touch at the end of the Congress
will consist of case discussions on the controversial issue "Complications—what can we learn from
them?" with a panel discussion also involving volunteers from the audience.
Several workshops, which will be held the
day before the congress, aim at giving to participants excellent opportunities for further expanding
practical experience and theoretical knowledge in
implant dentistry. According to organizers these
events are always booked out fast, so early registration is highly recommended.
46 I CAD/CAM
4_ 2013
_The 5th International CAMLOG Congress
will be held from 26 to 28 June 2014 in Valencia,
Spain. The meeting, with the motto: “The Ever
Evolving World of Implant Dentistry" will be based
on the CAMLOG Consensus Reports, the congress
will thus profoundly address the current developments in implant dentistry and the renowned
scientific committee, chaired by Prof. Mariano
Sanz (Spain) and Prof. Fernando Guerra (Portugal)
will be responsible for the quality of the presentations.
In addition to the first class content of the congress, the extraordinary attractiveness of Valencia
as a location should also be mentioned, in particular the Ciudad de las Artes y de las Ciencias, designed
by the well-known architect Santiago Calatrava,
where the Congress will be held in the spectacular
Palau de les Arts.
The surgical and prosthetic concepts and recommendations are at the core of the program.
According to organizers, these reports have
been and will be worked out by a renowned team
of experts from 18 countries during meetings
in 2013 and 2014. The first CAMLOG Consensus
Report has recently been accepted for publication
by the renowned Clinical Oral Implant Research
Journal. The CAMLOG Consensus Reports serve
as a basis for questions relating to daily practice
and these will be addressed at the Congress in
Valencia both from academic and practical points
of view.
_contact
Online registration for the congress is now open
at: www.camlogcongress.com._
CAMLOG Foundation
Margarethenstrasse 38
4053 Basel
Switzerland
Tel.: +41 61 5654100
Fax: +41 61 5654101
info@camlogfoundation.org
www.camlogfoundation.org
CAD/CAM
[47] =>
CAD0413_01_Title
CES TECHNOLOGIES
QUI CHANGENT VOTRE
QUOTIDIEN !
• Technologie CBCT & imagerie
dentaire 3D
• Chirurgie guidée et implantologie
• Technologie CFAO et articulateur
numérique
• Flux numérique complet entre
dentiste et le prothésiste dentaire
• Impressions numériques
• Laser et technologies combinées
• Photographie dentaire
• Dentisterie esthétique
• Ateliers pratiques et éducation
CONFÉRENCES – HALL D’EXPOSITION – ATELIERS PRATIQUES
Contact / Information :
participants@imaginadental.org
IMAGINADENTAL_2014_210x297.indd 1
13/09/13 13:32
[48] =>
CAD0413_01_Title
CAD0413_48_Events 12.12.13 14:30 Seite 1
I meetings _ events
International Events
2014
IMAGINA Dental
3rd 3-D & CAD/CAM Digital Dentistry Congress
13–15 February 2014
Monaco
www.imaginadental.org
ITI World Symposium
24–26 April 2014
Geneva, Switzerland
www.iti.org
9th CAD/CAM & Digital Dentistry
International Conference
9 & 10 May 2014
Dubai, UAE
www.cappmea.com
EAED 28th Annual Meeting
29–31 May 2014
Athens, Greece
www.eaed.org
APDC 36th Asia Pacific Dental Congress
17–19 June 2014
Dubai, UAE
www.apdentalcongress.org
IACA 2014 Annual Meeting
24–26 July 2014
Bahamas
www.theiaca.com
AAED 39th Annual Meeting
5–8 August 2014
Santa Barbara, CA, USA
www.estheticacademy.org
FDI Annual World Dental Congress
11–14 September 2014,
New Delhi, India
www.fdi2014.org.in
ESCD 11th Annual Meeting
9–11 October 2014
Rome, Italy
www.escdonline.eu
155th ADA Annual Session
9–12 October 2014
San Antonio, USA
www.ada.org
EAO 2014
16–19 October 2014
Rome, Italy
www.eao.org
BACD Annual Conference
6–8 November 2014
Liverpool, UK
www.bacd.com
48 I CAD/CAM
4_ 2013
[49] =>
CAD0413_01_Title
CAD0413_49_Submission 12.12.13 14:30 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
4_ 2013
I 49
[50] =>
CAD0413_01_Title
CAD0413_50_Impressum 12.12.13 14:30 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
Melissa Brown
m.brown@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
Esther Wodarski
e.wodarski@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: Esther Wodarski
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
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
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 2013 with four issues. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I CAD/CAM
4_ 2013
[51] =>
CAD0413_01_Title
3Shape Dental System™
The professional CAD/CAM system for dental labs
Dental System™ offers solutions for labs of any size and business model. The included 3Shape LABcare™
package gives users unlimited upgrades, plus access to online support, and expert training.
D900 Scanner with RealColor™ technology
Four high-res 5MP cameras provide extraordinary speed
and highly accurate color scanning. Capture all textures
and colors such as color markings on the model. The perfect scanner for high volume productive-orientated labs.
4 x 5.0 MP Cameras
RealColor
Implant Bar & Bridges and more
Get a precise and productive tool for designing sophisticated implant bars and bridges for both removable and
fixed prosthesis.Enjoy also Dentures, New Abutment Designer™, Post & Core, Orthodontic appliances and much
more.
TRIOS® Inbox & 3Shape Communicate™
Dental System™ includes free connectivity to TRIOS ®
systems in dental clinics so labs can receive impression
scans directly. Smart communication tools enhance cooperation with the dentist.
Stay up to date with the latest news,
product announcements, special offers,
articles, and more
Sign up for our newsletter – Digital Trends
Follow us on:
Scan the QR code to register.
™
[52] =>
CAD0413_01_Title
CARES ® X-Stream™
The complete implant-based single-tooth
prosthetic restoration in 1 step:
1 scan, 1 design and 1 delivery
Straumann® CARES ® X-Stream™ is a new solution-driven functionality providing a one-step single-tooth prosthetic solution.
Enhance your productivity and profitability with only one scan, one design, associated with an excellent component fit.
More on: www.straumann.com/CARES8
RZ_STRMN_CARES_8.0_X-Stream_A4.indd 1
11.04.13 13:50
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/ Digital implant dentistry —a workflow in five steps
/ Restoring implants using lithium-disilicate - CAD/CAM fabricated restorations
/ The finesse of the pink and the power of IPS e.max
/ Diode laser application optimises the clinical outcomes of digital workflow
/ MIS Dental Implants: When virtual becomes reality with the MGUIDE MORE
/ New open CAD/CAM solutions for dentists and dental laboratories from Planmeca
/ Compact 5 axis table-top machines for milling metal - zirconium dioxide - acrylics and wax
/ Straumann presents data and innovations that may change paradigms in implant dentistry
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