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CAD/CAM IN
PROSTHODONTICS
Fateema Priyam Feroz
IIIrd Year P.G
Dept. of Prosthodontics
1
CONTENTS
 Introduction
 History
 General principles
 Components of CAD/CAM
 Subtractive and Additive techniques
 Evolution of CAD/CAM
2
 Materials for CAD/CAM
 Common CAD/CAM systems
 Recent advances
 Advantages and disadvantages of CAD/CAM
 Summary
 Discussion
 Conclusion
3
INTRODUCTION
4
 The long-term success of restorations depends,
to a considerable extent ??????
 With the conventional impression procedures ----
--- lost-wax-casting technique in the production
of metal castings or frameworks, their accuracy is
greatly influenced by the properties of the
impression materials, investment and casting
alloy.
5
 With the lost wax modeling method, the fit of a
crown on the die can be satisfactory, but ????
 Because traditional procedures are time-
consuming, efforts have been made to replace these
with computer-assisted procedures.
6
 Milling of dental restorations from a block of
base material, such as metal, ceramic or resin, is
proposed as an alternative for fabricating
restorations ?????
 To produce milled restorations with accurate fit,
digitization of the prepared tooth surface and
converting the data into control signals for
computer-assisted milling is used.
7
 Computer-aided design/computer-aided
manufacturing (CAD/CAM) technology
which was developed in the late 1980s for
dentistry, incorporates the above mentioned
techniques and it significantly reduced and/or
eliminated problems associated with dental
castings.
8
HISTORY
9
 In dentistry, the major developments of dental
CAD/CAM systems occurred in the 1980s.
 Dr. Duret – developer of Sopha System
 Dr. Moermann - the developer of the CEREC
system
 Dr. Andersson - the developer of the Procera
system
10
 Dr. Duret fabricated crowns (1971) with the
functional shape of the occlusal surface using a
series of systems that started with an optical
impression of the abutment tooth in the mouth,
followed by designing an optimal crown considering
functional movement, and milling a crown using a
numerically controlled milling machine.
11
12
13
 Dr. Moermann, the developer of the
CEREC system.
 He directly measured the prepared cavity with an
intra-oral camera, which was followed by the design
and carving of an inlay from a ceramic block using a
compact machine set at chair-side.
 Benefit: ?????????
14
15
 Dr. Andersson, the developer of the
Procera system
 Fabricated titanium copings by spark erosion and
introduced CAD/CAM technology into the process of
composite veneered restorations.
 Later developed as a system with processing center
networked with satellite digitizers around the world for
the fabrication of all-ceramic frameworks.
16
17
18
GENERAL
PRINCIPLES
19
CAD/CAM SYSTEMS
 All CAD/CAM systems consist of three components:
1) A digitalization tool/scanner that transforms
geometry into digital data that can be processed by
the computer
2) Software that processes data and, depending on the
application, produces a data set for the product to be
fabricated
3) A production technology that transforms the data set
into the desired product.
20
21
CAD/CAM - PRODUCTION
CONCEPTS
 Depending on the location of the components
of the CAD/CAM systems, in dentistry three
different production concepts are available:
1) chairside production
2) laboratory production
3) centralised fabrication in a production centre.
22
CAD/CAM COMPONENTS
23
 CAD/CAM components can be grouped into
three:
1) Scanner / Data collecting tool
2) Design software
3) Processing devices
24
1. Scanner
 It includes the data collection tools that measure
three dimensional jaw and tooth structures and
transform them into digital data sets.
 Basically there are two different scanning
possibilities:
1) optical scanners
2) mechanical scanners.
25
1.a) Optical scanners
 It involves the collection of 3D structures in a
so-called ‘triangulation procedure’.
 The source of light and the receptor unit are in
a definite angle in their relationship to one
another.
 White light projections or a laser beam can
serve as a source of illumination
26
27
 Examples of optical scanners :
 Lava Scan ST (3M ESPE, white light
projections)
 es1 (etkon, laser beam).
28
1.b) Mechanical scanner
 The master cast is read mechanically line-by-line
by means of a ruby ball and the three-dimensional
structure measured.
 The Procera Scanner from Nobel Biocare
 This type of scanner is distinguished by a high
scanning accuracy, whereby the diameter of the
ruby ball is set to the smallest grinder in the
milling system
29
 Drawbacks of the system:
 The apparatus is very expensive
 Long processing times compared to optical
systems.
30
31
2. Design software
 With such softwares, crown and fixed partial dentures
(FPD) frameworks can be constructed.
 Some systems also offer the opportunity to design full
anatomical crowns, partial crowns, inlays, inlay
retained FPDs, and telescopic primary crowns.
 The software available on the market is being
continuously improved.
32

33
34
 The data of the construction can be stored in
various data formats.
 The basis therefore is often standard
transformation language (STL) data.
 Many manufacturers, however, use their own data
formats, specific to that particular manufacturer.
35
3. Processing devices
 The construction data produced with the CAD software
are converted into milling strips for the CAM-processing
and finally loaded into the milling device.
 Processing devices are distinguished by means of the
number of milling axes:
 3-axis devices
 4-axis devices
 5-axis devices.
36
37
3.a) 3-axis milling devices
 This type of milling device has degrees of
movement in the three spatial directions, and so
the mill path points are uniquely defined by the
X -, Y -, and Z – values
 A milling of subsections, axis divergences and
convergences, however, is not possible
 This demands a virtual blocking in such areas
38
 The advantages of these milling devices are short
milling times and simplified control by means of the
three axis.
 Also these devices are less costly than those with a
higher number of axes.
 Examples of 3-axis devises:
 inLab (Sirona),
 Lava (3M ESPE),
 Cercon brain (DeguDent).
39
40
41
3.b) 4-axis milling devices
 In addition to the three spatial axes, the tension
bridge for the component can also be turned
infinitely variably .
 As a result it is possible to adjust bridge
constructions with a large vertical height
displacement into the usual mould dimensions and
thus save material and milling time.
 Example: Zeno (Wieland-Imes).
42
43
44
3.c) 5-axis milling devices
 In addition to the three spatial dimensions and the
rotatable tension bridge (4th axis), the 5-axis milling
device has the possibility of rotating the milling spindle
(5th axis)
 This enables the milling of complex geometries with
complex shapes such as denture base resins.
Trial of a Cad/Cam system for fabricating dentures-Dental materials
journal-2011 45
46
 Example in the Laboratory Area: Everest
Engine (KaVo).
 Example in the Production Centre: HSC
Milling Device (etkon).
47
MILLING VARIANTS
Dry processing
 Applied mainly with respect to zirconium oxide
blanks with a low degree of pre-sintering.
 Advavtages:
 Minimal investment costs for the milling device
 No moisture absorption by the die ZrO2 mould
 Disadvantages:
 Higher shrinkage values for the frameworks.
48
 EXAMPLES
[Zeno 4030 (Wieland- Imes), Lava Form and
Cercon brain].
49
50
Wet milling
 In this process the milling diamond or carbide cutter
is protected by a spray of cool liquid against
overheating of the milled material.
 Useful for all metals and glass ceramic material in
order to avoid damage through heat development.
 ‘Wet’ processing is recommended, if zirconium oxide
ceramic with a higher degree of pre-sintering is
employed for the milling process.
51
 Examples:
Everest (KaVo), Zeno 8060 (Wieland-Imes),
inLab (Sirona).
52
53
54
3 D PRINTING
 It is another manufacturing approach to build
objects, one layer at a time and adding multiple
layers to form an object.
 It is also known as additive manufacturing or
rapid prototyping (RP).
55
 It may be used for the fabrication of metal
structures either indirectly by printing in burn-
out resins or waxes for a lost-wax process, or
directly in metals or metal alloys like FPD and
removable partial denture (RPD), polymerized
prostheses, and silicon prosthesis.
56
Selective laser sintering
 A scanning laser fuses a fine material powder,
to build up structures layer by layer, as a
powder bed drops down incrementally, and a
new fine layer of material is evenly spread over
the surface.
 Resolution as high as 60 μm may be obtained,
and the structures printed are supported by the
surrounding powder
57
58
Stereolithography
 Light-sensitive polymer cured layer by layer by
a scanning laser in a vat of liquid polymer.
 It is a widely employed RP technology. It was
invented by Charles Hull .
59
 It is an additive manufacturing process in
which a liquid photocurable resin acrylate
material is used.
 Stereolithography uses a highly focused
Ultraviolet (UV) laser to trace out successive
cross-sections of a 3D object in a vat of liquid
photosensitive polymer
60
 It may be used for the fabrication of metal
structures either indirectly by printing in burn-
out resins or waxes for a lost-wax process, or
directly in metals or metal alloys like FPD and
removable partial denture (RPD), polymerized
prostheses, and silicon prosthesis.
61
62
 Currently, subtractive milling is the most
widely implemented computer-aided
manufacturing protocol in dentistry and it has
been shown to be a suitable method for
fabricating intraoral prostheses.
63
 Additive methods have the advantage of
producing large objects, with surface
irregularities, undercuts, voids, and hollow
morphology that makes them suitable for
manufacturing facial prostheses and metal
removable partial denture frameworks.
64
EVOLUTION OF CAD CAM
65
66
Evolution of software and hardware in CAD CAM 2017
67
68
69
Materials for CAD/CAM
Processing
70
Materials
 Materials for processing by CAD/CAM devices
depends on the respective production system
 Some milling devices are specifically designed
for the production ZrO2 frames, while others
cover the complete palette of materials from
resins to glass ceramics and high performance
ceramics.
71
 The materials normally processed by
CAD/CAM systems include:
1) Metals
2) Resin materials
3) Silica based ceramics
4) Infiltrated ceramics
5) Oxide ceramics
72
Metals
 Presently titanium, titanium alloys and chrome
cobalt alloys are processed using dental milling
devices.
 The milling of precious metal alloys has been
shown to be of no economic interest, due to the high
metal attrition and the high material costs.
 Examples: coron (etkon: non-precious metal alloy),
Everest Bio T-Blank (KaVo, pure titanium).
73
Resin material
 It is possible to use resin materials directly as crown
and FPD frameworks for long-term provisional or for
full anatomical long-term temporary prostheses????
 Prefabricated semi-individual polymer blanks
(semi-finished) with a dentine-enamel layer are
provided by one manufacturer (artegral imCrown,
Merz Dental).
74
 The first commercial resin composite for
CAD/CAM –Paradigm MZ100(3M ESPE)
75
Silica Based Ceramics
 Grindable silica based ceramic blocks are offered by
several CAD/CAM systems for the production of inlays,
onlays, veneers, partial crowns and full crowns
 It is usually available as monochromatic blocks
 Various manufacturers now offer blanks with
multicoloured layers [Vitablocs TriLuxe (Vita), IPS
Empress CAD Multi (IvoclarVivadent)], for the purpose
of full anatomical crowns.
76
77
 Lithium disilicate ceramic blocks -full anatomical
anterior and posterior crowns,copings in the
anterior and posterior region and for three-unit
FPD frameworks in the anterior region due to
their high mechanical stability of 360 MPa
78
Glass Ceramics
 Glass ceramics are particularly well suited to
chairside application due to their translucent
characteristics, similar to that of the natural tooth
structure.
 Provides esthetically pleasing results without
veneering.
 Etchable with hydrofluoric acid due to their higher
glass content – can be inserted very well using
adhesive systems.
79
80
Infiltration Ceramics
 Grindable blocks of infiltration ceramics are processed
in porous, chalky condition and then infiltrated with
lanthanum glass.
 All blanks for infiltration ceramics originate from the
Vita In-Ceram system (Vita) and are offered in three
variations:
 Vita In-Ceram Alumina (Al2O3)
 Vita In-Ceram Zirconia (70% Al2O3, 30% ZrO2)
 VITA In-Ceram Spinell (MgAl2O4) 81
 Vita In-Ceram Alumina (Al2O3): suitable for crown
copings in the anterior and posterior region, three-unit
FPD frameworks in the anterior region
 Vita In-Ceram Zirconia (70% Al2O3, 30% ZrO2):
suitable for crown copings in the anterior and
posterior region, three-unit FPD frameworks in the
anterior and posterior region.
 Suitable for discolored teeth due to its superior
masking ability
82
VITA In-Ceram Spinell (MgAl2O4):
 Highest translucency of all oxide ceramics and
is thus recommended for the production of
highly aesthetic anterior crown copings, in
particular on vital abutment teeth and in the
case of young patients.
83
84
85
COMMON COMMERCIAL
CAD/CAM SYSTEMS
86
 CAD/CAM systems may be categorized as:
 In-office system
 Laboratory based system
 Milling center system
87
In-Office systems
88
CEREC
 Sirona, with their CEREC line of products, is the only
manufacturer that currently provides both in-office and
laboratory-based systems.
 CEREC 1 and CEREC 2 – optical scan of the prepared
tooth with a charged-coupled device (CCD) camera,
and the system automatically generates a 3D digital
image on the monitor
 Then, the restoration is designed and milled
89
 With the newer CEREC 3D, the operator can record
multiple images within seconds.
 This enables the clinicians to prepare multiple teeth in
the same quadrant and create a virtual cast for the entire
quadrant.
 On the virtual model, the operator designs the contour of
the restoration and electronically transmits the data to a
remote milling unit for fabrication.
 Better marginal adaptation
90
91
Laboratory-Based Systems
92
CEREC inLab
 It is a laboratory-based system
 Working dies are laser-scanned and a digital image of
the virtual model is displayed on a computer screen.
 After designing the coping or framework, the
laboratory technician inserts the appropriate ceramic
block into the CEREC inLab machine for milling.
93
 A wide range of high strength ceramic blocks are
available for the inLab system
 It includes Vita In-Ceram blocs two sintered
ceramics:
inCoris ZI (zirconium oxide) and inCoris AL
(aluminium oxide) (Sirona Dental Systems, LLC).
 After milling, the technician manually inspects and
verifies the fit of the milled coping or framework on
the die and working cast.
94
 Subsequently, the coping will be adjusted to
maximize adaptation to the die.
 The coping or framework then is either glass-in
filtrated (Vita In-Ceram) or sintered (zirconium
oxide or aluminium oxide), and the veneering
porcelain is added
95
96
Milling Center Systems
97
DCS Precident
 The system is comprised of a Preciscan laser scanner
and Precimill CAM multitool milling center.
 It can scan 14 dies simultaneously and mill up to 30
framework units in a single, fully automated
operation.
 It can mill titanium as well as fully dense sintered
zirconia.
98
99
Procera
 Procera/AllCeram was introduced in 1994
 Uses an innovative concept for generating alumina
and zirconia copings.
 The master die is scanned and the data is send to
the processing center.
 After processing,the coping is send back to the lab
for porcelain veneering.
100
 The recommended preparation marginal design for
a Procera/AllCeram restoration is a deep chamfer or
shoulder with a rounded internal line angle and a
well-defined cavosurface finish line.
 The recommended coping thickness is 0.4 mm to
0.6 mm.
101
102
 Nobel Biocare USA LLC has introduced various
implant abutments for its Procera system—
titanium (1998)
alumina (2002)
zirconia (2003)
 Capable of generating alumina (two to four units) and
zirconia (up to 14 units) bridge copings.
 The occlusal-cervical height of the abutment should
be at least 3 mm, and the pontic space should be less
than 11 mm.
103
VIDEO PRESENTATION
104
NEWER CONCEPTS
105
Cercon (2002)
 Wax pattern (coping) with a minimum thickness of
0.4 mm are to be made which is scanned and the
Cercon Brain milling unit milled a zirconia coping
from proprietary presintered zirconia blanks.
 The coping then was sintered in the Cercon Heat
furnace (1350 C) for 6 to 8 hrs.
 A low-fusing, leucite-free Cercon Ceram S veneering
porcelain was used to provide the esthetic contour.
106
 In 2005, DENTSPLY Ceramco introduced the
Cercon Eye 3D laser optical scanner and Cercon Art
CAD design software.
 Now, as a complete CAD/CAM system, Cercon can
produce single units and bridges up to nine units
from pre-sintered zirconia milling blocks that are
offered in white and ivory shades without any
infiltration required
107
108
Lava
 Lava system Introduced in 2002.
 It includes a mobile cart,a touch screen display
and a scanner with camera at the end.
 Camera has LEDs and lens systems
 Data-send through wireless to the laboratory
where the die is cut and margins are marked
digitally.
109
110
CEREC
 The system offers two possibilities:
o Scanning for in-office fabrication
o Sending digital images to the laboratory
 Transfer is only possible if the laboratory has
CEREC CONNECT
 Light source: LED (blue visible light)
111
CEREC AC machine
112
 The occlusion is recorded by simply scanning the
arches, and digital on-screen articulating paper
shows where there are contacts.
113
 Image acquisition is more rapid with CEREC AC
 The clinician can verify the preparation and
interocclusal clearance
 The system will also digitally mark the margins and
provide a digital version of the proposed restoration
prior to its fabrication
114
Lava C.O.S.
 The Lava C.O.S. system is used for chairside
digital impression making
 Scanner contains 192 LEDs and 22 lens systems
with a pulsating blue light
 It uses continuous video to capture the data that
appears on the computer touch screen during
scanning
 2,400 data sets are captured per arch.
115
 Can rotate and magnify the view on the screen
 Full arch is scanned after the preparation
imaging is complete, followed by the opposing
quadrant, and the occlusion is assessed
 Images can be transmitted directly to an
authorized laboratory
116
 Laboratory technician digitally marks the margins
and sections the virtual model prior to sending this
digitally to the manufacturer
 The model is then virtually ditched, articulated and
sent to the model fabrication center for
stereolithography (SLA) to create acrylic models
117
Lava C.O.S. system
118
KELKAR
119
120
TWO VISIT CAD CAM DENTURE
REHABILITATION-A CASE REPORT
121
122
123
124
125
126
127
128
129
Advantages
130
 The advantages of using CAD/CAM technology
for the fabrication of crowns and FPDs can be
summarized as:
1) application of new materials
2) reduced labor
3) cost effectiveness and
4) quality control.
131
 High-strength ceramics that were expected to be the
new materials for FPDs frameworks have been
difficult to process using conventional dental
laboratory technologies. CAD/CAM offers a
solution for this.
 CAD/CAM technology was useful and effective in
compensating for changes in dimensions that come
with processing chalky material and post-treatment
to obtain fit of crowns and FPDs to abutment teeth.
132
 Conventional dental laboratory technologies are
traditionally labor-intensive and the labor was
vastly reduced using CAD/CAM machine.
 Conventional porcelain dental laboratory
processing with powder build-up and baking
required a degree of proficiency both in terms of
reproducing natural esthetics and shaping –
increases the cost
 CAD/CAM due to mass production can reduce the
cost.
133
Drawbacks:
 Need for costly equipment
 Need for extended training
 Technique sensitive
 Inability to image in a wet environment
134
 The powder layer applied to the tooth surface
results in an additional thickness of 13 to 85 μm.
 The restricted measuring conditions in the mouth,
including the presence of adjacent teeth, gingiva,
and saliva, make accurate recognition of the margin
of an abutment difficult
135
 Regardless of the digitizing mode applied,
clinical parameters, such as saliva, blood, or
movements of the patient can affect the
accurate reproduction of teeth.
136
DISCUSSION
137
SUMMARY
138
 Newer CAD/CAM systems demonstrate
increasing user friendliness, expanded
capabilities, improved quality, and greater
range in complexity and application.
 Chairside digital impressions systems allow for
the creation of accurate and precise laboratory
models and restorations involving less
chairside time.
139
 Fractures of ceramic FPDs tended to occur in the
connector areas because of the concentrated
stress. Therefore, the design of the connector,
particularly the dimensions, must be made
independently depending on the type of ceramic
material used for the framework.
 CAD better guarantees the durability and reduces
the risk of fracture.
 Processing data can be saved and followed up
during the functional period for the device.
140
To conclude,
As Duret stated, “The systems will continue
to improve in versatility, accuracy, and cost
effectiveness and will be a part of routine
dental practice in coming time”.
141
REFERENCES
142
Text books
1. Anusavice, Shen, Rawls; Phillip’s Science of Dental
Materials 2013, 12th edition, Elsevier.
2. Ronald L Sakguchi, John M Powers; Craig’s Restorative
Dental Materials 2013, 13th edition, Elsevier.
3. Marco Anntonio Bottino; Perception: Esthetics in Metal
Free Prosthesis of Natural Teeth and Implants 2009, Artis
Medicas Dentistry.
4. Bernard Touati, Paul Miara, Dan Nathanson: Esthetic
Dentistry and Ceramic Restorations 1999, informa healthcare.
143
Journals
1. AD Bona, AD Noguiera, OE Pecho; Optical properties of
CAD/CAM ceramic sysems; J Dent 2014, 42: 1202-09
2. GD Quin, AA Guiseppetti, KH Hoffman; Chipping fracture
resistance of dental CAD/CAM restorative materials; Dent Mater
2014, 30(5): e112-e123
3. Z Zhang, Y Tamaki, Y Hotta, T Miyasaki; Novel method for
titanium crown casting using a combination of wax patterns
fabricated by a CAD/CAM system and a non expanded investment;
Dent Mater 2006, 22: 681-87.
144
4. O Moldovan, RG Luthardt, N Corcodel, H Rudolph; Three
dimensional fit of CAD/CAM made zirconia copings; Dent
Mater 2011, 27: 1273-78.
5. S Giaunetopoulos, RV Noort, E Triston; Evaluation of the
marginal integrity of ceramic copings with different marginal
angles using two different CA/CAM systems; J Dent 2010,
38: 980-86.
6. ER Batson, LF Cooper, I Duqum, G Mendonca; Clinical
outcomes of three different crown systems with CAD/CAM
technology; J Prosthet Dent 2014, 28(5): 234-40
145
7. Raul Euan, OF A lvarez, JC Termes, RO Parra; Marginal adaptation
of zirconium dioxide copings: Influence of the CAD/CAM system
and the finish line design; J Prosthet Dent 2014, 112: 155-62.
8. C Chen, FZ Trindade, N de Jager, CJ Kleverlaan, AJ Feilzer; The
fracture resistance of a CAD/CAM resin nano-ceramic (RNC) and a
CAD ceramic at different thickness; Dent Mater 2014, 30: 954-62.
9. Jeramies Hey, F Beur, T Bensel, AF Boeckler; Single crowns with
CAD/CAM fabricated copings from titanium: 6 year clinical results; J
Prosthet dent 2014, 112: 150-154.
146
10. AC Johnson, A Versluis, D Tantbirojn, S Ahuja; Fracture
strength of CAD/CAM composite and composite-ceramic
occlusal veneers; J Prosthodont Res 2014, 58(2): 107-114.
11. NS Birbaum, HB Aoronson; Dental impressions using 3D
digital scanners: Virtual becomes reality; Compendium 2008,
29(8): 494-505.
12. T Miyasaki, Y Hotta, J Kuni et al; a REVIEW OF DENTAL
cad/cam: Current status and future perspectives from 20
years of experience; Dent Mater 2009, 28(1): 44-56.
147
13. PR Liu, ME Essig; A panorama of dental CAD/CAM
restorative systems; Compendium 2008, 29(8): 482-493.
14. A Begum, R Ahmed, S Islam; Digital impressions; City
Dental College J 2012, 9(2): 31-34.
15. SS Manthri, AS Bhasin; CAD/CAM in dental restorations: An
overview; Annals and Essens of Dentistry 2010, II (3): 123-28.
148
THANK YOU
149

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Cad cam in prosthodontics

  • 1. CAD/CAM IN PROSTHODONTICS Fateema Priyam Feroz IIIrd Year P.G Dept. of Prosthodontics 1
  • 2. CONTENTS  Introduction  History  General principles  Components of CAD/CAM  Subtractive and Additive techniques  Evolution of CAD/CAM 2
  • 3.  Materials for CAD/CAM  Common CAD/CAM systems  Recent advances  Advantages and disadvantages of CAD/CAM  Summary  Discussion  Conclusion 3
  • 5.  The long-term success of restorations depends, to a considerable extent ??????  With the conventional impression procedures ---- --- lost-wax-casting technique in the production of metal castings or frameworks, their accuracy is greatly influenced by the properties of the impression materials, investment and casting alloy. 5
  • 6.  With the lost wax modeling method, the fit of a crown on the die can be satisfactory, but ????  Because traditional procedures are time- consuming, efforts have been made to replace these with computer-assisted procedures. 6
  • 7.  Milling of dental restorations from a block of base material, such as metal, ceramic or resin, is proposed as an alternative for fabricating restorations ?????  To produce milled restorations with accurate fit, digitization of the prepared tooth surface and converting the data into control signals for computer-assisted milling is used. 7
  • 8.  Computer-aided design/computer-aided manufacturing (CAD/CAM) technology which was developed in the late 1980s for dentistry, incorporates the above mentioned techniques and it significantly reduced and/or eliminated problems associated with dental castings. 8
  • 10.  In dentistry, the major developments of dental CAD/CAM systems occurred in the 1980s.  Dr. Duret – developer of Sopha System  Dr. Moermann - the developer of the CEREC system  Dr. Andersson - the developer of the Procera system 10
  • 11.  Dr. Duret fabricated crowns (1971) with the functional shape of the occlusal surface using a series of systems that started with an optical impression of the abutment tooth in the mouth, followed by designing an optimal crown considering functional movement, and milling a crown using a numerically controlled milling machine. 11
  • 12. 12
  • 13. 13
  • 14.  Dr. Moermann, the developer of the CEREC system.  He directly measured the prepared cavity with an intra-oral camera, which was followed by the design and carving of an inlay from a ceramic block using a compact machine set at chair-side.  Benefit: ????????? 14
  • 15. 15
  • 16.  Dr. Andersson, the developer of the Procera system  Fabricated titanium copings by spark erosion and introduced CAD/CAM technology into the process of composite veneered restorations.  Later developed as a system with processing center networked with satellite digitizers around the world for the fabrication of all-ceramic frameworks. 16
  • 17. 17
  • 18. 18
  • 20. CAD/CAM SYSTEMS  All CAD/CAM systems consist of three components: 1) A digitalization tool/scanner that transforms geometry into digital data that can be processed by the computer 2) Software that processes data and, depending on the application, produces a data set for the product to be fabricated 3) A production technology that transforms the data set into the desired product. 20
  • 21. 21
  • 22. CAD/CAM - PRODUCTION CONCEPTS  Depending on the location of the components of the CAD/CAM systems, in dentistry three different production concepts are available: 1) chairside production 2) laboratory production 3) centralised fabrication in a production centre. 22
  • 24.  CAD/CAM components can be grouped into three: 1) Scanner / Data collecting tool 2) Design software 3) Processing devices 24
  • 25. 1. Scanner  It includes the data collection tools that measure three dimensional jaw and tooth structures and transform them into digital data sets.  Basically there are two different scanning possibilities: 1) optical scanners 2) mechanical scanners. 25
  • 26. 1.a) Optical scanners  It involves the collection of 3D structures in a so-called ‘triangulation procedure’.  The source of light and the receptor unit are in a definite angle in their relationship to one another.  White light projections or a laser beam can serve as a source of illumination 26
  • 27. 27
  • 28.  Examples of optical scanners :  Lava Scan ST (3M ESPE, white light projections)  es1 (etkon, laser beam). 28
  • 29. 1.b) Mechanical scanner  The master cast is read mechanically line-by-line by means of a ruby ball and the three-dimensional structure measured.  The Procera Scanner from Nobel Biocare  This type of scanner is distinguished by a high scanning accuracy, whereby the diameter of the ruby ball is set to the smallest grinder in the milling system 29
  • 30.  Drawbacks of the system:  The apparatus is very expensive  Long processing times compared to optical systems. 30
  • 31. 31
  • 32. 2. Design software  With such softwares, crown and fixed partial dentures (FPD) frameworks can be constructed.  Some systems also offer the opportunity to design full anatomical crowns, partial crowns, inlays, inlay retained FPDs, and telescopic primary crowns.  The software available on the market is being continuously improved. 32
  • 34. 34
  • 35.  The data of the construction can be stored in various data formats.  The basis therefore is often standard transformation language (STL) data.  Many manufacturers, however, use their own data formats, specific to that particular manufacturer. 35
  • 36. 3. Processing devices  The construction data produced with the CAD software are converted into milling strips for the CAM-processing and finally loaded into the milling device.  Processing devices are distinguished by means of the number of milling axes:  3-axis devices  4-axis devices  5-axis devices. 36
  • 37. 37
  • 38. 3.a) 3-axis milling devices  This type of milling device has degrees of movement in the three spatial directions, and so the mill path points are uniquely defined by the X -, Y -, and Z – values  A milling of subsections, axis divergences and convergences, however, is not possible  This demands a virtual blocking in such areas 38
  • 39.  The advantages of these milling devices are short milling times and simplified control by means of the three axis.  Also these devices are less costly than those with a higher number of axes.  Examples of 3-axis devises:  inLab (Sirona),  Lava (3M ESPE),  Cercon brain (DeguDent). 39
  • 40. 40
  • 41. 41
  • 42. 3.b) 4-axis milling devices  In addition to the three spatial axes, the tension bridge for the component can also be turned infinitely variably .  As a result it is possible to adjust bridge constructions with a large vertical height displacement into the usual mould dimensions and thus save material and milling time.  Example: Zeno (Wieland-Imes). 42
  • 43. 43
  • 44. 44
  • 45. 3.c) 5-axis milling devices  In addition to the three spatial dimensions and the rotatable tension bridge (4th axis), the 5-axis milling device has the possibility of rotating the milling spindle (5th axis)  This enables the milling of complex geometries with complex shapes such as denture base resins. Trial of a Cad/Cam system for fabricating dentures-Dental materials journal-2011 45
  • 46. 46
  • 47.  Example in the Laboratory Area: Everest Engine (KaVo).  Example in the Production Centre: HSC Milling Device (etkon). 47
  • 48. MILLING VARIANTS Dry processing  Applied mainly with respect to zirconium oxide blanks with a low degree of pre-sintering.  Advavtages:  Minimal investment costs for the milling device  No moisture absorption by the die ZrO2 mould  Disadvantages:  Higher shrinkage values for the frameworks. 48
  • 49.  EXAMPLES [Zeno 4030 (Wieland- Imes), Lava Form and Cercon brain]. 49
  • 50. 50
  • 51. Wet milling  In this process the milling diamond or carbide cutter is protected by a spray of cool liquid against overheating of the milled material.  Useful for all metals and glass ceramic material in order to avoid damage through heat development.  ‘Wet’ processing is recommended, if zirconium oxide ceramic with a higher degree of pre-sintering is employed for the milling process. 51
  • 52.  Examples: Everest (KaVo), Zeno 8060 (Wieland-Imes), inLab (Sirona). 52
  • 53. 53
  • 54. 54
  • 55. 3 D PRINTING  It is another manufacturing approach to build objects, one layer at a time and adding multiple layers to form an object.  It is also known as additive manufacturing or rapid prototyping (RP). 55
  • 56.  It may be used for the fabrication of metal structures either indirectly by printing in burn- out resins or waxes for a lost-wax process, or directly in metals or metal alloys like FPD and removable partial denture (RPD), polymerized prostheses, and silicon prosthesis. 56
  • 57. Selective laser sintering  A scanning laser fuses a fine material powder, to build up structures layer by layer, as a powder bed drops down incrementally, and a new fine layer of material is evenly spread over the surface.  Resolution as high as 60 μm may be obtained, and the structures printed are supported by the surrounding powder 57
  • 58. 58
  • 59. Stereolithography  Light-sensitive polymer cured layer by layer by a scanning laser in a vat of liquid polymer.  It is a widely employed RP technology. It was invented by Charles Hull . 59
  • 60.  It is an additive manufacturing process in which a liquid photocurable resin acrylate material is used.  Stereolithography uses a highly focused Ultraviolet (UV) laser to trace out successive cross-sections of a 3D object in a vat of liquid photosensitive polymer 60
  • 61.  It may be used for the fabrication of metal structures either indirectly by printing in burn- out resins or waxes for a lost-wax process, or directly in metals or metal alloys like FPD and removable partial denture (RPD), polymerized prostheses, and silicon prosthesis. 61
  • 62. 62
  • 63.  Currently, subtractive milling is the most widely implemented computer-aided manufacturing protocol in dentistry and it has been shown to be a suitable method for fabricating intraoral prostheses. 63
  • 64.  Additive methods have the advantage of producing large objects, with surface irregularities, undercuts, voids, and hollow morphology that makes them suitable for manufacturing facial prostheses and metal removable partial denture frameworks. 64
  • 66. 66 Evolution of software and hardware in CAD CAM 2017
  • 67. 67
  • 68. 68
  • 69. 69
  • 71. Materials  Materials for processing by CAD/CAM devices depends on the respective production system  Some milling devices are specifically designed for the production ZrO2 frames, while others cover the complete palette of materials from resins to glass ceramics and high performance ceramics. 71
  • 72.  The materials normally processed by CAD/CAM systems include: 1) Metals 2) Resin materials 3) Silica based ceramics 4) Infiltrated ceramics 5) Oxide ceramics 72
  • 73. Metals  Presently titanium, titanium alloys and chrome cobalt alloys are processed using dental milling devices.  The milling of precious metal alloys has been shown to be of no economic interest, due to the high metal attrition and the high material costs.  Examples: coron (etkon: non-precious metal alloy), Everest Bio T-Blank (KaVo, pure titanium). 73
  • 74. Resin material  It is possible to use resin materials directly as crown and FPD frameworks for long-term provisional or for full anatomical long-term temporary prostheses????  Prefabricated semi-individual polymer blanks (semi-finished) with a dentine-enamel layer are provided by one manufacturer (artegral imCrown, Merz Dental). 74
  • 75.  The first commercial resin composite for CAD/CAM –Paradigm MZ100(3M ESPE) 75
  • 76. Silica Based Ceramics  Grindable silica based ceramic blocks are offered by several CAD/CAM systems for the production of inlays, onlays, veneers, partial crowns and full crowns  It is usually available as monochromatic blocks  Various manufacturers now offer blanks with multicoloured layers [Vitablocs TriLuxe (Vita), IPS Empress CAD Multi (IvoclarVivadent)], for the purpose of full anatomical crowns. 76
  • 77. 77
  • 78.  Lithium disilicate ceramic blocks -full anatomical anterior and posterior crowns,copings in the anterior and posterior region and for three-unit FPD frameworks in the anterior region due to their high mechanical stability of 360 MPa 78
  • 79. Glass Ceramics  Glass ceramics are particularly well suited to chairside application due to their translucent characteristics, similar to that of the natural tooth structure.  Provides esthetically pleasing results without veneering.  Etchable with hydrofluoric acid due to their higher glass content – can be inserted very well using adhesive systems. 79
  • 80. 80
  • 81. Infiltration Ceramics  Grindable blocks of infiltration ceramics are processed in porous, chalky condition and then infiltrated with lanthanum glass.  All blanks for infiltration ceramics originate from the Vita In-Ceram system (Vita) and are offered in three variations:  Vita In-Ceram Alumina (Al2O3)  Vita In-Ceram Zirconia (70% Al2O3, 30% ZrO2)  VITA In-Ceram Spinell (MgAl2O4) 81
  • 82.  Vita In-Ceram Alumina (Al2O3): suitable for crown copings in the anterior and posterior region, three-unit FPD frameworks in the anterior region  Vita In-Ceram Zirconia (70% Al2O3, 30% ZrO2): suitable for crown copings in the anterior and posterior region, three-unit FPD frameworks in the anterior and posterior region.  Suitable for discolored teeth due to its superior masking ability 82
  • 83. VITA In-Ceram Spinell (MgAl2O4):  Highest translucency of all oxide ceramics and is thus recommended for the production of highly aesthetic anterior crown copings, in particular on vital abutment teeth and in the case of young patients. 83
  • 84. 84
  • 85. 85
  • 87.  CAD/CAM systems may be categorized as:  In-office system  Laboratory based system  Milling center system 87
  • 89. CEREC  Sirona, with their CEREC line of products, is the only manufacturer that currently provides both in-office and laboratory-based systems.  CEREC 1 and CEREC 2 – optical scan of the prepared tooth with a charged-coupled device (CCD) camera, and the system automatically generates a 3D digital image on the monitor  Then, the restoration is designed and milled 89
  • 90.  With the newer CEREC 3D, the operator can record multiple images within seconds.  This enables the clinicians to prepare multiple teeth in the same quadrant and create a virtual cast for the entire quadrant.  On the virtual model, the operator designs the contour of the restoration and electronically transmits the data to a remote milling unit for fabrication.  Better marginal adaptation 90
  • 91. 91
  • 93. CEREC inLab  It is a laboratory-based system  Working dies are laser-scanned and a digital image of the virtual model is displayed on a computer screen.  After designing the coping or framework, the laboratory technician inserts the appropriate ceramic block into the CEREC inLab machine for milling. 93
  • 94.  A wide range of high strength ceramic blocks are available for the inLab system  It includes Vita In-Ceram blocs two sintered ceramics: inCoris ZI (zirconium oxide) and inCoris AL (aluminium oxide) (Sirona Dental Systems, LLC).  After milling, the technician manually inspects and verifies the fit of the milled coping or framework on the die and working cast. 94
  • 95.  Subsequently, the coping will be adjusted to maximize adaptation to the die.  The coping or framework then is either glass-in filtrated (Vita In-Ceram) or sintered (zirconium oxide or aluminium oxide), and the veneering porcelain is added 95
  • 96. 96
  • 98. DCS Precident  The system is comprised of a Preciscan laser scanner and Precimill CAM multitool milling center.  It can scan 14 dies simultaneously and mill up to 30 framework units in a single, fully automated operation.  It can mill titanium as well as fully dense sintered zirconia. 98
  • 99. 99
  • 100. Procera  Procera/AllCeram was introduced in 1994  Uses an innovative concept for generating alumina and zirconia copings.  The master die is scanned and the data is send to the processing center.  After processing,the coping is send back to the lab for porcelain veneering. 100
  • 101.  The recommended preparation marginal design for a Procera/AllCeram restoration is a deep chamfer or shoulder with a rounded internal line angle and a well-defined cavosurface finish line.  The recommended coping thickness is 0.4 mm to 0.6 mm. 101
  • 102. 102
  • 103.  Nobel Biocare USA LLC has introduced various implant abutments for its Procera system— titanium (1998) alumina (2002) zirconia (2003)  Capable of generating alumina (two to four units) and zirconia (up to 14 units) bridge copings.  The occlusal-cervical height of the abutment should be at least 3 mm, and the pontic space should be less than 11 mm. 103
  • 106. Cercon (2002)  Wax pattern (coping) with a minimum thickness of 0.4 mm are to be made which is scanned and the Cercon Brain milling unit milled a zirconia coping from proprietary presintered zirconia blanks.  The coping then was sintered in the Cercon Heat furnace (1350 C) for 6 to 8 hrs.  A low-fusing, leucite-free Cercon Ceram S veneering porcelain was used to provide the esthetic contour. 106
  • 107.  In 2005, DENTSPLY Ceramco introduced the Cercon Eye 3D laser optical scanner and Cercon Art CAD design software.  Now, as a complete CAD/CAM system, Cercon can produce single units and bridges up to nine units from pre-sintered zirconia milling blocks that are offered in white and ivory shades without any infiltration required 107
  • 108. 108
  • 109. Lava  Lava system Introduced in 2002.  It includes a mobile cart,a touch screen display and a scanner with camera at the end.  Camera has LEDs and lens systems  Data-send through wireless to the laboratory where the die is cut and margins are marked digitally. 109
  • 110. 110
  • 111. CEREC  The system offers two possibilities: o Scanning for in-office fabrication o Sending digital images to the laboratory  Transfer is only possible if the laboratory has CEREC CONNECT  Light source: LED (blue visible light) 111
  • 113.  The occlusion is recorded by simply scanning the arches, and digital on-screen articulating paper shows where there are contacts. 113
  • 114.  Image acquisition is more rapid with CEREC AC  The clinician can verify the preparation and interocclusal clearance  The system will also digitally mark the margins and provide a digital version of the proposed restoration prior to its fabrication 114
  • 115. Lava C.O.S.  The Lava C.O.S. system is used for chairside digital impression making  Scanner contains 192 LEDs and 22 lens systems with a pulsating blue light  It uses continuous video to capture the data that appears on the computer touch screen during scanning  2,400 data sets are captured per arch. 115
  • 116.  Can rotate and magnify the view on the screen  Full arch is scanned after the preparation imaging is complete, followed by the opposing quadrant, and the occlusion is assessed  Images can be transmitted directly to an authorized laboratory 116
  • 117.  Laboratory technician digitally marks the margins and sections the virtual model prior to sending this digitally to the manufacturer  The model is then virtually ditched, articulated and sent to the model fabrication center for stereolithography (SLA) to create acrylic models 117
  • 120. 120
  • 121. TWO VISIT CAD CAM DENTURE REHABILITATION-A CASE REPORT 121
  • 122. 122
  • 123. 123
  • 124. 124
  • 125. 125
  • 126. 126
  • 127. 127
  • 128. 128
  • 129. 129
  • 131.  The advantages of using CAD/CAM technology for the fabrication of crowns and FPDs can be summarized as: 1) application of new materials 2) reduced labor 3) cost effectiveness and 4) quality control. 131
  • 132.  High-strength ceramics that were expected to be the new materials for FPDs frameworks have been difficult to process using conventional dental laboratory technologies. CAD/CAM offers a solution for this.  CAD/CAM technology was useful and effective in compensating for changes in dimensions that come with processing chalky material and post-treatment to obtain fit of crowns and FPDs to abutment teeth. 132
  • 133.  Conventional dental laboratory technologies are traditionally labor-intensive and the labor was vastly reduced using CAD/CAM machine.  Conventional porcelain dental laboratory processing with powder build-up and baking required a degree of proficiency both in terms of reproducing natural esthetics and shaping – increases the cost  CAD/CAM due to mass production can reduce the cost. 133
  • 134. Drawbacks:  Need for costly equipment  Need for extended training  Technique sensitive  Inability to image in a wet environment 134
  • 135.  The powder layer applied to the tooth surface results in an additional thickness of 13 to 85 μm.  The restricted measuring conditions in the mouth, including the presence of adjacent teeth, gingiva, and saliva, make accurate recognition of the margin of an abutment difficult 135
  • 136.  Regardless of the digitizing mode applied, clinical parameters, such as saliva, blood, or movements of the patient can affect the accurate reproduction of teeth. 136
  • 139.  Newer CAD/CAM systems demonstrate increasing user friendliness, expanded capabilities, improved quality, and greater range in complexity and application.  Chairside digital impressions systems allow for the creation of accurate and precise laboratory models and restorations involving less chairside time. 139
  • 140.  Fractures of ceramic FPDs tended to occur in the connector areas because of the concentrated stress. Therefore, the design of the connector, particularly the dimensions, must be made independently depending on the type of ceramic material used for the framework.  CAD better guarantees the durability and reduces the risk of fracture.  Processing data can be saved and followed up during the functional period for the device. 140
  • 141. To conclude, As Duret stated, “The systems will continue to improve in versatility, accuracy, and cost effectiveness and will be a part of routine dental practice in coming time”. 141
  • 143. Text books 1. Anusavice, Shen, Rawls; Phillip’s Science of Dental Materials 2013, 12th edition, Elsevier. 2. Ronald L Sakguchi, John M Powers; Craig’s Restorative Dental Materials 2013, 13th edition, Elsevier. 3. Marco Anntonio Bottino; Perception: Esthetics in Metal Free Prosthesis of Natural Teeth and Implants 2009, Artis Medicas Dentistry. 4. Bernard Touati, Paul Miara, Dan Nathanson: Esthetic Dentistry and Ceramic Restorations 1999, informa healthcare. 143
  • 144. Journals 1. AD Bona, AD Noguiera, OE Pecho; Optical properties of CAD/CAM ceramic sysems; J Dent 2014, 42: 1202-09 2. GD Quin, AA Guiseppetti, KH Hoffman; Chipping fracture resistance of dental CAD/CAM restorative materials; Dent Mater 2014, 30(5): e112-e123 3. Z Zhang, Y Tamaki, Y Hotta, T Miyasaki; Novel method for titanium crown casting using a combination of wax patterns fabricated by a CAD/CAM system and a non expanded investment; Dent Mater 2006, 22: 681-87. 144
  • 145. 4. O Moldovan, RG Luthardt, N Corcodel, H Rudolph; Three dimensional fit of CAD/CAM made zirconia copings; Dent Mater 2011, 27: 1273-78. 5. S Giaunetopoulos, RV Noort, E Triston; Evaluation of the marginal integrity of ceramic copings with different marginal angles using two different CA/CAM systems; J Dent 2010, 38: 980-86. 6. ER Batson, LF Cooper, I Duqum, G Mendonca; Clinical outcomes of three different crown systems with CAD/CAM technology; J Prosthet Dent 2014, 28(5): 234-40 145
  • 146. 7. Raul Euan, OF A lvarez, JC Termes, RO Parra; Marginal adaptation of zirconium dioxide copings: Influence of the CAD/CAM system and the finish line design; J Prosthet Dent 2014, 112: 155-62. 8. C Chen, FZ Trindade, N de Jager, CJ Kleverlaan, AJ Feilzer; The fracture resistance of a CAD/CAM resin nano-ceramic (RNC) and a CAD ceramic at different thickness; Dent Mater 2014, 30: 954-62. 9. Jeramies Hey, F Beur, T Bensel, AF Boeckler; Single crowns with CAD/CAM fabricated copings from titanium: 6 year clinical results; J Prosthet dent 2014, 112: 150-154. 146
  • 147. 10. AC Johnson, A Versluis, D Tantbirojn, S Ahuja; Fracture strength of CAD/CAM composite and composite-ceramic occlusal veneers; J Prosthodont Res 2014, 58(2): 107-114. 11. NS Birbaum, HB Aoronson; Dental impressions using 3D digital scanners: Virtual becomes reality; Compendium 2008, 29(8): 494-505. 12. T Miyasaki, Y Hotta, J Kuni et al; a REVIEW OF DENTAL cad/cam: Current status and future perspectives from 20 years of experience; Dent Mater 2009, 28(1): 44-56. 147
  • 148. 13. PR Liu, ME Essig; A panorama of dental CAD/CAM restorative systems; Compendium 2008, 29(8): 482-493. 14. A Begum, R Ahmed, S Islam; Digital impressions; City Dental College J 2012, 9(2): 31-34. 15. SS Manthri, AS Bhasin; CAD/CAM in dental restorations: An overview; Annals and Essens of Dentistry 2010, II (3): 123-28. 148

Editor's Notes

  1. BETWEEN THE RESTORATION AND THE PREPARED TOOTH
  2. PROBLEMS WITH CONTACT WITH THE OCCLUDING SURFACE
  3. GREATER ACCURACY AND SURFACE HOMOGENICITY
  4. which had an impact on the later development of dental CAD/CAM systems in the world.
  5. 4. When this system was announced, it rapidly spread the term CAD/CAM to the dental profession. ---The emergence of this system was really innovative because it allowed SAME DAY RESTORATION
  6. Meanwhile, a number of Japanese universities started research and development of dental CAD/ CAM systems in the latter half of the 1980s9-13) and several CAD/CAM systems have been available on the domestic Japanese market.
  7. 1. The basis of this type of scanner is the
  8. 3. , with the result that all data collected by the system can also be milled
  9. 1.----With such software, crown and fixed partial dentures (FPD) frameworks can be constructed on the one hand 2. The latest construction possibilities are continuously available to the user by means of updates.
  10. The quality of the restoration does not necessarily increase with the number of processing axes. The quality results much more from the result of the digitalisation, data processing and production process.
  11. 2. as a result of which there are no initial drying times for the ZrO2 frame prior to sintering.
  12. 3. . A higher degree of pre-sintering results in a reduction of shrinkage factor and enables less sinter distortion.
  13. Numerically controlled machine
  14. METALLIC AND CERAMIC FABRICATIONS WERE GENERATED IN THE SECOND GEN
  15. Less susceptible to chipping during milling.
  16. 1.---(fully anatomical, anatomically partially reduced)
  17. Marginal fit with this system is found to be satisfactory
  18. Initially only cam and no cad
  19. 2. Now, as a complete CAD/CAM system,
  20. If satisfactory The CEREC MC XL milling center
  21. These models can then be used for conventional laboratory techniques or for CAD/CAM restorations Stereolithography (SLA or SL; also known as optical fabrication, photo-solidification, solid free-form fabrication and solid imaging) is an additive manufacturing or 3D printing technology used for producing models, prototypes, patterns, and production parts up one layer at a time by curing a photo-reactive resin with a UV laser or another similar power source
  22. 1. This total processing time was much shorter than that of conventional powder build-up and baking of porcelain. In addition, the operator attended the machine for only 5-6 min and most of the process was performed automatically by the CAD/CAM machine
  23. 1. some drawbacks of this fabrication technology have to be mentioned.
  24. Newer materials are more esthetic and wear more like enamel and strong enough for full crown and bridges.