I am all for the CAD/CAM method in the dental industry, but it must be used correctly so that it is beneficial to the patient. I understand that the times are changing, but the industry needs to evolve and adapt with/to the new technologies on offer.
The biggest stigma in the industry is the assumption that these new technological advancements will replace the current workforce (Dental Technicians, Technologists, etc).
I feel that this is not the case as Machines would not be able to reproduce the artistic flare that a trained Dental Technologist is able of achieving. Yes, the Machine is more accurate (up to 25μm- microns in some cases) and its manufacturing time might be quicker but it will have its limitations. Such as aesthetics in Crown build up. The milled Crown can only be as aesthetic pleasing as that of the milling material its been milled out of. Whereas in the conventional Ceramic build up of porcelain the Technician can layer the different porcelain layers where he deems necessary.
Yes, anyone can be trained to use CAD/CAM system. But the knowledge of the oral anatomy, tooth-morphology, etc. need to be adhered to when designing a Dental appliance or restoration. So Dental Technicians and Technologists need to be looking at getting trained in using these new innovations and methods to secure more jobs in the future.
CAD/CAM technology has been around for many years in various other industries it has only recent years made its appearance in the dental industry. It has bridged a gap in the technological market and brought us one step closer to becoming a slightly more technologically advanced industry.
CAD/CAM can be used to design crowns, inlays, onlays, veneers, fixed bridges, dental implant restorations, dentures removable or fixed as well as orthodontic appliances It has a wide array of options when it comes to choosing materials for manufacturing of different prostheses
According to DiMatteo: 2017 research suggests that today’s milled CAD/CAM restorations are stronger than those milled from earlier materials. They also are less likely to fracture. Although CAD/CAM technology is not a replacement for the accuracy and talent provided by a dental laboratory technicians. Dentists must be precise in creating the initial tooth preparation; both dentists and laboratory technicians must be accurate when taking the digital impression and drawing the restoration. Equally important is the accuracy and skill with which they design a restoration, particularly since the fit of a restoration is critical to preventing future tooth damage. It is important to note that not every tooth/ teeth can be treated with a CAD/CAM restoration. The dentist will determine if a CAD/CAM restoration is among the appropriate treatment options for the patient’s condition. As stated by Child: 2017 digital dentistry is more than just hype. When properly implemented and fully educated, return on investment can be excellent, increased joy in practicing dentistry can be experienced, and better care for the patients can be delivered. The future of dentistry is now. Waiting another 10 years to adopt or integrate these new areas of dentistry will leave you decades behind. My personal opinion on CAD/CAM is that it can only improve on what is, the advances in technology can only get better. The technology is only as good as the technician whom is using it, if the technician knows how to operate the system and continues learning as the technology evolves then CAD/CAM technology has a good place within the dental technology industry.
References
DiMatteo. A. 2017. Shaping Dentistry with CAD/CAM Technology. Available [Online]: http://www.yourdentistryguide.com/cad-cam-tech/ (12 August 2017). Child, P. L. 2017. Digital dentistry: Is this the future of dentistry. Available [Online]: http://www.dentaleconomics.com/articles/print/volume-101/issue-10/features/digital-dentistry-is-this-the-future-of-dentistry.html (12 August 2017).
Buere, Schweiger, & Edelhof (2008:204) define CAD as an abbreviation for “computer aided design” and –CAM “computer aided manufacturing”. The term CAD/CAM does not refer to the method of fabricating the dental restoration using the CAD/CAM technology therefor it is incorrect to associate that CAD/CAM is a synonym for “milling technology”. CAD/CAM is used to design precision tools, parts and has been incorporated in dentistry for the past 20 years. Buere, Schweiger, & Edelhof (2008:204) states that CAD/CAM systems consists of three components: ”A digitalisation tool/scanner that transforms geometry into digital data that can be processed by the computer Software that processes data and, depending on the application, produces a data set for the product to be fabricated A production technology that transforms the data set into the desired product.” CAD/CAM can be produced chair-side/in-office and in the laboratory. In-office the dentist design the restoration in their practice and dental surgery, without laboratory procedures, eliminating the process of the dental technician- or technologist. The CAD/CAM computer displays a 3-dimentional custom designed image of a prepared tooth or teeth optical scanner which captures a digital image (DiMatteo & Addleson). An intra-coronal camera replaces the conventional impression technique (Buere, Schweiger, & Edelhof, 2008:204). This image can also be retrieved by scabbing a plaster-/dental stone model poured from an impression taken of the patients oral cavity. In-office method eliminates the traditional impression procedure, the use of a temporary restoration and a second required appointment for fitting. Local anesthetic will be given to the patient for necessary tooth preparations (DiMatteo & Addleson). Laboratory production of CAD/CAM restorations is equivalent to the tradition and conventional procedures between dentists and dental technologist’/-technicians (DiMatteo & Addleson). Dentists and dental technologists use these 3-dimentional digital scans and software to design the dental restoration. The period of design is dependant on skill, experience, quality and case complexity/-simplicity of each individual patient. The final dental restorative design is milled in a milling chamber from a ceramic material block, the restoration is then customized to specific requirements of patient by staining, glazing to achieve a natural esthetic appearance and then fired in a ceramic oven, finished and polished (DiMatteo & Addleson). According to Buere, Schweiger, & Edelhof (2008:204) CAD/CAM is composed of the following components Scanner –optimal scanner and mechanical scanner Design software Processing devices Milling is available in two different variants: Dry processing which is applied to zirconium oxide blanks with low pre-sintering resulting in minimal investment expenses, no moisture absorption and the lower pre-sintering may cause higher shrinkage of the framework. Wet processing is when the milling diamond or carbide cutter is protected with a spray or cool liquid to prevent overheating of the material milled. Wet processing zirconium oxide result in higher pre-sintering which minimizes shrinkage of the framework. Processed CAD/CAM milled dental restorations are fabricated from resin materials, silica based ceramics, infiltration ceramics and high oxide performance ceramics (Buere, Schweiger, & Edelhof, 2008:204).
Buere, F., Schweiger, J. & Edelhof, D. 2008. Digital dentistry: an overview of recent developments for cas/cam generated restorations. British journal dentistry. 10 May. http://www.nature.com/bdj/journal/v204/n9/full/sj.bdj.2008.350.html (17/04/2017). DiMatteo, A. & Addleson, L. (ed). Shaping dentistry with cad/cam technology. Your dentistry. http://www.yourdentistryguide.com/cad-cam-tech/ (25/07/2017).
I support the use of CAD/CAM which stands for “computer-aided design/computer-aided manufacturing”. It is through the use of this technology that our work as dental technicians is able to provide the patients with a superior level of care when it comes to crowns, bridges, inlays, on lays, veneers, and as well as orthodontics defined by (Pocket Dentistry, 2017).The process start is with the CAD software. With the help of a sophisticated computer modelling program, It analyses a three dimensional scan of the patients mouth and use it as a guide to design the required dental prosthesis. Bridges and crowns are made to fit exactly with the existing teeth, allowing for an even and natural-feeling bite with no interference. Veneers are also designed to fit exactly on the front of the teeth. The CAM system together with the CAM software work together, allowing us to quickly and efficiently turn the digital models into a finished product that last a patient for a long time . The advantage of using CAD/CAM is that the patient no longer has to sit in for an impression to be taken into their mouth, turnaround time has significantly decreased. Rather than the traditional two to three week process of a model being made the patient can get their work done without the model, CAD/CAM can speed up time to creating a win-win situation for the technician and patients. CAD/CAM technology offers improved predictability of outcomes compared to traditional dental restoration methods. In addition with CAD/CAM there are many different system such as Zirkonzahn that exhibit the lowest marginal discrepancy, which is followed by the metallic copings groups; there’s statistically significant differences that can be found between these two groups. The less precise system was CAD/CAM Cerec InLab (Sirona), which exhibited statistically significant differences in all studied groups. Marginal precision of CAD/CAM systems depended on the manufacturing processes of each separate system stated by (Suárez et al., 2015:236). The emergence of computer-aided design/computer-aided manufacture (CAD/CAM) technology in dentistry has allowed the successful use of different materials. Using these systems to fabricate fixed restorations has gained popularity in comparison with conventional techniques. In addition, this technology permits shaping of materials with high precision that cannot be easily carried out via a traditional method to make a dental restoration, and this technology now includes the fabrication of provisional restorations (Escdonline.eu, 2017). Accurate provisional restorations are essential and serve a number of functions including protection of the pulpal tissues, bacterial contamination, and preservation of periodontal tissues. In addition, preventing rotation of the tooth from its normal position in terms of supra
or infra occlusion, maintaining aesthetics and oral functions, such as mastication. There are two major approaches for fabrication of provisional crowns: direct and indirect methods. A variety of new provisional blocks are available to use with the CEREC3 CAD/CAM system (Sirona, Bensheim, Germany). These materials can withstand the milling process because of their high strength. However, conventional provisional materials cannot be prepared via the milling process, but require to be fabricated manually (Yao, 2014; 649). There are certain difficulties associated with this manual technique, for example, inadequate surface texture and insufficient mechanical properties such as flexural strength. It has been reported that CAD/CAM provisional crowns were stronger and exhibited better marginal accuracy than directly fabricated bis-acryl composite crowns, especially following thermal cycling. Therefore, using CAD/CAM may resolve these issues. The difference in performance of provisional crowns is that they are fabricated either by a traditional direct technique or with the more sophisticated indirect CAD/CAM approach as mentioned above. The importance of precise provisional restorations is generally accepted in order for the definitive restoration to fit and function properly. In addition, there is certain evidence that the CAD/CAM provisional restorations may be superior to their direct counterparts. The introduction of provisional CAD/CAM restorations promises a certainly easier method of fabrication for the clinician, but also offers potentially stronger provisional restorations. However, there may be an impetuous to use CAD/CAM provisional materials; these restorations comprise a more expensive alternative to conventional directly made provisional restorations. If the performance of these restorations is similar to conventionally fabricated provisional chairside restorations, then their use may be regarded as excessive. Regarding the marginal adaptation, it is critical in each case of provisional restorations, since poor marginal fit can lead to inflammation of periodontal tissue, a situation that can postpone the fit of the definitive restorations. In literature there are different approaches to measure the marginal gap of restorations. Two common techniques to measure the marginal and internal gap are measurement of embedded and sectioned specimens, and measurement of the replica of the marginal and internal gap explained by (Reifeis et al., 2017: ) . The replica technique is a non-invasive and valid technique to measure the adaptation of a restoration to the tooth structure. In this study a replica technique that was used in a previous study was applied in order to evaluate the effectiveness of each material and method of provisional crown fabrication.
The meaning of marginal gap of the CEREC provisional crowns reported in the current study ranged between 47-193 µm. These findings are far from the theoretically based requirements according to which the cementation film thickness should be between 25-40 µm15. However, in the literature, the marginal gaps reported for provisional crowns are well above the gap reported. However, this could be due to the different methodology followed since a replica technique was used to measure the marginal gap (Beuer, Schweiger and Edelhoff, 2017). One of the problems reported for the directly made provisional restorations is the marginal discrepancies that occur due to polymerization shrinkage. This problem is significantly greater with PMMA provisional materials and is comparatively less with bis-acryl composite resin material, but still poses a problem. CAD/CAM provisional materials do not face this issue as the restoration is milled from pre-polymerized blocks of the provisional material, in such a way that any degree of polymerization shrinkage has taken place during processing of the block. In this study, the CAD/CAM provisional crowns demonstrated lower marginal gaps compared with the direct counterpart. This result was consistent with a study by Yao, et al. (2014), in which it was found that the CAD/CAM provisional crowns had lower marginal gaps compared with direct provisional crowns26. However, when comparing the values reported, the marginal gap value in this study for Telio CAD-Temp and VITA CAD-Temp. This could be due to the different methodology followed by Yao, et al.26 (2014), in which the crowns were cemented with glass ionomer cement. Furthermore interesting finding is that for the CAD/CAM groups, the greater average internal gap is found at the occlusal part of the restorations, while for the direct provisional material a more universal gap is found internally. This result was consistent with a previous study and may be due to the machining process of fabricating the crowns and the shape of the milling burs.
In order to measure the fracture strength of the provisional restorations, provisional cement was used to fit the crowns to simulate the clinical situation. The fracture strength exhibited by all tested materials occurred at loads above the maximum loads that can occur in the mouth in normal situations. Therefore, these materials may not be able to withstand extreme occlusal forces in the oral environment.
The marginal and internal fit, fracture strength, and mode of fracture of provisional CAD/CAM crowns compared with chair side directly made provisional crowns. The CAD/CAM provisional crowns will have a better marginal and internal fit than direct counterparts. In addition, the CAD/CAM provisional crowns have superior strength to that of the directly fabricated crowns explained by (Abdullah, Tsitrou and Pollington, 2016; 258).
References ABDULLAH, A., TSITROU, E. and POLLINGTON, S. 2016. Comparative in vitro evaluation of CAD/CAM vs conventional provisional crowns. Journal of Applied Oral Science, 24(3), pp.258-263. Beuer, F., Schweiger, J. and Edelhoff, D. (2017). Digital dentistry: an overview of recent developments for CAD/CAM generated restorations. Escdonline.eu. (2017). CAD/CAM Dentistry | ESCD – European Society of Cosmetic Dentistry. [online] Available at: http://www.escdonline.eu/cosmetic-dentistry/cadcam-dentistry/ [Accessed 23 Aug. 2017]. Pocket Dentistry. (2017). The Use of CAD/CAM in Dentistry. [online] Available at: https://pocketdentistry.com/the-use-of-cadcam-in-dentistry/ [Accessed 23 Aug. 2017]. Reifeis, P., Kirkup, M., Willis, L. and Browning, W. 2017. Introducing CAD/CAM into a Predoctoral Dental Curriculum: A Case Study. [online] Jdentaled.org. Available at: http://www.jdentaled.org/content/78/10/1432.full [Accessed 23 Aug. 2017]. Yao J, Li J, Wang Y, Huang H.2014. Comparison of the flexural strength and marginal accuracy of traditional and CAD/CAM interim materials before and after thermal cycling. J Prosthet Dent ;112(3):649-57.
I come from an engineering background, and I have known that Computer aided design and computer aided manufacturing has been around in the engineering industry for many years. Engineering is a very precise industry, with very small tolerances and margins for error. The CAD/CAM process can yield exceptional precise results. In dentistry, and especially in crown and bridge work and implant work, the precision of work is of utmost important for the success of a restoration. Clinically the tolerance for the cement gap of a crown is 50 microns. That cement gap can be made much smaller with good techniques. The dental milling machines are getting much better, as well as the dental scanners. Accuracy ranges from 20 microns and upwards. CAD/CAM is a great tool to speed up the work flow in a lab, and to get very good results. In this profession time is very valuable, because it take a lot of time to fabricate a good restoration. I cannot see the CAD aspect changing in crazy ways in the near future, because it is software based. Yes software will improve and make it much easier and better for technicians to design restorations. But after saying that I must add that the CAD aspect is the part that is holding us back. The possibilities of what can be done are endless, and it is up to the software engineers to develop new software to realise the dreams of us as dental technicians, and they are getting very close to those dreams. We are already producing full acrylic dentures, full arch ceramic bridges, milled Pekton bridges and so much more, all thanks to the software that makes it possible, because the CAM technology has been there all the time. However in the CAM aspect things are already starting to change again even though it is such a new technology to dentistry. I can see a big change in the form of milling machines becoming obsolete and laser milling machines becoming the thing of the future. Not burs and tools that wear out and no physical cutting which requires many calibrations over and over. Also the time that lasers will take to cut will be quicker than conventional milling machines. 3D printing is another emerging aspect on the CAM front. However with today’s technology I don’t think the 3D printers are up to standard yet regarding accuracy in the crown and bridge aspect of dental technology. I think that CAD/CAM is an invaluable tool that came into dentistry, it makes our work much easier and so much less troublesome. If it is used correctly it will lead to much better restorations, less stress on our shoulders, better results for the sake of the patient and a much more enjoyable career. CAD/CAM may replace some technicians work, but there will always need to be a technician doing the designing of the restoration, because of their knowledge of tooth morphology, occlusion etc. And the final product will always need that manual labour from the technicians hand to finish it off, because I don’t think there will ever be a machine capable of coming close to a great technicians hand and eye.
CAD CAM technonlogy is hated or disliked by a large number of technicians. Another large amount like the idea about using CAD CAM but is not interested in learning to use this technology to thier advantage. These technicians are most likely older technicians close to retirement and are set in thier ways, or technicians which cannot afford the investment. Luckily the new generation of technicians entering the work force every year are more computer literate and make use of this technology. We are used to work in computers daily and have adopted computers in daily life long time ago. Designing any prosthesis on computers have several advantages including accuracy and manufacturing time. This means that the patient is more likely to recieve better treatment in less time. Materials for use of CAD CAM are improving rapidly with modern Zirconia exhibiting far better colour and transluceny than in the past. New polymers are also appearing on the market which enable the manufacture of dentures and denture frameworks either to be casted after milling or new strong polymers such as PEEK which replace the metal framework in partial dentures. With new materials new possibilities are created as trratment options and cost of these appliances and restorations are becoming more affordable. That is why I would encourage the use of CAD CAM technology for now and future use.
In my opinion CAD has been coming on for quite some time now and has been used in other fields as well. It is used in the aviation industry to design wings for planes and in the motor vehicle industry to design Cam shafts. In dental technology it can be quite an effective method of designing and manufacturing certain dental prosthesis.
Lots of people in the industry has mixed emotions about CAD/CAM and feel as if it could jobs away from technicians, however I don't feel as if that is the case because there are always going to be jobs for technicians especially in lower income areas as the people who need treatment will not be able to afford anything made using CAD/CAM as the materials for it is pricey.
So with regards to dental technology CAD CAM it's got a place in dental technology as it allows you to manufacture various dental appliances and restorations with minimum physical effort however you will still need knowledge of tooth morphology for crown and bridge, fulcrum lines for cobalt chrome, knowing how much rotation and translation is possible for orthodontics and the anatomical landmarks for dentures. So in conclusion is say CAD CAM is here and is here to stay
CAD (computer-aided design) software is used by architects, engineers, drafters, artists, and others to create precision drawings or technical illustrations. CAD software can be used to create two-dimensional (2-D) drawings or three-dimensional (3-D) models. However CAD is used in the dentistry field as well and to improve the design and creation of dental restorations especially dental prosthesis which includes crowns, crown inlays, veneers, inlays and onlays, fixed bridges, dental implant restorations, dentures (removable or fixed) and the list goes on. CAD/CAM complements earlier technologies used for these purposes by any combination of increasing the speed of design and creation, increasing the convenience or simplicity of the design, creation, and insertion processes and making possible restorations and appliances that otherwise would have been infeasible. Other goals include reducing unit cost and making affordable restorations and appliances that otherwise would have been prohibitively expensive. However, to date, chairside CAD/CAM often involves extra time on the part of the dentist and the fee is often at least two times higher than for conventional restorative treatments using lab services. CAD/CAM is one of the highly competent dental lab technologies.
This revolutionary technology allows us to manufacture custom-made ceramic restorations more accurately and efficiently, saving you time spent in the dental chair. CAD-CAM technology is the future in modern dentistry. Technological advances make the system easier to use and more accurate, so you get a better fit right away. How ever it makes you ask if it's the end of dental labs or a new beginning??
High tech words like digital dentistry, CAD/CAM, intraoral scanning, extraoral scanning, 3-D milling, and 3-D printing are reverberating throughout the dental industry. While everyone seems to agree that “the future is now,” there was also some ambivalence and trepidation toward the future that is knocking on the doors of dental labs and surgeries. The question worrying some, especially the older and more established labs and technicians, is whether its arrival is sounding the death knell of the traditional, craftsmen-based prosthetics and restoration business or heralding a boom that will see more demand in developing economies? The doomsday scenario is in many technicians minds is that the advances in scanning technologies, coupled with more powerful and capable software, feeding virtual 3-D models to ever cheaper and more accurate 3-D printers, while dentists will be able to handle their own manufacturing needs.
According to the manufacturers and surveyors of the various digital dental technologies, that day has already arrived. The technology is available to allow dentists to scan patients teeth and create crowns for patients while they wait. A process that traditionally took weeks, can now be done in an hour or two. Instead of making a mold and sending it to a lab for scanning, a well-equipped dentist can use a variety of technologies, from intraoral cameras to CBT, to scan teeth directly. The digitized scan can then be sent to an on-site milling or 3-D printing machine to carve the crown from a block of porcelain or print it from resin while the patient relaxes in the waiting room. After a little finishing and preparation work, the crown is ready for fitting, and the satisfied patient is heading back to work.
This is a scenario that definitely appeals to patients a single visit with no need to wonder around with a temporary crown that offers them savings in both time and money. In theory it appeals to quite a few dentists too, as they see an opportunity to cut out the mold and the middleman which is the technician. But is this yet reality? The short answer is no. Any lab owners or technicians who have been losing sleep over the imminent loss of their livelihoods can relax. It’s not that CAD/CAM won’t revolutionize the industry, it is certainly already doing that and will continue to do so but it is unlikely that it will do so in the hands of dentists.
While 3-D printing is still new, CAD/CAM is not. In Europe, the United Kingdom, and the United States, dentists have had access to the scanning technology, computer power and even desktop milling machines for 20 years or more but they have not adopted it an mass. Even in the U.S., the world’s largest and most technically advanced dental market, only something like 8% to 10% of dental surgeries have in-house CAD/CAM facilities. Roughly one in 10 of those don’t use the equipment despite significant financial investments usually because they find the learning curve too steep or were put off by mishaps or clinical issues. The majority of those that do use the equipment do so only for single posterior crowns and still send the more complex posterior and all anterior jobs to external labs. Either that or they have hired their own in-house technicians to utilize the equipment to its full potential.
It’s unlikely that the majority of dentists with 10 to 20 years before retirement will be willing to change to these new technologies. While they might be at the stage of their careers where they can afford it, they are usually put off by the daunting learning curve. While fresh graduates are comfortable with the latest scanning technology at the start of their careers, they are unlikely to have the capital to invest in in-house production facilities.
I can’t imagine a future without highly skilled, artist technicians helping them create the cutting-edge prosthodontics they are famous for. It is a mater of remembering that as technology and materials advance and make more elaborate and complex restorations possible, the role of the expert artisan technician will become increasingly important in delivering the best possible outcome for patients. There will always be a need for technicians, for highly skilled professionals who are experts in the use of the machines that make the prosthodontics that modern dental practices. The machines and technologies they use may change, but the need for experts to operate them will remain. So as long as technicians keep their skills and knowledge up to date, they will always be a vital part of the dental team.CAD/CAM represent a great opportunity for dental labs and technicians. This is a time of wonderful opportunity for dentists and technicians and a new generation of dentists and technicians coming on to cater to their needs. So it seems the theme was on target with “The future is now,” and dental labs and technicians need to embrace that future and make it their own
Davidowitz. G. & Kotick. P. G. 2011. The use of CAD/CAM in dentistry. Dent Clin North Am,55 (3), 559–570. Rekow. D. 1987. Computer-aided design and manufacturing in dentistry: a review of the state of the art. American Journal. 58 (4): 512–51 Miyazaki. T.,Hotta, Y., Kunii, J., Kuriyama. S & Tamaki, Y. 2009. A review of dental CAD/CAM current status and future perspectives from 20 years experience. Dent Mater Journal. 28 (1): 44–45
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I am all for the CAD/CAM method in the dental industry, but it must be used correctly so that it is beneficial to the patient. I understand that the times are changing, but the industry needs to evolve and adapt with/to the new technologies on offer.
ReplyDeleteThe biggest stigma in the industry is the assumption that these new technological advancements will replace the current workforce (Dental Technicians, Technologists, etc).
I feel that this is not the case as Machines would not be able to reproduce the artistic flare that a trained Dental Technologist is able of achieving. Yes, the Machine is more accurate (up to 25μm- microns in some cases) and its manufacturing time might be quicker but it will have its limitations. Such as aesthetics in Crown build up. The milled Crown can only be as aesthetic pleasing as that of the milling material its been milled out of. Whereas in the conventional Ceramic build up of porcelain the Technician can layer the different porcelain layers where he deems necessary.
Yes, anyone can be trained to use CAD/CAM system. But the knowledge of the oral anatomy, tooth-morphology, etc. need to be adhered to when designing a Dental appliance or restoration. So Dental Technicians and Technologists need to be looking at getting trained in using these new innovations and methods to secure more jobs in the future.
CAD/CAM technology has been around for many years in various other industries it has only recent years made its appearance in the dental industry. It has bridged a gap in the technological market and brought us one step closer to becoming a slightly more technologically advanced industry.
ReplyDeleteCAD/CAM can be used to design crowns, inlays, onlays, veneers, fixed bridges, dental implant restorations, dentures removable or fixed as well as orthodontic appliances
It has a wide array of options when it comes to choosing materials for manufacturing of different prostheses
According to DiMatteo: 2017 research suggests that today’s milled CAD/CAM restorations are stronger than those milled from earlier materials. They also are less likely to fracture.
Although CAD/CAM technology is not a replacement for the accuracy and talent provided by a dental laboratory technicians.
Dentists must be precise in creating the initial tooth preparation; both dentists and laboratory technicians must be accurate when taking the digital impression and drawing the restoration.
Equally important is the accuracy and skill with which they design a restoration, particularly since the fit of a restoration is critical to preventing future tooth damage.
It is important to note that not every tooth/ teeth can be treated with a CAD/CAM restoration. The dentist will determine if a CAD/CAM restoration is among the appropriate treatment options for the patient’s condition.
As stated by Child: 2017 digital dentistry is more than just hype. When properly implemented and fully educated, return on investment can be excellent, increased joy in practicing dentistry can be experienced, and better care for the patients can be delivered. The future of dentistry is now. Waiting another 10 years to adopt or integrate these new areas of dentistry will leave you decades behind.
My personal opinion on CAD/CAM is that it can only improve on what is, the advances in technology can only get better. The technology is only as good as the technician whom is using it, if the technician knows how to operate the system and continues learning as the technology evolves then CAD/CAM technology has a good place within the dental technology industry.
References
DiMatteo. A. 2017. Shaping Dentistry with CAD/CAM Technology. Available [Online]:
http://www.yourdentistryguide.com/cad-cam-tech/ (12 August 2017).
Child, P. L. 2017. Digital dentistry: Is this the future of dentistry. Available [Online]:
http://www.dentaleconomics.com/articles/print/volume-101/issue-10/features/digital-dentistry-is-this-the-future-of-dentistry.html (12 August 2017).
Buere, Schweiger, & Edelhof (2008:204) define CAD as an abbreviation for “computer aided design” and –CAM “computer aided manufacturing”. The term CAD/CAM does not refer to the method of fabricating the dental restoration using the CAD/CAM technology therefor it is incorrect to associate that CAD/CAM is a synonym for “milling technology”.
ReplyDeleteCAD/CAM is used to design precision tools, parts and has been incorporated in dentistry for the past 20 years.
Buere, Schweiger, & Edelhof (2008:204) states that CAD/CAM systems consists of three components:
”A digitalisation tool/scanner that transforms geometry into digital data that can be processed by the computer
Software that processes data and, depending on the application, produces a data set for the product to be fabricated
A production technology that transforms the data set into the desired product.”
CAD/CAM can be produced chair-side/in-office and in the laboratory. In-office the dentist design the restoration in their practice and dental surgery, without laboratory procedures, eliminating the process of the dental technician- or technologist. The CAD/CAM computer displays a 3-dimentional custom designed image of a prepared tooth or teeth optical scanner which captures a digital image (DiMatteo & Addleson). An intra-coronal camera replaces the conventional impression technique (Buere, Schweiger, & Edelhof, 2008:204). This image can also be retrieved by scabbing a plaster-/dental stone model poured from an impression taken of the patients oral cavity. In-office method eliminates the traditional impression procedure, the use of a temporary restoration and a second required appointment for fitting. Local anesthetic will be given to the patient for necessary tooth preparations (DiMatteo & Addleson).
Laboratory production of CAD/CAM restorations is equivalent to the tradition and conventional procedures between dentists and dental technologist’/-technicians (DiMatteo & Addleson).
Dentists and dental technologists use these 3-dimentional digital scans and software to design the dental restoration. The period of design is dependant on skill, experience, quality and case complexity/-simplicity of each individual patient. The final dental restorative design is milled in a milling chamber from a ceramic material block, the restoration is then customized to specific requirements of patient by staining, glazing to achieve a natural esthetic appearance and then fired in a ceramic oven, finished and polished (DiMatteo & Addleson).
According to Buere, Schweiger, & Edelhof (2008:204) CAD/CAM is composed of the following components
Scanner –optimal scanner and mechanical scanner
Design software
Processing devices
Milling is available in two different variants:
Dry processing which is applied to zirconium oxide blanks with low pre-sintering resulting in minimal investment expenses, no moisture absorption and the lower pre-sintering may cause higher shrinkage of the framework.
Wet processing is when the milling diamond or carbide cutter is protected with a spray or cool liquid to prevent overheating of the material milled. Wet processing zirconium oxide result in higher pre-sintering which minimizes shrinkage of the framework.
Processed CAD/CAM milled dental restorations are fabricated from resin materials, silica based ceramics, infiltration ceramics and high oxide performance ceramics (Buere, Schweiger, & Edelhof, 2008:204).
Buere, F., Schweiger, J. & Edelhof, D. 2008. Digital dentistry: an overview of recent developments for cas/cam generated restorations. British journal dentistry. 10 May. http://www.nature.com/bdj/journal/v204/n9/full/sj.bdj.2008.350.html (17/04/2017).
DiMatteo, A. & Addleson, L. (ed). Shaping dentistry with cad/cam technology. Your dentistry. http://www.yourdentistryguide.com/cad-cam-tech/ (25/07/2017).
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ReplyDeleteI support the use of CAD/CAM which stands for “computer-aided design/computer-aided manufacturing”. It is through the use of this technology that our work as dental technicians is able to provide the patients with a superior level of care when it comes to crowns, bridges, inlays, on lays, veneers, and as well as orthodontics defined by (Pocket Dentistry, 2017).The process start is with the CAD software. With the help of a sophisticated computer modelling program, It analyses a three dimensional scan of the patients mouth and use it as a guide to design the required dental prosthesis. Bridges and crowns are made to fit exactly with the existing teeth, allowing for an even and natural-feeling bite with no interference. Veneers are also designed to fit exactly on the front of the teeth.
DeleteThe CAM system together with the CAM software work together, allowing us to quickly and efficiently turn the digital models into a finished product that last a patient for a long time . The advantage of using CAD/CAM is that the patient no longer has to sit in for an impression to be taken into their mouth, turnaround time has significantly decreased. Rather than the traditional two to three week process of a model being made the patient can get their work done without the model, CAD/CAM can speed up time to creating a win-win situation for the technician and patients. CAD/CAM technology offers improved predictability of outcomes compared to traditional dental restoration methods. In addition with CAD/CAM there are many different system such as Zirkonzahn that exhibit the lowest marginal discrepancy, which is followed by the metallic copings groups; there’s statistically significant differences that can be found between these two groups. The less precise system was CAD/CAM Cerec InLab (Sirona), which exhibited statistically significant differences in all studied groups. Marginal precision of CAD/CAM systems depended on the manufacturing processes of each separate system stated by (Suárez et al., 2015:236).
The emergence of computer-aided design/computer-aided manufacture (CAD/CAM) technology in dentistry has allowed the successful use of different materials. Using these systems to fabricate fixed restorations has gained popularity in comparison with conventional techniques. In addition, this technology permits shaping of materials with high precision that cannot be easily carried out via a traditional method to make a dental restoration, and this technology now includes the fabrication of provisional restorations (Escdonline.eu, 2017).
Accurate provisional restorations are essential and serve a number of functions including protection of the pulpal tissues, bacterial contamination, and preservation of periodontal tissues. In addition, preventing rotation of the tooth from its normal position in terms of supra
or infra occlusion, maintaining aesthetics and oral functions, such as mastication. There are two major approaches for fabrication of provisional crowns: direct and indirect methods. A variety of new provisional blocks are available to use with the CEREC3 CAD/CAM system (Sirona, Bensheim, Germany). These materials can withstand the milling process because of their high strength. However, conventional provisional materials cannot be prepared via the milling process, but require to be fabricated manually (Yao, 2014; 649). There are certain difficulties associated with this manual technique, for example, inadequate surface texture and insufficient mechanical properties such as flexural strength. It has been reported that CAD/CAM provisional crowns were stronger and exhibited better marginal accuracy than directly fabricated bis-acryl composite crowns, especially following thermal cycling. Therefore, using CAD/CAM may resolve these issues.
DeleteThe difference in performance of provisional crowns is that they are fabricated either by a traditional direct technique or with the more sophisticated indirect CAD/CAM approach as mentioned above. The importance of precise provisional restorations is generally accepted in order for the definitive restoration to fit and function properly. In addition, there is certain evidence that the CAD/CAM provisional restorations may be superior to their direct counterparts. The introduction of provisional CAD/CAM restorations promises a certainly easier method of fabrication for the clinician, but also offers potentially stronger provisional restorations. However, there may be an impetuous to use CAD/CAM provisional materials; these restorations comprise a more expensive alternative to conventional directly made provisional restorations. If the performance of these restorations is similar to conventionally fabricated provisional chairside restorations, then their use may be regarded as excessive.
Regarding the marginal adaptation, it is critical in each case of provisional restorations, since poor marginal fit can lead to inflammation of periodontal tissue, a situation that can postpone the fit of the definitive restorations. In literature there are different approaches to measure the marginal gap of restorations. Two common techniques to measure the marginal and internal gap are measurement of embedded and sectioned specimens, and measurement of the replica of the marginal and internal gap explained by (Reifeis et al., 2017: ) . The replica technique is a non-invasive and valid technique to measure the adaptation of a restoration to the tooth structure. In this study a replica technique that was used in a previous study was applied in order to evaluate the effectiveness of each material and method of provisional crown fabrication.
The meaning of marginal gap of the CEREC provisional crowns reported in the current study ranged between 47-193 µm. These findings are far from the theoretically based requirements according to which the cementation film thickness should be between 25-40 µm15. However, in the literature, the marginal gaps reported for provisional crowns are well above the gap reported. However, this could be due to the different methodology followed since a replica technique was used to measure the marginal gap (Beuer, Schweiger and Edelhoff, 2017).
DeleteOne of the problems reported for the directly made provisional restorations is the marginal discrepancies that occur due to polymerization shrinkage. This problem is significantly greater with PMMA provisional materials and is comparatively less with bis-acryl composite resin material, but still poses a problem. CAD/CAM provisional materials do not face this issue as the restoration is milled from pre-polymerized blocks of the provisional material, in such a way that any degree of polymerization shrinkage has taken place during processing of the block. In this study, the CAD/CAM provisional crowns demonstrated lower marginal gaps compared with the direct counterpart. This result was consistent with a study by Yao, et al. (2014), in which it was found that the CAD/CAM provisional crowns had lower marginal gaps compared with direct provisional crowns26. However, when comparing the values reported, the marginal gap value in this study for Telio CAD-Temp and VITA CAD-Temp. This could be due to the different methodology followed by Yao, et al.26 (2014), in which the crowns were cemented with glass ionomer cement.
Furthermore interesting finding is that for the CAD/CAM groups, the greater average internal gap is found at the occlusal part of the restorations, while for the direct provisional material a more universal gap is found internally. This result was consistent with a previous study and may be due to the machining process of fabricating the crowns and the shape of the milling burs.
In order to measure the fracture strength of the provisional restorations, provisional cement was used to fit the crowns to simulate the clinical situation. The fracture strength exhibited by all tested materials occurred at loads above the maximum loads that can occur in the mouth in normal situations. Therefore, these materials may not be able to withstand extreme occlusal forces in the oral environment.
The marginal and internal fit, fracture strength, and mode of fracture of provisional CAD/CAM crowns compared with chair side directly made provisional crowns. The CAD/CAM provisional crowns will have a better marginal and internal fit than direct counterparts. In addition, the CAD/CAM provisional crowns have superior strength to that of the directly fabricated crowns explained by (Abdullah, Tsitrou and Pollington, 2016; 258).
DeleteReferences
ABDULLAH, A., TSITROU, E. and POLLINGTON, S. 2016. Comparative in vitro evaluation of CAD/CAM vs conventional provisional crowns. Journal of Applied Oral Science, 24(3), pp.258-263.
Beuer, F., Schweiger, J. and Edelhoff, D. (2017). Digital dentistry: an overview of recent developments for CAD/CAM generated restorations.
Escdonline.eu. (2017). CAD/CAM Dentistry | ESCD – European Society of Cosmetic Dentistry. [online] Available at: http://www.escdonline.eu/cosmetic-dentistry/cadcam-dentistry/ [Accessed 23 Aug. 2017].
Pocket Dentistry. (2017). The Use of CAD/CAM in Dentistry. [online] Available at: https://pocketdentistry.com/the-use-of-cadcam-in-dentistry/ [Accessed 23 Aug. 2017].
Reifeis, P., Kirkup, M., Willis, L. and Browning, W. 2017. Introducing CAD/CAM into a Predoctoral Dental Curriculum: A Case Study. [online] Jdentaled.org. Available at: http://www.jdentaled.org/content/78/10/1432.full [Accessed 23 Aug. 2017].
Yao J, Li J, Wang Y, Huang H.2014. Comparison of the flexural strength and marginal accuracy of traditional and CAD/CAM interim materials before and after thermal cycling. J Prosthet Dent ;112(3):649-57.
I come from an engineering background, and I have known that Computer aided design and computer aided manufacturing has been around in the engineering industry for many years.
ReplyDeleteEngineering is a very precise industry, with very small tolerances and margins for error.
The CAD/CAM process can yield exceptional precise results.
In dentistry, and especially in crown and bridge work and implant work, the precision of work is of utmost important for the success of a restoration. Clinically the tolerance for the cement gap of a crown is 50 microns. That cement gap can be made much smaller with good techniques.
The dental milling machines are getting much better, as well as the dental scanners. Accuracy ranges from 20 microns and upwards.
CAD/CAM is a great tool to speed up the work flow in a lab, and to get very good results. In this profession time is very valuable, because it take a lot of time to fabricate a good restoration.
I cannot see the CAD aspect changing in crazy ways in the near future, because it is software based. Yes software will improve and make it much easier and better for technicians to design restorations. But after saying that I must add that the CAD aspect is the part that is holding us back. The possibilities of what can be done are endless, and it is up to the software engineers to develop new software to realise the dreams of us as dental technicians, and they are getting very close to those dreams. We are already producing full acrylic dentures, full arch ceramic bridges, milled Pekton bridges and so much more, all thanks to the software that makes it possible, because the CAM technology has been there all the time.
However in the CAM aspect things are already starting to change again even though it is such a new technology to dentistry. I can see a big change in the form of milling machines becoming obsolete and laser milling machines becoming the thing of the future. Not burs and tools that wear out and no physical cutting which requires many calibrations over and over. Also the time that lasers will take to cut will be quicker than conventional milling machines.
3D printing is another emerging aspect on the CAM front. However with today’s technology I don’t think the 3D printers are up to standard yet regarding accuracy in the crown and bridge aspect of dental technology.
I think that CAD/CAM is an invaluable tool that came into dentistry, it makes our work much easier and so much less troublesome. If it is used correctly it will lead to much better restorations, less stress on our shoulders, better results for the sake of the patient and a much more enjoyable career.
CAD/CAM may replace some technicians work, but there will always need to be a technician doing the designing of the restoration, because of their knowledge of tooth morphology, occlusion etc. And the final product will always need that manual labour from the technicians hand to finish it off, because I don’t think there will ever be a machine capable of coming close to a great technicians hand and eye.
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ReplyDeleteCAD CAM technonlogy is hated or disliked by a large number of technicians. Another large amount like the idea about using CAD CAM but is not interested in learning to use this technology to thier advantage. These technicians are most likely older technicians close to retirement and are set in thier ways, or technicians which cannot afford the investment.
ReplyDeleteLuckily the new generation of technicians entering the work force every year are more computer literate and make use of this technology. We are used to work in computers daily and have adopted computers in daily life long time ago. Designing any prosthesis on computers have several advantages including accuracy and manufacturing time. This means that the patient is more likely to recieve better treatment in less time.
Materials for use of CAD CAM are improving rapidly with modern Zirconia exhibiting far better colour and transluceny than in the past. New polymers are also appearing on the market which enable the manufacture of dentures and denture frameworks either to be casted after milling or new strong polymers such as PEEK which replace the metal framework in partial dentures.
With new materials new possibilities are created as trratment options and cost of these appliances and restorations are becoming more affordable. That is why I would encourage the use of CAD CAM technology for now and future use.
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ReplyDeleteIn my opinion CAD has been coming on for quite some time now and has been used in other fields as well. It is used in the aviation industry to design wings for planes and in the motor vehicle industry to design Cam shafts. In dental technology it can be quite an effective method of designing and manufacturing certain dental prosthesis.
ReplyDeleteLots of people in the industry has mixed emotions about CAD/CAM and feel as if it could jobs away from technicians, however I don't feel as if that is the case because there are always going to be jobs for technicians especially in lower income areas as the people who need treatment will not be able to afford anything made using CAD/CAM as the materials for it is pricey.
So with regards to dental technology CAD CAM it's got a place in dental technology as it allows you to manufacture various dental appliances and restorations with minimum physical effort however you will still need knowledge of tooth morphology for crown and bridge, fulcrum lines for cobalt chrome, knowing how much rotation and translation is possible for orthodontics and the anatomical landmarks for dentures. So in conclusion is say CAD CAM is here and is here to stay
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ReplyDeleteCAD (computer-aided design) software is used by architects, engineers, drafters, artists, and others to create precision drawings or technical illustrations. CAD software can be used to create two-dimensional (2-D) drawings or three-dimensional (3-D) models. However CAD is used in the dentistry field as well and to improve the design and creation of dental restorations especially dental prosthesis which includes crowns, crown inlays, veneers, inlays and onlays, fixed bridges, dental implant restorations, dentures (removable or fixed) and the list goes on. CAD/CAM complements earlier technologies used for these purposes by any combination of increasing the speed of design and creation, increasing the convenience or simplicity of the design, creation, and insertion processes and making possible restorations and appliances that otherwise would have been infeasible. Other goals include reducing unit cost and making affordable restorations and appliances that otherwise would have been prohibitively expensive. However, to date, chairside CAD/CAM often involves extra time on the part of the dentist and the fee is often at least two times higher than for conventional restorative treatments using lab services. CAD/CAM is one of the highly competent dental lab technologies.
ReplyDeleteThis revolutionary technology allows us to manufacture custom-made ceramic restorations more accurately and efficiently, saving you time spent in the dental chair.
CAD-CAM technology is the future in modern dentistry. Technological advances make the system easier to use and more accurate, so you get a better fit right away. How ever it makes you ask if it's the end of dental labs or a new beginning??
High tech words like digital dentistry, CAD/CAM, intraoral scanning, extraoral scanning, 3-D milling, and 3-D printing are reverberating throughout the dental industry. While everyone seems to agree that “the future is now,” there was also some ambivalence and trepidation toward the future that is knocking on the doors of dental labs and surgeries. The question worrying some, especially the older and more established labs and technicians, is whether its arrival is sounding the death knell of the traditional, craftsmen-based prosthetics and restoration business or heralding a boom that will see more demand in developing economies? The doomsday scenario is in many technicians minds is that the advances in scanning technologies, coupled with more powerful and capable software, feeding virtual 3-D models to ever cheaper and more accurate 3-D printers, while dentists will be able to handle their own manufacturing needs.
ReplyDeleteAccording to the manufacturers and surveyors of the various digital dental technologies, that day has already arrived. The technology is available to allow dentists to scan patients teeth and create crowns for patients while they wait. A process that traditionally took weeks, can now be done in an hour or two.
Instead of making a mold and sending it to a lab for scanning, a well-equipped dentist can use a variety of technologies, from intraoral cameras to CBT, to scan teeth directly. The digitized scan can then be sent to an on-site milling or 3-D printing machine to carve the crown from a block of porcelain or print it from resin while the patient relaxes in the waiting room. After a little finishing and preparation work, the crown is ready for fitting, and the satisfied patient is heading back to work.
This is a scenario that definitely appeals to patients a single visit with no need to wonder around with a temporary crown that offers them savings in both time and money. In theory it appeals to quite a few dentists too, as they see an opportunity to cut out the mold and the middleman which is the technician. But is this yet reality?
ReplyDeleteThe short answer is no. Any lab owners or technicians who have been losing sleep over the imminent loss of their livelihoods can relax. It’s not that CAD/CAM won’t revolutionize the industry, it is certainly already doing that and will continue to do so but it is unlikely that it will do so in the hands of dentists.
While 3-D printing is still new, CAD/CAM is not. In Europe, the United Kingdom, and the United States, dentists have had access to the scanning technology, computer power and even desktop milling machines for 20 years or more but they have not adopted it an mass. Even in the U.S., the world’s largest and most technically advanced dental market, only something like 8% to 10% of dental surgeries have in-house CAD/CAM facilities. Roughly one in 10 of those don’t use the equipment despite significant financial investments usually because they find the learning curve too steep or were put off by mishaps or clinical issues. The majority of those that do use the equipment do so only for single posterior crowns and still send the more complex posterior and all anterior jobs to external labs. Either that or they have hired their own in-house technicians to utilize the equipment to its full potential.
It’s unlikely that the majority of dentists with 10 to 20 years before retirement will be willing to change to these new technologies. While they might be at the stage of their careers where they can afford it, they are usually put off by the daunting learning curve. While fresh graduates are comfortable with the latest scanning technology at the start of their careers, they are unlikely to have the capital to invest in in-house production facilities.
I can’t imagine a future without highly skilled, artist technicians helping them create the cutting-edge prosthodontics they are famous for. It is a mater of remembering that as technology and materials advance and make more elaborate and complex restorations possible, the role of the expert artisan technician will become increasingly important in delivering the best possible outcome for patients.
There will always be a need for technicians, for highly skilled professionals who are experts in the use of the machines that make the prosthodontics that modern dental practices. The machines and technologies they use may change, but the need for experts to operate them will remain. So as long as technicians keep their skills and knowledge up to date, they will always be a vital part of the dental team.CAD/CAM represent a great opportunity for dental labs and technicians. This is a time of wonderful opportunity for dentists and technicians and a new generation of dentists and technicians coming on to cater to their needs. So it seems the theme was on target with “The future is now,” and dental labs and technicians need to embrace that future and make it their own
Davidowitz. G. & Kotick. P. G. 2011. The use of CAD/CAM in dentistry. Dent Clin North Am,55 (3), 559–570.
Rekow. D. 1987. Computer-aided design and manufacturing in dentistry: a review of the state of the art. American Journal. 58 (4): 512–51
Miyazaki. T.,Hotta, Y., Kunii, J., Kuriyama. S & Tamaki, Y. 2009. A review of dental CAD/CAM current status and future perspectives from 20 years experience. Dent Mater Journal. 28 (1): 44–45
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