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CAD/CAM in Dentistry: Pioneering Digital Transformation

| Knowledge

CAD/CAM is of enormous importance in the dental industry, especially in the course of digitalization, so we want to explain what it is all about and how dentistry is going digital thanks to CAD/CAM.

1 Dental CAD/CAM: The future of dentistry - everything you need to know 

The dental industry has seen significant technological advances in recent decades, particularly with the introduction of CAD/CAM systems. These technologies have not only revolutionized the way dental treatments are carried out, but have also significantly improved the efficiency and accuracy of these procedures. 
Dental CAD and CAM make the production of dentures much easier for patients, dentists and dental technicians. Patients no longer need an unpleasant impression, and automated production makes dentures more cost-efficient. The workload for dentists and dental technicians is reduced. The end product includes highly compatible and tooth-colored implants, crowns, bridges and inlays, made from high-quality materials such as zirconium dioxide, titanium, ceramics and special plastics.

1.1 What is CAD/CAM in dentistry?

The terms CAD (Computer Aided Design) and CAM (Computer Aided Manufacturing) stand for the computer-aided design and manufacture of workpieces. Originally developed for industries such as the automotive and aviation industries, these technologies are increasingly being used in dentistry. CAD and CAM have been in use in dental practices and laboratories since the 1980s and are therefore not considered a novelty. Advances in related fields such as optics, computer science, mechanics and software development have further increased the attractiveness of CAD/CAM for dental applications. In particular, the networking of devices and users promotes collaboration, which strengthens the digital workflow in the dental industry through the efficient use of CAD/CAM technologies.

1.2 Advantages of CAD/CAM in dentistry

Precision and accuracy of fit: CAD/CAM enables extremely high accuracy in denture fabrication, resulting in a better fit and greater comfort for the patient.

Speed: While traditional methods can take several days or weeks, CAD/CAM often enables dental prostheses to be completed within a day.

Variety of materials: CAD/CAM allows dentists to choose from a wide range of materials, including metals, ceramics, zirconium and composites, which are known for their esthetics and durability.

Repeatability: Once designed, the data can be stored and accurately replicated, which is particularly useful for future expansions/renewals.

1.3 What general steps are involved in the dental CAD/CAM process?

Dental CAD and dental CAM encompass all work phases within the production of a workpiece: from the digital surface recording of the ground tooth and soft tissue to the milling of the workpiece. An Intraoral camera, with which the dentist moves along the rows of teeth almost without touching them, initially captures a three-dimensional data set via a narrow mouthpiece. The images obtained in this way show the positional relationships to the neighboring teeth and to the teeth of the opposing jaw. The dentist is able to check the image quality immediately on the screen and make any necessary adjustments or additions. This procedure therefore offers maximum precision in terms of planning and execution and enables a minimally invasive procedure.

1.4 Technical overview. How does it work?

The CAD/CAM workflow is divided into three phases: 

1.    The data acquisition step (CAI)
2.    data processing (CAD) 
3.    and finally that of production (CAM)

The first step is data acquisition. Here, the oral situation is documented and digitized either using an intraoral scanner or indirectly via a model scanner. This scans the plaster models, which were produced using the classic impression procedure, and transforms them into the digital world. It is also possible to add the bone structures to the data set with the help of a 3D X-ray device, making implant planning and temporomandibular joint diagnostics possible.

The second step requires optimized computers and specialized CAD software for displaying and editing digital work. Based on this digital data, the software is used to plan the treatment and design the dentures, implant abutments or splints. In addition to individual prosthetics, templates for teeth, abutments or implants can also be selected and adapted from the software's own database. It is now possible to immediately insert this digital denture into the virtual denture and simulate its function within the software. If the inserted dentures fit functionally and esthetically, the data record can be exported.

The final phase describes CAM production. In the event of minor changes, it is possible to make these directly in the software with just a few mouse clicks. The CAM software now evaluates the design data. The commands are then transmitted to the dental milling machine and the nesting is transferred.

1.5 Various manufacturing processes

Both additive and subtractive manufacturing processes are used in the dental CAM technique. 

Additive methods include various types of 3D printing that are used to produce models, drilling templates, plastic crunch splints and metal frameworks. In dental technology, DLP, SLM and SLA printers are used in particular.

In subtractive techniques, milling and grinding machines are used to manufacture products from different materials such as metal, plastic, titanium, ceramic or various types of glass. These materials are machined from blanks or blocks.

1.6 Digital workflow: In- and out-office systems

There are two main types of digital workflow in dental CAD/CAM production. The first option is the "out-office systems", where production and possibly also data processing are carried out externally, in a milling center or dental laboratory.

The second option is the "in-office systems", where both the design and production take place directly in the practice laboratory or dental practice, known as "chairside production". These in-office systems offer advantages in terms of data protection, as no data transfer to external parties is necessary.

The future of CAD/CAM technology in dentistry looks promising. Advances in AI could lead to even faster and more precise designs, while new materials could provide even more durable and natural-looking prostheses.

1.7 Areas of application for CAD/CAM dentures

The areas of application for CAD/CAM in dentistry are diverse and are revolutionizing the way dental prostheses are manufactured. Here are some of the most important areas of application for CAD/CAM dentures:

1. crowns
The production of crowns is one of the most common areas of application for CAD/CAM technology in dentistry. With CAD/CAM, dentists can design and manufacture accurately fitting, esthetically pleasing crowns directly in the dental practice in one day. This is a significant improvement over traditional methods, which can take several weeks.

2. bridges
Dental bridges, which are used to replace one or more missing teeth, can also be produced efficiently using CAD/CAM technologies. The precision of digital design and production ensures an excellent fit and functionality of the bridge.

3. inlays and onlays
Inlays and onlays are restorative treatments used to repair damaged or decayed teeth. CAD/CAM allows for precise adjustment and color matching, resulting in a virtually invisible restoration that restores the natural shape and function of the tooth.

4. veneers
Veneers are thin veneers that are applied to the front of the teeth to conceal cosmetic defects or to restore mechanical function, e.g. when the jaw moves sideways. With CAD/CAM, veneers can be quickly customized and fabricated, reducing treatment time and providing immediate results.

5. full and partial dentures
The fabrication of full and partial dentures can also be optimized using CAD/CAM systems. This technology enables a personalized fit and a natural appearance, resulting in improved functionality and comfort for the wearer.

6. implant abutments
CAD/CAM is also used to fabricate customized abutments and other implant abutments. These parts connect the implant in the bone to the visible prosthesis above it and are crucial for the long-term success of an implant-supported restoration.

1.8 Conclusion

While CAD/CAM dental has already become established in most dental laboratories, dental practices still have some catching up to do. Practices that recognize and use the potential of digitalization gain a clear competitive advantage over other colleagues. CAD/CAM technologies have changed the landscape of dentistry by shortening treatment times and improving the patient experience. As technology advances, this field will surely continue to innovate and improve the efficiency and quality of dental treatments worldwide. The benefits of CAD/CAM dental are clear, as sources of error can be reduced, significantly improving communication between dentist and dental technician. CAD/CAM systems and chairside fabrication can help dentists who are still hesitant. 
Modern solutions, such as those from "imes-icore GmbH", are not only convenient, but also highly efficient and, above all, affordable.