CAD/CAM chairside: All done in one appointment

Have you ever wondered what advantages and opportunities digital dentistry could hold in store for you? Are you considering using CAD/CAM technology in your practice in the future? If these questions are on your mind, our interview with dentist Dr Michael Dieter (Ivoclar Vivadent AG, Schaan/Liechtenstein) will help you find some answers.

 
Dr Dieter, when did you start using digital technologies in your dental practice?

Dr Michael Dieter: I began to use digital techniques over 18 years ago. At the time, CAD/CAM was still in its infancy. We produced many inlays and onlays, for which we already then used tooth-coloured materials. All the other applications - crowns, partial crowns, veneers – were still fairly unchartered territory. I nonetheless dared to venture into it. Initially, it was very trying with the chairside work taking a long time. However, the feedback from the patients was fabulous. They were happy because they did not need a temporary. Instead, they were all done in a single appointment as the restorations were placed adhesively straight away.

How has CAD/CAM technology developed since then?

Dr Michael Dieter: The technology has undergone rapid development. Similar to the most popular communication devices, advances have been made at an astonishing pace. While at first only comparatively small single-tooth restorations were feasible, today many more options are available. Standard crown restorations– on both vital teeth and implants – can now be done with ease. Take hybrid crowns: the all-ceramic structure can be milled, for instance, from an IPS e.max CAD ceramic block at chairside and cemented onto a titanium base – and this abutment is then directly mounted on the implant and fixed with screws. Three-unit bridges can also be created without difficulty using today's digital technology – something which had previously been unthinkable. Even veneers, or minimally invasive esthetic anterior restorations, can be accomplished. They may require a touch more effort but they lead to results that are of very high quality and esthetics. In a nutshell: the range of indications has been extended by a host of possibilities.

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What advantages does CAD/CAM technology bring to the dentist?

Dr Michael Dieter: Dentists benefit from CAD/CAM in a number of ways. If you restore the tooth immediately after preparation, you do not need to place a temporary. In that way, you can be more efficient. The bond to the tooth is also improved because the bond strength is considerably higher on freshly prepared teeth. If a temporary is used, the quality of the bond is diminished.

Another aspect: if you provide the dental technician with a conventional impression, he or she cannot always verify if the entire preparation margin has been faithfully reproduced and if the preparation depth is adequate. Dentists that have already had some experience with using intraoral scanning devices normally provide better preparations. This is because you can enlarge a scan to view it and you can often display it in colour. If you spot any irregularities, you can correct them straight away. This immediate visual feedback is only possible if you use CAD/CAM. This is a clear advantage for the dentist and, by extension, for the dental technician, who no longer receives and needs to re-do inadequate preliminary work.

And one more thing: CAD/CAM enhances the image of the practice. When patients can watch in person how their teeth are scanned and then their restoration is designed, milled and seated, they are really impressed. I have had patients that explicitly asked for a CAD/CAM restoration even if it was not indicated for their treatment. Last but not least, the dentist will get happier patients.

Why happier? What exactly are the benefits for patients?

Dr Michael Dieter: There are quite a few benefits for patients. For instance, they like it that only one appointment is required for the treatment. They leave the practice, and everything is done and dusted. Patients that have quite long travelling times are especially grateful for this. And as they will not need a temporary, lost or broken temporaries are no longer an issue.

Another advantage is that damaged restorations can be quickly replaced- often in 15 to 20 minutes. Such a rapid replacement is possible because you will store all data, including the tooth shade and degree of translucency, in a database. So, you simply retrieve the information for the restoration and mill it again.

And finally, patients will appreciate their restorations even more if they can witness with their own eyes how their restoration is created by their dentist. They may even be able to watch their restoration emerge from the milling process, as some dentists keep their milling machines in a visible place, for instance in the waiting room. This turns a visit to the dentist into an exciting experience.

How can dentists obtain further education on CAD/CAM?

Dr Michael Dieter: Many dental associations offer further education and training. There are even some associations, for instance in Germany, that are specializing in computer-assisted dentistry. The industry also offers a range of activities in this field. Ivoclar Vivadent, for instance, offers courses on CAD/CAM at their training centres (ICDEs) from time to time. In these courses, the participants will be trained on all aspects of the workflow.  All steps involved – indication, preparation techniques, ceramic selection, fabrication of the restoration from the ceramic, crystallization of IPS e.max or polishing, esthetic design, cementation and final polishing – will be discussed. The courses should enable dentists to start using the materials of the supplier on their CAD/CAM system straight away.

Ivoclar Digital is the name of a strong and focused new brand developed by Ivoclar Vivadent. It provides dentists and dental technicians with state-of-the-art professional expertise throughout the entire digital process chain.

IPS e.max is a registered trademark of Ivoclar Vivadent AG. The availability of certain products may vary from country to country.