CAD/CAM in Prosthodontics

Introduction
ensure adequate strength
of the restoration
• developed to solve 3 challenges

to create restorations with

a natural appearance.

to make restoration easier,

faster, and more accurate
 Dr. Francois Duret, Dr Werner H Mörmann
Father of Digital Scanning the developer of the CEREC® system

Dr Matt Andersson Dr Elizabeth Dianne Rekow

the developer of the Procera® system Data acquisition using photographs and a high-resolution
Scanner, and to mill restorations using a 5-axis machine.
Advantages
• Reduced labour
• Time effectiveness
• Quality control
• No Provisionals are required
• Review and correction of preparation
• Full arch preparations
• Patient is freed from the trouble of impression and impression
materials
• Light transmission into the gingival sulcus is possible
• Allows occlusion to be viewed and developed in dynamic state
• Cost effective
Disadvantages
• the length of the learning curve
• Capital costs
• making subgingival margin capture challenging.
• expenses for technical support and software upgradation.
Components of CAD/CAM system
2. Software that process the data

CLOSED OPEN
SYSTEMS SYSTEMS
Production technology
Subtractive
manufacturing

SPARK
MILLING PROCESSING
EROSION

DRY
3-AXIS 4-AXIS 5-AXIS WET MILLING
PROCESSING
Production technology

Additive
Manufacturing/3D
Printing

LASER POWDER SELECTIVE ELECTON

STEREOLITHOGRAPHY FUSED SEPOSITION INKJET PRINTING
FORMING BEAM MELTING
(SLA) MODELLING (FDM) TECHNOLOGY
TECHNIQUES (SEBM)

SELECTIVE LASER
SELECTIVE LASER
SINTERING
MELTING(SLM)
(SLS/DMLS)
Classification of CAD/CAM systems
• In office systems
• CAD/CAM for dental laboratory models
• CAD/CAM for out sourcing
 Materials used for CAD/CAM systems

METALS SILICA BASED INFILTRATED

CERMICS CERAMICS

Cr Co
TITANIUM Ti ALLOYS
ALLOYS MONOCHROMATIC MULTOCOLOUR VITA IN CERAM VITA IN CERAM VITA IN CERAM
BLOCKS LAYERED BLANKS ALUMINA ZIRCONIA SPINELL

RESIN
ALUMINIUM YITTRIUM
MATERIALS OXIDE ST’ZED Zr OXIDE

CERCON SMART
IN CERAM AL IN CORIS LAVA FRAME EVEREST ZS
ERAMICS (Degu-
BLOCK (Vita) (Sirona) (3M ESPE) UND ZH (KaVo)
Dent)
CEREC AC powered by BlueCam E4D Dentist system Cadent iTero Lava COS

3SHAPE DENTAL SYSTEM SCANNERS

Dental Considerations
Shoulder less
continuous preparation
preparations and parallel
margin, which is clearly
walls should be avoided Rounded edges
recognisable to the
(4° to 10° is
scanner
recommended)

diameter of the smallest

grinder is 1 mm in most
abutment teeth cannot
systems, so structures
show any divergence
smaller than 1 mm
cannot be milled precisely
Limitations of CAD/CAM systems
• restricted measuring conditions in the mouth
• CAD/CAM milling procedures may induce surface and subsurface
flaws that may adversely affect the strength of this ceramic
• he application of a titanium dioxide or magnesium oxide powder to
the abutment teeth before scanning
• zirconia frameworks on teeth requiring longer curved frameworks are
subjected to a greater sintering distortion than the shorter straight
frameworks
Complete Dentures
Removable Partial Dentures
• A 3D scan dental cast was obtained using a digitizer
• Cad Software aided surveying – identifying area of undercut in
different colour
• Undercuts removed
• The STL file of the buck model is imported to a suitable sotware like
FreeFormA
• Relief created by virtual clay
• Framework created on the relieved buck cast with undercuts
removed, clasps designed. Components joined to main framework.
Removable Partial Dentures
• Pattern is manufactured
• Rapid Prototyping – Fabrication of Prototype and
casting in CoCr-S
• Milling or spark erosion or SLS
Advantages of digital fabrication of dentures
• Decreased number of appointments
• Shrinkage of acrylic base caused by milling of prepolymerized acrylic resin
with an increase in the strength and fit of dentures
• Decreased duration of prosthesis manipulation
• Decrease in the risk of microorganism colonization on the denture
surfaces and consequent infection
• Advances in standardization for clinical research on removable prostheses
• Easy reproduction of the denture and manufacture of a trial denture using
stored digital data
• Superior quality control by clinicians and technicians
Limitations and disadvantages of digital fabrication
of dentures
• Manufacturing challenges caused by impression-taking and OVD-recording
procedures,
• MMR transfer, and maintenance of lip support, which are all similar to the
procedures used in the conventional process
• Inability to define the mandibular occlusal plane
• Expensive materials and increased laboratory cost compared with those for
conventional methods
• Lack of trial denture manufacture which precludes the evaluation of
dentures by patients and dentists before final denture fabrication.
 Implantology

CAD/CAM Custom CAD/CAM Custom

Implant Abutment Implant
Systems Framework
•Procera system Systems
(Nobel Biocare) •Procera
•Atlantis abutment •CAM StructSURE
(Astra Tech •BioCad:
•Encode Restorative •Etkon system Healing abutment CAD/CAM
Digital System (ARCHITECH CAD/CAM Implant
Surgical stents PSR, Biomet 3i): CAD/ and Digital Technology; Bars
impressions Abutments
•CAM system limited Emergence profile and Frameworks
to a specific implant
(Biomet 3i)
•CARES (Computer
Aided Restoration
Service; Straumann)
•Etkon
Maxillofacial Prosthetics
• CT scan digital data has revolutionized the ability to
produce both actual models of cranial defects and deformities
as well as the ability for manufacturers to create
reconstruction models and implantable materials (MIRRORING)

• Use of high-density polyethylene, custom titanium, and PEEK

implants (Patient Specific Implants)

• CAD CAM scaffolds with 3D Bioprinting living cells

Regenerative Medicine
General schematic representation of the
current strategy for whole tooth
regeneration using iPS cells. The patient's
somatic cells are harvested. Reprogramming
conditions/factors are introduced to induce
self-renewal and pluripotency, and patient-
specific iPS cells are established. iPS cells are
induced to form ectodermal epithelial cells and
neural crest-derived mesenchymal cells, and
they are further induced to form odontogenic
cells in vitro. The two cell populations are
combined by direct contact, mimicking the in
vivo arrangement. Interaction of these cells
leads to formation of an early-stage tooth germ.
Once transplanted into the mouth, the
recombinants develop and lead to functional
recovery from tooth loss.