REVIEW ARTICLE

A REVIEW ON CAD CAM IN DENTISTRY

Umer bin Irfan1 BDS
Kashif Aslam2 BDS, MSc
3
Rizwan Nadim BDS, MSc

ABSTRACT: Evidence suggest that CAD CAM was in use in the ancient times. In dentistry, CAD CAM was
introduced in 1970s. Since then, its use in dentistry has been increasing day by day. Many companies are developing
new CAD CAM systems. With CAD CAM, dentists can get high quality inlays, onlays, implant abutments, cast
partial dentures, crowns, bridges etc. Maxillo-facial prosthesis and orthodontic clear aligners are also being produced
by CAD CAM. Apart from quality and quick production of restorations, cost and difficult usage of CAD CAM are
the reasons which are causing hurdles in mass production of these restorations. This review is about a brief history
types and current clinical applications of this modality.
HOW TO CITE: Irfan UB, Aslam K, Nadim R. A review on cad cam in dentistry. J Pak Dent Assoc 2015; 24(3):112-
116.
Received: October 10 2015, Accepted: October 26 2015

INTRODUCTION HISTORY OF CAD CAM

O
ver the past 30 years, CAD CAM (computer
aided design computer aided machine) has
gained popularity and confidence of the
profession and patients alike. It has provided ease,
comfort, and quality of restoration to both the dentists
and dental lab technician. Moreover, restorations which
are being produced through cad cam these days, are
more durable, more marginally adaptive, more
esthetically pleasing and more faster in fabrication as
compared to the conventional restorations. But despite
of these advantages, cost is the major issue which has
limited its use. Because of the financial constraints, in
the under developed countries, dentists are still reluctant
in using cad cam However, one should not overlook the
benefits which CAD CAM provides. Accuracy and
quality of CAD CAM in producing inlays, on lays,
implant abutments, fixed partial dentures, crowns and
bridges is acceptable and improving every day. This
review article highlights the history and current
indications of CAD CAM. It also provides information
that how it works and what can be itsadvantages and
disadvantages.
1. Dept. of Prosthodontics, Dow Dental College, DUHS, Karachi.
2. Assistant Professor Dept. Of Prosthodontics Dow Dental College, DUHS, Karachi,
Kings College, London.
3. Assistant Professor Dept. Of Community Dentistry Dow Dental College, DUHS,
Karachi.
Corresponding author: “Dr Kashif Aslam” < taimoor.links@gmail.com >
The history of dentistry is as old as human civilization
in the ancient times. Hippocrates and Aristotle, have
written many things about dental diseases and their
treatments.1 In the eastern world, ancient Chinese literature
is available regarding silver pastes (primitive amalgam).
As the civilization was getting developed, newer and
newer findings kept on becoming the part of dentistry.
Commercial production of porcelain teeth by Samuel
Stockton, introduction of amalgam by Crawcours and
origination of cohesive gold foil method by Robert Arthur
all have brought revolution in the field of dentistry.1 So
revolutionization has become the habit of dentistry.
The history of cad cam itself is old. In ancient Egypt,
Greece, and Rome, evidences suggest that cad cam was
being practiced there even. Even Leonardo di Vinci has
shown in his works, the use of modern graphics
convention. 2 But Euclid of Alexandria, the great
mathematician, can truly be regarded as the person behind
the modern CAD soft ware because today's CAD software
is based on Euclid's axioms and postulates, which laid
the foundation of Euclidian geometry.3,4 Iven Sutherland
in early 1960s, developed the CAD software (sketchpad)
but before that Dr. Patrick J. Hanratty, had already designed
first numerically controlled CAM that was named as
Pronto. So Dr Patrick is called as Father of CAD CAM.3,4
The introduction of CAD CAM in dentistry begins
with the work of Dr Duret. He took optical impression

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 Irfan UB / Aslam K / Nadim R A review on cad cam in dentistry

of an abutment tooth after cutting and then with the help
of that impression he fabricated a crown by using
numerically control machine. He did that miracle in the
field of dentistry in the year 1971.5 Later on Dr Duret
along with his team mates, worked on Sopha system and
introduced it but due to few reasons that system was not
generally accepted by the people. 6 Mormann was
the person who introduced first commercially designed
CAD CAM system in the year 1985 and given the name
of CEREC to that system. 7 He fabricated an inlay
from a ceramic block after taking digital impression from
intra oral camera. That was bit easy as compared to take
impression of a prepared abutment tooth. Now this
system is being used all over the world successfully
for the fabrication of crowns, inlays, onlays etc.
Dr Andersson developed Procera system in the mid-1980s
and worked on titanium as a substitute of nickel chromium
alloys.8 Previously, gold alloys were being used, but due
to increase in prices of gold, people had to think of
substitutes. Dr Andersson came up with titanium because
allergies were reported with nickel chromium.
Fig 1: Summarizes the major advancements in CAD CAM.
In 1971, Dr Duret designed 1st
CAD CAM
In 1985, Dr Mormann designed
CEREC system
In 1980s, Dr Andersson
introduction Procera
In 1994, Siemens made
CEREC 2 system
In 2000, Sirona introduced
CEREC 3 & InLab
CEREC 2 was introduced in 1994 by Siemens. This
system was based on two dimensional principles and
capable of producing inlay, onlay, veneers, partial & full
crowns and copings. Currently 3rd generation of CEREC
Types of CAD CAM Production
CAD CAM restorations can be produced by three different
ways.
a) Chair side production
b) Laboratory production
c) Centralized production
1. Chair side production:
It involves taking an impression chair side and then
producing the restoration at the same time. It doesn't
require involvement of the laboratory and the patient/s
can have their restoration at the same appointment10.
Obviously it saves times but it is expensive and puts extra
cost on the patient.
2. Laboratory production
It is somewhat similar to the conventional method. The
dentist takes the impression & sends it to the lab, where
other works carried out by the lab technician.
3. Centralized production
In centralized production of the restoration, an impression
is taken and a master cast is digitized in the lab, then it
sends to outsource laboratory through internet. In that
outsource lab, the final restoration is fabricated which
sends back to the dentist. The idea is right in the sense
that it requires digitizer and software only to perform the
initial steps and a high quality restoration.10
METHODS OF DATA ACQUISITION IN CAD CAM
There are several methods by which data can be
collected for CAD.
1) Intra oral scanning
2) Contact and non - contact digitization
3) Ct scan or MRI
Fig 2
DIGITAL IMPRESSION CONVENTIONAL IMPRESSION

is in use, which is capable of producing inlay, onlay,

veneers, partial & full crowns, copings as well as virtual 1. Less patient discomfort 1. More patient discomfort
automatic occlusal adjustment. This system was introduced 2. Takes less time 2. Takes more time
by Sirona in 2005. This system is basically the advanced 3. No need for model VS 3. Model pouring is needed
form of CEREC 3 which was earlier introduced in 2000 poring 4. Shelves are required to
by Sirona but that system worked on two dimensional 4. No extra space is keep the models esp.in
required to keep the orthodontics
principles and was not able to provide virtual automatic
models
occlusal adjustments.9

113 JPDA Vol. 24 No. 03 July-Sep 2015

 Irfan UB / Aslam K / Nadim R
1. Intra oral scanning
There are several intra oral scanners available in market
namely CEREC® - by Sirona Dental System GMBH
(DE), Lava™ C.O.S. - by 3M ESPE (US), iTero - by
C A D E N T LT D ( I L ) a n d E 4 D - b y D 4 D
TECHNOLOGIES, LLC (US) etc. What these systems
do, they take 3-D virtual picture of the prepared tooth/teeth
and the adjacent structures, directly into the patient's
mouth Later on these images transfer to the CAD for
designing of the prosthesis.11 A comparison of intra oral
scanning which is also called as digital impression and
conventional impression is given below.
But despite of the advantages of digital impression
technique, there are certain things which need to be
considered while taking digital impressions. The dentist,
who is taking intra oral pictures, must take care of moisture
control. Soft tissue retraction and hemostasis should be
considered too.12
2. Contact & Non - Contact Digitizing
This method involves taking an conventional
impression and then after producing a model, transferring
of that data into CAD through probe digitization (
contact) or laser light ( non - Contact ). In contact
digitizing or scanning, a contact probe reads the anatomy
of the model by following the contour of the physical
structure. In non-contact scanning, apart from laser light,
optics and charged -coupled devices are also used.
Obviously, this technique doesn't require any physical
contact with the model, but precision in recording the
details is required. It is assumed that, in comparison to
contact scanning, this technique is relatively quick in
gathering the data.13
3. Ct scan /MRI:
Computed Tomography (CT & Magnetic Resonance
Imaging (MRI) are newer techniques for data acquisition
for CAD Cam.By this method, individual images can be
taken and then can be transferred to CAD. CT scan utilizes
radiation for its data acquisition but MRI doesn't. For soft
tissue modelling, MRI data is suitable and for hard tissue
(bone) modelling, CT data can be used.14
USES OF CAD CAM IN DENTISTRY
CAD CAM is being used in almost every field of
dentistry these days. Following are its some of the uses
in different specialties of dentistry:
JPDA Vol. 24 No. 03 July-Sep 2015 114
A review on cad cam in dentistry
1. Prosthodontics:
Whether it is removable or fixed prosthodontics,
fabricating them through CAD CAM is becoming the
choice of almost every leading dentist.
a) Removable Complete Dentures:
A group of Japanese investigators named Maeda et
al, published a report in 1994, in which they proposed
that removable complete dentures can be fabricated using
CAD Cam technology.15 Since then many researches have
been proposed regarding fabrication of removable
complete dentures through CAD CAM but no clinical
reports or trials have been published yet. Only 2 of the
manufacturers claim that they manufacture RCD through
CAD CAM.16
b) Removable Partial Dentures
Partial denture framework can be produced through
CAD CAM by using additive prototyping technique.17,18
c) Crowns / Bridges
Zirconia is the widely used material for the fabrication
of crown and bridge through CAD CAM. However, metal
& porcelain crown & bridge can also be fabricated through
CAD CAM. A study suggests that zirconia exhibits
acceptable clinical results.19
d) Inlay, Onlay & Veneers
These restorations are also being produced through
CAD CAM.20 A study says that inlays & onlays, produced
through CAD CAM, have a higher survival rate. 21
2. Orthodontics
In orthodontics, clear aligners have gained so much
popularity due to esthetics. Now patients don't have to
show metallic brackets and wires. The credit goes to CAD
CAM again.22 Also lingual bracket system is in demand
due to its invisibility. The wires and bracket system for
the lingual bracket system is fabricated through CAD
CAM.23 Orthodontic mini implants can also be positioned
using CAD CAM technology.24
3. Implant Dentistry:
Implant abutments and surgical guides for the
placement of implants are being produced through CAD
CAM these days.25
4. Maxillo-Facial Prosthetics:
A study shows the difference in between the outcome of
 Irfan UB / Aslam K / Nadim R
the artificial ear prosthesis carved by hand & fabricated
through CAD CAM. The latter is superior over the hand
carved prosthesis.26 So artificial ear27, artificial nasal
prosthesis28 are being produced through CAD CAM. Not
only this, but certain bony defects following trauma
or removal of tumors are also being treated by
manufacturing implants through CAD CAM.29
ADVANTAGES AND DISADVANTAGES OF
CAD CAM
If we compare the advantages of CAD CAM
restorations over the conventional one, we will definitely
place CAD CAM restorations on top. They provide us
quality restorations with quick and easy fabrication.
Scanning of intra oral tissues takes less time than
conventional impression, and if the chair side system is
available, the patients can get their restorations in one
appointment.Quality of these restorations has been
demonstrated in so many studies.
But despite of these advantages, cost is still a major
issue. Also taking digital impression is a big challenge
for the dentists, because they have to take care of soft
tissue retraction, moisture control etc.
CONCLUSION
CAD CAM has no doubt changed the concept of modern
world dentistry. Different specialties of dentistry are being
successfully benefited by CAD CAM. Either orthodontics
or prosthodontics, quality treatment is possible with
accuracy and effectiveness. But cost of these treatments
is still a problem for the patients and the dentists, esp. of
the developing countries. We are hopeful that in the near
future, CAD CAM will be started using widely in the
developing countries as well.
Author Contribution: UBI conceived the idea and made
the initial draft, KA revised the manuscript and RN
collected the references.
Disclosure: None disclosed
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