Digital Dentistry

CAD/CAM Technology

In Dentistry

DR . MO HA ME D K HA L E D A DD A S ( B D S , MD S , P HD)
ASSI TA NT PR OFE SSOR

DE PA R T MENT O F P R O ST HO DO NTICS

CO L L E GE O F DE NT ISTR Y - K I NG K HA L I D U NI VE R SIT Y

Digital Dentistry

-Foundational Knowledge of Digital Dentistry

-Applying Science in Digital Dentistry

-Step-by-Step of Computer Aided Design/Computer Aided

Manufacturing (CAD/CAM)

-Step-by-Step Protocol for Implant Planning

Foundational Knowledge of Digital Dentistry

-History of Digital Dentistry -Overview on digital systems

• Workflows
-Fundamentals of digital dentistry

• Modern digital lab and office

-Terminology (Glossary)
-Basics of 3D Radiology

-Imaging (Photography, Radiology, Surface)

-Electronic Health Record

-Science behind scanning

• Chairside
-Assessment and diagnosis of CBCT and

digital radiograph

• Laboratory
-Merging datasets – DICOM, stl, etc

• Facial

-Science behind production

• Milling

• 3D Printing

Applying Science in Digital Dentistry

-Fundamentals of tooth preparation

• Full coverage restoration

• Partial coverage restoration

-Materials used for production

• Metal alloy

• Ceramic

• Composite Resin

• PMMA

• Wax pattern

-Luting Agent

CONTENTS

• DEFINITIONS

• CAD/CAM HISTORY

• CAD/CAM SYSTEMS

• RESTORATIVE MATERIALS FOR DENTAL CAD/CAM

• TOOTH PREPARATION FOR CAD/CAM RESTORATION

• SCANNING AND DESIGNING FOR SINGLE UNIT USING INTRAORAL

SCANNER (CARESTREAM SYTEM).

• DISCUSSION

DIFINITION

• CAD= Computer Aided Design

• refers to the use of software to assist engineers, architects and other design

professionals in their design activities

• CAM= Computer Aided Manufacturing

• refers to the use of computer systems for the control of robotics and tools during

the product manufacture

HISTORY

CAD/CAM introduced in the 70’s of 20th century

• John Young and Bruce Altshuler (USA) 1977: intraoral grid surface

mapping system

• Francois Duret (France)1984: Duret system then Sopha bioconcept

system demonstrating the ability of CAD/CAM to generate single

unit, full coverage restoration.

• Werner Mormann and Marco Brandestini (Switzerland) the first

commercially CAD/CAM system (CEREC) sirona

• Examples of CAD/CAM systems used in dentistry:

• Cerec 3 (Sirona, Germany)

• 3Shapes (Denmark)

• Amman Girrbach (Germany)

• Dental wings (USA)

• etc……

COMPONENTS of CAD/CAM SYSTEMS

• All CAD/CAM systems consist of three components:

• A digitalization tool/scanner that transforms geometry into digital

data that can be processed by the computer.

• Design Software that processes data and produces a data set for the

product to be fabricated.

• Production unit A production technology that transforms the data

set into the desired product.

CHA I R SIDE CA D / CA M SY S T E MS L A B CA D / CA M S Y S T E MS

• The dentist sends the impression to the

• All components of the CAD/CAM

laboratory where a master cast is fabricated

system are located in the dental first.

cabinet. • The remaining CAD/CAM production steps

are carried out completely in the

• Fabrication of dental restorations laboratory.

can thus take place at chairside • With the assistance of a scanner, three-

without a laboratory procedure. dimensional data are produced on the basis

of the master die. These data are processed

by means of dental design software.

• The digitalization instrument is an • After the CAD-process the data will be sent

intra oral camera, which replaces a to a special milling device that produces the
conventional impression in most real geometry in the dental laboratory.

clinical situation. • Finally the exact fit of the framework can be

evaluated and, if necessary, corrected on the

basis of the master cast.

• this system was the first CAD/CAM

• The ceramist carries out the veneering of

system in dentistry 20 years ago)

the frameworks in a powder layering or

and is currently available in its over pressing technique.

third product generation (CEREC 3

Closed System VS Open system

3D Imaging Methods in Health Sciences.

1. Computed tomography (CT) .

2. Cone beam computerized tomography (CBCT) .

3. Micro-computed tomography (MCT) .

4. 3D laser scanning.

5. Structured light technique.

6. Sterophotogrametry.

7. 3D facial morphometry (3DFM) .

8. Tuned-aperture computer tomography (TACT).

9. Magnetic Resonance Imaging (MRI).

Cone Beam Computerized Tomography

(CBCT) .

• A medical imaging technique

consisting of X-ray computed

tomography where the X-rays are

divergent, forming a cone.

• It allows for the collection,

storage, and utilization of 3D

radiographic data in the DICOM

file format, utilizing the .dcm file

extension.

• Machines are often classified as

• large volume (20-cm height and 15-cm

diameter cylinder) and

• small volume/limited view (40 × 40 mm2

or 60 × 60 mm2) based on the exposure

area.

Micro-Computed Tomography (MCT) .

• The same as CT except that the reconstructed cross-section are bounded to a

much minor area

• 0.012 mm thin cross-sections can be taken with conventional CT, but MCT can

be obtained with the nano-sized sections.

Structured light technique Scanner

• Scanning device for

measuring 3D shape of

an object using

projected light patterns

and a camera system.

The basic principle of Light/Laser 3D scanner

• All dental 3D scanners are constructed

on the same basic principle.

Fundamentally, a 3D scanner consists of:

1. A light source,

2. one or more cameras, and

3. A motion system supporting several

axes for positioning the scanned

object towards the light source and

camera(s).

2ND set fringes aligned coaxially and mutually

perpendicular to the first pattern creating a rectangular

parallopiped grid pattern projected upon an observed

object.

Stone Cast 3D Meshwork 3D Virtual Cast

3D scanners

•Mechanical scanners.

•Optical scanners.

•Intraoral scanners.

Mechanical Scanner/contact scanner.

coordinate measuring machine (CMM)

A device for measuring the physical geometrical

characteristics of an object.

This machine may be manually controlled by an

operator or it may be computer controlled.

Measurements are defined by a probe attached to the

third moving axis of this machine and can be referred to

as a contact scanner.

The master cast is read mechanically line-by-line by

means of a ruby ball and the three-dimensional

structure measured. (PROCERA)

Desktop Optical Scanners

A device that uses light/laser to scan and

digitize objects (impressions, casts,

articulator). This device is stationary and

cannot be used for intraoral scanning

Intraoral scanning

• The process of scanning and capturing the intraoral cavity for translation

into a digital file format, such as STL using intraoral scanner.

Photogrammetry

• Photogrammetry uses methods • is used in fields such as

from many disciplines, including topographic mapping,

optics and projective geometry. architecture, engineering,

manufacturing, quality control,

• Digital image capturing and police investigation, cultural

photogrammetric processing heritage, and geology.

includes several well-defined

stages, which allow the generation

of 2D or 3D digital models of the

object as an end product.

• Stereophotogrammetry, involves

estimating the three-dimensional

coordinates of points on an object

employing measurements made in

two or more photographic images

taken from different positions

Magnetic Resonance Imaging (MRI)

• MRI operates by achieving a resonance

signal from the hydrogen nucleus.

• Therefore, it is basically imaging of

water in the tissue.

• MRI method is the highest contrast

resolution medical imaging technique.

• Radio waves are sent to desired location

for examination in a magnetic field. Normal meniscus (m) posterior and superior to

• The energy produced from hydrogen

condyle (C) , the articular eminence (E) and

atoms in the cells stimulated by radio auditory canal (AC).

waves are converted to numbers; they

are processed on a computer and then

converted to image.

Otodesk

Dental Design software ‫ريكاب‬

• 3shape (Dental system)

• Exocad (Amann Girrbach)

• Dental wings (DWOSx)
• Restore(Carestream)
• Etc…….
Processing devices
Processing devices are distinguished by means of the number of axes of
milling machines or using 3D Printers
• 3 axis devices
• 4 axis devices
• 5 axis devices

a. Dry milling
Subtractiv technology
b. Wet milling
 Additives technologies

3D Printing technologies
• Stereolithography (SLA) Resin material

• Digital Light Processing (DLP)

• Fused deposition Modeling (FDM)
• Selective Laser Sintering (SLS)
Metal
• Selective Laser Melting (SLM)
• Electronic Beam Melting (EBM)
• Laminated Object Manufacturing (LOM)
• Binder Jetting (BJ)
• Material Jetting (MJ) ‫تعطيني واكس‬
 1- Stereolithography
◼ Is a common rapid manufacturing
and Rapid Prototyping (RP)
technology for producing parts
with high accuracy and good
surface finish.
◼ A device that performs
stereolithography is called an SLA
or Stereolithography Apparatus
(SLA)
Stereolithography
• SLA utilizes a vat of liquid resin
and a UV laser to grow parts in a
layer-by-layer process.

• The laser beam traces a cross-

section on the surface of the
resin, curing and solidifying the
pattern while building on the
previous layer.
• This action is repeated until a
complete 3D part is formed.
• Parts are then cleaned in a
chemical bath and cured in a UV
oven.
2- Digital Light Processing (DLP)
• DLP is the oldest of the 3D printing
technologies (1987).
• DLP achieves quicker print times for
most parts. The reason it’s faster is
because it exposes entire layers at
once.
• DLP printing technology produces
high resolution models
 3- Fused Deposition Modeling (FDM)
FDM works on an "additive" principle
by laying down material in layers. A
plastic filament or metal wire is
unwound from a coil and supplies
material to an extrusion nozzle which
can turn on and off the flow.
The nozzle is heated to melt the
material and can be moved in both
horizontal and vertical directions by a
numerically controlled mechanism,
directly controlled by a computer-aided
design software package.
4- Selective Laser Sintering (SLS).
5) Selective Laser Melting (SLM) Technology

The SLM approach uses high-powered laser in a chamber of noble, or inert

gas.
Crowns , Bridges and RPD’s

• A crowns , bridges and RPD made

of CoCr. From the scan data
individual caps, bridges and inlets
are manufactured in short time
but with high precision.
Implant design and production
• The selective laser
melting (SLM) process is
used for production of
detailed anatomic macro-
and micro-structures in
100% dense steel and in
titanium.
Stereolithography models were used
for preoperative planning in surgery
CT-scanning of the plastic models CAD-planning of the anatomic models
Real models produced by selective laser melting.
 6- Electron beam melting technology (EBM)
technology
This technology uses an electron
beam gun to melt metal powder and
build solid parts layer-by-layer.
EBM, uses a powerful electron beam
in a vacuum.
It has the ability to achieve complex
geometries with freedom of design.
Can creates fully functional, durable
parts on demand for wide-ranging
industries
7- Laminated Object Manufacturing (LOM)
8- Binder Jetting (BJ)
9- Material Jetting (MJ) Polyjet and Wax Casting

MJ 3D printers produce high-resolution parts, mainly for the dental and

Jewelry industries
Tooth Preparation

Pre-Treatment Lower right Rough occlusal reduction Gross reduction of buccal,

first molar with large using 15558sc mesial and lingual
restoration and recurrent Removal of occlusal enamel The 1558sc is used to break
caries following the cuspal inclines the proximal contact and
remove the buccal and
lingual enamel
 Tinker bur

Occlusal reduction refined Smoothing axial wall

Gross reduction is completed
with the 58110.37 The axial walls are smooth
The initial reduction is
The occlusal surface is now with 5856.016 or 58560.18
complete. The preparation is
refined with an occlusal round end chmafer bur. This
at the level of the gingiva
reduction diamond bur. The bur is also used to refine the
except the distal where it is
reduction should be 1.5-2.0 margin
deeper to break contact.
mm.
Completed reduction Refining axial reduction with
8856.018 round end chamfer.
The axial walls and margin
are finished with a fine
diamond.
Sharp corner created by axial
and occlusal reduction. This
corner must be rounded for
CAD/CAM. The milling tool
cannot reproduce the 90o
corner.
Sharp corner rounded with
8833R.31 FFB . This angle can
be eliminated with a diamond
instrument designed to
conform the milling tool
Screenshot of the intra-oral
scan showing occlusal
reduction has beed rounded.
Cemented Lithium disilicate
crown
Completed crown requiring
no adjustment to the occlusal
surface or contact points.
 Partial Denture
Design

3 D WA X
P R INT ER
Design a RPD
 CAD/CAM RPD

Printed wax RPD’s Framework Metal RPD Framework

Complete Denture CAD/CAM Design
Haptic technology
also known as kinaesthetic communication or 3D touch, refers to any technology that
can create an experience of touch by applying forces, vibrations, or motions to the
user.

The SensAble™ Dental Lab System v2

SU B STRU CTURE RE SIN ( 1 ) –
FI NA L PR E SS ED 3 - U NI T B R I DG E.
M E TA L ( 2) PATT E RN
Orthodontic solutions
Dental Implants Workflow
Digital workflow

Load open format CBCT scan and Start placing virtual crowns to guide
surface scan. Receive surface scans your implant planning for optimal
from intraoral scanners and your dental esthetics and function.
lab.
Virtually place implants while accounting for the
Easily design a customized surgical
clinical situation including prosthetics, gingiva,
guide based on the implant positions
bone density, and nerve positions
and surface scan.
Utilizing the implant positions, Dentists receive a complete treatment
technicians can design and produce package including surgical guide and
the full range of prosthetic prosthetic components, and perform
components surgery in one single visit.
MATERIALS USED IN CAD/CAM PROCESSING
a) Metals
• At present, titanium, titanium alloys and chrome cobalt
alloys are processed using dental milling devices.
• The milling of precious metal alloys has been shown to be
of no economic interest, due to the high metal attrition
and the high material costs.
Examples:
• coron (etkon: non-precious metal alloy),
• Everest Bio T-Blank (KaVo, pure titanium).
 Bio T-Blank
EVEREST

coron CrCo
ETKON
b) Resin materials
• long-term provisional or for full anatomical longterm
temporary prostheses.
• Prefabricated semi-individual polymer blanks (semi-
finished) with a dentine enamel layer are provided by one
manufacturer (artegral imCrown, Merz Dental).
• The exterior contour conforms to an anatomically complete
anterior tooth crown, while the internal aspect of the
crown is milled out of the internal volume of the blank.
 artegral
ImCrown
Evolution and State of the Art of CAD/CAM
Ceramic Restorative Materials
• Glass-Ceramics Leucite
• Silica. Vita Mark II
• Leucite-Reinforced Glass-Ceramics. Empress CAD.(SiO2-Al2O3-K2O(
• Lithium Disilicate Ceramics. Empress 2 and IPS e.max Press (LDS). Silica
• Lithium Silicate/Phosphate Glass-Ceramics. VITA Suprinity. (LSP).

• Resin-Matrix-Ceramics
Alumina
• Resin-Based Composites (CAD/CAM). (Lava Ultimate). Resin nano ceramic
Lava™ Ultimate Restorative is no longer indicated for crowns

• Polymer-infiltrated-ceramic-network (PICN) Materials. VITA Enamic.

(hybrid ceramic with a dual ceramic-polymer network structure), Spinelle
• Infiltration ceramics (infiltrated with lanthanum glass)
• Vita In-Ceram Alumina (Al,o) (anteriors)
• Vita In-Ceram Zirconia (70% Al,03. 30% Zr O.(Posteriors)
Zirconia
• VITA In-Ceram Spinlle ((MgAl,O.) highly aesthetic anterior crown copings (Translucent )

• Oxide Ceramics
Zirconia Ceramics. Yttrium stabilized zirconium oxide (ZrO, Y-TTP)
• Monolithic Zirconia.
• Translucent Zirconia.
Minimally Invasive CAD/CAM Restorations

• LDS and leucite-reinforced glass-ceramics at a thickness of 0.5 mm.

• LDS 0.3 mm