TITLE OF THE ARTICLE -

CAD/CAM IN ORTHODONTICS – AN OVERVIEW

DR.BHARATHI *1DR. SANJANA A*2,

TYPE OF ARTICLE - REVIEW

AUTHOR DETAILS-
1.DR.BHARATHI
Senior lecturer,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital,
BIHER.

2.Dr. SANJANA A,
Postgraduate,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital,
BIHER.

1. Dr. KANNAN MS, MDS,

Head of the Department,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital,
BIHER.

CORRESPONDING AUTHOR-
Dr. SANJANA A,
Postgraduate,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital, BIHER.
Contact No: 9444639096
E-mail: sanjanaananth97@gmail.com
 CAD/CAM IN ORTHODONTICS – AN OVERVIEW
ABSTRACT- 
Computer-aided design and computer-aided manufacturing (CAD/CAM) technology is
widely used to create individualized appliances for various orthodontic purposes. Data
collection is primary for accuracy in the final manufacturing of three-dimensional models.
Rapid prototyping is a technique for the construction of physical 3D models which includes
digitization of models used for diagnosis and treatment planning, fabrication of orthodontic
removable appliances, impression trays for indirect bonding, a surgical stent for implant
placement, and customized lingual brackets. This protocol transfers the planned bracket
position from the digital setup to the patient's dentition with high placement accuracy and is
more efficient in favour of overall treatment duration and reduces the total treatment time by
producing desired results.

INTRODUCTION-
Three customization approaches are used to generate a theoretical ideal force system and to
produce tooth movements desired by orthodontists.
The above-mentioned approaches are as follows-
1. Individualized archwire
2. Individualized bracket slot/bracket base
3. A combination of the first two approaches
Computer-aided design and computer-aided manufacturing (CAD/CAM) technology was
widely used to create individualized appliances for various orthodontic purposes.
Current uses of CAD/CAM technology in orthodontics include aids for diagnosis and
treatment planning, clear aligner therapies, custom labial, and lingual systems, and titanium
Herbst appliances.

CAD-CAM COMPONENTS-
1. SCANNERS-
Data collection tool that measures three-dimensional jaw and tooth structures and transforms
them into digital data sets. 
There are two different scanning possibilities-
1. Optical Scanners
 2. Mechanical Scanners
3. DESIGN SOFTWARE-
The data of the construction can be stored in various data formats. 
The basis, therefore, is often standard transformation language (STL) data. Many
manufacturers, however, use their data formats, specific to that manufacturer, with the result
that data of the construction programs are not compatible with each other – Closed design

1. PROCESSING DEVICES (MILLING)-

The construction data produced with the CAD software is converted into milling strips for the
CAM-processing and finally loaded into the milling device.
Processing devices are distinguished employing the number of milling axes –
3-axis devices
4-axis devices
5-axis devices
1. 3-axis devices-
 This type of milling device has degrees of movement in all three spatial directions.
Therefore, the mill path points are defined by the X-, Y-, and Z- values.
All 3-axis devices used in the dental area can also turn the component by 180° while
processing the inside and the outside.
 Advantages- Short milling times
 Simplified control utilizing the three axes
 Less expensive
1. 4-axis devices-
In addition to the three spatial axes, an added rotatable tension bridge in the component can
also be turned infinitely variably. 
1. 5-axis devices-
With a 5-axis milling device, there is also, in addition to the three spatial dimensions and the
rotatable tension bridge, there is a possibility of rotating the milling spindle.
 This enables the milling of complex geometries with various subsections.

RAPID PROTOTYPING-
Rapid prototyping (RP) is an advanced technique that is considered a group of related
techniques that are used to build physical 3D models. 3D models with the help of rapid
prototyping are built layer by layer based on CAD/CAM. It accurately reproduces almost all
forms of shapes, and this includes complex external and internal anatomic structures as well
as artistic structures. Its orthodontic application includes digitization of models used for
diagnosis and treatment planning, fabrication of orthodontic removable appliances,
impression trays for indirect bonding, a surgical stent for implant placement, and customized
lingual brackets.
 Procedure-
1. Anatomical data acquisition through Computed tomography, Magnetic Resonance
Imaging, Laser surface digitizing, Ultrasound, and Mammography.
2. Evaluation of the design includes the elimination of unnecessary data.
3. Surgical planning and superimposition (if required)
4. The process of fabrication of the model can be done through various methods which
can include either additive or subtractive methods. The additive method as the name
suggests involves addition of substrate in a sequential layer by layer format to
produce the desired appliance. Whereas the subtractive method involves the removal
of a substrate to achieve said products.
5. Stereolithography- A 3D printing process that uses a computer-controlled moving
laser beam and is pre-programmed using CAM/CAD software
6. Fused deposition modeling- Similar to stereolithography where a thermoplastic
material is extruded by a temperature-controlled head in a layer-by-layer fashion.
7. Selective laser sintering- SLS also works with additive manufacturing principle where
there is a computer-directed laser for fusing a layer of specified powder into complex
geometries.
8. Inkjet printing- An inkjet printer moves along the X and Y axes selectively depositing
a liquid binding material.
9. Validation of the model

APPLICATION IN ORTHODONTICS-
CAD-CAM is widely used in orthodontics for various purposes to improve bracket position
accuracy and clear aligner therapies. Bracket placement is made simpler with the help of a
guided bonding device consisting of 3 parts. The said device has an L-shaped guide that fits
on the distal and occlusal edge of the bracket that needs to be bonded onto the tooth surface.
It also consists of a splint that covers the occlusal surfaces completely or partially, and
connecting rods that connect the other two parts of the system. This protocol transfers the
planned bracket position from the digital setup to the patient's dentition with high placement
accuracy. One of the major disadvantages of this system is that even a single wrong bracket
positioning on the 3D model can only be discovered after the tray removal. The Insignia
system used customized slots that are already cut into the bracket at the desired position.
These cuts present in the bracket are created to produce desired tooth movement via archwire
progression into a straight final archwire. Digital models are generated from pre-treatment
impressions, and these are used to create a virtual setup of the desired outcome. Similarly, the
Incognito system combines the individuation of bracket slot and archwires to generate fully
customized lingual orthodontic appliances. 

CONCLUSION-
Technological advances in orthodontics are not limited to customized appliances but extend
also to diagnostic and treatment planning tools. CAD/CAM appliances are more efficient in
favour of overall treatment duration and reduce the total treatment time by producing desired
results. 
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