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THE DENTAL ADVISOR is leading the way in CAD/CAM dentistry. We are quickly becoming industry experts in this very exciting area of growth. John W. Farah, DDS, PhD, Santine Anderson, DDS, Sabiha Bunek, DDS, and John M. Powers, PhD, are lecturing nationwide on Digital Impressions and CAD/CAM technology. Joining with Chris Brown, Manager of Apex Dental Milling, they have been lecturing to both dentists and laboratory technicians and have published several articles on CAD/CAM dentistry for publications such as the Journal of Dental Technology, Dental Lab Products and Compendium of Continuing Education in Dentistry. In addition, John M. Powers, PhD, and Ron Yapp, MS, have completed research and are planning additional projects on the properties of ceramics and zirconia and their cementation.
Currently, THE DENTAL ADVISOR is working with a number of leaders in CAD/CAM dentistry, including 3M ESPE, Cadent, D4D Technologies, and Sirona Dental Systems. We are also providing education and training at THE DENTAL ADVISOR for dentists, laboratory technicians, and sales representatives.
Our goal is to be the worldwide resource for CAD/CAM dentistry. Please take a moment to review the information below, gathered together to assist you in learning more about this exciting new technology.
To read a listing of Questions and Answers on Digital Impressions and In-office CAD/CAM
To read a listing of Questions and Answers on Zirconia click here.
This issue of THE DENTAL ADVISOR discusses criteria for ceramic selection and describes the current status of digital impressions and zirconia restorations. Intra-oral scanners (CEREC AC, E4D Dentist, Lava Chairside Oral Scanner C.O.S., iTero) are compared. Materials available for chairside milling and for full-contour zirconia restorations are discussed. Click here for the full article.
Over the past three years, THE DENTAL ADVISOR has evaluated four digital impression and CAD/CAM systems (3M ESPE Lava Chairside Oral Scanner C.O.S., 3M ESPE; CEREC AC, Sirona Dental Systems; E4D Dentist, D4D Technologies; and iTero, Cadent, Inc.). Our readers continue to have many questions about the process and advantages from a clinical perspective. In this issue clinical consultants of THE DENTAL ADVISOR will address common questions and concerns about digital impressions.
In an interview conducted by Dr. John Powers, THE DENTAL ADVISOR’s co-editor, Dr. John Farah, Dr. Lori Brown, Dr. Santine Anderson, and Dr. Sabiha Bunek, along with Chris Brown and Mary Yakas, discuss common questions and concerns about digital impressions and CAD/CAM technology. Drs. Farah, Brown, Anderson, and Bunek practice in Ann Arbor, MI, and are editors of THE DENTAL ADVISOR. Chris Brown is the Business Manager at Apex Dental Milling in Ann Arbor, MI. Mary Yakas is the Executive Director at THE DENTAL ADVISOR. CLICK HERE TO READ THIS ARTICLE.
This issue of THE DENTAL ADVISOR will focus on the ever-changing world of CAD/ CAM. We will review all of the chairside systems, provide tips for choosing the right system for your practice, present clinical tips for using the systems, as well as protocols for success in CAD/CAM. In addition, the role of the laboratory and milling center and the concepts of closed and open architecture systems will be discussed. Finally, materials for use in CAD/CAM will be discussed along with clinical tips and information on training and support.CLICK HERE TO READ THIS ARTICLE
This issue of THE DENTAL ADVISOR reports on the performance of many of these restorations over time and provides the clinician with insight as to what works and why. Of special interest is the fracture rate of nine all-ceramic materials. CLICK HERE TO READ THIS ARTICLE
This issue of THE DENTAL ADVISOR introduces CAD/CAM densitry, from basics to the complex, featuring relevant and timely information on chariside intraoral scanners, chairside CAD/CAM, digital workflow, outsourcing, tooth preparation guidelines and more. CLICK HERE TO READ THIS ARTICLE
This issue of THE DENTAL ADVISOR describes zirconia ceramics and discusses the advantages and disadvantages of several different brands of material. CLICK HERE TO READ THIS ARTICLE
Illustrated guidelines for tooth preparation for zirconia crowns and the importance of preparation design are presented. DOWNLOAD THE FULL CLINICIAN TECHNIQUE GUIDE.
CAD/CAM dentistry is allowing us to provide better dental care to our patients. An accurate digital image of the prepared tooth and adjacent teeth has the potential to be inherently more precise than a traditional impression material poured into a stone model and trimmed. The long-term success of the ceramic restoration, however, is dependent on tooth preparation and material selection. This report will offer preparation guidelines for successful all-ceramic restorations using CAD/CAM dentistry, the E4D Dentist system and diamond burs.DOWNLOAD THE FULL CLINICAL CASE REPORT
E4D Dentist, E4D Studio and E4D Labworks along the Digital Skyway
D4D Technologies the developer of the E4D Dentist system has recently introduced E4D Studio and E4D Labworks and is completing a networking solution called E4D Sky. These total systems allow the dentist to link the E4D Dentist chairside scanning system to the laboratory in a variety of ways. E4D Sky allows the clinician to scan the tooth chairside with the E4D Dentist system and send the file to another computer in your own office, to an authorized E4D laboratory for designing and milling or to D4D Technologies. E4D Studio is a remote design center that may be located in another operatory within your office or remote location. E4D Labworks is a complete scanning, design and milling center for laboratory use. Using E4D Labworks, your existing lab can scan models or impressions as well as receive files from the doctor’s chairside system using E4D Sky. The possibilities for utilizing the digital technology to provide higher quality restorations are endless. The following case presentation outlines the preparation, scan and design of a single tooth using E4D Dentist, E4D Studio, and E4D Labworks all communicated through E4D Sky. Three laboratory technicians in three remote locations each fabricated a single crown from a single scan file.
Integrating iTero into a Busy Dental Practice
iTero (Cadent, Inc.) is a versatile digital impressioning system that utilizes an intraoral scanner that takes 3-D images of a prepared tooth, magnifies it and displays it on a monitor. The dentist can evaluate and approve the preparation before forwarding it electronically simultaneously to the laboratory and Cadent Center, which prepares a working model from the file and ships it to the dental laboratory where the restoration is fabricated and subsequently sent to the dentist.
The Lava™ Chairside Oral Scanner C.O.S. from 3M ESPE is used to capture high accuracy scans of patient teeth. Data from the scan are used to create an articulated stereolithography (SLA) model that a dental laboratory uses to design restorations such as crowns, inlays, onlays, and bridges. DOWNLOAD THE FULL CLINICAL CASE REPORT
A 45-year-old woman presented in September 2008 with a chief complaint of a fractured upper left molar (#15). She was interested in repairing the tooth with a long-term restoration and expressed concern about loss of additional tooth structure. A clinical exam revealed a fractured distobuccal cusp and occlusal amalgam restoration on tooth #15. A radiograph revealed decay on the mesial of #15. There was no evidence of fracture in the remaining tooth structure or bruxism in the remaining dentition. A treatment plan for an MODB onlay was presented and accepted as a conservative, long-term treatment option. DOWNLOAD THE FULL CLINICAL CASE REPORT.
E4D Dentist is a complete chairside scanning, design and milling system. It has the capability to scan an entire arch and design up to 16 restorations. DentaLogic Software and Autogenesis allow the design of multiple restorations simultaneously in the same screen. A restoration does not need to be completed or virtually seated before the design of the next restoration. The following article outlines the preparation, scan and design of three restorations in the same quadrant.DOWNLOAD THE FULL CLINICAL CASE REPORT
A 50 year-old man presented with recurrent decay under a gold crown on tooth #30. A core and full-coverage ceramic crown was the recommended treatment as it allowed optimal support for the tooth and resistance to fracture. The ability of E4D Dentist to scan a final impression allowed utilization of the system and optimal material selection while minimizing the patient’s chair-time. DOWNLOAD THE FULL CLINICAL CASE REPORT
Optimizing Margin Isolation for Digital Captures with the E4D Dentist System
This report offers three methods for effective ways to optimize clarity and manage soft tissue when using CAD/CAM dentistry and the E4D Dentist (D4D Technologies) system. DOWNLOAD THE FULL CLINICAL CASE REPORT
In-office Chair-side Scanning and Milling with CEREC 3D and E4D Dentist
This article focuses on the in-office chair-side systems, CEREC 3D and E4D Dentist. To date, dentists at Enspire Dental have placed over 100 CEREC 3D and E4D Dentist ceramic restorations. This article is a brief update on each system based on their experiences. DOWNLOAD THE FULL CLINICAL CASE REPORT
A 52-year-old man presented with a large composite restoration on tooth #12. The rotation of the tooth and lingual extension of the composite restoration left insufficient support for the lingual cusp. A significant fracture was clinically visible. An E4D Dentist MODL onlay was selected as the most ideal treatment option after consideration was given to the preservation of facial esthetics, protection of the lingual cusp and elimination of concerns associated with a provisional. DOWNLOAD THE FULL CLINICAL CASE REPORT
Incorporating any new technology into a successful practice can be a daunting task. When you choose to incorporate a chairside CAD/CAM system successful integration requires a number of steps. This article describes our experience with E4D Dentist®. DOWNLOAD THE FULL CLINICAL CASE REPORT
The 3M ESPE Lava™ Chairside Oral Scanner C.O.S. is used to capture high accuracy digital images of teeth. Data from the scan was used to create traditional (PFM) or CAD/CAM zirconia copings and an articulated stereolithography (SLA) model that a milling center and a dental laboratory use to design restorations such as crowns, inlays, onlays, and bridges, veneers and seated implant abutments.. DOWNLOAD THE FULL RESEARCH REPORT.
The purpose was to evaluate the shear bond strength of a self-cured resin cement to as-sintered zirconia prepared with different treatments under two storage conditions. The ceramic substrate tested was as-sintered zirconia (IPS e.max ZirCAD) with the following treatments: A –zirconia with Clearfil Esthetic Cement, B - zirconia with Clearfil Ceramic Primer and Clearfil Esthetic Cement, C – zirconia ground with a diamond bur with Clearfil Ceramic Primer and Clearfil Esthetic Cement, and D – zirconia sandblasted with Clearfil Ceramic Primer and Clearfil Esthetic Cement. DOWNLOAD THE FULL RESEARCH REPORT.
The purpose of this study was to evaluate the in-vitro bond strengths of Clearfil Esthetic Cement and Clearfil Ceramic Primer to sintered zirconia and leucite-reinforced ceramic substrates.
DOWNLOAD THE FULL RESEARCH REPORT.
3M ESPE Lava Crowns and Bridges is a CAD/CAM system for anterior and posterior all-ceramic crowns and three- or four-unit bridges with a maximum span of 48 mm. Read more.
3M ESPE RelyX Unicem Self-Adhesive Universal Resin Cement is a dual-cured resin cement. It is self-adhesive, requiring no tooth surface preparation such as etching or priming. Read more
IPS e.max CAD and IPS Empress CAD Blocks using E4D Dentist and Mill (1 yr)
IPS e.max CAD (Ivoclar Vivadent) is a high-strength, lithium disilicate ceramic block used for anterior and posterior restorations as well as three-unit bridges. IPS Empress CAD (Ivoclar Vivadent) is a leucite-reinforced ceramic block used for anterior and posterior restorations. The purpose of this evaluation was to determine the clinical results of IPS e.max CAD and IPS Empress CAD when prepared using the E4D Dentist and Mill (D4D Technologies) and placed over a 12-month period.
Crystal with IPS e.max Ceram 1-year Clinical Performance
Crystal zirconia restorations overlaid with IPS e.max Ceram were fabricated and cemented beginning in February 2009. As of May 15, 2010, a total of 393 restorations were in function in approximately 300 patients. At recall, 90 restorations were evaluated for resistance to fracture/chipping, esthetics, resistance to margin discoloration, and wear resistance. Read more.
CLEARFIL CERAMIC PRIMER is a single-bottle silane/acidic adhesive monomer (MDP)-based coupling agent for use with indirect porcelain, ceramic, hybrid ceramic and composite restorations. It may also be used for intraoral porcelain or composite repairs. Read more
Clearfil Esthetic Cement is a dual-cured, radiopaque resin cement that is used in combination with a self-etching adhesive system (Clearfil DC BOND included in the evaluated kit). The cement is indicated for cementation of all types of ceramic restorations including laminates, posts, and etched-metal bridges. Read more
E4D Dentist is a chair-side CAD/CAM system capable of scanning in the mouth, from an impression or on a model. A laser is used to scan the preparation, preoperative condition, approved provisionals or diagnostic wax-up. DentaLogic software and Autogenesis are used to create a 3-D virtual model and proposed restoration compatible with the neighboring teeth and opposing dentition. Multiple design tools allow the user to manipulate the virtual tooth and a multi-color display shows strength of occlusal and interproximal contacts as well as material thickness. The E4D mill uses two of the three Two-Striper (Premier Dental Products) diamond burs under constant water spray to fabricate the final restoration from porcelain or composite blocks (from Ivoclar Vivadent or 3M ESPE).
ThermaGrip is a placement system for indirect restorations. The system includes a heating unit, adhesive pellets and bendable brushes. The lightweight, portable heating unit is used to soften an adhesive pellet and transfer it to the restoration. Read more.
Ann Arbor, MI 48103
734-623-4236 | 866-755-4236
Apex Dental Milling is an Authorized Lava Milling Center located in Ann Arbor, MI. Contact Chris Brown (firstname.lastname@example.org) for further information or visit www.apexdentalmilling.com
John M. Powers, John W. Farah, Kathy L. O'Keefe, Brent Kolb, Gytis Udrys
All-ceramic restorations are favorable alternatives to metal-ceramic and all-metal restorations. All-ceramic restorations have superior esthetics, are biocompatible and are durable. Twenty-five years of experience by THE DENTAL ADVISOR shows that fracture and chipping of all-ceramic restorations are similar to those of ceramic-metal
There are two major categories of all-ceramic materials: silica-based (feldspathic porcelains, leucite-reinforced ceramics, lithium disilicate ceramics) and non-silica-based (zirconia or Y-TZP, alumina). Because of differences in strength and requirements for bonding or cementation,
the selection of cement is important.
This article describes characteristics and properties of various types of all-ceramic materials and associated cements.
Sponsored by Kuraray America, Inc.