Digital dentistry

1. Life Cycle of CAD CAM Restorations from
Full Mouth to a Tooth
Prof .Dr. Vivek Choukse
Dean and HOD Department of Prosthodontics
Dr. HSRSM Dental college and Hospital, Hingoli Maharashtra 1
49th IPS Conference 2021, Chennai
Confluence of Concepts, Techniques and Technologies

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3. Milling Softwares
Milling Strategies
Nesting
CAM Software
Computer Assisted
designing Software.
CAD Software
Intraoral Scanners
Extraoral Scannners
Scan / Digital
Impression
Different Milling Units
Milling Unit
Shading Procedures of
Presintered Prosthesis
Dopants and
Shading
Final Layering Finishing
,cementation
Delivery of
Prosthesis
Smile Design
Prep Guide
Planning and
Tooth Prep
Sintering Units and
Process
Sintering
CAD
Software
CAM
Software
Milling
Unit
Dopents
and
Shading
Sintering
Scan /
Digital
Impression
Planning
and
Tooth
Prep
Delivery of
Prosthesis
CAD CAM

5. DIGITAL SMILE DESIGN
Digital Smile Design is a technique used to
design and modify the smile of patients by
using only images and videos and help them
visualize it beforehand by creating and
presenting a digital mockup of their new smile
design before even their actual treatment
starts
Benefits of Digital Smile Design
1.Awesome Predictability
2.Motivation to Patients
3.No manual errors
4.Automation
5.Effective collaboration
6.Easy to Operate
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6. DIGITAL SMILE DESIGN SOFTWARES
Apart from DSD and GPS like softwares
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7. DIGITAL PREP GUIDE
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8. Virtual Diagnostics and Guided tooth Preparation
Hyeonjong Lee et al . Virtual diagnostics and guided tooth preparation for the minimally invasive rehabilitation of a
patient with extensive tooth wear: A validation of a digital workflow, J Prosthet Dent. 2018; 133: 20-26.
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9. CAD CAM
 With the rapid evolution of CAD/CAM (Computer Aided Design, Computer
Aided Manufacture), this has led to a dramatic impact on all disciplines of
dentistry especially in the fields of Prosthodontics and restorative dentistry .
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10. SCAN AND DIGITAL IMPRESSIONS
Digital impressions
Digital models
Virtual articulators and
Facebow
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11. CAD/CAM components
• Collects the data from the area of the preparation,
adjacent and opposing structures and then converts
them to virtual impressions through intraoral scanners or
through stone models
Data
Acquisition
Unit
• Designing virtual restorations on a virtual working cast
and then computing the milling parameters
Software
• Manufacturing the restoration from a solid block of
restorative material
A
Computerized
Milling Device
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12. DIGITAL IMPRESSIONS/SCANNING
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13. General classification of CAD/CAM systems
1. According to systems:-
CAD/CAM
Laboratory
CAD/CAM systems
Laboratory
CAD/CAM
CAD
CAM
Chair side
CAD/CAM
systems
Chair side
CAD/CAM
Image acquisition
system
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14. Examples of Laboratory CAD/CAM systems
Laboratory CAD/CAM
Amann Girbach, 3M
ESPE, Sirona Dental
Systems, Zirkon
Zahn,Planmeca, KaVo
Dental
CAD
D2000, 3 Shape; Dental
Wings 7 series, Dental
Wings; Iscan D104,
Imetric 3D SA; Ceramill
Map, AmannGirrbach;
Activity 850 3D, Smart
Optics
CAM
DWX-50, Roland DGA
Corporation; inLab MC
X5, Sirona; M5,
Zirkonzahn; Tizian Cut 5
Smart, vhf camfacture
AG; Ceramill Motion 2,
Amann Girrbach
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15. Examples of Chairside CAD/CAM
Chairside
CAD/CAM
Dentsply Sirona and
Planmeca
Image acquisition
system
True Definition Scanner, 3M ESPE;
iTero, Align Technology, Inc; Trios,
3Shape,Apollo DI, Dentsply Sirona,
CS 3700, Carestream Dental LLC
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16. 2. According to data sharing
CAD/CAM
Open
Allow the adoption of the
original digital data by CAD software
and CAM devices from
different companies
Closed
All CAD/CAM procedures, including data
acquisition, virtual design, and
restoration manufacturing by the same
company in one system
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18. The laboratory CAD systems must always be an open system because after acquiring the
data and designing the restoration, the data has to be stored in an STL file and then sent to
an open laboratory CAM system, which accepts that type of STL file from that laboratory
CAD system where the restoration will be fabricated.
Additionally, the image acquisition unit is always an open system, and the STL file of a
certain restoration can be accepted by an open laboratory CAD system for the restoration to
be designed and then sent to an open CAM system for the restoration or model to be
fabricated.
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19. Classification of scanners
Laboratory
scanners
Optical
scanners
Use the projection of a
measuring light grid onto dental
structures under a definite angle
causing a depth-dependent
phase shift of the grid, which
the camera registers on its
digital sensor
Mechanical
scanners
The scanner (e.g., Procera
Scanner from Nobel Biocare), is
capable of reading a master cast
mechanically line by line by
means of a ruby ball in order to
obtain 3D measurements.
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22. Intraoral scanners
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25. INTRAORAL SCANNERS
The intraoral cameras are optical scanners and can be separated into two types:-
-Record individual
images of the
dentition.
iTero, PlanScan
(Plan-meca), CS
3700 (Carestream
Dental LLC), and
Trios (3
shape)scanners
Single
image
camera
Used by the True
Definition scanner
(newest version of
the Lava Chairside
Oral Scanner,
COS), Apollo DI
(Sirona Dentsply)
and OmniCam
(Sirona Dentsply)
systems.
Video
cameras
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26. Intraoral scanner
 Records individual images of the dentition i.e three teeth in a single image.To record larger areas of the
dentition, a series of overlapping individual images are recorded such that the software program can
assemble these into a larger three-dimensional virtual model.
 The camera is positioned in different angles to ensure accurate recording of data below the height of
contour that would be hidden from the camera if only an occlusal view was obtained.
 Those areas not visualized by the camera in the overlapping images would then be extrapolated by the
software program to fill in the missing data areas in the virtual mode.
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27. Protocol for scanning
 Depending on the system, the clinician has two scanning options intraorally
for developing the final restoration:
Preoperative scanning which provides for incorporating the existing anatomical
contour and occlusal planes into the final restoration
Postoperative scanning of the preparation only with the CAD design being
extrapolated from selected data points in the acquired image, and which may be
combined with an internal library of tooth anatomic designs contained within the
computer data base
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28. The preparation margins can be exposed by a cord
retraction technique or cordless retraction technique
scanner tip is slided over the tooth in multiple directions for capturing the images
After the scan of the prepared tooth is completed, the antagonists of the
opposing arch are scanned in the same exact manner.
The transfer of the image from the tooth to the final
fabrication of the restoration can be done by several methods
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30. Comparisons of different in-office CAD/CAM systems
Type of
system(open/
closed)
Type of CAD/CAM Acquisition
technology
Color
image
Imaging type
CEREC Omnicom
(Sirona)
closed Digital imaging and
in-office
manufacturing
White light yes Filming (Video)
PlanScan
(Planmeca) {can’t
scan full arch}
open Digital imaging and
in-office
manufacturing
Blue Laser No Filming (Video)
Trios Color (3
Shape
open Image acquisition
unit Photographing
(multiple images )
Blue LED Yes Photographing
(multiple images )
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31. iTero (Align
Technology
Open Image acquisition
unit
Red Laser yes Photographing
(multiple images )
True Definition
Scanner (3M
ESPE)
Open Image acquisition
unit
Blue LED No Filming (Video)
CS 3700
(Carestream
Dental LLC)
Open Image acquisition
unit
White LED Yes Photographing
(multiple images
Apollo DI
(Sirona) unit
Closed Image acquisition NAa No Filming (Video)
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32. INTRAORAL ACCURACY (Mesh files)
1 Carestream CS 3700 (mean error 30.4 μm)
2iTero ELEMENTS 5D (31.4 μm)
3 Medit i-500 (32.2 μm)
4 3Shape TRIOS 3 (36.4 μm)
5 Carestream CS 3600 (36.5 μm)
6 CEREC PRIMESCAN (38.4 μm)
7 Dental Wings VIRTUO VIVO (43.8 μm)
8 Runyes QUICKSCAN(44.4 μm)
9 Planmeca EMERALD S (52.9 μm)
10 Planmeca EMERALD (76.1 μm)
11 CEREC OMNICAM (79.6 μm)
12 Dental Wings DWIO (98.4 μm)
Francesco Guido Mangano 1 , Oleg Admakin 2 , Matteo Bonacina 3 , Henriette Lerner 4 , Vygandas Rutkunas 5 , Carlo Mangano. Trueness of 12 intraoral scanners in the full-arch
implant impression: a comparative in vitro study.
BMC Oral health Sept 2020; 20(1):263.
• Intraoral scanner accuracy for the mesh/mesh (STL files) comparison is as follows:
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33. INTRAORAL ACCURACY (SCAN BODY POSITION )
1.iTero ELEMENTS 5D (mean error 16.1 μm)
2.CEREC PRIMESCAN (19.3 μm)
3.3Shape TRIOS 3 (20.2 μm)
4.Medit i-500 (20.8 μm)
5.Carestream Dental CS 3700 (21.9 μm)
6.Carestream Dental CS 3600 (24.4 μm)
7.Dental Wings VIRTUO VIVO (32.0 μm)
8.Runyes QUICKSCAN (33.9 μm)
9.Planmeca EMERALD S (36.8 μm)
10.CEREC OMNICAM (47.0 μm)
11.Planmeca EMERALD (51.9 μm)
12.Dental Wings DWIO (69.9 μm)
Francesco Guido Mangano 1 , Oleg Admakin 2 , Matteo Bonacina 3 , Henriette Lerner 4 , Vygandas Rutkunas 5 , Carlo Mangano. Trueness of 12 intraoral scanners in the full-arch
implant impression: a comparative in vitro study. BMC Oral health Sept 2020; 20(1):263.
• Intraoral scanner accuracy for the nurbs/nurbs (scanbody positions in space) comparison is as
follows:
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34. Digital Scan/ Cast / Impressions
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35. DIGITAL IMPRESSIONS
• Less time is required.
• Cost savings
• Processed data can be saved and can be used for subsequent follow up.
• Elimination of may issues associated with impressions materials, properties of materials, inappropriate soft
tissue management, improper tray selection, distortion of impression casts, incorporation of bubbles etc.
• Enhanced patient comfort.
• Scanning an image can help the clinicians to view their preparations and make immediate adjustments.
• Better margins than conventional methods
• More accurate.
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36. DIGITAL MODEL
• Elimination of polymerization shrinkage of impression, disinfection of
impression,vaccum mixing, pouring of impression, etc.
• Die ditching done digitally.
• The technicians cannot alter the margins.
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37. CAD SOFTWARES
• CAD software is known for its speedy operation and
ease of use,
• Helping to minimize training costs and
• Maximize productivity.
• It is reliable and robust even when dealing with
complex cases on a daily basis.
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39. Standard version of CAD
Wide range of indications
and functionality
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40. Add-on modules
DentalCAD standard version
• It’s easy to upgrade standard version according to your needs.
• Choose from many add-on modules for advanced indications
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41. Bar Module
• Advanced bar design for both standard and complex bars
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42. Model Creator
• Create physical models from digital impression scans
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43. Model creator
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44. Bite Splint Module
• With exocad’s Bite Splint Module, therapeutic night guards can be designed quickly and of
high quality.
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45. Provisional Module
• Create eggshell temporaries from pre-op scans
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46. Partial Framework Module
• With Partial Framework Module, provides with a digital solution to design high quality
removable partial denture frameworks.
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47. Full Denture Module
• Add-on module Full Denture provides a guided workflow to design high aesthetic full dentures.
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48. TruSmile Technology
• TruSmile Technology provides near photorealistic rendering of dental restorations –
in real-time during the design process.
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49. Virtual Articulator
• Virtual Articulator allows you to consider dynamic occlusion when
designing crowns and bridges.
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50. Jaw Motion Import
• The Jaw Motion Import module allows you to import jaw
movement registration data from external devices such as the
JMA system from Zebris.
• The module works in combination with the Virtual Articulator
module.
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51. DICOM Viewer
• DentalCAD platform includes an integrated
• DICOM Viewer* that allows you to visualize voxel data
• from CT machines during the design of dental restorations
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52. Smile Design
With the upcoming Smile Design Module, exocad provides an easy solution for
aesthetic planning that leads to more predictable results.
Load patient photos
• Match the photos with the scanned 3D situation
• Automatically add and edit guidelines
• Select tooth shapes from our extensive library
• Edit outline shapes on the 2D image
• Design in 2D and see the 3D result in real-time from various angles 52

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54. An integrated solution for
3D implant planning
• The software supports the pre-operative planning of dental
implants and uses the visualization of the implant placement
within images of the patient’s anatomy.
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55. Ortho Archiver
An integrated solution for orthodontic indications
• Ortho Archiver for the creation of orthodontic archive
models.
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56. Ortho Software
• placement, and more will be available further on. Additional ortho modules for
virtual tooth setups, bracket
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57. Webview
• Send true 3D previews that can be viewed directly in your web browser*.
• webview.dental/demo
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58. DIFFERENT CAD SOFTWARES
ZFx Dental CAD Design Software from Zimmer Biomet
inLab CAD SW 18 from Dentsply Sirona CAD/CAM
Ceramill Mind CAD Software from AmannGirrbach GmbH
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59. CAM
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61. OVERVIEW OF CAD CAM PRODUCTION
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62. CAM Computer Assisted Milling/ Manufacturing
DentMILL®
WORKNC
PiCAM Dental CAM software
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63. CAM or Nesting software
• The DENTALCAM is a powerful software package that allows for imports from all
common CAD programs with its open STL import feature and utilizes optimized CAM
strategies for the fastest possible processing.
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64. Comparison between milling and 3D printing.
Subtractive technology
‘‘milling and grinding’’
Additive technology ‘‘3D
printing’’
Chromium Cobalt Removable
Partial Framework
No through Direct Metal Laser
Sintering (DMLS)
Chromium Cobalt Copings,
Crowns, Bridges
Yes DMLS
Complete Dentures Yes (Weiland, AvaDent) Yes (Pala, Dentica)
Digital Models Yes Preferred through
StereoLithography (SLA),
Scan, Spin and Selectively
Photocuring (3SP), PolyJet,
Direct Light Projection (DLP)
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65. Burnout Pattern for Copings/Frameworks, Crowns,
FPD, Inlays, Onlays, Veneers, Removable Partial
Framework
Yes by wax or resin Yes by photopolymeric resin through
DLP
Zirconia Restoration Yes No
Glass-Ceramic Restoration Yes No
Titanium Abutments Yes No
Titanium Bars Yes No
Wax-up Yes Yes through DLP
Provisional Restorations Yes Yes through DLP
Splint Yes No
Custom Trays No Yes through PolyJet
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66. Surgical Drill Guide Yes Preferred through PolyJet, DLP
Advantages It is available for all types of
materials
(1) Finer detail reproduction (undercuts, better
anatomy), (2) more economical than milling, (3) more
mass production (greater numbers of units), (4) larger
objects produced (facial prosthesis), (5) better passive
production (no force application), (6) can reproduce
complex shapes without requiring special cutting
tool, (7) unlimited geometry options, (8) faster than
milling, and (9) print exactly as designed without
waste.
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67. Disadvantages (1) The thinnest part of the restoration is
limited by the size of the bur; if the thinnest
part is smaller than the smallest bur, it will
result in over-milling and cause loose fit
restoration, (2) expensive for using glass-
ceramic blocks, and (3) require expensive
CAM unit
It is not available for ceramics and titanium
metals
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68. Classification and comparison of milling units according to the number of
axes.
Four axes milling unit Five axes milling unit
Dry/wet It can be wet (chairside) or dry (laboratory) Always dry and wet
Maintenance Low High
Weight Lighter Heavier
Applications General dentistry: veneers, inlays, onlays,
copings/frameworks, crowns, fixed partial
dentures
In addition to general dentistry, it can mill
attachments, implant abutments, telescope
crowns, splints, models, bars, screw retained
implant crown and FPD, surgical drill guide
Cost Cheaper More expensive
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69. Linear movement and
rotations
Three spatial directions X, Y, Z and tension
bridge A (rotation around X axes)
Three spatial directions X, Y, Z,
tension bridge A (rotation around X
axes) and milling spindle B (rotation
around Y axes)
Milling of sharp angles and
undercuts
Yes (one direction which is less accurate) Yes (different directions which are
more accurate)
Number of cutting tools Less More
Milling time Short Long
Milling accuracy Low High
Chairside milling unit Yes No
Laboratory milling unit Yes Yes
Processing material: block Yes (chairside and laboratory) Yes
Processing material: disc) Yes (laboratory only) Yes
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70. Dopants and shading
Zirconia ceramics for
frameworks of fixed
partial dentures can be
color shaded to better
match the shade of
veneering porcelain in
green stage.

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Infiltration of various metal salts at low concentrations
-non uniform color(porosity gradients,limited diffusion depth of coloring
solutions)
Y-TZP blocks could be custom colored
-infiltration of the machined restoration at the presintered stage-a highly
porous state-with special coloring solutions to produce work pieces of various
shades.
-after drying and at the initial stages of heating of the immersed porous
presintered zirconia blocks, the acetic,chloric and nitric ions probably vapourized
and disappear on the surface of the pores.The metal ions from an oxide layer on
the surface of the pores of zirconia blocks

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The ability to control the shade of the zirconia core
may eliminate the need to veneer the lingual and
gingival aspects of the connectors in difficult
situations like limited interocclusal distance and the
required connector dimensions are minimally
achieved.
• Also, the palatal aspect of anterior crowns and FPDs
may be fabricated of the core material only in cases
like extensive vertical overlap and lack of space for
lingual veneering porcelain

73. Sintering

75. Zirconia sintering
The milling of a fully sintered zirconia blank to the actual size of the restoration provides precise accuracy,
as the technique requires no further sintering process, thus eliminating the sintering shrinkage of zirconia .
However, this technique causes excessive wear of the milling bur and takes a long time .
Partial sintered zirconia blank is easily machinable, but it needs to be sintered further to achieve fully
sintered zirconia restoration . The zirconia restoration needs to be designed in an enlarged dimension prior
to the milling process, in order to compensate for linear sintering shrinkage of zirconia by approximately
15–30% . The heat for sintering furnace is transmitted to the material’s surface and reaches its core by
thermal conduction to achieve a mature sintered zirconia. The sintering process comprises a heating, a
sintering, and a cooling phase . The sintering process may be altered in order to optimize the properties of
zirconia.

76. Finishing and Delivery
Layering / Staining
Polishing
Finishing
Delivery

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78. Thanks
Emailid :- vivc_12@yahoo.com
Contact No. :- 9826034340
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