Dental Tribune USA

The expanding role of CAD/CAM in today’s restorative dentistry

By Lee Culp & Dr Lida Swann, USA
December 28, 2009

While it took slightly longer than anticipated to integrate digital dentistry into the daily practice, the new millennium seemed to have been the catalyst for change as several different CAD/CAM systems have now been introduced as solutions for restorative dentistry. Today’s CAD/CAM systems, both chair-side and laboratory-based, are being used to design and manufacture metal, alumina and zirconia frameworks, as well as all-ceramic and composite full-contour crowns, inlays and veneers that may be stronger, fit better and appear more esthetic than restorations fabricated using traditional methods.

As restorative dentistry evolves into the digital world of image capture, computer design and creation of dental restorations through robotics, our perceptions and definitions of the dental laboratory must evolve also. First, in order to fully understand this concept, we must clearly define what a laboratory is.

At first thought, we might say that a lab is the place that a dentist sends his or her patients’ impressions to be processed into restorations, which are then sent back to the dentist for adjustment and delivery. This definition does seem to fit well with the traditional concept of a dentist-laboratory workflow.

However, just as the Internet has forever changed the landscape of communication through related computer technology, the ability to use CAD/CAM restoration files electronically has provided the catalyst for a significant change in the way we view and structure the dentist-laboratory relationship.

Let us imagine first that our laboratory is not a place, does not have walls and exists only in the talents of the partners in the restorative process — the dentist and technician. The equipment we use to create the restoration may be located next to the chair or in a dental laboratory.

Our ‘laboratory’ is actually nothing more than a workflow, which is flexible to the degree that our abilities, our access and our equipment allow. The primary decision becomes where the hand-off from one partner to another should occur.

Moreover, a dentist who has the ability to optically scan intraorally for impressions and who often chooses CAD/CAM restorations as the best treatment option for his or her patients has enhanced freedom as to where I believe the hand-off to the technician partner should occur.

The lab is no longer a place; it is, to a large degree, virtual and a fluid entity.

In some instances, it makes sense for the dentist to work independently and to prepare, design and finish the restoration chairside in a single visit with the obvious advantages a clinical CAD/CAM system has to offer.

Other times, it is advantageous to engage the services of the restorative partner, a dental technician, because he or she possesses the skill and, perhaps more importantly, the time to create restorations that either demand more complex characterization or can be more efficiently created in an indirect manner.

The digital process

The introduction of E4D Dentist System (D4D Technologies) in 2008, along with its accompanying DentaLogic software and Autogenesis libraries, became the first computerization model to accurately present a real 3-D virtual model and automatically take into consideration the occlusal effect of the opposing and adjacent dentition.

It also has the ability to design 16 individual, full-contour, anatomically correct teeth at the same time.

It essentially takes a complex occulsal scheme and its parameters and condenses the information, displays it in an intuitive format that allows dental professionals with basic knowledge of dental anatomy and occlusion to make modifications to the design, and then sends it through to the automated milling unit.

For the dental profession, the introduction of the E4D Dentist System effectively automated some of the more mechanical and labor-intensive procedures (waxing, investing, burnout, casting and pressing) involved in the conventional fabrication of a dental restoration, allowing the dentist and technician the ability to create functional dental restorations with a consistent, precise method.

Many dental professionals regard CAD/CAM technology as just a machine that fabricates full-contour ceramic restorations or framework. But digital dentistry and the digital dental team represent a completely new way to diagnose, treatment plan and create functional esthetic restorations for our patients in a more productive and efficient manner. CAD/CAM dentistry will only further enhance the dentist/assistant/technician relationship as we move together into this new era of patient care.

About the authors

Lee Culp, CDT, is the vice president of dental technologies at D4D Technologies where he guides development of the E4D Dentist and Labworks system and its applied application to restorative dentistry. He is the 2007 recipient of the Kenneth Rudd Award from the American Society of Prosthodontics, the 2007 recipient of the AACD Presidents Award for Excellence in Dental Education and the 2003 recipient of the National Association of Dental Laboratories Excellence in Education Award. Lee has also been appointed adjunct professor at University of North Carolina School of Dentistry, Graduate Prosthetics Department. Contact him at lculp@d4dtech.com.

Dr Lida Swann is the clinical trainer at D4D Technologies where she is responsible for clinical education and documentation of all clinical procedures necessary for success with the D4D Technologies intra-oral scanning and design center. Her educational focus is on proper tooth preparation and tissue management for CAD/CAM restorations. Swann lectures nationally and internationally on CAD/CAM technology and other topics related to restorative dentistry. She has written several journal articles detailing proper clinical techniques for clinical implementation of digital dentistry, and her research into preparation design for CAD/CAM dentistry led her to develop the D4D Technologies burr kits for full crown, inlay/onlay and veneer preparations.

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