Advances in CAD/CAM
Andew Koenigsberg, DDS
Over the past few years, the number of CAD/CAM manufactured restorations has surpassed those made by conventional techniques. The main reasons are the availability of new CAD/CAM-specific restorative materials, decreased manufacturing cost, and increased accuracy. Over the past 5 years, the number of dental laboratories has shrunk by about 30% and the vast majority of the survivors have adopted CAD/CAM technologies.
Dentists and patients are benefiting from recent advances in CAD/CAM materials. Zirconia, which just a few years ago was limited to substructures, is gaining popularity as a full-contour restoration. Esthetics are improving, and the strength and ease of use appeal to many clinicians. Lithium disilicate is now being used for custom implant restorations and new zirconium/silicate products are being introduced by major manufacturers. Nano-ceramic materials have been introduced that combine the strength of ceramics with the flexibility of composites. This allows for thinner margins, which are often needed for inlays and subgingival preparations. Short mill times and the ability to easily achieve a high polish have made these materials especially appealing for single-visit chairside restorations.
Optical scanning is steadily growing and is predicted to replace most traditional impression materials in just a few years. The main reasons are its ease of use, improved patient experience, speed, and immediate feedback on the quality of the impression. The technology continues to improve and now there are now several powderless scanners available. This reduces what was once a formidable learning curve and most clinicians can be up and scanning with just a few hours of practice. Several manufacturers have introduced scanners that connect to a laptop, simplifying the ergonomics, which can be especially helpful in small operatories. There are scanners that are being offered in a wide price range so that clinicians can get started with this technology at a price point that is comfortable for their practice.
A growing trend is for CAD/CAM systems to be “open” allowing clinicians to choose components from different manufacturers. By choosing the scanner, software, and milling unit that best suits your practice’s needs, you may save money and avoid purchasing features that won’t be used. The limitation is that you will not have one manufacturer to turn to if there is a problem. With an evolving technology and constant upgrades, that may be an issue in the future.
The applications for CAD/CAM continue to expand and now include implant restorations, implant planning, and surgical guides. Orthodontics is moving quickly into the digital world. Optical scanning is easier than impression material around brackets and more comfortable for young patients. As planning software increases in sophistication, more appliances are being designed and manufactured via CAD/CAM.
Clinicians need to educate themselves on the digital workflow and decide how best to integrate this technology into their practices.
ABOUT THE AUTHOR
Andrew Koenigsberg, DDS, is partner at Gallery57Dental in Manhattan, New York. He is co-founder of CAD/CAM Excellence.
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