Dr. Harish G et al. / IJRID Volume 5 Issue 2 Mar-Apr.

2015
Available online at www.ordoneardentistrylibrary.org

ISSN 2249-488X

Review report

INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY

CAD / CAM IN DENTISTRY- A Review

Dr. Kalpana D, Dr. Harish G*, Dr. Mahesh P C, Dr. Swati Suhasaria, Dr. Madhuri V ,
Dr. Brunda K
Department of Prosthodontics, Dayananda Sagar College of Dental Sciences, Kumara Swamy Layout,
Bangalore.
Received: 10 Feb 2015; Revised: 15 Mar. 2015; Accepted: 25 Apr 2015; Available online: 5 May 2015

ABSTRACT
Computer Aided Design Computer Aided Manufacturing (CAD/CAM) technology has already made significant strides in
the field of dentistry. CAD software renders the geometrical shape of an object, and the CAM software directs the fabrication
process. Applications of CAD/CAM in dentistry include fabrication of inlays, crowns, implant abutments/prostheses, surgical
guides, partial and complete dentures. The advent of CAD/CAM has enabled the dentists and laboratories to harness the power
of computers to design and fabricate esthetic and durable restorations.
Key Words: CAD/CAM, Digitalization, CAD/CAM systems, CAD/CAM components

INTRODUCTION
The technological changes taking place are truly revolutionizing the way dentistry is practiced and the manner
in which laboratories are fabricating restorations. The advent of CAD/CAM has enabled the dentists and
laboratories to harness the power of computers to design and fabricate esthetic and durable restorations. The
term CAD/CAM in dental technology is currently used as a synonym for prostheses produced by milling
technology. This is not entirely correct. CAD is the abbreviation for computer-aided design and CAM stands
for computer aided manufacturing. The term CAD/CAM does not provide any information on the method of
fabrication. 14

History:
The major developments of dental CAD/CAM systems occurred in the 1980s. Dr. Duret was the first to develop
dental CAD/CAM.1 From 1971, he began to fabricate crowns with an optical impression of abutment followed
by designing and milling. Later he developed Sopha system. Dr. Mormann developed CEREC System, an
innovative approach to fabricate same day restorations at the chair side in the dental office.2 Dr. Anderson
developed Procera System

He attempted to fabricate titanium copings by spark erosion and introduced

CAD/CAM technology into the process of composite veneered restorations.4 This system later developed as a
processing center networked with satellite digitizers around the world for the fabrication of all ceramic
frameworks. 5-13
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Applications of CAD/CAM Technology in Dentistry:

Inlays

Onlays

Conventional Crowns

Endo Crowns

Veneers

Fixed partial dentures

Implant abutments

Surgical guides

Partial dentures

Complete Dentures

Maxillofacial prosthesis

CAD/CAM Systems:
All CAD/CAM systems consist of three components:

1. A digitalization tool/scanner that transforms geometry into digital data that can be
processed by the computer.
2. Software that processes data and, depending on the application, produces a data set for
the product to be fabricated.
3. A production technology that transforms the data set into the desired product.
Depending on the location of the components of the CAD/CAM systems, in dentistry three different production
concepts are available:
Chairside production (Office System)
Laboratory production
Centralized fabrication in a production centre.

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Chairside production (Office System): (Table 1)
The digitalization instrument is an intra-oral camera, which replaces a conventional impression. This system can
scan the tooth preparation intraorally and by selecting appropriate materials, the dentist can fabricate the
restorations and seat it within a single appointment.

System

Scanning method

Restoration produced

Comments

Cerec 1/2/3

Laser

Ceramic I/O/C*/V*

Most widely used

Sopha

Laser and holography

Ceramic I/O/C/V

Lengthy design and

manufacture

Denticad

Contact probe

Ceramic I/O/C/V

Most automated

Celay

Cantact probe

Ceramic I/O/C/V

Copy milling only

Table 1: CAD/CAM systems in-office (I Inlays; O - Onlays; C Crowns; V Veneers; *Cerec 2 and 3 only)

Historically, cerec system was the first CAD/CAM system in dentistry and is currently available in its third
product generation. One of the benefits of this very mature system is the software that has been supplemented
by a very exact three-dimensional reconstruction of the occlusal surface.
CAD/CAMS Laboratory production: (Table 2)
The indirect systems scan a stone cast or die of the prepared tooth, in the dental lab (eg Cerec-in lab). These
data are processed by means of dental design software. After the CAD-process the data will be sent to a special
milling device that produces the real geometry in the dental laboratory. Finally the exact fit of the framework
can be evaluated and, if necessary, corrected on the basis of the master cast. The ceramist carries out the
veneering of the frameworks in a powder layering or overpressing technique.15-18

System

Scanning method

Restoration produced

Comments

Dux (Titan)

Contact probe

Titanium substructures

Requires aesthetic
veneering

Denti CAD

Contact probe

Ceramic I/O/C/V

Mills wide variety of

materials

Cerec in-lab

Contact probe

Ceramic I/O/C/V

Requires lab stage

Decim

Laser

Ceramic copings

Requires aesthetic
veneering

Cicero

16

Laser

Ceramic crowns

Built in veneering

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LAVA

Laser

Ceramic copings

Requires aesthetic
veneering

Everest

Optical scanner

Ceramic copings

Mills up to 16 units at
once

Table 2: CAD/CAM systems in laboratory (I Inlays; O - Onlays; C Crowns; V Veneers)

Centralised fabrication in a production centre: (Table 3)

CAD/CAM is combined with network machining center via internet. satellite scanners in the dental
laboratory to be connected with a production centre via the Internet. Data sets produced in the dental laboratory
are sent to the production centre for the restorations to be produced with a CAD/CAM device. Finally, the
production centre sends the prosthesis to the responsible laboratory. Thus, production steps 1 and 2 take place in
the dental laboratory, while the third step takes place in the centre.16,19

System

Scanning method

Restoration produced

Comments

Procera

Contact probe

Ceramic copings

Requires aesthetic
veneering

Table 3: CAD/CAM systems in Centralised fabrication in a production centre

CAD/CAM COMPONENTS

1. Scanner:

Under the term scanner one understands, in the area of dentistry, data collection tools that measure three
dimensional jaw and tooth structures and transform them into digital data sets. Basically there are two different
scanning possibilities: optical scanners and mechanical scanners.
a) Optical scanners:
The basis of this type of scanner is the collection of three-dimensional structures in a so-called triangulation
procedure. Here, the source of light (eg laser) and the receptor unit are in a definite angle in their relationship
to one another. Through this angle the computer can calculate a three-dimensional data set from the image on
the receptor unit.20 (Fig. 1).

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Fig 1

The following can be named as examples of optical scanners on the dental market:
Lava Scan ST (3M ESPE, white light projections)
Everest Scan (KaVo, white light projections)
Es1 (etkon, laser beam).
b) Mechanical scanner
In this, the master cast is read mechanically line-by-line by means of a ruby ball and the three-dimensional
structure measured. The Procera Scanner from Nobel Biocare (Gteborg) is the only example for mechanical
scanners in dentistry. This type of scanner is distinguished by a high scanning accuracy, whereby the diameter
of the ruby ball is set to the smallest grinder in the milling system, with the result that all data collected by the
system can also be milled.16,21
The drawbacks of this data measurement technique are to be seen in the inordinately complicated mechanics,
which make the apparatus very expensive with long processing times compared to optical systems.

Fig 2

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2. Design software

The systems available on the market are differentiated mostly in their construction software. While many
systems emphasise on broad spectrum , other manufacturers place emphasis on intuitive use and userfriendliness. The latest construction possibilities are continuously available to the user by means of updates. The
data of the construction can be stored in various data formats. The basis therefore is often standard
transformation language (STL) data.20
3. Processing devices
The construction data produced with the CAD software are converted into milling strips for the CAMprocessing and finally loaded into the milling device. Processing devices are distinguished by means of the
number of milling axes:

3-axis devices
4-axis devices
5-axis devices.

Fig 3

Fig 4

a) 3-axis milling devices This type of milling device has degrees of movement in the three spatial directions.
Thus, the mill path points are uniquely defined by the X -, Y -, and Z values. The calculation investment is
therefore minimal. milling of subsections, axis divergences and convergences, however, is not possible. This
demands a virtual blocking in such areas.
Examples of 3-axis devices: inLab (Sirona), Lava (3M ESPE), Cercon brain (DeguDent)
b) 4-axis milling devices In addition to the three spatial axes, the tension bridge for the component can also be
turned infinitely variably (Fig. 3). As a result it is possible to adjust bridge constructions with a large vertical
height displacement into the usual mould dimensions and thus save material and milling time.
Example: Zeno (Wieland-Imes).

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c) 5-axis milling devices With a 5-axis milling device there is also, in addition to the three spatial dimensions
and the rotatable tension bridge (4th axis), the possibility of rotating the milling spindle (5th axis) This enables
the milling of complex geometries with subsections.
Example in the Laboratory Area: Everest Engine (KaVo).
Example in the Production Centre: HSC Milling Device (etkon).
References
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2. Mormann W.H., The origin of the cerec method: a personal review of the first 5 years. Int J Comput Dent.
2004; 7(1): 11-24.
3. Anderson M, oden A. A new all ceramic crown: a dense sintered, high purity alumina coping with porcelain.
Acta Odontol Scand 1993; 51: 59-64.
4. Anderson M. Carlsson L, Persson M, Bergmann B. Accuracy of machine milling and sparkerosion with a
CAD/CAM system. J. Prosthet Dent 1996; 76:187-93.
5. Ellingsen LA, Fasbinder DJ. An in vitro evaluation CAD/CAM ceramic crowns. J. Dent Res 2002; 81:331
6. May KB, Russel MM Razzoog ME, et al. Precession of fit; the procera all Ceram crown. J Prosthet Dent
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7. Tinschert J, Natt G, Mautsch W. et. al. Marginal fit of alumina and zirconia based fixed partial dentures
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Kokubyo Gakkai Zasshi 2003;70:114-123 (Japanese).
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restorations. J. Dent Res 2003; 82:194.
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ceramic crown. J Prosthet Dent 2001; 85:261- 67.
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future perspectives from 20 years of experience. Dent Mat J. 2009; 28 (1): 44 56.
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Annals and Essences of Dentistry Vol. - II Issue 3 July Sept. 2010
15. Luthy H, Filser F, Loeffel O, Schumacher M et al. Strength and reliability of four unit all-ceramic posterior
bridges. Dent Mater 2005; 21: 930-937.
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16. May K B, Russell M M, Razzoog M E, Lang B R. Precision of fit: the Procera AllCeram crown. J Prosthet
Dent 1998; 80: 394-404.
17. Raigrodski A J. All-ceramic full-coverage restorations: concepts and guidelines for material selection. Pract
Proced Aesthet Dent 2005; 17: 249-256, quiz 258.
18. Raigrodski A J, Chiche G J. The safety and effi cacy of anterior ceramic fixed partial dentures: a review of
the literature. J Prosthet Dent 2001; 86: 520-525.
19. Reich S, Wichmann M, Nkenke E, Proeschel P. Clinical fit of all-ceramic three-unit fixed partial dentures,
generated with three different CAD/CAM systems. Eur J Oral Sci 2005; 113: 174-179.
20. Mehl A, Gloger W, Kunzelmann K H, Hickel R. A new optical 3-D device for the detection of wear. J Dent
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21. Webber B, McDonald A, Knowles J. An in vitro study of the compressive load at fracture of Procera
AllCeram crowns with varying thickness of veneer porcelain. J Prosthet Dent 2003; 89: 154-160.

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