by Krista Houstoun, Assistant Editor, Dentaltown Magazine
Dentaltown Magazine reached out to a few leading manufacturers of CAD/CAM technology and materials to get a snapshot on
the current state of CAD/CAM usage in the dental industry.
Once a cumbersome practice, CAD/CAM technology
in dentistry has improved and refined
endlessly since its genesis in the mid-1980s.
Coupled with evolving computer technology
and software, new developments in dental
materials have made the popularity of
CAD/CAM soar over the past couple of decades
- despite initial hefty financial and training
investments. Innovations are a fact of the
future, so Dentaltown Magazine reached out to
leaders in the CAD/CAM industry to get the
scoop on which direction CAD/CAM materials,
specifically, are likely to take.
Hi everyone. First and foremost, where are materials headed
Adam Busch, Product Manager, Sirona: Historically, conversations of
CAD/CAM materials were centered around monochromatic feldspathic
blocks on the chairside, and lifeless zirconium oxide frameworks for the labs.
This trend held true for almost two decades. Within the past few years we
have seen the evolution (or revolution) in materials. Lithium disilicate
blocks, translucent zirconium and many others have joined the CAD/CAM
community. Each has its own set of features and salient benefits. The future
holds a whole new crop of innovative, extraordinary materials, each developed
with a unique chemistry and designed for a particular outcome that
will answer the requests of the dental community.
Take for instance the idea of milled metal in the form of nickel-free
cobalt-chrome blocks, which can be sintered and married with full contour
materials. This was seen in concept by Sirona at the 2011 IDS meeting in
Cologne, Germany. Such advances open the door for the first fully digital
PFM fabricated from a simple digital impression from a dentist's office and
transmitted via the Internet to a dental laboratory. The idea of digitizing the
PFM process shows where we can cover the spectrum of production with
Lava Ultimate - 3M ESPE
Lava Ultimate CAD/CAM Restorative
is a unique CAD/CAM material
with long-lasting aesthetics
and performance. It's fast and easy
to mill, with no firing necessary and
its new resin nano-ceramic technology offers a polish that
lasts. Lava Ultimate restorative is tough and durable while
also gentler to opposing dentition. In 2013, Lava Ultimate
restorative will fall under the CDT Code's broadened definition
of porcelain/ceramic materials, allowing Lava Ultimate
restorative to be classified as a porcelain/ceramic.
IPS e.max CAD - Ivoclar Vivadent
IPS e.max is a lithium disilicate glass ceramic that has
optimized translucency, durability and strength for full
anatomical restorations. IPS e.max restorations exhibit
superior durability, featuring 360-400 MPa of flexural
strength. When fabricated to full-contour, the monolithic
structure provides an extremely robust restoration. The
opalescence, translucency and light diffusion properties
were all designed to replicate natural tooth structure for
beauty and undetectable restorations. The material is also
backed by over 10 years of clinical evidence in which it
shows a 98.2 percent crown survival rate.
CEREC Omnicam - Sirona
CEREC Omnicam's revolutionary design
features a completely new, ergonomic
handpiece and special optics to guarantee
optimal intraoral access. New Color-
Streaming allows continuous capture of
the oral cavity as well as displaying the 3D
data in full color. Operator convenience
has been greatly improved by making the
system completely powder-free while
retaining Sirona's high standards for precision.
The CEREC Omnicam also records
2D and 3D data, captures half-arch and
There is also still work to be done on the implant restorative side, which
increasingly becomes a simple chairside process. We can foresee a lot of
growth in this arena.
All recent developments in CAD/CAM materials move us toward high
strength and easy-to-use materials.
Peter F. Golden, Professional Relations Manager, 3M ESPE: As computer-
aided design and manufacturing becomes more advanced for both
indirect and chairside procedures, CAD/CAM restorations will become
more popular, driving ever-faster development of more aesthetic and
stronger materials that are increasingly easy to use. While hardware and software
advancements will continue to allow for easier integration of these
technologies in both laboratories and in dental offices (for chairside applications),
better CAD/CAM materials will allow the dentist clinician to provide
a better service to his or her patients.
Donald E. Bell, Director of Marketing - CAD/CAM Materials and
Furnaces, Ivoclar Vivadent: Developing strong, durable, highly aesthetic
materials to mimic natural teeth that can be processed in a very efficient
manner, ideally being able to create the restoration without requiring a secondary
process, is where CAD/CAM is headed. The concept of "building" a
custom restoration in layers instead of "milling" it destructively from a block
of material is a vision of true customization, aesthetics and strength.
What are some major trends shaping the direction of CAD/CAM
Busch (Sirona): High strength and ease of use. The strongest materials
in dentistry today are accessible to the dentist through CAD/CAM milling,
and CEREC specifically. Recently 3M ESPE joined the CAD/CAM material
revolution with its innovative resin-reinforced material, Lava Ultimate.
Again, all manufacturers are focused on developing higher strength materials
and making them easier to use and place.
New CAD/CAM users can now focus on what materials they need to
provide the best patient care possible, regardless of the clinical situation. This
shift in the mindset of the dental community will no doubt bring about new
technologies to improve the materials and CAD/CAM experience for dentists
and patients alike.
Golden (3M): Materials are now coming to the marketplace that more
closely mimic the physical properties of natural teeth; these include ceramicresin
products that provide both the patient and the clinician the best of both
worlds: aesthetics and toughness, which lead to increased longevity of the
restoration. Also, software and hardware advances allow previously unimagined
levels of productivity for both lab- and operatory-based systems, ultimately
providing much improved satisfaction and profitability. As the
baby-boomer generation ages, they require conservative dental restorations
that can, in many cases, best be produced by CAD/CAM; these include
inlays, onlays and crowns.
Bell (Ivoclar Vivadent): 1) Going fast, particularly in chairside CAD/
CAM, 2) going fast and 3) going fast. I'm attempting to be funny. There is
so much focus on going fast - one appointment, and as fast as possible in
that one appointment - that aspects such as fit, finish, aesthetics, durability
and clinical longevity could be sacrificed. The term "good enough" gets used
quite a bit when referring to CAD/CAM technology. Ivoclar Vivadent develops
products with passion, vision and innovation - and innovation without
sacrificing performance. Corners can always be cut in the name of innovation,
but I don't believe going faster and giving up performance and aesthetics
Do you think the need for an oven will soon be eliminated?
Busch (Sirona): Ovens, to which I will clarify to include porcelain ovens
and sintering furnaces, serve many purposes in the CAD/CAM
materials world, especially in dental laboratory processes. From
fully crystallizing materials to staining and glazing methods
that require varying degrees of heat treatments, ovens are an
integral part of today's dentistry.
Some lower-strength materials do not require sintering in a
furnace and offer a lot of flexibility for the clinician (e.g., polishing).
The trade off, however, is those materials need to be
adhesively cemented (bonded). Until now, all materials that
can be cemented traditionally need to be sintered in a furnace.
It is also important to note that we are seeing ovens and furnaces
advance in their speed and efficiency at nearly the same
rate as material advancements aimed at decreasing the need for
lengthy sintering/baking times.
Golden (3M): Not soon, as the current offerings of popular
materials include those that can only be processed that way
(final firing/glazing). Processing without porcelain ovens will
be the obvious goal to increase utilization of chairside systems,
and will allow the clinician to service or repair restorations
intraorally (this cannot be done with fired ceramic materials).
Bell (Ivoclar Vivadent): An oven isn't needed now - it's up
to the clinician and lab based on the materials they choose to
utilize. The industry has moved to placing IPS e.max CAD
from labs and in chairside systems for a variety of reasons such
as durability - it doesn't break even in challenging clinical situations
- and it offers excellent aesthetics processed in a short time. As of today, it's a great combination of features for the dental professional
and patient. I do believe as the industry progresses, better and more
efficient "creation" of the restoration might virtually eliminate the need for a
Are there any CAD/CAM materials for which you advocate conventional
Busch (Sirona): As the equipment manufacturer, we defer to our
materials partners for their cementation requirements.
Golden (3M): Currently, we recommend
that available materials will provide better performance
when they're used to produce adhesively
bonded restorations. Each material has
different physical properties and luting requirements
- it is always best to observe the directions for intraoral use provided
by the manufacturer of each material; the development teams of each manufacturer
tests their materials and can recommend the optimum method for
clinical use. For example, restorations produced using 3M ESPE's Lava
Ultimate Restorative are placed using a specific technique designed to maximize
this materials (restorations) performance; this technique differs from
that of other materials produced by other manufacturers.
Bell (Ivoclar Vivadent): The evolution of lithium disilicate from
framework material to a monolithic restorative material known as IPS
e.max CAD offers a unique option to conventionally cement upon achieving
the preparation guidelines. This is a powerful option for chairside
CAD/CAM owners who can prepare a retentive preparation similar to a
PFM prep, mill, crystallize and conventionally cement the final restoration.
IPS e.max CAD is currently the only material offered chairside that can be
Are there any new CAD/CAM materials on the horizon from
Busch (Sirona): While Sirona is predominately an equipment manufacturer,
we do keep an eye on the materials market and participate from time
to time. Many of our users worldwide choose to only use Sirona-branded
consumables because they trust the manufacturer of the equipment to provide
materials under its umbrella suitable for all indications, and in some
markets not all material partners are represented. The need for Sirona consumables
also presents itself when we develop proprietary process (e.g.,
CEREC Guide), which require the research and development of a materials
solution to fulfill the needs of a software feature. With that in mind, should
partnerships and innovations present themselves to the extent that we feel
our users will benefit greatly from a Sirona-branded materials addition, we
will consider such opportunities and participate as needed.
Golden (3M): Yes, 3M ESPE is always working to produce betterperforming
products in restorative and operative dentistry. New CAD/CAM
materials are under development that will meet the always-increasing
demands of today's clinicians and increasingly educated patients. Our future
materials will be designed to work with our newest and most advanced bonding
and cementation systems, so clinicians will have confidence that the
restorations they place will provide years of service.
Lava Ultimate restorative for chairside is currently available through
Patterson and Henry Schein and the suggested retail price is $149.50 for one
refill (includes five blocks); however, dental professionals should contact
their distributors for current pricing. Lava Ultimate Restorative is also available
by dental labs through Jensen Dental, InLab and Straumann Cares.
Bell (Ivoclar Vivadent): Short term we are developing more ways to use
IPS e.max CAD in more clinical indications. Expanding the indications into
bridges and abutments is very exciting for CAD/CAM owners. They have
purchased one of the greatest tools in dentistry, and we want to offer them
as many ways as possible to use it and use it as efficiently as possible.
There are new materials on the horizon, too. I think that's all I can say
without risk of losing my job! We are continuously developing materials,
new or variations on existing, all with the intent of being innovative without
sacrificing performance. The International Dental Show (IDS) in Cologne
will debut numerous new product launches that will shortly thereafter be
launched here in North America.