An Update on CAD/CAM Dentistry...An Update on CAD/CAM Dentistryadhesive technologies. Early CAD/CAM...

Knowledge for Clinical Practice

An Update on

CAD/CAMDentistry

G. Franklin Shull, Jr., DMD

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EDUCATIONAL OBJECTIVES

The overall goal of this article is to provide the reader with infor-mation on the delivery of indirect restorations using CAD/CAM dentistry. On completing this article, the reader will be able to:

1. Describe the types of procedures that can be performed using CAD/CAM systems;

2. Review the considerations and features available when selecting a CAD/CAM system;

3. List and describe the properties and benefi ts achieved with laboratory fabricated CAD/CAM restorations versus chairside milling; and

4. Outline the sequence of steps when providing a CAD/CAM laboratory fabricated indirect restoration.

CAD/CAM dentistry was a transformational change for dentistry. It is now possible to accurately scan and fabricate restorations, models, abutments, bars, prostheses and diagnostic wax-ups, as well as to use CAD/CAM for implant and orthodontic planning. Within the restorative dentistry discipline, in-offi ce options for in-direct restorations include traditional impressions, CAD scanning for traditional or CAM restoration fabrication, or CAD/CAM with chairside milling. The accuracy, versatility and reliability of CAD/CAM systems as well as their ease-of-use, portability and cost are all considerations. In addition, different types of scanners have dif-ferent attributes as do the programs supporting digital impressions and CAD/CAM. CAD/CAM has been proven to offer esthetic and durable solutions in esthetic dentistry.

ABSTRACT

Introduction

The introduction of dental computer-aided design (CAD) and computer-aided design/computer-aided manufacturing (CAD/CAM) into dentistry has

revolutionized the way in which dentistry can be practiced. This transformational development has resulted in advances in the areas of restorative, implant and reconstructive dentistry, as well as orthodontics. From the beginning, CAD/CAM technology has been a promising development.1-4 In particular, digital intraoral scanners have gained in popular-ity over the last few years as many new systems have been introduced to the market. The development of CAD/CAM dentistry owes its origins to the transfer of technology from industrial manufacturing, just as is the case with initial

G. Franklin Shull, Jr., DMD, graduated from the Medical University of South Carolina School of Dentistry in 1993 and completed his General Practice Residency in 1994 at Palmetto Richland Hospital. He has a private practice in Lexington, SC, and is on the teaching faculty at both the Pal-metto Richland Hospital in the General Practice Residency Program and at the Medical College of Georgia School of Dentistry. Dr. Shull also is

a member of the faculty at the L.D. Pankey Institute in Key Biscayne, FL. In addition to being a Fellow of the Academy of General Dentistry and a member of the American Dental Association, Dr. Shull is the past president of both the Greater Columbia Dental Association and the South Carolina Academy of General Dentistry. Dr. Shull writes and lectures on esthetic dentistry, dental materials, and dental photography. AUTHOR DISCLOSURE: Dr. Shull has no confl ict of interest to disclose. He can be reached at: [email protected].

ABOUT THE AUTHOR

SPONSOR/PROVIDER: This is a Dental Learning, LLC continuing education activity. COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from 3Shape. DESIGNATION STATEMENTS: Dental Learning, LLC is an ADA CERP recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not ap-prove or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Dental Learning, LLC designates this activity for 2 CE credits. Dental Learning, LLC is also designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership, and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 2/1/2012 - 1/31/2016. Provider ID: # 346890. EDUCATIONAL METHODS: This course is a self-instructional journal and web activity. Information shared in this course is based on current information and evidence. REGISTRATION: The cost of this CE course is $29.00 for 2 CE credits. PUBLICATION DATE: February 2015. EXPIRATION DATE: January 2018. REQUIREMENTS FOR SUCCESSFUL COMPLETION: To obtain 2 CE credits for this educational activity, participants must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. AUTHENTICITY STATEMENT: The images in this course have not been altered. SCIENTIFIC INTEGRITY STATEMENT: Information shared in this continuing education activity is developed from clinical research and represents the most current information available from evidence-based dentistry. KNOWN BENEFITS AND LIMITATIONS: Information in this continuing education activity is derived from data and information obtained from the reference section. EDUCATIONAL DISCLAIMER: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the fi eld related to the course topic. It is a combination of many educa-tional courses and clinical experience that allows the participant to develop skills and expertise. PROVIDER DISCLOSURE: Dental Learning does not have a leadership position or a commercial interest in any products that are mentioned in this article. No manufacturer or third party has had any input into the development of course content. CE PLANNER DISCLOSURE: The planner of this course, Casey Warner, does not have a leadership or commercial interest in any products or services discussed in this educational activity. She can be reached at [email protected]. TARGET AUDIENCE: This course was written for dentists, dental hygienists, and assistants, from novice to skilled. CANCELLA-TION/REFUND POLICY: Any participant who is not 100% satisfi ed with this course can request a full refund by contacting Dental Learning, LLC, in writing. Please direct all questions pertaining to Dental Learning, LLC or the administration of this course to [email protected]. Go Green, Go Online to www.dentallearning.net take your course. © 2015

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An Update on CAD/CAM Dentistry


adhesive technologies. Early CAD/CAM devices offered dentists the ability to capture a digital scan and create an indirect chairside-milled inlay—at that time, inlays were the only type of restoration that was possible using CAD/CAM.

Dental material advances have also accelerated, with an increased demand from patients for esthetic direct and indirect restorations. The advent of CAD/CAM brought with it the development of new metal-free esthetic materi-als such as zirconia and high-strength ceramics that can be milled chairside or in the laboratory and that meet these demands.5-9 While experimental, CAD/CAM milling of an extracted third molar to create a restoration for a severely compromised tooth was recently reported.

Dental practitioners in multiple disciplines now have sev-eral options for incorporating CAD/CAM into the practice. Options for restorative dentistry include: Taking a digital scan and milling the restoration chairside in the offi ce; taking a digital scan and sending the scan data to a dental laboratory for fabrication of the restoration; taking a traditional impression that is then scanned to create a digital impression from which the indirect restoration can be de-signed in the laboratory; or, pouring a gypsum model from a

traditional impression, and scanning the model to recreate it digitally for CAD design. This last option also enables CAD/CAM design and restoration fabrication if there is no scanner available in the offi ce or lab that can directly scan impressions. Although scanning traditional impressions digitizes the information and this data can be used to CAM fabricate models, dies and restorations, it also replicates

TABLE 1. CAD/CAM system restorative capabilities

CrownsBridges

VeneersInlaysOnlays

ImplantAbutments

Digital Shade

MatchingPowder

Natural Color Scans

HD Photos

System

3M True Defi nition Yes Yes Yes Yes No Yes No No Open

3Shape Trios Yes Yes Yes Yes Yes No Yes Yes Open

CEREC (Bluecam) Yes Yes Yes No No Yes No No Closed

CEREC (Omnicam) Yes Yes Yes Yes No No Yes No Closed

PlanScan/E4D NEVO Yes Yes Yes No No No No No Open

iTero Yes Yes Yes Yes No No No No Open

Figure 1. Digital virtual diagnostic wax-up

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4 VOLUME 4 | ISSUE 2

any errors that were present in the impression. However, it removes the possibility of operator error associated with traditional model pouring and restoration fabrication. The sections below review some of the considerations in using CAD/CAM systems and their properties.

CAD/CAM systemsCAD/CAM systems vary in capabilities. Some are now

able to scan images for all types of indirect restorations as well as implant components and have modules for differ-ent disciplines, while other systems are more specialized by discipline and type of restoration. The versatility of systems in scanning for indirect restorations has increased considerably, and several systems now offer a broad range of indirect restorative options.10-12 Diagnostic wax-ups and models are now also options with some systems, as well as CAD/CAM creation of implant abutments and compo-nents, without the need for additional programs. Combining CBCT scans with digital impressions is another option, for accurate implant planning and digital manufacturing of sur-gical guides using 3D printers. Table 1 shows the scanning capabilities of current systems for restorations.

Different systems use differing methods for image acquisi-tion and processing routes to obtain data for restorations. Methods used for image acquisition include blue light emit-ting diode (LED) light (note that if the blue LED Light is shortwave, it will not produce color images), blue laser tech-nology, multiple single images that are then stitched together to create a 3D image, optical scanners, and continuous acquisition (“streaming”) of optical images. All are designed to produce high accuracy images.13-15 Differentiating factors include the use of powder and scanning versatility. While the earliest systems used powder, increasingly systems have evolved to where powder is not required to scan prepara-tions. Systems providing color images enhance the visibility of the scans in colors that approach real life, which helps the clinician read the scan and identify any areas of concern that may need adjusting or rescanning. If physical models are required, rather than virtual models, these can be milled or printed in the laboratory using CAD/CAM and sent to the

office. These models are free of the defects associated with pouring stone/plaster models from traditional impressions, and also stronger than traditional models. Models have been found to be reliable and accurate with blue LED light scan-ning when measured against laser-based scanning.

Shade matching is now also automated in CAD/CAM with one system, which also takes digital intraoral photo-graphs. Traditional shade matching is subject to error—when using a Vita shade guide, daylight and artificial light sources influence the shade perceived by the user, which can result in false readings and shade requests. In addi-tion, the color of lipstick and clothing affects the perceived shade when using the naked eye to determine shade(s) as do variances in the optical abilities of individuals.16-18 The scanner automatically reads the shades of the adjacent teeth while scanning the area for the preparation(s) and adjacent topography. This removes the possibility of human error/misperception of shades, and also saves time by removing a step in the process. The shades are automatically noted on the images at several points and can be viewed on the screen. There is no need to write a shade on the prescription since it is automatically entered into the data. The ability to separately take intraoral photographs using a CAD/CAM scanner is an additional new option. These can be superim-posed over the scanned image, with the potential to improve readability and detection of any areas of concern.

Footprint, Portability and FlexibilityFurther considerations include the space required for

the scanning device (and in-office milling machine if this is being considered). A system that uses a cart system offers flexibility to move it between operatories, and the ultimate in portability is obtained with a portable “pod” solution that uses a laptop into which the scanner is plugged via a USB port. This degree of flexibility with a scanner system means that the same device can be used in different loca-tions; in other words, only one device need be purchased if, for instance, there are two locations and its use is not highly intensive at both locations. Conversely, where CAD/CAM scanning will be performed in only one operatory, depending

5FEBRUARY 2015


on the system an alternative solution to a cart or pod is to integrate the system into the chair.

Laboratory fabrication or chairside millingThe process following image acquisition represents fun-

damental differences between CAD/CAM systems. The abil-ity of some to enable chairside fabrication using an in-office milling machine allows same-visit creation and seating of in-direct restorations. This saves the patient having to return a second time, potentially receiving a second local anesthetic, and removes the need for a provisional restoration and the cost involved. By avoiding a second appointment, some office time including turnaround time is also saved.

On the other hand, digitally transmitting scanning data from the office to the laboratory or a central manu-facturing location is quick and saves chair time, although a provisional restoration and separate seat appointment are necessary. If a scan is first sent to the laboratory, a provisional restoration can be fabricated using CAD/CAM

and delivered to the office as an alternative to chairside or traditional laboratory fabrication. Laboratory milling/ fabrication also means that staining and glazing is not required in the office, which saves time in the dental office, and more complex esthetic tailoring of the restora-tions can be achieved. Polishing, staining and glazing in the laboratory simplifies the process for the clinician. A CAD/CAM restoration that is laboratory milled/ fabricated does obviously incur a lab fee; however, the CAD/CAM scanner is significantly less expensive than also acquiring a milling machine and provides a less expensive point of entry for clinicians. Restoration customization is enhanced when required.

When considering purchase of a CAD/CAM system that will be used collaboratively with your laboratory, it is helpful to consult with your dental lab technician. He/she may have excellent knowledge of digital dentistry and may have experience with the software of several systems as well as open architectures that are compatible with several types of CAM milling devices. In this regard, the lab may be able to give you advice that will enhance collaboratively working on CAD/CAM dentistry. Some CAD/CAM systems' software programs are 'closed' meaning that the files can only be transferred and used for specific devices. Other systems are 'open', meaning that the digital files can be transferred with an 'open connection' that allows the laboratory to use virtu-ally any CAD/CAM system for fabrication. This increases flexibility and versatility.

Ultimately, scanners are vehicles for obtaining dental images in CAD/CAM dentistry — they still require a suitable preparation design and accurate image acquisition. The latter relies on the scanner being able to “access” the area, which requires soft tissue retraction around the margins where these are subgingival or equigingival, in ad-dition to adequate isolation. Options for soft-tissue retrac-tion, when required, remain the same as with traditional techniques and include the use of either gingival retraction cord (with or without hemostat), a displacement cap, or the use of a putty-like retraction paste that also provides for hemostasis. A further option is a soft-tissue laser, which

Table 2. CAD/CAM options and attributes

Chairside Milling

Removes need for a separate seat appointment

No provisional is required

Greater chairside time is required

Cost of equipment is high, but no lab fees

Requires space in the operatory

Laboratory Milling

Still requires a separate seat appointment

A provisional restoration is required

Reduces cost of equipment in-office; incurs lab fees

Enables collaboration with the laboratory

More complex customization is possible

Simplifies the process for the clinician (polishing/glazing in lab)

Reduces chairside time



troughs the tissue (rather than retracting it, soft tissue is ablated) and also provides for hemostasis.

Regardless of which CAD/CAM option is chosen and which retraction method is selected, accurate image acqui-sition of the preparation as well as the adjacent dentition and opposing arch is still paramount in delivering accurate, functional and long-lasting indirect restorations and pros-theses.19-22 The case below shows a methodology, scanning and imaging results and fi nal indirect restorations using CAD/CAM dentistry.

Case PresentationThe patient in this case was a 45-year-old female. Her

chief complaint was a tooth on her lower left that was pain-ful on biting. On examination, tooth #19 was found to have multiple fractures in the tooth structure surrounding a large occlusal amalgam (Figs. 2, 3). Pain on biting was isolated to the mesiolingual cusp. A full mouth examination was performed, and radiographs were taken that included bite-wings and periapicals. No pathology was found on tooth #19 other than the fractures. After discussing this with the patient, a decision was reached to treat this tooth with a full cuspal coverage porcelain restoration. It was also decided that a digital impression system would be used – this was particularly advantageous since the patient was a gagger

and would not tolerate traditional impressions well.At the fi rst treatment appointment, local anesthesia

was given to the patient and the preparation was created. The old restoration and fractures were removed resulting in a full cuspal coverage preparation. No buildup material was needed due to the selection of a high-strength ceramic that would be adhesively bonded. As mentioned earlier in this article, accurate image acquisition is still essential, and the margins must be accessible for the scanner. Soft tissue retraction was not needed in this case as the preparation margins were all supragingival.

The Trios pod was used for scanning (3Shape, Copenha-gen), using the handheld scanning handpiece plugged into a laptop via the USB port. A scan was taken of the prepara-tion together with the adjacent teeth. Scanning the adjacent teeth provides for built-in detail shade mapping, which ultimately results in an excellent restoration shade match. Scans were also taken of the lower opposing quadrant, which took around 1 minute, and of the opposing arch. Next, a high-defi nition clinical image was taken using the scanning handpiece.

During scanning, the patient was able to hold an iPad con-nected via Bluetooth to the computer and watch the scanning procedure. This engages patients with the technology, keeps them involved in their treatment and helps during diagnosis

Figure 2. Presentation of tooth #19 Figure 3. Tooth #18 following removal of the old amalgam restoration

7FEBRUARY 2015


Figure 7. Interface of the scan and clinical image

Note the true-to-life color imaging, making visualization easier

Figure 6. Scan of opposing arch Figure 9. Margin line on the virtual model

Figure 4. Inter-occlusal space verification with green color coding indicating appropriate space is present

Figure 5. Insertion profile Figure 8. Scan prepared for transmission to laboratory



of other issues. Once connected, an iPad also can be used as a touch screen by the clinician during scanning and analysis.

After image acquisition was complete, the case was digitally analyzed to double check that there was sufficient inter-occlusal space and a suitable insertion profile. The scan of the prepara-tion and the opposing arch were checked and found to be sat-isfactory (and could otherwise have been rescanned in specific areas without rescanning the whole arch). The photograph was also digitally superimposed over the scan to view the high- definition margins of the prep (Figs. 4-7).

The scans were then prepared for transmission to the laboratory, together with the case’s digital prescription form and the automatically generated shade measurements that were present on the scan image of the preparation and adjacent teeth (Fig. 8).

The patient was provided with a provisional crown, which was checked after seating. At the same visit, the leaking occlusal amalgam and caries in the adjacent molar was removed and replaced with a composite. Selective etching was performed on the enamel margins and a single-component, light-cured adhesive was used prior to restoring with a nanohybrid resin composite. The patient was then dismissed.

When the virtual model and dies were developed in the laboratory, these were digitally viewed in the office along with the proposed crown form (Figs. 9-11). One of the advantages of the CAD/CAM scanner system used is that it is an open system, allowing the laboratory to determine the CAD/CAM fabrication method that it preferred.

The crown was fabricated using monolithic lithium disilicate. On delivery, at the patient’s seat appointment, the fit, margins, occlusion and shade were first checked; no adjust-ments were necessary. A one-step universal adhesive was applied and cured, the crown was then luted using a transpar-ent shade dual-cured resin cement, and the occlusion again checked. The patient was pleased with the esthetic result and appearance of the crown (Fig. 12).

Conclusion CAD/CAM dentistry has opened up new possibilities

in dentistry in several disciplines. Esthetic restorative care

Figure 12. Final result

Figure 10. Removable dies on virtual model

Figure 11. Verification of crown form using Smile composer

9FEBRUARY 2015


has been streamlined with CAD/CAM, with several options available – the clinician can digitally scan the preparation and either mill the restoration chairside or send the digital files to the laboratory. There are advantages to both methods. CAD/CAM system selection needs careful consideration of the scanning device and software, its versatility and flex-ibility, accuracy, and ease-of-use. When it is planned to use a laboratory for fabrication of the restorations, it is also helpful to discuss with your laboratory technicians and to find out what their experience has been with different systems. Using a scanning system that also automatically provides for shade matching and intraoral imaging at the same time as scanning the preparation(s), adjacent teeth and opposing arch saves time and further streamlines the process. Regardless of which system is used, accurate image selection is essential.

References1. Duret F and Termoz C, inventors: Method of and apparatus for making a prosthesis, especially a dental prosthesis. US Patent 4663720; 2010.2. Brandestini M, Moermann WH, inventors: Method and apparatus for the three dimensional registration and display of prepared teeth. US Patent 4837732; 1989.3. Leinfelder KF, Isenberg BP, Essig ME. A new method for generat-ing ceramic restorations: a CAD/CAM system. J Am Dent Assoc. 1989;118(6):703-7. 4. Mörmann WH, Brandestini M, Lutz F, Barbakow F. Chair side com-puter-aided direct ceramic inlays. Quintessence Int. 1989;20:329–39.5. Herrguth M, Wichmann M, Reich S. The aesthetics of all-ceramic veneered and monolithic CAD/CAM crowns. J Oral Rehabil. 2005;32(10):747-52.6. Bindl A, Luthy H, Mörmann WH. Strength and fracture pattern of monolithic cad/cam-generated posterior crowns. Dent Mater. 2006;22(1):29–36. 7. Schlichting LH, Schlichting KK, Stanley K, Magne M, Magne P. An approach to biomimetics: the natural CAD/CAM restoration: a clini-cal report. J Prosthet Dent. 2014;111(2):107-15.8. Baltzer A. All-ceramic single-tooth restorations: choosing the material to match the preparation--preparing the tooth to match the material. Int J Comput Dent. 2008;11(3-4):241-56. 9. Giordano R. Materials for chairside cad/cam-produced restora-tions. J Am Dent Assoc. 2006;137 (Suppl):14s–21s.10. Miyazaki T, Hotta Y. CAD/CAM systems available for the fabrication of crown and bridge restorations. Aust Dent J. 2011;56 Suppl 1:97-106.11. Birnbaum NS, Aaronson HB, Stevens C, Cohen B. 3D digital scanners: a high-tech approach to more accurate dental impressions.

Inside Dent. 2009;5:70-4.12. Brawek PK, Wolfart S, Endres L, Kirsten A, Reich S. The clinical ac-curacy of single crowns exclusively fabricated by digital workflow--the comparison of two systems. Clin Oral Investig. 2013;17(9):2119-25. 13. Seelbach P, Brueckel C, Wöstmann B. Accuracy of digital and conventional impression techniques and workflow. Clin Oral Investig. 2013;17(7):1759-64. 14. Lee W-S, Kim WC, Kim H-Y, Kim W-T, Kim J-H. Evaluation of dif-ferent approaches for using a laser scanner in digitization of dental impressions. J Adv Prosthodont. 2014;6:22-9.15. Persson AS, Odén A, Andersson M, Sandborgh-Englund G. Digitization of simulated clinical dental impressions: virtual three-dimensional analysis of exactness. Dent Mater. 2009;25(7):929-36.16. Stevenson B. Current methods of shade matching in dentistry: a review of the supporting literature. Dent Update. 2009;36(5):270-6. 17. Haddad HJ, Jakstat HA, Arnetzl G, Borbely J, Vichi A, Dumfahrt H, et al. Does gender and experience influence shade matching quality? J Dent. 2009;37(suppl 1):e40-4.18. Vafaee F, Rakhshan V, Vafaei M, Khoshhal M. Accuracy of shade matching performed by colour blind and normal dental students using 3D Master and Vita Lumin shade guides. Eur J Prosthodont Restor Dent. 2012;20(1):23-5.19. Fasbinder DJ. Clinical performance of chairside CAD/CAM resto-rations. J Am Dent Assoc. 2006;37(suppl):22s-31s.20. Schaefer O, Decker M, Wittstock F, Kuepper H, Guentsch A. Impact of digital impression techniques on the adaption of ceramic partial crowns in vitro. J Dent. 2014;42(6):677-83.21. Ng J, Ruse D, Wyatt C. A comparison of the marginal fit of crowns fabricated with digital and conventional methods. J Prosthet Dent. 2014 Mar 11. Epub ahead of print.22. De Vico G, Ottria L, Bollero P, Bonino M, Cialone M, Barlattanu A, Gargari M. Aesthetic and functionality in fixed prosthodontic: sperimental and clinical analysis of the CAD-CAM systematic 3Shape. Oral Implantol. 2008;3-4:104-15.

WebliographyFasbinder DJ. Clinical performance of chairside CAD/CAM restora-tions. JADA 2006;137(9 supplement):22S–31S. Available at: http://jada.ada.org/content/137/suppl_1/22S.abstract?ijkey=24969cbaa0bb04f7453ddfdf45afb2725a09b127&keytype2=tf_ipsecshaGiordano R. Materials for chairside CAD/CAM–produced restora-tions. JADA 2006;137(9 supplement):14S–21S. Available at: http://jada.ada.org/content/137/suppl_1/14S.full.pdf+htmlHickel R, Manhart J. Longevity of restorations in posterior teeth and reasons for failure. J Adhes Dent. 2001 Spring;3(1):45-64. Ab-stract available at: http://www.ncbi.nlm.nih.gov/pubmed/11317384Wittneben JG, Wright RF, Weber HP, Gallucci GO. A systematic review of the clinical performance of CAD/CAM single-tooth restora-tions. Int J Prosthodont. 2009 Sep-Oct;22(5):466-71. Abstract avail-able at: http://www.ncbi.nlm.nih.gov/pubmed/20095195



1. The development of CAD/CAM dentistry owes its origins to the transfer of technology from __________.a. the aviation industryb. industrial manufacturingc. medicined. none of the above

2. Scanning traditional impressions __________.a. digitizes the information for CAM fabricationb. replicates any errors that were present in the impressionc. removes the possibility of operator error associated with

traditional model pouring and restoration fabricationd. all of the above

3. Methods used for image acquisition include __________.a. blue LEDb. laser technologyc. multiple single images or streaming of imagesd. all of the above

4. Physical models can be milled in the laboratory using CAD/CAM, and __________.a. are free of the defects associated with pouring stone/plaster

modelsb. are stronger than traditional modelsc. have been found to be reliable and accurated. all of the above

5. Digital shade matching __________.a. avoids the risk of human error and misperceptions in shade

matchingb. is less accurate than using a shade guidec. requires additional stepsd. b and c

6. When considering purchase of a CAD/CAM system that will be used collaboratively with your laboratory, it is helpful to consult with __________. a. the end user b. your dentistc. your dental lab techniciand. all of the above

7. CAD/CAM solutions in the dental office include use of a __________.a. chairside integrated systemb. cartc. pod with laptop computerd. all of the above

8. Chairside milling of restorations __________.a. allows same-visit creation and seating of indirect restorationsb. saves the patient having to return a second timec. removes the need for a provisional restoration and the cost

involvedd. all of the above

9. Digitally transmitting scanning data for laboratory/manufactur-ing facility CAD/CAM fabrication of restorations __________.a. is easyb. removes the need for a provisional restorationc. necessitates a separate seat appointmentd. all of the above

10. Laboratory milling/fabrication __________.a. allows for more complex tailoring of restorationsb. complicates the process for the clinicianc. incurs more chairside timed. none of the above

CEQuizTo complete this quiz online and immediately download your CE verification document, visit www.dentallearning.net/UCD-ce, then log into your account (or register to create an account). Upon completion and passing of the exam, you can immediately download your CE verification document. We accept Visa, MasterCard, and American Express.

11FEBRUARY 2015


11. An 'open' system means that __________.a. the files do not need to be closed before transmitting themb. the laboratory can choose which CAD/CAM system to use

for fabricationc. anyone can read the transmitted filesd. all of the above

12. An accurate image acquisition relies on _________. a. adequate soft tissue retraction around subgingival and

equigingival preparations b. adequate control of hemostasisc. good isolationd. all of the above

13. CAD/CAM scanning only is __________ than CAD/CAM chairside milling of restorations. a. more accurate b. less expensivec. less time-consuming chairsided. a and b

14. CAD/CAM system selection needs careful consideration of __________. a. the scanning device and softwareb. its versatility and flexibilityc. its ease-of-use d. all of the above

15. With respect to CAD/CAM, a functional and long-lasting accurate indirect restoration requires accurate image acquisition of the __________. a. preparation b. opposing arch c. adjacent dentition d. all of the above

16. Viewing scans of high-definition margins of preps can be aided by __________. a. loupes b. a photograph digitally superimposed over the scanc. microscopesd. none of the above

17. Intraoral photographs using a CAD/CAM scanner have the potential to __________. a. increase complexity b. improve readability c. reduce isolation requirementsd. remove the need for powder

18. Pouring a gypsum model from a traditional impression, and scanning the model to recreate it digitally for CAD design, enables CAD/CAM design and restoration fabrication if there is __________. a. no scanner available that can directly scan impressionsb. an inability to achieve isolation c. less time availabled. none of the above

19. If the patient can see the scanning procedure, this __________. a. engages the patient with the technologyb. keeps the patient involved in his/her treatmentc. helps during the diagnosis of other issuesd. all of the above

20. The process can be streamlined by using a scanning system that automatically provides for __________. a. shade matchingb. intraoral imaging c. isolation d. a and b

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Please direct all questions pertaining to Dental Learning, LLC or the administration of this course to [email protected]. COURSE EVALUATION and PARTICIPANT FEEDBACK: We encourage participant feedback pertaining to all courses. Please be sure to complete the evaluation included with the course. INSTRUCTIONS: All questions have only one answer. Participants will receive confirmation of passing by receipt of a verification certificate. Verification certificates will be processed within two weeks after submitting a completed examination. EDUCATIONAL DISCLAIMER: The content in this course is derived from current information and research based evidence. Any opinions of efficacy or perceived value of any products mentioned in this course and expressed herein are those of the author(s) of the course and do not necessarily reflect those of Dental Learning. Completing a single continuing education course does not provide enough information to make the participant an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. COURSE CREDITS/COST: All participants scoring at least 70% on the examination will receive a CE verification certificate. Dental Learning, LLC is an ADA CERP recognized provider. Dental Learning, LLC is also designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership, and membership maintenance credit. Please contact Dental Learning, LLC for current terms of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. Dental Learning, LLC is a California Provider. The California Provider number is RP5062. The cost for courses ranges from $19.00 to $90.00. RECORD KEEPING: Dental Learning, LLC maintains records of your successful completion of any exam. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of request. Dental Learning, LLC maintains verification records for a minimum of seven years. CANCELLATION/REFUND POLICY: Any participant who is not 100% satisfied with this course can request a full refund by contacting Dental Learning, LLC in writing or by calling 1-888-724-5230. Go Green, Go Online to www.dentallearning.net to take this course. © 2015

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

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QUIZ ANSWERSFill in the circle of the appropriate answer that corresponds to the question on previous pages.

EDUCATIONAL OBJECTIVES1. Describe the types of procedures that can be performed using CAD/CAM systems;2. Review the considerations and features available when selecting a CAD/CAM system;3. List and describe the properties and benefits achieved with laboratory fabricated CAD/CAM

restorations versus chairside milling; and4. Outline the sequence of steps when providing a CAD/CAM laboratory fabricated indirect restoration.

If you have any questions, please email Dental Learning at [email protected] or call 888-724-5230.

COURSE SUBMISSION: 1. Read the entire course.2. Complete this entire answer sheet in

either pen or pencil.3. Mark only one answer for each question.4. Mail answer form or fax to 732-303-0555. For immediate results:1. Read the entire course.2. Go to www.dentallearning.net/UCD-ce.3. Log in to your account or register to create an

account.4. Complete course and submit for grading to

receive your CE verification certificate.

A score of 70% will earn your credits.

Dental Learning, LLC500 Craig Road, First FloorManalapan, NJ 07726

*If paying by credit card, please note:Master Card | Visa | AmEx | Discover

*Account Number

______________________________________________

*Expiration Date

______________________________________________

The charge will appear as Dental Learning, LLC.

If paying by check, make check payable to Dental Learning, LLC.

ALL FIELDS MARKED WITH AN ASTERISK (*) ARE REQUIRED

AGD Code: 612

Price: $29 CE Credits: 2Save time and the environment by taking this course online.

COURSE EVALUATIONPlease evaluate this course using a scale of 3 to 1, where 3 is excellent and 1 is poor.

1. Clarity of objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 1

2. Usefulness of content . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 1

3. Benefit to your clinical practice . . . . . . . . . . . . . . . . . . . . 3 2 1

4. Usefulness of the references . . . . . . . . . . . . . . . . . . . . . . 3 2 1

5. Quality of written presentation . . . . . . . . . . . . . . . . . . . . 3 2 1

6. Quality of illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 1

7. Clarity of quiz questions . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 1

8. Relevance of quiz questions . . . . . . . . . . . . . . . . . . . . . . 3 2 1

9. Rate your overall satisfaction with this course . . . . . . . . 3 2 1

10. Did this lesson achieve its educational objectives? Yes No

11. Are there any other topics you would like to see presented in the future? __________________________________________________________________________

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An Update on CAD/CAM Dentistry...An Update on CAD/CAM Dentistryadhesive technologies. Early CAD/CAM...

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