The World’s Lab Newspaper · Asia Pacific Edition · Eduardo Mahn, among other pro - minent...

DT Asia Pacific

SINGAPORE: With digital imag-ing and dental CAD/CAM, ad-vanced information technologyhas gained increased signifi-cance in dental practice in recentyears. While it has become widelyestablished in Western markets by now, most dentists and dentallaboratories in Asia are only nowstarting to incorporate the newtechnology into their workflow.Owing to under-penetration indental offices and increasing in-terest by dentists in investing in the technology, markets in the region are therefore expected tosee dramatic growth by 2016, ac-cording to a recent paper by Cana-

dian market intelligence providerMillennium Research Group.

In order to facilitate this devel-opment and to give professionals in the region access to the latest expertise and developments in the field, the Centre for AdvancedProfessional Practices (CAPP) Asia is hosting its second CAD/CAM and Digital Dentistry InternationalConference on 4 and 5 October atthe Marina Bay Sands hotel in Sin-gapore. A spin-off of the successfulcongress series held by CAPP inDubai in the United Arab Emiratesannually since 2006, the event is organised in collaboration with the Singapore Dental Association(SDA). The first show, held in Octo-

ber 2012, saw over 500 dentists anddental technicians from the regionattending the two-day congress.Similar figures are anticipated forthis year’s event, with a larger shareof professionals from countriesoutside the city-state expected.Last year, the conference saw par-ticipation by professionals fromMalaysia, the Philippines and Thai-land, among other countries.

According to the organiser, aDental Tribune International affili-ate, the scientific programme in-cludes presentations by interna-tional digital dentistry experts ontopics ranging from digital impres-sion taking to digital orthodonticsand computer-guided implant

planning. Presenters include DrsLutz Ritter, Andreas Bindl and Eduardo Mahn, among other pro -minent dental clinicians. A parallelsession to be held on the second dayof the conference will be targeted at dental technicians and discussthe latest solutions, materials andworking processes for the digitalworkflow in dental laboratories.

In addition, leading providersin the field will have their latest so-lutions and equipment on display.The industry exhibition, stagedalongside the scientific sessions,has been sponsored by a number of companies, including SironaDental Systems, Ivoclar Vivadent,3Shape and DeguDent. Specialist

companies, such as rapid prototyp-ing specialist Roland DG, have alsoannounced their participation inthe showcase event, which will hostover 30 companies from around theworld. In between sessions, atten-dees will have the opportunity to interact with the sponsors directlyand try out the latest digital gadgetsand tools, CAPP Asia said.

Dental professionals interest-ed in attending the event can stillregister in advance on the eventwebsite at www.capp-asia.com oron-site once the event has begun.Discounts are available to mem-bers of the SDA, as well as dentalauxiliaries and students, accordingto the organiser. LT

4Page 28

CAD/CAM, Growth factorsKey areas of dental innovation

4Page 26

Guided implantologyDr Ritter on how taking itto the next level

4Page 29

Computer-aided crown designFabrication of CAD/CAMcrowns chairside

LAB TRIBUNEThe World’s Lab Newspaper · Asia Pacific Edition

PUBLISHED IN HONG KONG www.dental-tribune.asia NO. 9 VOL. 11

Digital dentistry event held forthe second time in SingaporeGlobal movers and shakers to gather at CAD/CAM and Digital Dentistry International Conference

The CAD/CAM and Digital Den-tistry International Conferenceorganised by CAPP Asia will againbe held in collaboration with theSingapore Dental Association thisyear. Dental Tribune Asia Pacificspoke with the president of the organisation and Q & M DentalGroup shareholder Dr Kuan CheeKeong about the association’s

decision to support the event andwhat it will do to advance den-tistry in the city-state.

Dental Tribune Asia Pacific:This year CAPP Asia’s CAD/CAMand Digital Dentistry Interna-tional Conference will be held inSingapore for the second time.What was the response to the firstevent in 2012 from the dental community here?

Dr Kuan Chee Keong: The inaugural symposium was well at-tended, which was a pleasant sur-prise for all of us. When CAPP Asiafirst approached us with its proposalto organise a CAD/CAM symposiumin Singapore jointly, there was un-certainty among members of thecouncil whether to proceed. A few ofus however made a strong pitch forit and fortunately we made a com-mitment to collaborate. Feedbackfrom dentists so far has been mostlypositive and encouraging. However,we shall also be looking out for areasthat need improvement.

What made you decide to sup-port this event in the first place,and what in your opinion are itsprospects?

When we were debating whe -ther to collaborate with CAPP Asia,one argument was that CAD/CAM is a new and relatively unproventechnology compared with conven-tional prosthodontics and thereforethe Singapore Dental Associationshould not be involved in a CAD/CAM event. Computerisation andadvanced technologies howeverhave become the future of dentistry.When I was in dental school, I neverused a laptop but now it is an essen-tial tool. A paperless dental office,digital imaging, online transactionsand many other advances are justsome examples of commonplacecomputerisation.

Shouldn’t we face up to CAD/CAM? In fact, dentistry is way behindin embracing new technologies.High-tech industries are using 3-Dprinting and we are still struggling

with digital impressions. Dentistryneeds to be evolving constantly too.

Singapore dentists are usuallyamong the first adopters of newtechnologies in Asia. How com-mon is the use of dental CAD/CAM,and for what clinical purposes is itused the most to your knowledge?

Perhaps this question is betteranswered by suppliers like FondacoDental and others. There are no of-ficial statistics about the use of CAD/CAM to my knowledge. At Q & MDental Group, we make use of it withCEREC 3D for fabricating crownsand bridges primarily.

In your opinion, what are thebenefits of using dental CAD/CAMin clinical practice?

Less time is needed for the pro-duction of fixed prostheses. In ad -dition, we do not need to fabricatecustomised trays or use impressionmaterials, so waste can be reduced.This is a step in the right direction tobe more environmentally friendly.

Singapore is poised to becomean important hub for dental tou -rism. Will the use of dental CAD/CAM help to support this devel -opment in the long run?

Providing excellent dental carein shorter treatment time holds sig-nificant appeal to dental tourists.With travelling costs going downconstantly, more people from the re-gion will be able to fly to Singaporein the morning, have some porce-lain prostheses fabricated usingCAD/CAM and fitted almost imme-diately, then do some shopping before taking the late flight backhome. Singapore is not alone how-ever. Other countries in the regionare catching up and it is a mistake to assume that Singapore will al-ways be the leader in health care. We have to make an effort to stayabreast of the latest technologies.The CAPP Asia conference is a goodexample of that.

Thank you very much for theinterview. LT

Dr Kuan Chee Keong

“Dentistry is way behind inembracing new technologies”An interview with SDA president Dr Kuan Chee Keong

DTAP0913_25-26_LT 13.09.13 16:38 Seite 1

Opinion LAB TRIBUNE Asia Pacific Edition26

Dr Lutz RitterGermany

Exciting times are indeedahead for digital dentistry, as was evident from the fire-work of innovations present -

ed again in all fields of den-tistry at the latest Interna-tional Dental Show in Ger-many. As professionals, wehave to keep up to date, butalso be cautious of new tech-nologies.

Despite all the improve-ments in different technolo-gies, it has not necessarily be-come easier to stay abreast ofdevelopments. The ongoingexpansion of possibilities andupdates in the field of CAD/

CAM dentistry has increasedthe need for qualified edu -cation and professional ex-change at peer level.

Particularly in guided im-plantology, new opportunitiesfor treatment planning andtherapy are becoming avail-able through the combinationof existing 3-D technologies.The use of new 3-D diagnosticswith the help of CBCT has notonly improved pretreatmentdiagnostics in general, but hasalso opened up new possibil -ities in the planning processthrough the use of intelligentsoftware.

At the same time, questionsarise constantly and the re-sponsibilities of the user to offer complete diagnosticshave increased as well. Link-ing X-ray-aided planning withCAD/CAM systems already inthe planning phase is an in -novation that is intended tomake the transition to implant-supported prostheses mucheasier.

By now, dentists are able to perform many of the stepsthemselves, including digitalplanning, manufacturing dril -ling templates chairside andfabricating CAD/CAM pros -theses.

In considering its many ad-vantages, it should not to beforgotten that technology hasto remain comprehensible,transparent and usable for thedentist. The aim of my presen-tation at this year’s CAPP Asiaconference in Singapore is toplace the emphasis on thepractice-relevant aspects ofthe latest technologies and toprovide perspectives on the advantages they have to offer.

Along with the latest tipsand tricks, I want to communi-cate the possibilities and limitsof current technology, such asmanufacturing drilling tem-plates chairside and many others.

I hope that you draw some-thing of interest from the pres-entation. Personally, I want toinvite newcomers to becomeacquainted better with the often-difficult first steps withthe help of experienced users.Even from a surgical perspec-tive, I can say it is worth the effort.

Dr Lutz Ritter is currently a maxillo-facial and plastic surgeon at the Uni-versity Hospital of Cologne’s Centrefor Dental, Oral and MaxillofacialSurgery. On Saturday, 5 October 2013,he will be presenting a paper titled“Taking guided implantology to thenext level: Integrating CAD/CAM andCBCT” as part of the second Asia Pa-cific CAD/CAM and Digital DentistryInternational Conference scientificprogramme in Singapore.

LT

Taking guided implantology to the next level

Dr Lutz Ritter

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DTAP0913_25-26_LT 16.09.13 17:33 Seite 2

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Trends & Applications LAB TRIBUNE Asia Pacific Edition28

Dr Nilesh R. ParmarUK

Dentistry has come a long waysince our colleagues wereforced to use foot powereddrills and mix amalgam fromits bare components. Modernday dental equipment and ma-terials are at the cutting edge ofmedical and dental innovation,and it’s trade shows such as the International Dental Show(IDS) where the developmentsof the future are announced.Modern dentists no longerhave merely a straight probeand a dental drill at their dis-posal. We now have scans, 3-Dimages, growth factors and analmost unlimited choice of materials available to use.

In writing this piece, I made atough decision to focus on what I believe to be key areas of dentalinnovation. It is in these areas ofimaging, CAD/CAM technologyand growth factors that I believeare going to be important in thedental surgery of the future.

CAD/CAMComputer-aided design/

computer-aided manufacturinghas had a presence in dentistryfor nearly 20 years. However, it isonly in the last ten years that de-velopments have really made adifference in the reliability, easeof use and functionality of thesedevices. We now have CAD/CAMmachines (e.g., CEREC, iTero,Lava) that can scan an entirearch, design and fabricate all-ce-ramic restorations in the prac-tice. The popularity of chairsideCAD/CAM units has never beengreater. The materials that weare able to use in conjunctionwith CAD/CAM scanners havegone from monolithic, one shade blocks to multi-layered,all-ceramic, lithium-disilicateconstructions that can be sin-tered and finalised in as little as15 minutes.

The appearance of these re -storations, although still need-ing a well-trained (and artistic)dentist, could be said to be on par with certain lab-based fab -rications whilst maintaining theadvantages of being a chairside

single visit restoration. CAD/CAM technology is now almostuniversally used in the fabrica-tion of dental implant abutmentsand bars, reducing constructiontimes, designs and fit. Dentistsare now beginning to use chair-side CAD/CAM devices to restoredental implants without the needfor any impressions.

CBCT 3-D scanners andCAD/CAM integration

Cone beam computed tomo -graphy (CBCT) scans are nowcommonplace in dentistry, par-ticularly in implant dentistrywhere Grondahl (2007) foundthat 40 per cent of all CBCT scanswere taken for implant treat-ment. Where 3-D scans werereaching a shortfall was in actu-ally relaying the information ob-tained into the mouth during thesurgical procedure. One recentinnovation has been to overlayscans of the patient’s own teethand soft tissues onto the CBCTscan data. This gives an accuraterepresentation of the hard andsoft tissues and their relationship

to each other. For example, animplant can be planned in the implant software with the angu-lation of the implant taking into account the ideal position of thefinal crown, which can also beshown in the CBCT scan.

In order to do this previously,the dentist would have to make

a study model and then wax upthe ideal final restoration con-tour, ensuring some barium sul-fate within the wax in order for it to show up in the scan. Thiswas both costly and time con-suming. Recent developmentshave allowed one to take an in-

tra-oral scan using a suitable de-vice, such as a CEREC or iTeromachine, and overlay this withthe CBCT scan. No models, nowax ups; the procedure is al-most instant and can be donewith the patient in the chair. As a patient education tool, this visual format is invaluable, al-lowing patients to fully under-

stand the proposed work and itsexecution.

Taking this one step further,guided implant surgery now al-lows us to not only plan implantplacement using ideal restora-tively driven protocols, but ac-

tually allows us to make a guidedsurgical stent, made in-house orby a lab, and place the implantthrough the stent. Studies havefound that this is an accuratetreatment modality that can bereliably executed. Flapless sur-gery with immediate tempori -sation has the ability to revolu-tionise the patient journey andhelp us to meet their expecta-tions.

Facial scannersA small but rapidly develop-

ing area of digital dentistry is fa-cial scanners. These are in theirinfancy at the moment, with a lotof companies still trying to ironout the bugs in the machines.Their potential applications inthe field of plastic surgery, facialaesthetics, orthodontics, implantsurgery and orthognathic sur-gery are endless.

I have been fortunate to see aprototype facial scanner fromSirona and even managed to havemy face scanned (Figs. 1 & 2).The detail achievable with theseunits is impressive. Once this information is combined with 3-D scans, teeth scans and jawarticulation, a fully working andmovable representation of thepatient’s head can be compiledon the computer screen. Allow-ing for treatment planning andassessment to be carried outwithout any need to see the patient. One application of thismay be in developing countries,where various experts from

around the world can examinecomplicated facial reconstruc-tion cases without them actuallyseeing the patient. As alreadymentioned, the opportunitiesfor patient education are huge,and with procedures such asplastic surgery and orthogna -thic surgery being so difficult to properly consent for, facialscanners will greatly aid clini-cians.

Growth factors Available for a long time in

medicine and dentistry, growthfactors have been the reserve of PhD students and professorsuntil recently. The resurgence ofthe usage of platelet rich plasma(PRP) has come about with addedresearch showing that using PRPcan great ly improve osteoblastproliferation (Parmar 2009) andaccelerate soft-tissue healing.Companies are now offeringclinical courses for dentists tomake, produce and use PRP intheir own surgeries within 15 to30 minutes. The main advantageof PRP is that it’s free; is obtainedfrom the patients’ own blood,thus removing the risk of rejec-tion; and can be made in vastquantities. As more research ispublished, coupled with simplerproduction kits, PRP use will in-crease in all aspects of invasivedental surgery.

The above is just a short de-scription of what is being devel-oped for the future. Dentistry hasnever been so intertwined withtechnology. The next ten yearswill prove to be exciting and I eagerly await to hear, see anduse the new technologies that are being developed today.

Dr Nilesh R. Parmar runs a success-ful five-surgery practice close to London and is a visiting implantdentist to a central London practice.His main area of interest is in den-tal implants and CEREC CAD/CAMtechnology. He can be contacted [email protected]. Moreinformation can be found on his website, www.drnileshparmar.com;Twitter: @NileshRParmar; or Face-book: Dr Nilesh R. Parmar.

LT

“The popularity of chairsideCAD/CAM units has never been greater.”

CAD/CAM and growth factors—Key areas of dental innovation

Dr Nilesh R. Parmar

Fig. 2

Fig. 1

DTAP0913_28_LTPamar 13.09.13 16:38 Seite 1

LAB TRIBUNE Asia Pacific Edition Trends & Applications 29

Dr Andreas BindlSwitzerland

CAD/CAM technology allowsdental professionals to man-ufacture solid all-ceramiccrowns chairside. A digitalimage of the preparation iscaptured with an intra-oralcamera and the crown is de-signed accordingly.

A variety of ceramics areavailable for the construction ofthe crown, for example an aes-thetic, easy-to-mill ceramic suchas IPS Empress CAD (Ivoclar Vivadent). As this leu cite glass-ceramic is weaker than zirco-nium oxide, these crowns mustbe seated with the adhesivetechnique (for example with

Syntac/Variolink II or MultilinkAutomix, all Ivoclar Vivadent).This makes them strong enoughto withstand masticatory forcesin the long term.

IPS e.max CAD (Ivoclar Vivadent), which has been on

the market for some time, is a lithium disilicate glass-ce-ramic that demonstrates a flex-ural strength of 360 MPa. Thisceramic is machined to the desired shape while it is still in its metasilicate or blue state(approximately 130 MPa). Sub-

sequently, the ceramic is crys-tallised for 20 minutes. Duringthis process, the material at-tains its final state and obtainsits excellent mechanical andaesthetic properties. IPS e.maxCAD is available in a lowtranslucency (LT) version,

which is suitable for the fabri-cation of crowns and implant-retained crowns. The hightranslucency form is intendedfor the construction of inlaysand partial crowns. The stains

Computer-aided crown design—Fabrication of CAD/CAM crowns chairside

AD

Fig. 2

Fig. 3

Fig. 4

Fig. 1

Fig. 1: Pre-op situation: the buccalwall of tooth #25 was cracked and fea-tured a large, damaged composite fill-ing—a clear indication for a crown.—Fig. 2: A digital impression was takenof the preparation and the antagonistsand the situation in centric occlusion(CEREC Bluecam) from the buccal aspect (middle).—Fig. 3: Semi-auto-matic alignment of the maxillary andmandibular jaw models with the helpof the buccal image.—Fig. 4: The bio-generic crown software designs an occlusal surface according to the in -dividual situation.

‡ page 30LT

DTAP0913_29-31_LTBindl 13.09.13 16:39 Seite 1

and glaze are applied beforethe crystallisation process.

As a result, subsequent pol-ishing is unnecessary. Owingto the high strength of therestoration, adhesive cemen-tation with a separate dentineconditioner is not indicated aslong as the thickness of the ce-ramic is not less than 1.5 mm.Self-adhesive cementation ma -terials can be used. The newself-adhesive composite cementSpeedCEM (Ivoclar Vivadent)is particularly suitable for thispurpose.

In this case report, thechairside creation of a crown is described on the basis of aclinical case using IPS e.maxCAD LT and the new Speed-CEM luting ceme

Clinical case reportTooth #25 of a 32-year-old

female patient was restoredwith a crown owing to exten-sive destruction of the den-tal hard tissue (Fig. 1). First,the tooth was prepared with a shoulder of approximately 1 mm in width (epigingivally).Subsequently, the preparationwas dusted with IPS ContrastSpray (Ivoclar Vivadent) and a digital impression was takenwith the CEREC Bluecam cam-era (Sirona).

The Version 3.8 of theCEREC software generates avisual image of the antago-nists, which replaces the cen-tric bite record. In order tomatch the maxillary and man -dibular teeth, an image of thecentric situation was capturedfrom the buccal aspect (Fig. 2).The maxillary and mandibu-lar teeth were matched semi-automatically (Fig. 3).

The 3.8 version is capable of designing biogeneric oc-clusal surfaces for full crowns.The software provides a designproposal for the tooth mor-phology, which is based on theocclusal surface of the distalneighbouring tooth and the antagonist (Fig. 4). The imageof the bucco-oral cross-sec-tion of the crown allows theuser to check the minimum occlu-sal thickness of 1.5 mm(Fig. 5). The minimal densifi-cation of the ceramic (0.2 vol.%)during the crystallisation pro -cess is taken into account bythe software and adjusted ac-cordingly.

Trends & Applications LAB TRIBUNE Asia Pacific Edition30

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14 continuing education credits.CAPP designates this activity for


towards the traditional craftmanship“Performance is our Passion” A survey on CAD/CAM today

Decoding Digital Impression TakingMorten Ryde, Denmark

The new world of images in dentistry and implantologyDr. Philippe Tardieu, France

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Morten Ryde, Denmark

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“Performance is our Passion” A survey on CAD/CAM today

Dentistry and Dental Technology?The Bridge in the Digital Future! How do we combine Ralf Oppacher, MDT, Germany


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What about CAD/CAM in Orthodontics?Dr. Khaled Abouseada, Egypt ? KSA

Dentistry and Dental Technology?


The Bridge in the Digital Future! How do we combine Ralf Oppacher, MDT, Germany


Dentistry and Dental Technology?


The Bridge in the Digital Future! How do we combine Ralf Oppacher, MDT, Germany


The Bridge in the Digital Future! How do we combine


Bindl, SwitzerlandDr. med. Andreas

Bindl, SwitzerlandDr. med. Andreas Dr. Eduardo Mahn

ChileDr. Eduardo Mahn

GermanyLutz Ritter

Dr. Med. Dr. Med Dent

DMD, DD, Germany Dr. Kurt DawirsDr. Med. Dr. Med Dent

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Taking guided Implantology to the next level: Integrating

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Fig. 6 Fig. 7 Fig. 8Fig. 5

Fig. 5: Bucco-oral cross-section of the restoration: the minimum occlusal thickness of 1.5 mm was checked.—Fig. 6: Occlusal view of the crown in the blue state during try-in, before crystallisation firing.—Fig. 7: Buccal view of the crown in the blue state during try-in, before crystallisation firing.—Fig. 8: Occlusal view of the crystallised and glazed crown on tooth #25.

fl page 29ET


After the crown had beenmilled, the proximal and oc-clusal contacts were adjustedon the patient (Figs. 6 & 7). Inthis case, the white and cremematerials from the correspon-ding stain assortment (IPSe.max CAD Crystall./Stains,Ivoclar Vivadent) were spar-ingly applied to the cusp tipsand the sunset material to thetooth neck and in the fissures.

Immediately afterwards, aglaze in spray form (IPS e.maxCAD Crystall./Glaze Spray)was applied to the outer sur-faces of the crown. The spraywas applied several times.Once the restoration had beenfully coated with a white-opaque glaze layer, the crownwas fired in a combined crys-tallisation and firing process in the Programat CS furnace(Figs. 8 & 9).

Before the restoration wascemented in place, the innersurface of the crown wasetched with 4.9 per cent hydro-fluoric acid (IPS Ceramic Etch-ing Gel, Ivoclar Vivadent) for20 seconds. Subsequently itwas silanised for 60 seconds(Monobond Plus, Ivoclar Viva -dent). The crown lumen wasfilled with the self-adhesiveSpeedCEM. Next, the crownwas securely seated on the pre-pared tooth by applying evenpressure (Fig. 10).

The cement residue waspolymerised for one secondper surface (mesio-oral, disto-oral, mesio buccal, distobuc-cal) with a curing light (blue-phase in the low power mode,Ivoclar Vivadent) at a distanceof about 5 mm. In this curedstate, the cement was removedwith great care using a scalerand a probe. The cement wasfully cured with the bluephasein the high power mode. Sub -sequently, the cement marginwas polished.

The final inspection re-vealed the restoration to be inharmony with the overall situ-ation (Figs. 11 & 12). LT

LAB TRIBUNE Asia Pacific Edition Trends & Applications 31

3Shape TRIOS® Impression-taking has never been easier

Follow us on:

We can’t wait to meet you!

We welcome you to our booth at CAD/CAM & Digital Dentistry Interna-

tional Conference, where you can see live demos, try our products and

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Booth 16 + 17

Dont miss 3Shape’s lectures, with Inspiring topics for dentists and technicians

Scientific Session:

Friday 15:00 Surface Scanning in Computer Guided Dental Implantology

Saturday 9:00 Clinical advantages in digital dentistry

Dental Technicians Parallel Session:

Saturday 14:00 Design of high quality Implant Bars and removable partials

3Shape TRIOS® is the next-generation intraoral digital impression solu-

tion. Easily create accurate digital impressions and send cases directly to the lab with a single click.

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Fig. 10 Fig. 11 Fig. 12Fig. 9

Fig. 9: Buccal view of the crystallised and glazed crown on tooth #25.—Fig. 10: Cementation of the crown with the dual-curing, self-adhesive luting composite cement SpeedCEM.—Fig. 11: Buccal view of the crown seated with a self-adhesive luting cement after the removal of excess.—Fig. 12: Occlusal view of the crown seated with a self-adhesive luting cement.

Dr Andreas Bindlmaintains as pri-vate dental prac-tice in Zurich inSwitzerland. Hecan be contacted

at [email protected].

Contact Info


The World’s Lab Newspaper · Asia Pacific Edition · Eduardo Mahn, among other pro - minent...

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Transcript of The World’s Lab Newspaper · Asia Pacific Edition · Eduardo Mahn, among other pro - minent...