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by Kathryn O’Brien | Aug 18, 2020 | 3D Printing, Dentures | 0 |

The term CAD/CAM in dentistry has become synonymous with computer-aided manufacturing. CAD stands…

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by Chris Bonninger | Jul 7, 2020 | 3D Printing | 0 |

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The term CAD/CAM in dentistry has become synonymous with computer-aided manufacturing. CAD stands for computer-aided design and CAM is the abbreviation for computer-aided manufacturing. CAD/CAM is used in many manufacturing industries, for example in the automotive and aircraft industries, and model making. 

But digital technologies also greatly facilitate the workflow in the manufacturing of dentures. In essence, technological know-how is just as important in dentistry as are technological skills and knowledge of materials science.

What does CAD/CAM mean in denture manufacturing?

In dentistry, computer-aided design (CAD) means the virtual construction of a tooth restoration on the computer. Computer-aided manufacturing (CAM) refers to the actual making a dental prosthesis using automated milling or grinding processes, or by using a 3D printer.

Based on a digital data record of the patient’s mouth and teeth obtained by a mouth and model scan, the dental technician and/or the dentist use special software to ‘construct’ the denture. This is the CAD part of the process, and can, for instance, be the framework for a bridge, or an anatomically complete crown.

This design data is transmitted to a milling or grinding machine, or a 3D printer, as an STL file (which stands for stereolithography). Here, the CAD data is utilised to physically make the corresponding object during the CAM part of the process. Once the machine has created the object, the final finishing-off of the dental prosthesis will be done by hand. For instance, the dental technician will veneer a bridge framework by hand with a tooth-coloured ceramic. Or he will paint the monolithic full-contour crown manufactured in the CAD/CAM process to match the colour of the patient’s teeth exactly.

CAD/CAM manufacturing methods

In brief, CAD/CAM production in dentistry can be divided into subtractive and additive manufacturing. In the case of subtractive technology, the CAD design is milled out of a material blank, or ground into the correct shape by removing material. Additive technology, however, refers to a process whereby material is built up, for instance where the computer design is implemented by using 3D printing.

Advantages of manufacturing using CAD/CAM technology in dentistry?

Dentures are medical devices that require great precision during the manufacturing process. The manual skills of the dental technician is greatly enhanced by CAD/CAM technology. Other advantages include a high level of accuracy and a product that is consistently of excellent quality. Some of today’s extensive variety of advanced materials can only be used by applying CAD/CAM technology, as is the case with zirconium oxide.

Digitization in the dental laboratory or dentist practice also allows networking with other digital dental technologies.

For example, digital X-ray data, DICOM, can be used in conjunction with the data about the patient’s mouth and teeth contained in an STL file. This means that a realistic virtual image of the patient’s jaw and teeth can be created. The dentist can then use this to plan the positioning of dental implants, for example.

Another example is where the data of a patient’s mouth is combined with the data contained in a facial scan, or a portrait photograph. This enables the dentist and/or the dental technician to access a virtual 3D model of the patient’s face, jaws and teeth. They are then able to have a detailed and in-depth discussion with the patient about tooth position, shape and colour by using the virtual 3D image. 

Further readings:

CAD/CAM dental materials (material science)

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A dental bridge replaces missing teeth, and this type of denture comes very close to copying natural dentition. Dental bridges, like tooth crowns or inlays, are part of fixed dentures. Bridges are unique pieces that are individually designed for the patient by close cooperation of the dentist and the technician in a dental laboratory.

The dental technician brings craftmanship, anatomical knowledge and technical expertise to the process. The dental bridge is designed so that it blends harmoniously and aesthetically into the patient’s row of teeth. The patient will hardly be aware of the presence of dentures in his or her mouth.

Read more articles about dentures here.

What is the function of a dental bridge?

If a tooth is missing in a row of teeth, a bridge is created to close the gap. The teeth adjacent to the gap, called abutment teeth, serve as the attachment points for the bridge. They are fitted with crowns and the gap is closed by using a false tooth called the pontic. If more than one tooth is missing, the resultant gap can be bridged in the same way. A well-made dental bridge, of high-quality materials, will remain in the patient’s mouth for many years, provided the patient practises good oral hygiene, and the abutment teeth retain their stability.

Why does a tooth gap have to be closed at all?

If one or more teeth are lost, the patient’s chewing function often suffers. In addition, the stability of other teeth is lost. Teeth that are adjacent can start ‘leaning’ into the gap. Incorrect loads can also result. The opposite tooth in the other jaw can become elongated and start ‘growing’ into the gap. Particularly when an anterior tooth is lost, the patient’s appearance really suffers, and often their pronunciation is also impaired affecting the clarity of their speech. These problems can all be avoided, however, with a bridge. The well-made dental bridge restores the appearance of a natural row of teeth seamlessly in an aesthetically pleasing manner.

How is the treatment done?

At least two treatment sessions are required to provide a bridge. First, the teeth adjacent to the gap are prepared by the dentist to be fitted with crowns to serve as abutments for the dental bridge. This is done very carefully, and only as much of the tooth is ground down as is necessary for anchoring the bridge. Then moulds of the upper and lower jaw are taken and transmitted to the dental laboratory. The affected jaw area is provided with a temporary bridge.

In the dental laboratory, the dental technician creates plaster models and produces a precisely fitting dental bridge. In many cases, it is tested in the patient’s mouth so that the dentist can check the fit and function.

If the bridge meets all the necessary criteria, the dental technician can complete the bridge. The dentist then firmly anchors the bridge to the abutment teeth with a special dental cement. The bridge should work perfectly and give the patient a feeling of chewing naturally.

Various materials are available to the dental technician for making the dental bridge. The most suitable material is selected in consultation with the dentist and the patient.

What types of dental bridges are available?

Full-cast dental bridge

This is a dental bridge that can be made entirely of a metal alloy containing precious metals, or alloys free of precious metals. For aesthetic reasons, these bridges are normally just used in the back of the mouth.

Bridges veneered with ceramic

If a tooth-coloured bridge is preferred, ceramic material is used. In the case of a veneering ceramic bridge, a thin metal framework is first created, which is then covered with a ceramic material by the dental technician. The technician builds up the teeth layer by layer using his craftsmanship and knowledge of the anatomy and function of teeth and the mouth. The result is a stable denture that hardly differs in appearance from patient’s natural adjoining teeth.

All-ceramic dental bridge

No metal is used in this highly aesthetic type of bridge. The teeth are made entirely of ceramic material. Here, too, the dental technician’s skill and craftsmanship ensure that the bridge looks natural and beautiful. The light-optical properties of modern ceramics have opened wonderful design options in this regard.

Are there any contraindications to the use of dental bridges?

Having to look after a dental bridge is not recommended for children and adolescents. In addition, a good prognosis for success is less likely in patients who do not practise good oral hygiene. Teeth that do not fit into the jaw very firmly are also a contraindication for anchoring a dental bridge.

Kathryn O’Brien, Editor, Next Smile

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Next Smile is the leading free go-to resource for impartial and independent advice on everything to do with dentures.

Our experts have a combined 65 years’ experience in the field of dentures. If you cannot find the answer to what you are looking for, please do not hesitate to get in touch and one of our inhouse team will help you.

NextSmile is the leading free resource site for independent advice on all aspects of dentures, dental implants and dental aesthetics.

Together, our experts have more than 65 years of experience in the field of dentures. With this amount of experience, NextSmile helps to provide answers to general and more specific questions about dentures and beautiful teeth. In-depth knowledge of manufacturing technologies (e.g. CAD / CAM, 3D printing), materials (e.g. zirconium oxide, all-ceramic, titanium) and dental prosthesis solutions (e.g. dental implants, veneers) are the basis of NextSmile. Experienced copywriters and medical writers put the information together in an easy-to-read way for everyone.

Modern dentures offer the perfect solution for every patient – from simple dentures to all-ceramic crowns and bridges to dental implants and highly aesthetic veneers. We explain possible solutions and alternatives. Clinical dentists are always responsible for the medical assessment of the individual patient situation and the specific therapy proposal. An appointment with a specialist in the preferred region can be booked directly via NextSmile. This makes NextSmile an important link between the patient, the dental practice and the dental laboratory.

If you cannot find the answer to your question about dentures, please do not hesitate to contact us. Our in-house team will help you!

But what can be the cause and, above all, what helps against the severe pain? Here we provide some tips for immediate help.

Pressure sores caused by dentures can have various causes. A poorly fitted prosthesis is often a trigger. Tartar or deposits on or under the prosthesis can also cause unpleasant pain.

You can alleviate the local discomfort. But please do not try to adjust your dentures yourself. Here the dentist is the expert.

A visit to the dentist is advisable here. In many cases, it is sufficient for the denture to be professionally cleaned and tartar removed at the dental practice. If necessary, the dentist can grind or reline the denture at one point and this ensures that the prosthesis fits snugly on the gums. It eliminates the causes of the pressure points, but there are a few things you can do yourself to avoid or relieve pressure points:

1. Food debris under the prosthesis can lead to sore spots. These causes of pressure points can be effectively prevented by regularly cleaning the prosthesis. Remove leftover food from the prosthesis under running water and rinse out your mouth with a little water. A mild detergent and gentle denture cleaning brushes can also be used. Regular professional denture cleaning at the dentist is also important. Otherwise tartar can form, which with its rough surface, can trigger pressure points.

2. In the case of acute pressure points in the mouth, rinsing with warm salt water relieves the pain. In addition, home remedies such as chamomile or arnica tincture help soothe irritated gums. Pain relieving gels or ointments also alleviate the symptoms; temporarily. Basically we recommend a visit to the dental practice to get professional help.

3. Disinfecting mouthwashes can aid healing. Mouth rinsing improves the environment in the mouth. This is particularly helpful if the pressure point has become infected. Inflamed pressure points can be infected with yeasts, which have an ideal environment in the moist mouth and throat to multiply.

4. Pressure points are painful changes in the mucous membrane that trigger local inflammation. In principle, these can occur temporarily with new prostheses. After a short period of acclimatization (a few days), the symptoms should subside. If this is not the case, the prosthesis must be adjusted. A denture must sit perfectly on the mucous membrane. In many cases, a so-called relining at the dentist can be helpful. Sealing the edge is also important as it prevents food residues from penetrating under the prosthesis.

With Zocdoc, you can see doctors’ open appointment times and book instantly online, make informed choices with verified reviews, and stay on top of important checkups with tailored reminders. And those pesky waiting room forms? Fill them out online, just once, and keep them forever. Book your dentist appoint from the comfort of your home-screen. 

Would you like a metal-free removable denture? Then a modern one made of high-performance plastic, or PEEK, that is biologically well-tolerated, is a definite possibility. In this article, we’ll take a closer look at Metal-Free PEEK for you

Polyetheretherketone (PEEK) is a material that has been tried and tested in medicine for years. Due its good mechanical properties, resistance to high temperatures and chemical resistance, it has been used in surgery as a material for knee replacements, spinal surgery and hip prostheses. Now PEEK can be used for dentures as well, because PEEK combines excellent biocompatibility with bone-like properties. Scaffolding for dentures can be produced from industrially manufactured blanks using CAD/CAM technology.

There are many good reasons to choose a metal-free denture. Some people are intolerant to metals; other people don’t want dentures containing metal for ethical reasons. Ceramics can be used for crowns, bridges or implants. But up now removable dentures, which are fastened in the mouth with braces, clamps or crowns, have depended only on the use of metal. But the use of high-performance plastic, PEEK (which belongs to the PAEK family of polyaryletherketone semi-crystalline plastics) is changing this.

The use of Metal-Free PEEK

Long before PEEK became known in dentistry, it was extensively used in the automotive and aircraft industry, as well as orthopedics where it is highly regarded. Because PEEK is a bioinert and sterilizable material with low water absorption, it is highly suitable for implants in hips, knees, finger joints and as replacement of individual intervertebral bodies in the spine. So far it has not shown clinically relevant material fatigue along the lines of metal fatigue. This has resulted in PEEK being increasingly used for the manufacture of dentures. Scientific studies on dentures made of PEEK is very promising.

• Advantages of PEEK as a denture material
• Compared to materials that have traditionally used in dentistry, i.e. gold or other metallic alloys, PEEK has several advantages. It is corrosion-free, X-ray transparent, and displays bone-like elasticity. As PEEK is resistant to wear and abrasion, it causes very little damage to adjacent healthy teeth. After its many years of use in medicine, there have been no indications of allergic reactions on the part of patients.
• Its mechanical properties include resistance to high temperatures, as well as excellent chemical resistance. These qualities have made PEEK an indispensable material in the entire medical field. Its good physical and chemical properties result from the semi-crystalline structure of the material which ensures that it is not brittle.
• It also has notable elasticity and a high melting point – PEEK only melts at temperatures above 280° C. Its bending strength of 3.1 GPS prevents the material from breaking and gives it a bone-like consistency which ensures flexibility (as opposed to metals) and resistance to distortion. All these qualities make it ideal for making removable dentures and implants. Its shock absorbing properties ensure a gentle effect on the jawbone.
• PEEK dental prostheses are comfortable to wear. Patients like the ease of wearing them and the fact that the bite feels natural. They also like the fact that PEEK is tasteless and has low heat and electrical conductivity.

So don’t hesitate to ask your dentist or specialized dental laboratory about PEEK or PAEK dentures!

As a relative newcomer to dental materials, PEEK can’t really be compared long-term yet. However, compared to conventional materials such as gold or base metals (non-precious metals), PEEK has advantages. Gold is an expensive material so patients often can’t afford it. The processing of non-precious metals is complex, and patients can have an allergic reaction to them. The possibility of dangerous interactions with other materials also exists.

THE USE OF PEEK FOR DENTURES

Light, metal-free denture frameworks can be made from the high-performance polymer PEEK. They are long-lasting and have a low susceptibility to plaque. The water absorption is only 0.1% compared to the prosthetic material PMMA (polymethyl methacrylate), where the water absorption is 0.3%.

Metal-free PEEK is resistant to wear-and-tear in the mouth. Furthermore, its low specific weight, resistance to plaque, bone-like elasticity, coupled with the freedom from metals and its almost non-existent material fatigue, is ensuring that this material is becoming increasingly popular for dentures.

In prosthetic dentistry, the term dental adhesive refers to a modern method for permanently attaching a denture to a tooth. Ceramic or composite inlays, on-lays, or veneers, are glued to the patient’s natural tooth to form a firm, with it. The word adhesive comes from the Latin word adhaerere which means to stick, which is, of course, where the term ‘adhesive technology’ comes from in dentistry.

What are the advantages of attaching dentures by this adhesive technique?

Adhesive technology opens up many exciting possibilities in dentistry, particularly as regards aesthetic aspects. Crowns or bridges were previously anchored to the tooth with the help of mechanical retentions, called cementing. The adhesive bonding technique preserves more of the healthy tooth as it has to be ground down much less to have ceramic restoration fixed to the tooth.

More delicate restoration work can be done and securely bonded to the tooth using the adhesive technique. Veneers can be made wafer-thin and yet be permanently glued to the tooth in order to correct small tooth misalignments. Often the dentist has to grind nothing, or very little, of the surface from the natural tooth. A slight roughening of the tooth’s enamel is often all that is needed. In technical terms, this is referred to as a non- or just minimally invasive procedure.

By using this adhesive technology, ceramic inlays can also be permanently bonded to the tooth. This results in a very pleasing look aesthetically, because these inlays hardly differ very little from healthy teeth.

How does this adhesive bond between the tooth and the dental restoration work?

In a nutshell, this adhesive technology is based on the combination of a micro-mechanical and a chemical bond. First the dentist roughens the tooth enamel by applying a special acid to the tooth. Then a low-viscosity adhesive is rubbed into the tooth and cured with a light-curing device. This part of the process is referred to as polymerisation.

In the next step the ceramic restoration is also prepared for bonding; this is called conditioning. Finally a very thin layer of a high-quality adhesive glue is used to ensure a strong bond between the tooth and the denture.