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Case Study
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Clinical Application of CAD/CAM Software For Accurate Reproduction of Tooth Anatomy

Learning Objectives:

As a result of reviewing this case study, the reader should:

  • See how advances in CAD/CAM technology make the process easier and more reliable for dental professionals
  • Understand the process of creating accurate models of tooth anatomy using CAD/CAM technology


Since the introduction of CAD/CAM technology to dentistry over 20 years ago, the systems and procedures used to apply it during patient care have evolved considerably. In the design stage, previous generations of CAD software have required clinicians to define  the margins around the circumference of the remaining tooth structure, after which the computer would generate the suggested morphology of the restoration. Through this approach, the clinician often had to make time-consuming adjustments to the proposed restoration prior to milling. New CAD/CAM software virtually eliminates the adjustment step, creating a predictable restoration for users of virtually all skill levels.


Acquisition of Data During the CAD Process

The latest generation of CAD software allows the clinician to design and produce high-quality, all-ceramic restorations through easy-to-use chairside tools. In order to facilitate data acquisition, the clinician must first prepare the tooth as for any restoration, image the treatment site and adjacent structures, and similarly capture and image a bite registration of the opposing dentition. (Note that the bite registration requirement may not be necessary depending on the CAD system utilized.) These processes yield data points (eg, cusp tips, fissures) that will be analyzed in the software in order to recreate harmonious tooth morphology and occlusion for the restoration.

Once the virtual models are generated, the user simply draws a margin around the preparation. The software then recreates the tooth morphology unique to the tooth that is being restored. The inclusion of a bite registration allows for complete occlusal adjustments to occur automatically. Thus, the initial proposed restoration is often the final result that is sent to the milling machine for the production of the definitive restoration. Ultimately, features of contemporary CAD/CAM software eliminate the need for time-consuming margin adjustments, streamlines the design process, and ensures a more predictable outcome.


*Private practice, Charlotte, NC.


Related Reading:

  1. Spreafico R. Direct vs. semidirect vs. indirect restorations: Establishing criteria for clinical decision making [interview].  In: Sadan A, ed. Quintessence of Dental Technology 2003. Hanover Prk, Il:Quintessence Publishing; 2003:82-89. 
  2. Morin D, Delong R, Douglas WH. Cusp reinforcement by the acid-etch technique. J Dent Res 1984;63(8):1075-1078. 
  3. Liebenberg WH. Controlling contacts and contours using preformed ceramic inserts. Compend Contin Educ Dent 2000;21(2):147-150. 
  4. Choi KK, Ryu GJ, Choi SM, et al. Effects of cavity configuration on composite restoration.  Oper Dent 2004;29(4):462-466. 
  5. Nikolaenko SA, Lohbauer U, Roggendorf M, et al. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent Mater 2004;20(6):579-585. 
  6. Kuijs RH, Fennis WM, Kreulen CM, et al. Does layering minimize shrinkage stresses in composite restorations? J Dent Res 2003;82(12):967-971. 
  7. Versluis A, Douglas WH, Cross M, Sakaguchi RL. Does an incremental filling technique reduce polymerization shrinkage stresses? J Dent Res 1996;75(3):871-878. 
  8. El-Badrawy WA, Leung BW, El-Mowafy O, et al. Evaluation of proximal contacts of posterior composite restorations with 4 placement techniques. J Can Dent Assoc 2003;69(3):162-167. 
  9. Broderson SP. Complete crown and partial coverage tooth preparation designs for bonded cast ceramic restorations. Quint Int 1994;25(8):535-539. 
  10. Dietschi D, Spreafico R. Adhesive Metal Free Restorations: Current Concepts for Esthetic Treatment of Posterior Teeth. Carol Stream, IL: Quintessence Publishing; 1997:79-99. 
  11. Magne P, Belser UC. Porcelain versus composite inlays/onlays: Effects of mechanical loads on stress distribution adhesion and crown flexure. Int J Periodont Rest Dent 2003;23(6):543-555. 
  12. Swift B, Walls A, McCabe JF. Porcelain veneers: The effects of contaminants and cleaning regimens on the bond strength of porcelain to composite. Brit Dent J 1995;179(6):203-208. 
  13. Canay S, Hersek N, Ertan A. Effect of different acid treatments on a porcelain surface. J Oral Rehabil 2001;28(1):95-101. 
  14. Barghi N, Berry T, Chung K. Effects, timing and heat treatment of silanated porcelain on the bond strength. J Oral Rehabil 2000;27(5):407-412. 
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