CERECZeitung
No.14 - 2009 International edition
Outstanding precision
Laser haemostasis
Digital impressions
New optical impression technology
ensures an optimum fit Page 2
The basis for accurate digital impressions
and effective adhesive bonding Page 6
Strong arguments for investing in
modern treatment methods Page 8
Editorial
Bart Doedens
Vice President Dental
CAD/CAM Systems
at Sirona
New standard in
restorative dentistry
Major events are on the horizon.
Countless innovations – spectacular, practical and (more or
less) sensible – will be on display
at the Chicago Midwinter Meeting in February and at the IDS,
Cologne in March. Confronted
with this flood of information,
users are often unsure where the
true benefits lie. In this issue of
CEREC Zeitung we want to describe a new product with benefits which are clear for all to see:
the new CEREC AC Acquisition
Center. Never before has a dental
CAD/CAM system achieved such
levels of precision and efficiency.
Never before has CEREC been so
easy to use. Never before has it
been possible to cater for so many
different chairside restorations.
If we have awakened your
curiosity, you can find out more
either in Chicago or in Cologne
on the Sirona stand. We look
forward to welcoming you there!
Kind regards,
Blue light for perfect
optical impressions
CEREC AC. Once again, CEREC is setting new standards in the field of dental CAD/
CAM. The CEREC system is now able to capture whole jaw arches – quickly and
conveniently. This expands the spectrum of chairside applications and simultaneously
fosters closer collaboration with dental laboratories, without the need for conventional
tooth impressions.
T
he new CEREC AC acquisition
centre includes a new camera
plus an updated version of the
CEREC 3D software (V3.40). It replaces the CEREC 3 acquisition unit. A
defining feature of the new acquisition centre is the CEREC Bluecam
with its innovative lens system. Instead of a conventional laser or infrared light source the Bluecam boasts
high-performance LEDs which emit
blue light with a short wavelength.
Each exposure triggers a sequential
series of measurements which are
then combined to generate the final
outcome. Thanks to its increased
light sensitivity, the new camera reduces the duration of the imaging
process by up to 50 percent. In addition, the CEREC Bluecam delivers
razor-sharp image quality – from the
centre to the periphery. A built-in
shake detection system ensures that
images are acquired only when the
camera is absolutely still.
Additional user benefits
CEREC Zeitung
Published by:
Sirona Dental Systems GmbH, Fabrikstraße 31,
D-64625 Bensheim, Germany
Tel.: +49 6251-16-0, Fax: +49 6251-16-2591,
contact@sirona.de, www.sirona.de
Responsible for content:
Bart Doedens, Sirona Dental Systems GmbH
Editorial team:
Bart Doedens, Hans-Georg Bauer, Birgit Möller,
Nicole Eloo, Manfred Kern, Christoph Nösser,
E-mail: info@cerec-zeitung.de
Design und production:
ergo Kommunikation, Köln/Frankfurt a.M./Berlin,
Germany, www.ergo-komm.de
Printing:
Sieprath Druckservice GmbH,
Karl-Friedrich-Straße 76, D-52072 Aachen,
Germany
Photos: Sirona.
A 91100 - M41 - A849 - 01 - 7600
The CEREC Bluecam is capable of
capturing the clinical situations for
four-unit bridges. This provides the
basis for the chairside fabrication of
long-term temporary restorations – a
significant addition to the CEREC
spectrum. When designing the occlusal surfaces of single crowns the
CEREC 3D software analyzes the fissure alignment and cusps of the adjacent teeth, as well as the morphology
of the antagonist (optional). After the
design process has been completed
the data can be transmitted via a wireless link to the milling unit or the inhouse dental laboratory. Alternatively,
the restoration data can be sent to an
external dental lab via the Internet.
When the fast milling mode is selected the CEREC MC XL can machine a
four-unit bridge in about 20 minutes.
The new CEREC Connect web portal allows dentists to transmit optical
impressions (including impressions of whole arches)
to an external laboratory of
their choice. This creates
the basis for model-free
restorations. If required,
the lab can use this data
from CEREC AC in order
to create its own physical
models. Laboratories that
do not have a CEREC
milling machine at their
disposal have the future
option of outsourcing the modelmaking process to the
infiniDent manufacturing
service. CEREC Connect
and the new CEREC AC
are the ideal entrylevel solution for
new users. The
CEREC system can
then be successively upgraded. On the basis of
the digital impressions
submitted by dental practices external laboratories
are in an ideal position
to fabricate all-ceramic
crowns and bridges using
the sophisticated inLab
milling unit.
The CEREC AC, the
CEREC MC XL milling
unit, the new CEREC 3D
software and CEREC
Connect represent an
unrivalled
combination and set new standards in restorative
dentistry. The userfriendly features of theses
CEREC components promote a
seamless and efficient workflow. In
addition, they open up new possibilities for efficient and profitable
collaboration with external dental
laboratories. The modular design of
the CEREC system, its continuous
development and the full compati-
NEWS
Study confirms the benefits of
dispensing with temporary
restorations
Prof. Dr. Roland Frankenberger
from Erlangen University has won
this year’s Society for Dental Ceramics Research Prize for his study
“Chairside vs labside ceramic inlays – the influence of temporary
restorations and bonding on enamel integrity and margin quality."
Within the framework of an in
vitro study Prof. Frankenberger examined the influence of various
temporary restoration types and
adhesive bonding techniques on
enamel defects and margin quality.
Some of his findings: The longer
the temporary restorations are in
place, the more frequently enamel
chipping occurs. In the absence of
a force-locked connection with the
hard tissue the cavity walls lack proper stabilization. The forces acting
on the tooth are unevenly distributed, resulting in stress peaks at the
interface between the tooth and
the temporary restoration. At the
same time the weakly supported
cusp walls are subject to deformation. In this context immediately
adhesive bonded inlays have proved
advantageous. A slightly extended
adhesive gap does not result in inferior margin quality. The three-bottle
system is superior to self-adhesive
system in terms of durability and
clinical bond. Selective enamel etching enhances the bond with the
hard tooth tissue and improves the
quality of the enamel margin.
Frontpage MBK0750 50x 90:DT Frontpage
METAL-BITE ® GOLD
CEREC AC: modern, user-friendly design,
plus unprecedented precision.
bility of all the various components
(including the inLab system) ensure
optimum flexibility as well as a sustained return on investment.
W
D.
GOL RD.
DA
STAN
Universelles,
scanbares
CAD/CAMRegistriermaterial
R-dental Dentalerzeugnisse GmbH
Info-Tel.: +49 (0)40-22 75 76 17
r-dental.com
3
2
CEREC Zeitung No.14 - 2009
Razor-sharp full-arch impressions
in just a few seconds
The integration of CEREC in diagnosis and therapy
CEREC & GALILEOS:
3D planning of
implants
BLUECAM TECHNOLOGY. The tried and tested triangulation principle has been further deve-
loped for the new CEREC AC acquisition centre. The scans are faster, sharper and more
accurate – thanks to the aspherical lens system and short-wavelength light. This provides
the basis for acquiring full-arch images for the impression free dental practice.
T
he key component in the new
acquisition centre is the CEREC
Bluecam, which boasts an entirely new optical system. Instead of
a conventional laser or infrared light
source the camera is built around a
high-performance blue LED. An array
of aspherical lenses concentrates the
light beam and aligns it parallel to the
CCD image sensor. The sensitivity of
the sensor has been enhanced, thus
enabling multiple images to be created in the shortest possible time. The
CEREC Bluecam acquires 3D images
by projecting a grid of dark and light
stripes onto the tooth surface.
What are the benefits for the CEREC
user? Expressed briefly, the imaging
process is much faster, the optical
impressions are more precise (a
prerequisite for an optimum fit), and
CEREC now caters for a broader range
of indications.
and full arches. This allows dentists
to expand their treatment portfolio.
For example, they can now offer their
patients temporary bridges with up
to four units – created directly at the
chairside without the need for a conventional impression. In future dentists will also be able to send digital
User-friendly features save
valuable time
The blue light, the shake detection system and
the extensive depth of field result in razorsharp image quality.
Outstanding precision, plus a
broader range of indications
The basis for optimum CAD/CAM
restorations is the accurate scanning
of the preparation and the adjacent
teeth. The short-wavelength blue
light emitted by the CEREC Bluecam
delivers optical impressions of unprecedented precision. In vitro studies
carried out at Zurich University have
revealed that the optical impressions
generated by the CEREC Bluecam
deviate by only 19 microns (standard
deviation: 6 µm) from measurements
derived from a reference laser scanner. Nineteen microns are less than
one third of the diameter of a human
hair. This high degree of precision
ensures an excellent accuracy of fit,
speeding up the adhesive bonding
process and reducing the amount of
excess luting composite that needs to
be removed.
In addition, the CEREC Bluecam
images are virtually distortion-free
(also in the peripheral areas). The system can superimpose an unlimited
number of images and thus generate virtual 3D models of quadrants
small, data transmission is quicker
and simpler than ever before. During the imaging process the software
analyzes each image pixel by pixel
and selects the optimum data. Substandard image files are automatically
deleted. As a result the data volume of
a virtual upper or lower jaw model can
be reduced to approx. 25 megabytes.
The prism of the CEREC Bluecam projects shortwavelength blue light onto the imaging site.
The CEREC Bluecam is mounted on the righthand side of the acquisition centre.
impressions of quadrants – or full upper and lower arches – to a laboratory
of their choice via the CEREC Connect
web portal. As the files are relatively
The CEREC Bluecam is easy to use
and hence speeds up the treatment
workflow. The blue light enables the
user to pinpoint the imaging site. The
measuring depth has been increased
by 20 percent. The depth of field is
14 millimetres. It is not necessary
to maintain a prescribed clearance
between the camera and the tooth.
Instead the Bluecam can be placed directly on the tooth with the help of a
small support. This makes it easier to
acquire images in the distal area. The
CEREC Bluecam can acquire optical
impressions of all areas of the oral
cavity that are inaccessible to cameras
with a divergent light beam.
Blurred images can be practically
ruled out. The built-in shake detection system triggers the exposures
only when the camera is absolutely still. The user simply moves the
camera continuously along the jaw. It
is no longer necessary to depress the
foot switch or closely coordinate the
movement of the eye and foot. As a
result an entire quadrant or arch can
be acquired very quickly, resulting
in time savings for the dentist. The
sensitivity of the shake detection system is adjustable. This enhances the
overall precision of the virtual model
– especially when several images are
superimposed. Thanks to the automatic exposure function and the extensive depth of field of the camera,
the entire impression-taking process
prior to the actual preparation can be
delegated to an assistant. This results
in a seamless and efficient practice
workflow.
W
C
M
Y
CM
MY
CEREC & inLab:
Implant superstructures
(custom abutments, temporaries,
crowns, bridges)
inLab & infiniDent:
Fabrication of all
restoration types
CEREC Connect:
Optical impressions
(digital CEREC AC impressions)
Always a step ahead
FUTURE PROSPECTS. CAD/CAM has revolutionized dentistry.
The proportion of inlays and onlays has risen sharply.
Fewer crowns are being used, even in the USA. Dr. Wilhelm
Schneider, who prior to his transfer to the Imaging Systems
Division of Sirona was the Marketing Manager for CEREC,
looks ahead to the future of dental CAD/CAM technology.
F
or more than 20 years the CEREC
system has spearheaded developments in computerized all-ceramic dentistry. This success story has
encouraged other companies to follow
suit and launch their own CAD/CAM
systems and consumables. This in turn
provides a strong incentive to maintain CEREC’s technological leadership and open up new avenues in
computerized dentistry.
Increased range of indications
Originally regarded as an “inlay
machine”, CEREC has proved to be
especially advantageous with regard
to onlays, which are a substance-conserving alternative to conventional
crowns. Chairside onlays will enjoy
increasing popularity due to their numerous clinical and economic benefits. Veneers – the minimally invasive
alternative to anterior crowns – have
become firmly established in CEREC
practices with their own in-house
laboratories. In the very near future
CEREC will allow dentists to fabricate
and incorporate temporary bridges
with up to four units – directly at the
CY CMY
chairside and during a single appointment. In the medium term toothconserving Maryland-type bridges
will also become established.
The capabilities of CEREC extend far
beyond chairside restorations. Indeed,
CEREC is all set to become the central restoration system for dental practices – a system which interfaces directly with diagnostics, implant therapy and external dental laboratories.
CEREC is an open and adaptable system. New indications such as integrated implant planning can be satisfactorily resolved with good clinical results.
CEREC meets GALILEOS
Three-dimensional GALILEOS CBCT
images are superimposed with optical impressions generated by the
CEREC camera. This will allow dentists to perform prosthetic planning
and surgical planning simultaneously. Initially, this process will
take place manually. Over time,
however, the software will acquire
more and more ‘smart’ functions.
Continued on page 3
K
Accelerate your model fabrication …
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the no.1 die-stone for CAD/CAM- and implant-models – now
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Dr. Andreas Kurbad,
Viersen
“As a dentist, I can find
nothing to compare
with esthetic-base®
gold quick.”
www.dentona.de
Telephone: +49 (0)231 55 56 - 0
Photos: Sirona.
Officially
certified by
» Optimal scanning properties – no powder coating required!
» Minimum expansion – perfect for all implant models!
» Can be demoulded after 10 min. – saves waiting time!
No.14 - 2009 CEREC Zeitung
Continued from page 2: Always a step ahead
Taking a perfectly designed crown as
its basis the software will propose the
position, dimensions and alignment
of the implant. The dentist will then
verify the surgical feasibility of this
proposal. In the event of conflicts
he can refer directly to the monitor
The first steps have already been taken,
as evidenced in Sirona’s inLab system.
In the course of the current year
new solutions will become available
for internationally available implant
systems.
CEREC Connect
Dr. Wilhelm Schneider
Head of Marketing Imaging
Systems at Sirona Dental Systems in Bensheim/Germany.
image and discuss the available alternatives (e.g. bone augmentation) with
the patient. The dentist also has the
option of ordering a surgical guide
from an external production centre.
In the medium term it will be possible to create surgical guides inhouse with the aid of the inLab system. This workflow will ensure a high
degree of reliability – and hence will
soon become standard practice. In the
middle of 2009 a software upgrade
will become available which allows
superimposition of CEREC and
GALILEOS images.
Custom abutments
When placing an implant dentists
aim to achieve the best possible outcome – in clinical and aesthetic terms.
Custom abutments made of ceramic
materials play a key role in this respect.
Only a small percentage of dentists
actually want to create the complete
spectrum of CEREC chairside restorations in-house. Close collaboration
with external dental labs is a decisive
success factor. Via the user-friendly
CEREC Connect web portal dentists
now have the option of sending optical impressions to a laboratory of
their choice. The lab can either order
the physical model from a central production facility – or else produce the
model directly on the premises with
the help of its inLab milling system.
In both cases the dentist’s optical impression delivers the necessary data.
In the long run the laboratory will not
need the physical model at all. CEREC
Connect is already up and running in
the USA. The necessary infrastructure will be created in other countries in the course of the current year.
CEREC Connect is available free of
charge to CEREC users.
CEREC is undergoing a transition –
from a chairside-oriented system to a
central tool for cost-effective collaboration between dental practices and
laboratories. It will soon be possible
to cater for the complete spectrum of
clinical applications – from a simple
inlay to a long-span bridge; and from
a single implant to a complex smile
design procedure. It goes without
saying that the CEREC system makes
allowance for the antagonists and the
patient’s individual articulation. It
is already possible to acquire optical
impressions of static and dynamic
bite registrations – a prerequisite for
designing perfect occlusal surfaces.
But CEREC has by no means reached
the limits of its development potential. Virtual articulation – possibly
with reference to cone beam computer tomography (CBCT) images –
is already on the horizon. And, who
knows, somewhere in the world a
CEREC user may already be thinking
of ways to integrate the neuromuscular system into the design process.
As we said before, CEREC is on the
way to becoming the central restoration system for dental practices. On
the one hand, CEREC interfaces with
modern diagnostic systems. On the
other hand, CEREC provides the basis
for the manual and computer-aided
manufacture of all types of restoration. This will result in more effective,
economic and user-friendly dental
treatment. Patients will be willing to
invest their hard-earned money in
such services.
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Digital model-making processes
CEREC CONNECT. The traditional modus operandi between dentists and dental technicians – i.e. the production of tooth models on the basis of
Photos: Sirona.
a conventional impression – is expensive, time-consuming and error-prone. Via the CEREC Connect web portal CEREC users are now in a
position to transmit digital impressions to an external dental laboratory, which then produces the restoration.
Prepare the tooth. Take a conventional impression. Fill in the order
form. Send everything off to the laboratory. This procedure may soon
be a thing of the past. Launched at
the 2008 Chicago Midwinter Meeting, the CEREC Connect web portal allows dentists to transmit digital impressions acquired using the
CEREC camera to a dental lab of
their choice. The lab then produces
the restorations to the dentist’s specifications. Numerous dental practices have already signed up for this
new service in the USA.
CEREC Connect not only saves
time and money. It is also more
pleasant for the patient and eliminates potential sources of error. A wide variety of restoration types are now available via
www.cerec-connect.com – for example including all-ceramic anterior
crowns, lithium disilicate crowns
and provisional bridges with up to
three units. The craft skills of a dental technician still play a decisive
role, especially with regard to aesthetically challenging anterior restorations. On the other hand, these
restorations can now be produced
entirely on the basis of digital
impressions – i.e. physical models are
no longer required. The infiniDent
manufacturing service has made an
important addition to its portfolio.
With the aid of the new CEREC AC
and the CEREC Bluecam dentists are
now in a position to acquire complete
quadrants – with such outstanding
precision that infiniDent can now
create physical models on the basis of
digital impressions alone. This greatly
simplifies the design and fabrication of
layered anterior and posterior crowns,
as well as zirconium oxide bridge
frameworks with up to four units.
When processing the data delivered by the CEREC Connect software
infiniDent deploys a special stereolithography machine. This machine
uses a computer controlled laser to
cure a photo-sensitive resin, layer by
layer, in order to create the 3D model.
Models made of light-cured
resin
The process could not be simpler.
Using the CEREC Bluecam the dentist acquires digital impressions of
the preparation and the antagonist.
On the basis of just one overlapping
image the software is capable of computing both half arches. After check-
ing the 3D model on the monitor, the
dentist then clicks the “Send” button, enters the order details and up-
CEREC Connect launched
in Chicago in 2008.
loads the data to the CEREC Connect
portal.
After downloading the data from
CEREC Connect, the dental lab decides whether or not an intermediate
model is required. If not, the dental
technician can begin fabricating the
restoration immediately.
infiniDent supplies the models in
the form of pinned sawcuts mounted
on a perforated base. The laboratory
places these models on a suitable
articulator in order to simulate the
final occlusion. In other words, the
situation mapped by the dentist can
be exactly replicated in the laboratory. This means that the technician
is in an ideal position to fine-tune the
restoration.
Before dentists and dental laboratories can start collaborating they need
to register with CEREC Connect. The
Praxis
Practice
relevant contact details and delivery
addresses are stored on the website.
Dental laboratories also have an opportunity to publicize their range of
services.
The new CEREC Connect software, the new inLab software and
the CEREC AC acquisition centre
will figure prominently at the 2009
Chicago Midwinter Meeting. At
present CEREC Connect is available
only in the USA. The service will be
extended to further markets in the
near future.
W
Labor
Laboratory
Models outsourced to infiniDent
If the laboratory needs a model (e.g.
for a zirconium oxide bridge framework), it simply places a corresponding order with infiniDent. Using
the 3D data supplied by the laboratory
infiniDent produces the model out
of an acrylic material. In the meantime the laboratory can design, mill
and sinter the bridge framework. As
soon as the model is received from
infiniDent the technician makes the
final adjustments to the framework
and then applies the veneer facing.
Abdruck
1 optischer
Optical impression
2 CEREC
CEREC Connect
ConnectPortal
portal
3 CEREC
CERECConnect
ConnectPortal
portal
4 Modellfertigung
Model produced by
infi
niDent
mit
InfiniDent
6 Auslieferung
Delivery
4 Gerüstfertigung
Framework produced
on the
mit inLab
Inlab system
5 Verblendung
Veneering
The model and the framework can be produced simultaneously. This saves time.
3
4
CEREC Zeitung No.14 - 2009
Focus on the user
CUSTOMER BENEFITS. Not all new products and product enhancements create genuine value added for the user. By contrast,Sirona’s product
developers are totally committed to delivering perceptible user benefits. The CEREC AC acquisition centre is a good example of this.
sion and distortion-free optical impressions of the preparation margins.
The system is capable of combining
an unlimited number of images,
thus allowing whole quadrants to be
acquired. This function expands the
spectrum of chairside indications to
include four-unit temporary bridges.
No special skills are required in
order to operate the CEREC Bluecam.
Thanks to the extensive depth of
field the user does not have to maintain a prescribed distance between
the camera and the tooth. Instead the
camera can be placed directly on the
tooth with the help of a handy support.
This makes it much easier to acquire
images in the distal area. The automatic shake detection function triggers
the exposure only when the camera is
Thank to its user-friendly design, the CEREC AC promotes a relaxed mode of working. The grafical user interface has been updated with a fresh new look
Anzeige
Cerec en_de_fr:Layout 1 12.01.2009 14:00 Uhr Seite 1
to020529_0409
increase the ease of
use of the software.
motionless. As a result the dentist has
the option of delegating the optical
impressions to his assistant, thus leaving him free to concentrate on more
complex treatment aspects.
In addition to being easy to use
the new CEREC AC acquisition centre
is fast and efficient. An entire arch can
be scanned in less than one minute.
Thanks to the optional uninterrupted
power supply, the CEREC AC can continue working for up to six minutes
while disconnected from the mains.
After the milling process has been
initiated the acquisition centre can
be wheeled into the next treatment
room ready to take the next optical impression. A further advantage is that
no data will be lost in the event of a
power cut.
Numerous Sirona products have
won prestigious industrial design
prizes. The CEREC AC also sets new
standards in terms of aesthetics.
Its user-friendly features include a
large-sized monitor, a user-friendly
keyboard and a compact footprint. In
short, the CEREC AC is the perfect
complement to a modern practice
interior. W
The automatic capture system prevents blurred
The sleek lines of the CEREC AC complement
images.
modern practice interiors.
systems
M
Futar® Scan –
A
/C
D
A
C
in
e
Ideal for us
State-of-the-art bite registration
material for optical data recording
See for yourself the advantages of
Futar® Scan, the scanable bite registration material on vinyl polysiloxane basis, in a cartridge.
Futar® Scan – State-of-the-art material for optical data recording.
Futar® Scan guarantees ideal results during recording via optics or laser in CAD/CAM systems:
Best scan results for optical and laser systems (without powdering)
Hard A-silicone (Shore-D 35) with excellent flexural stability
Extra-fast setting characteristics: Total working time 15 seconds, intra oral
setting time 45 seconds
Easy to trim with a scalpel or acrylic bur
Efficient material usage due to extrusion through short mixing tip
Can also be used as a syringeable material for “conventional”
bite registration, or for other laboratory applications that require an
hard silicone
0
Scannable Bite Registration Materials
When using modern CAD/CAM
systems in the dental office or
laboratory, perfectly accurate image
replication is of utmost importance.
That is exactly where Futar® Scan
comes into play. Futar® Scan – the
state-of-the-art material for optical
data recording. Futar® Scan stands
out due to its high-quality scan
results without using powder.
Excellent optical properties assure
best dynamic results, recording
quality and optical image reproduction.
®
20
40
60
80
100
40
60
80
100
Futar Scan
Futar® Scan,
REF 11971
2 x 50 ml + 12 mixing tips
Competitor A
Competitor B
0
20
Dynamic Range Increase*
KETTENBACH GmbH & Co. KG
Im Heerfeld 7 · 35713 Eschenburg · Germany
Phone +49 (0) 27 74 7 05 0 · Fax +49 (0) 27 74 7 05 33
info@kettenbach.com · www.kettenbach.com
Kettenbach
Competitor A
Competitor B
*Interaction between brightness and contrast
Tested by Kettenbach using
Cerec 3 Cam by Sirona
Photos: Sirona.
For further information contact:
020529_0409_en
T
he prime goal of conservative
dentistry is to achieve the best
possible restoration quality. The
accurate fit of a restoration depends
on the skills of the dentist and/or dental technician – and on the precision of
the equipment they use. The CEREC AC
acquisition centre from Sirona sets
new standards in this respect. The new
CEREC Bluecam creates high-preci-
No.14 - 2009 CEREC Zeitung
5
Spray instead of powder
The success story
CONSUMABLES. The easy-to-use CEREC Optispray enables precise optical impressions.
PRODUCT STRATEGY. Thanks to its modular design concept,
A
the CEREC system offers users a high degree of flexibility.
precondition for accurate
imaging performance is a
non-reflective surface. Until
now dentists have been compelled
to use a titanium dioxide powder
or special spray-on products. Improper
use
can
compromise
the quality of the optical impressions.
To
eliminate
this
problem Sirona has introduced
CEREC Optispray. This product
has already evoked a very positive
response from users.
preparation margins. This has a positive impact on the accuracy of fit.
Simple handling
Optispray is an all-in-one solution –
i.e. no additional items of equipment
have to be laboriously assembled.
The ergonomic, swivelling nozzle
is not prone to blockages. In the interests of effective infection control
the nozzle can be easily replaced
after each patient. Once the optical impression has been acquired
CEREC Optispray is easy to remove
as it is water-soluble This results
in additional time savings for the
dentist.
CEREC Optispray has been optimized for the new CEREC Bluecam.
The camera generates bright, highcontrast images of the preparation,
due to the ultra-thin layer.
W
High-precision coating
CEREC Optispray is ideal for achieving a very homogeneous coating of
The ultra-thin coating
enhances the performance
of the CEREC system.
the preparation site. It prevents the
formation of “puddles” in the cavities and “snowdrifts” (a frequent
problem with powders). In addition,
it is not necessary to apply a bonding agent. Hence no prolonged drying times are required. The optical
impressions display a high degree
of conformity, especially along the
Optimized for the CEREC AC: Optispray.
I
n 1980, CEREC began as the fascinating idea of two pioneering inventors. Meanwhile CEREC has
become a technically sophisticated
restorative dental procedure which
is clinically recognized and applied
all over the world. Around 14 million
CEREC restorations have already been
created and fitted. Approx. 8,000 new
restorations are created every day.
At the end of the 1990s, after two
successful product generations, Sirona
launched the modular CEREC 3 system. To exploit the continuous improvements in computer hardware and software, the company decided in favour
of an organic development path based
on continuous updates and upgrades.
Over the years numerous key components have been added to the CEREC
portfolio – for example, the MC XL
milling machine, infiniDent production centre, CEREC Connect web portal,
inEos scanner, the inLab MC XL milling machine, InFire sintering furnace, the special-purpose software
and materials for dental labs and –
last but not least – the new CEREC AC
acquisition centre. There have also
been ground-breaking advances in the
CEREC software – for example, the
automatic design of occlusal surfaces.
The most important aspect is that these
components are all compatible with
each other. The user can adopt CAD/
CAM technology without running the
risk that his existing hardware will soon
become obsolete. On the contrary, he
can rely on receiving a sustained return
on investment. What’s more he is in a
position to combine the various components in line with his specific requirements and can upgrade his CEREC
system at any time. In addition, he can
rest assured that CEREC will remain at
the forefront of technological progress.
CEREC is capable of performing every
procedure that is currently possible in
the area of restorative dentistry.
And this will remain true in future.
The convergence of CAD/CAM and
imaging technology will pave the way
for innovative treatment procedures
such as the integrated planning of customized implants. CEREC Connect
will create an entirely new basis for the
collaboration between dental practices
and laboratories. The trend towards
automated processing will continue
– for example, with regard to occlusal
surface design. CEREC will remain the
centrepiece of all these developments
and reinforce its status as the epitome
of modern restorative dentistry.
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The perfect partner for CEREC AC and CEREC 3
SOFTWARE. To ensure that users fully reap the benefits of the new CEREC Bluecam Sirona has made further enhancements to its CEREC 3D
software. As a result CEREC is easier to operate than ever before. The software incorporates a number of sophisticated features geared to the
long-standing wishes of experienced CEREC 3 users.
Photos: Sirona.
T
he new CEREC AC and the
CEREC Bluecam set new
standards for the chairside
fabrication of multi-unit restorations. To ensure that users exploit the advantages of the new
CEREC Bluecam camera Sirona
has introduced an updated version
of its CEREC 3D software. Version 3.40 also supports the existing
CEREC 3 camera.
The most important change: instead of a 2D image catalogue the
new software boasts a 3D preview
of the virtual model. This preview
is successively refined with each
additionally acquired image. The
software analyzes each image pixel
by pixel. In the case of overlapping
images only the best data is used.
This not only increases the accuracy of the 3D model, but also minimizes the volume of data. Unsuitable images (e.g. those marred by
the rubber dam or cotton rolls) are
automatically eliminated from the
preview. In the past this task had to
be performed manually. As a result
the user can acquire multiple optical impressions in one continuous
process. This helps to streamline the
practice workflow.
Another user-friendly feature is the
shake detection system. The software
automatically triggers the camera
only when the latter is motionless.
The user can choose from five different shake sensitivity settings.
The new restoration dialogue, including
bridge option.
Simpler and more intuitive
either copy or move it from one
3D preview to another. This feature
is especially useful when correlat-ing
the preparation, the occlusion and
the antagonist. In addition, the userfriendly interface and the program
icons have been further revised in
the interests of greater clarity.
The milling preview has been
modified in the new Version 3.40
of CEREC 3D. It is now divided
into three sections. In the first
section the user can select the milling unit he wishes to use (in cases
where more than one milling
unit is available). In the second
section the user is able to view the
restoration within the block and
adjust its vertical position. The
polychromatic layering of the
block is also displayed. This gives
the user a valuable insight into
the shading of the finished restoration. In the third section of the
milling preview the user can determine the location of the sprue
in accordance with the clinical
indication and the shape of the
restoration.
In short, the new CEREC 3D software represents a significant step
forward – for experienced users as
well.
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The images placed on the dockbar create a 3D
Substandard images are automatically
The user can manually adjust the preparation
Visualisation of a bridge restoration in the
preview model.
eliminated.
margin and insertion axis.
milling preview.
The new CEREC 3D software also
includes a convenient Copy & Move
function. This allows the user to
click on a thumbnail image and then
Taking optical
impressions is now
easier than ever.
An especially innovative feature
of the new CEREC 3D software is
the automatic selection of the
reference image. This means that
the user can begin with the distal
tooth and then work his way towards
the mesial tooth. Experience has
shown that this is a simpler and more
intuitive approach. The reference
image can also be selected manually.
Modified milling preview
6
CEREC Zeitung No.14 - 2009
SIROLaser delivers excellent results in connection
with ceramic restorations
PRACTICE REPORT. If bleeding occurs during impression-taking and treatment, this can have a serious impact on the quality of ceramic
restorations. The CEREC user Dr. Helmut Goette deploys the SIROLaser to overcome this problem. In this article he describes his therapy
approach with reference to a typical case.
T
oday, lasers are widely used in
endodontics, periodontics and
dental surgery. Sirona’s compact
and powerful SIROLaser now plays
an indispensable role in my CEREC
Dr. Helmut Goette
operates a dental practice in
Bickenbach, Germany, and is
a certified CEREC trainer and
lecturer.
treatment procedures. I use it for haemostasis purposes and to define the
preparation margins.
It is essential to prevent bleeding at
all stages of the CEREC procedure. The
contamination of the anti-reflective
powder with blood during impressiontaking is especially critical. The data
can be flawed, resulting in incorrect
height readings and inaccurate dimensions of the proximal box. To achieve an
absolutely clean environment I apply
a rubber dam anduse the SIROLaser
to arrest any bleeding.
Bleeding is especially problematical during adhesive bonding. Blood
and saliva contamination can destroy
the etched microretentive enamel
and dentine surfaces. Proper adhesive bonding is then impossible,
and treatment failure is the consequence. A combination of the
SIROLaser and a rubber dam effectively rule out such contamination.
Case study: haemostasis prior to
impression-taking
A 38 year-old male patient came to
my dental practice complaining of
bite oversensitivity in tooth 25. The
oral examination revealed an extended glass ionomer filling with a replacement palatinal cusp and a missing
mesial contact point. I recommended
a replacement filling, as glass ionomer is not indicated for cusp replacement and this was the cause of the
oversensitivity. The tooth was vital.
An X-ray did not reveal any signs of
periapical periodontitis.
After the defective filling had been
removed copious bleeding occurred
in the mesial proximal box (Fig. 1).
With the aid of the SIROLaser I arrested this bleeding and then exposed
"With the SIROLaser and the
rubber dam I achieve an
absolutely clean environment"
and defined the preparation margin.
(Fig. 2). For this purpose I selected
the “Periodontology” program preset (2.5 W and 75 Hz). In addition I
prepared a distal box, and defined an
additional preparation margin with
the aid of the SIROLaser.
The outcome was a clear and dry representation of the operation site for
the preparation. The CEREC optical
impression yielded a clearly defined
3D model. The automatic detection
function had no trouble in marking
the preparation margins (Fig. 3).
Thanks to the rubber dam, the optical
impression and the adhesive bonding
of the restoration were performed under absolutely dry conditions (Fig. 4).
I chose CEREC Blocs (shade: S2-M)
for the restoration. Adhesive bonding was performed by means of
Syntac-Heliobond (Ivoclar Vivadent)
in combination with Tetric EvoCeram (Ivoclar Vivadent), shade A2. The
restoration was inserted with the aid
of an ultrasonic handpiece. Haemostasis remained effective throughout
the treatment process. As a result
repeated laser therapy was not required
prior to adhesive bonding.
To sum up
Fig. 1: Pronounced sulcus bleeding following
Fig. 2: Clear, dry representation of the
Fig. 3: The automatic margin detector
Fig. 4: Thanks to the rubber dam, the try-in of
the removal of the old filling.
operation site following laser therapy.
functions perfectly.
the restoration takes place under dry conditions.
I have used the SIROLaser for CEREC
treatment with great success since
its introduction around three years
ago. It is ideal for haemostasis during
impression-taking and treatment,
as well as for gum contouring and
for the correction of the preparation
margin.
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A further step towards metal-free dentistry
CAD / CAM SYSTEMS | INSTRUMENTS | HYGIENE SYSTEMS | TREATMENT CENTERS | IMAGING SYSTEMS
INNOVATION IN DETAIL
TENEO. Simplicity redefined.
to evaluate the new CEREC AC acquisition centre.
Dr. Reiss, in your role as a tester and
user you have accompanied the evolution of the CEREC system from the
very beginning. What benefits does
the new CEREC AC offer to users?
Compared with the old acquisition
unit, the CEREC AC is a genuine
step forward. This is due above all to
the new camera technology, which
Dr. Bernd Reiss
is a dental practitioner based in
Malsch, Germany. The CEREC
pioneer is Secretary General of
the ISCD.
generates unprecedentedly precise
3D images. In addition, the CEREC
AC lays the foundations for a whole
range of developments with great
future potential: large-sized chairside
restorations; the automation of functional occlusal surface design; fullarch scans; and the “impression-free”
dental practice – to give you just a few
examples.
www.sirona.com
T h e
D e n t a l
44415_Anz_TENEO_e_105x170.indd 1
C o m p a n y
What are the main features of the
CEREC AC?
The imaging technology has been refined. It is so intuitive and easy to operate that new users will have no pro-
07.01.2009 12:47:24 Uhr
blems getting to grips with the new
CEREC AC. Indeed, I’d even say that
established CEREC users face more
of a challenge when making the transition to the new system. I am very
impressed by the high camera resolution. This has led to enhanced image
quality and an enhanced visualization
of the preparation. In addition, the
software skilfully combines various
display modes.
How will these advantages make
themselves felt in practice?
The treatment process has become
simpler and more convenient. One
example is the optional uninterrupt-ed power supply. The CEREC AC
can be disconnected from the electricity mains for several minutes –
time enough to wheel the unit into
another treatment room after the
milling process has been initiated,
leaving the dentist free to concentrate
on other tasks.
How does the CEREC procedure differ from other CAD/CAM methods?
What sets CEREC apart from other
methods is the possibility of performing complete chairside treatment during a single appointment. In other
words, the patient leaves the practice with a finished restoration. More
important in my view are the clinical
aspects. Direct chairside restorations
stabilize the healthy tooth tissue –
also in the case of very thin walls
and undermined cusps. This allows
the dentist to adopt a conservative,
defect-oriented preparation approach.
In addition, temporary restorations
can lead to the contamination of the
healthy tooth tissue. This in turn has
a negative impact on the bonding
mechanism. In other words, dispensing with temporaries has a positive
effect on the adhesive bond and the
longevity of the restoration.
Why should dentists opt for allceramic CAD/CAM-restorations?
The future of dentistry lies with
metal-free restorations. It is illogical
to use metals in cases where mineral materials of equivalent quality are
available. Tried-and-tested CAD/CAM
methods play a key role here. Thanks
to the new CEREC AC acquisition
centre, CAD/CAM technology has
become even easier to use.
Dr. Reiss, thank you for giving your
assessment of the new CEREC AC.
Photos: Götte, Reiss.
E-407-76-V0
Interview. CEREC Zeitung asked Dr. Bernd Reiss, one of the earliest CEREC adopters,
No.14 - 2009 CEREC Zeitung
7
Function, articulation and CAD/CAM are converging
CONGRESS REPORT. Reconstructive occlusal surface design and functional articulation have become easier and more practicable – this
consensus was reached by the leading CEREC proponents Professor Werner Mörmann and Professor Alexander Gutowski at the 16th Annual
Meeting of the German Society of Computerized Dentistry (DGCZ) in Ettlingen.
D
uring his lecture Professor
Gutowski emphasized that
“occlusion is not everything,
but without occlusion you’re left with
nothing.” Prior to each restoration, he
argues, the dentist should closely
examine and document the clinical
situation of the teeth, checking for
pathological findings in the tissues
surrounding the teeth, and examine
the TMJ for any disfunction. Possible
courses of therapy include the milling
of the occlusal surfaces and the appli-
cation of bite splints. Other possibilities include reconstructive occlusal
modifications, bite elevations, orthodontic procedures and – in the case
of TMJ disorders – disc repositioning.
According to Gutowski, computeraided diagnosis and restoration procedures have significantly simplified
the functional analysis process.
Professor Werner Mörmann, Zurich,
reported on the "fast mode" of the
CEREC MC XL milling unit, which
permits a molar crown to be com-
Digital technology will determine the future of dental practices and laboratories – this was the
3386E_270x190:Layout
02.12.2008
13:16
Uhr Meeting
Seiteof 1the DGCZ.
unanimous
conclusion drawn by the1experts
who attended the
16th Annual
pleted in six minutes. According to
Mörmann, fast milling leads to different effects in ceramic materials. During milling trials the glass
ceramic material Empress CAD displayed slightly reduced strength.
However, this is not clinically relevant.
No changes were observed in feldspar
ceramic (VITA Mark II). Mörmann
established that the fast mode increases the rate of wear of the diamond
burs. Hence shorter milling times
are set against increased tool costs.
An adhesive, all ceramic bridge replacing
teeth 12 and 22.
PD Dr. Sven Reich, Leipzig, described
various bonding techniques and materials. In his view zinc oxide phosphate
cement is suitable for bonding zirconium oxide in cases where the framework displays a very good circular fit
and the crown margin offers perfect
support. Glass ionomer cement (Ketac)
is the first choice for the conventional
bonding of restorations with an exact
marginal fit. In the case of very short
crowns a tribochemical silicate coating contributes to improved retention. Alternatively, the dentist can carefully sandblast the crown lumen using
corundum particles.
Dr. Günter Fritzsche, an experienced
CEREC user based in Hamburg, recommended a detailed examination
of the TMJ, the bite height and the
support zone prior to performing
quadrant restorations. In the case of
clinical insufficiency he favours splint
therapy or the milling of the existing
teeth. He is also in favour of the successive preparation and incorporation
of each multiple-surface restoration in
the quadrant. This enables the dentist
to take account of lateral occlusal surfaces when adjusting the occlusion. If
the support zones are insufficient, the
dentist should prepare all the cavities,
retrieve the occlusal surfaces from
the tooth database and then adapt the
design to the antagonists.
According to Dr. Hans Müller,
Munich, biogeneric reconstruction
provides the basis for creating individual occlusal surfaces for inlays, onlays
and partial crowns. As the biogeneric
design function is not yet available for
crowns, Müller uses the CEREC crown
design tool in the case of orthognatic
tooth alignment and normal occlusion. For this purpose he selects adult
and juvenile shapes from an extensive
collection of prosthetic teeth.
Adhesive bridges number among the
most complex prosthetic procedures –
above all in the aesthetically challenging anterior region. The dentist Peter
Neumann, Berlin, presented various
examples of chairside-manufactured,
two-wing adhesive bridges made of
lithium disilicate. In his view adhesive bridges offer two key advantages:
firstly, future treatment options are
left open; secondly, the attachment to
the adjacent teeth is non-invasive or
minimally invasive.
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VITABLOCS TriLuxe forte – the direct way !
®
Photos: Kern.
3386 E
Multi-layered and already customized – the new ceramic blocks for CAD/CAM systems.
Take off with VITABLOCS TriLuxe forte to reach new heights. The ceramic blocks for the
the color gradient, enhanced chroma and fluorescence towards the neck, make TriLuxe
CEREC and inLab systems reproduce the translucency, fluorescence and intensity of a
forte the CAD/CAM block of choice for unsurpassed natural esthetics. Look forward to
natural tooth even without the application of stains to the surface. Subtler nuances in
the new and direct way towards all-ceramic restorations./www.vita-zahnfabrik.com
8
CEREC Zeitung No.14 - 2009
Rethinking entrenched opinions
PRACTICE PROFILE. Dr. Michael Tessmer had reservations about chairside CAD/CAM technology – until his colleagues persuaded him
to rethink his opinion. This case underlines the benefits – for dentists and patients – of investing in modern treatment procedures.
A
clever man once said, “Only a
truly experienced person can
distinguish between the useful
and the useless.” Applied to Dr. Tessmer this means that he is now performing treatment procedures that
he did not learn at university or
during his dental training.
After completing his university
studies and clinical training Dr. Tessmer set up a dental practice with the
goal of providing high-quality treatment services and achieving reproducible therapy outcomes. Given his uncompromising dedication to quality,
he approached all-ceramic CAD/CAM
systems with a degree of scepticism:
“I preferred to order all-ceramic inlays and crowns from a dental laboratory. CEREC was uncharted territory
for me – until last year.”
A friend of Dr. Tessmer’s (who had
trained as a dental technician before
studying to be a dentist) already deployed the CEREC CAD/CAM system
to fabricate inlays and crowns. Given
his laboratory-trained background, this
friend devoted top priority to the occlusal surfaces and the accuracy of fit.
Reports on his chairside restorations
in scientific journals attracted the attention of fellow dental professionals.
Dr. Tessmer was very impressed by the
photographs sent to him by his friend.
The accuracy of fit and the occlusion
were so outstanding that Dr. Tessmer
even doubted that digital technology
had actually been deployed.
Dr. Tessmer decided to visit his
colleague’s practice and find out
more about the benefits of the
CEREC 3 system. “I was amazed and
could hardly believe that this ma-
I was amazed and could
hardly believe how precisely the CEREC system works.
chine was capable of reproducing
an accuracy of fit in the region of 30
- 50 microns,” Dr. Tessmer explains.
In order to gain hands-on experience
he treated two patients using the
CEREC 3D system. He prepared the
cavities in line with the recommendations for pressed ceramics.
On the basis of optical impressions of
the residual tooth tissue the system
retrieved the cusps and fissures from
the built-in tooth library and proposed
individual occlusal surfaces that were
automatically adapted to the antagonist. The restorations were milled out
of silicate ceramic blocks in just 20
minutes. This was followed by polishing and adhesive bonding. After just
one hour the patients left the practice
– with finished restorations and not
with fragile temporaries. The restorations were perfect in terms of fit and
occlusion. Adjusting the contacts and
final polishing took just three minutes.
What impressed him most of all was
the patients’ look of gratitude when
they took a look in the mirror. “And
there was really no need for an impression, Dr. Tessmer?”
After this positive experience Dr.
Tessmer decided to use the CEREC
system. He soon discovered that the
triangulation camera can acquire
the preparation margins much more
accurately than can the human eye.
It is also possible to combine optical
impressions as a basis for restoring
entire quadrants (e.g. when replacing
amalgam fillings with ceramic inlays).
The patients are very relieved that they
require neither an impression nor a
temporary – and that the restoration
can be completed during a single
appointment.
To stay abreast of technological developments Dr. Tessmer decided to lease his CEREC system for four years –
and this is already paying dividends.
Each CEREC restoration yields a
positive contribution and generates
resources for future investments. The
patients also benefit: CEREC restorations are long-lasting and fulfil the
highest aesthetic standards.
Dr. Michael Tessmer sums up his
experience as follows: “Whenever I
encounter dentists who have not yet
adopted CEREC, I like to quote the
famous phrase coined by Mikhail
Gorbachev: ‘Life punishes those who
act too late’. I also regularly invite
interested colleagues to test the
CEREC system in my dental practice
at the weekends. In this way they can
discover how much fun it is to work
with the latest technology.”
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Coming Soon
24 - 28 January CIOSP, Sao Paolo/Brasilia
13 - 14 February Smile on Clinical Innovation, Cape Town/South Africa
26 February - 01 March South Dental China, Guangzhou/China
26 February - 01 March Chicago Midwinter Meeting, Chicago/USA
Enthusiastic CEREC fans: Dr. Tessmer and his team.
emaxCAD CEREC-ProgramatCS-e-160x220.qxd:Layout 1
6.8.2008
13:07 Uhr
Seite 1
CAD
FOR THE CAD/CAM TECHNIQUE
Programat CS
®
all ceramic
A STORY OF SUCCESS
all you need
IPS e.max restorations, Prof. Dr. D. Edelhoff / O. Brix, Germany
IPS e.max CAD and the Programat CS – a strong couple
Fabricate high-strength aesthetic
IPS e.max CAD crowns which can be
cemented – even conventionally – in a
quick and easy manner.
The multi-functional Programat CS
furnace provides optimum crystallization
and glazing of the innovative CAD/CAM
material.
05 - 07 March Scandefa, Copenhagen/Denmark
10 - 12 March AEEDC, Dubai/United Arab Emirates
24 - 28 March IDS International Dental Show, Cologne/Germany
www.ivoclarvivadent.com
08 - 11 May Asia Pacific Dental Congress, Hong Kong/China
Ivoclar Vivadent AG
18 - 20 June CAD/CAM Symposium, Sydney/Australia
Bendererstr. 2 | FL 9494 Schaan | Liechtenstein |
Tel.: + 423 / 235 35 35 | Fax: + 423 / 235 33 60
Photos: Kern.
13 - 15 March ADA Exhibition, Perth/Australia