Technical Report: Precisely Fitting Bars on Implants in Five Steps—A CAD/CAM Concept for the Edentulous Mandible

Various treatment concepts have been presented for the edentulous mandible. Manufacturing tension‐free and precisely fitting bars on dental implants was previously a great challenge in prosthetic dentistry and required great effort. Modern computer aided design/computer aided manufacturing technology in combination with some clinical modifications of the established workflow enables the clinician to achieve precise results in a very efficient way. The innovative five‐step concept is presented in a clinical case.     

Optimal restoration of dental esthetics and function with advanced implant-supported prostheses: a clinical report

For more than 25 years, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used in implant restorative dentistry. Today this technology offers a means of milling titanium frameworks that fit dental implants accurately. This report presents a restoratively driven protocol employing advanced implant restorative and surgical techniques. Treatment of a patient with advanced periodontitis with extensive loss of hard and soft tissues is presented. After extraction of the patient's remaining hopeless teeth, dental implants were placed, along with interim, fixed-margin abutments and abutment protection caps. Two days later, acrylic resin fixed-interim prostheses restored the patient's esthetics and partial masticatory function. After implant osseointegration, maxillary, and mandibular frameworks for definitive prostheses were milled from Ti alloy, using one specific CAD/CAM technology. The benefits of this technology are also discussed.     

Two new clinical/laboratory protocols for CAD/CAM implant restorations

BACKGROUND: Conventional casting technology has some disadvantages for dental laboratory technicians and restorative dentists, including porosity of restorations, miscasting and inaccuracy. It also is labor-intensive. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was developed in the late 1980s for dentistry, and it significantly reduced and/or eliminated problems associated with dental castings. The purpose of this article is to give readers an overview of the use of CAD/CAM technology for dental implants and illustrate two clinical protocols for that use. CLINICAL IMPLICATIONS: The CAD/CAM technology described in this article can reduce restorative dentists' chairside time associated with implant treatment in both edentulous and partially edentulous patients, can decrease costs without sacrificing accuracy or biocompatibility for both clinicians and dental laboratory technicians, and is available to dental laboratories without the capital expenses associated with purchasing new technology.     

CADCAM瓷贴面修复的临床效果探析

[摘要] 目的 评价CAD/CAM全瓷贴面修复前牙的临床效果。方法 选择98颗前牙,采用CEREC的椅旁CAD/CAM修复系统及IPS e.max CAD瓷块即刻完成修复体并粘结。参照改良Ryge评价方法,对临床使用1周、6个月、12个月、24个月的贴面在颜色匹配、瓷表面完整度、边缘染色、边缘适应性、术后敏感、牙龈健康状况、继发龋方面进行临床评价。结果 CAD/CAM全瓷贴面在这些方面的临床评级,90%以上达到A级。结论 用CEREC的椅旁CAD/CAM修复系统及IPS e.max CAD瓷块完成的贴面临床效果良好可靠。     

双排龈技术在CAD/CAM全瓷修复中的临床应用

目的：评价双排龈技术在CAD/CAM全瓷修复中的临床应用效果。方法：对30例48单位前牙行CAD/CAM全瓷修复,牙体预备后采用双排龈技术进行排龈,检查牙龈及预备体、光学印模以及修复体边缘情况。结果：双排龈技术的满意率分别为97.91%,95.83%,100.0%。结论：双排龈技术在CAD/CAM全瓷修复时具有很好的应用效果。     

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计算机辅助设计和制作系统（CAD／CAM）应用于牙科学领域已有20余年历史,其快速发展和不断完善为口腔种植修复治疗提供越来越广泛的服务。无牙颌患者因颌骨条件较差,传统的黏膜支持式义齿通常存在固位不佳、咀嚼功能恢复不良的问题。种植体支持的固定义齿彻底改善了无牙颌患者的固位和稳定,但种植固定长桥的制作及就位困难。利用CAD／CAM制作的无牙颌修复体具有精确的边缘密合性、良好的机械学性能及生物相容性,本文介绍CAD／CAM技术发生、发展、制作过程及临床应用注意事项,并通过运用CAD／CAM技术完成1例颌骨重度萎缩无牙颌患者的种植修复。     

椅旁牙科CAD/CAM系统及临床应用进展

CEREC系统作为目前世界上唯一的椅旁牙科修复CAD／CAM系统,运用人机交互方式,高速度高质量地获得设计方案,并将可切削材料自动加工成形,已被临床证明是当今牙科修复的好助手,在临床工作中日渐显出其优势。     

Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems

In this study, the hypothesis was tested that the marginal and internal fit of CAD/CAM fabricated all-ceramic three-unit fixed partial dentures (FPDs) can be as good as in metal-ceramic FPDs. Twenty-four all-ceramic FPDs were fabricated and randomly subdivided into three equally sized groups. Eight frameworks were fabricated using the Digident CAD/CAM system (DIGI), another eight frameworks using the Cerec Inlab system (INLA). Vita Inceram Zirkonia blanks were used for both groups. In a third group frameworks were milled from yttrium-stabilized Zirconium blanks using the Lava system (LAVA). All frameworks were layered with ceramic veneering material. In addition, six three-unit metal-ceramic FPDs served as control group. All FPDs were evaluated using a replica technique with a light body silicone stabilized with a heavy body material. The replica samples were examined under microscope. The medians of marginal gaps were 75 microm for DIGI, 65 microm for LAVA and INLA and 54 microm for the conventional FPDs. Only the DIGI data differed significantly from those of the conventional FPDs. Within the limits of this study, the results suggest that the accuracy of CAD/CAM generated three-unit FPDs is satisfactory for clinical use.     

CAD／CAM制作瓷全冠边缘适合性的评价

目的研究采用第二代计算机辅助设计及制作系统(CERECⅡ)制作的瓷全冠的边缘适合性。方法在离体牙上制备标准的全瓷全冠预备体,采用CERECⅡCAD/CAM系统制作瓷全冠并就位,用工具显微镜测量瓷全冠与预备体之间的间隙。结果所有全冠均能顺利就位,平均边缘间隙在肩台为56±26μm,牙合面为64±21μm,轴面为81±31μm,其所有测量点的平均值为64±28μm。结论CERECⅡ系统制作的标准瓷全冠就位顺利,边缘适合性达到临床应用要求。     

CAD/CAM氧化锆全瓷冠修复临床疗效评价

目的：探讨CAD／CAM氧化锆全瓷冠的修复效果。方法：选择82例（192颗患牙）,分别在CAD／CAM氧化锆全瓷冠粘接后1、3、6、12个月进行随访观察。采用美国公共健康协会的修订标准对修复体的临床效果进行评价。结果：观察期间失访4例,随访78例共181件修复体,结果显示CAD／CAM全瓷冠颜色达到好以上91．2％,CAD／CAM氧化锆全瓷冠的崩瓷率2．76％,与修复体部位有明显相关性（P〈0．01）,在粘接12个月后有1个修复体的边缘密合度欠佳,所有复诊患者在12个月的临床观察中均未见边缘着色,继发龋和基牙松动。结论：氧化锆全瓷修复体具有良好的稳定性和生物相容性,近期临床效果满意。     

Cerec2 CAD/CAM全瓷修复体的临床研究

目的：采用Cerec2 CAD／CAM系统制作各类修复体，并对其近期临床效果进行评价。方法：本研究共选取65名患者，用Cerec2 CAD／CAM系统按照标准程序制作各类全瓷修复体106个，其中贴面32个，嵌体4个，高嵌体33个，全冠30个，种植全冠2个，连桩全冠5个。记录修复体加工时间，修复后一周复诊时，填写修复体满意度调查表。并由两位医师每半年按照改良的USPHS标准对修复体进行评价。结果：修复体的加工时间平均在20min以内，其中贴面所需时间最少，嵌体需要时间最长。患者的总体满意率达到93％。83％的修复体各项检查标准都达到了USPHS标准的A类。结论：Cerec CAD／CAM系统操作独立，简单，制作修复体快捷。整个修复过程一次就诊就能完成。研究显示Cerec全瓷修复体有着广泛的应用范围。     

CAD/CAM全瓷冠边缘适合性的评价

目的：研究采用计算机辅助设计及制作系统（Kavo Everest）制作的氧化锆全瓷冠的边缘适合性。方法：选取1颗无龋的离体前磨牙行牙体预备,双重印模法取模,翻制20个相同尺寸的超硬石膏代型,将代型随机分为2组,分别制作10个金属烤瓷冠和10个Kavo Everest氧化锆全瓷冠。然后采用双色硅橡胶印模法复制间隙模型,应用光学显微镜采集间隙图像及使用AutoCAD2006软件对其厚度进行测量。结果：利用失蜡铸造法制作的金属烤瓷冠的垂直边缘间隙（69.6±29.7）μm,水平边缘间隙（56.1±20.8）μm,绝对边缘间隙（91.1±28.8）μm;利用CAD/CAM制作的氧化锆全瓷冠的垂直边缘间隙（51.4±19.9）μm,水平边缘间隙（41.1±16.8）μm,绝对边缘间隙（66.2±21.9）μm。两种系统制作的冠的水平边缘间隙、垂直边缘间隙、绝对边缘间隙均具有显著性差异（P〈0.05）。结论：利用Kavo Everest系统制作的全瓷冠具有良好的边缘适合性。     

CAD／CAM制作陶瓷嵌体的三年临床评价

采用计算机辅助设计／计算机辅助制作系统制作陶疱嵌体修复磨牙牙体缺损，通过三年来对２１例修复体的临床观察均未发现继发龋，病人对修复体的颜色匹配，耐磨性等方面较为满意。临床成功率为７６．２０％。但也发现有５例嵌体拆裂及２例嵌体边缘与牙齿窝洞壁之间出现明显缝隙，其主要原因是嵌体厚度不足，粘固剂选择不当。     

The Use of CAD/CAM Technology for Fabricating Cast Gold Survey Crowns under Existing Partial Removable Dental Prosthesis. A Clinical Report

The fabrication of a survey crown under an existing partial removable dental prosthesis (PRDP) has always been a challenge to many dental practitioners. This clinical report presents a technique for fabricating accurate cast gold survey crowns to fit existing PRDPs using CAD/CAM technology. The report describes a technique that would digitally scan the coronal anatomy of a cast gold survey crown and an abutment tooth under existing PRDPs planned for restoration, prior to any preparation. The information is stored in the digital software where all the coronal anatomical details are preserved without any modifications. The scanned designs are then applied to the scanned teeth preparations, sent to the milling machine and milled into full‐contour clear acrylic resin burn‐out patterns. The acrylic resin patterns are tried in the patient's mouth the same day to verify the full seating of the PRDP components. The patterns are then invested and cast into gold crowns and cemented in the conventional manner.     

Dermal Filler Presenting as Lobular Radiopacities in an Edentulous Patient: A Clinical Report

This clinical report describes the unusual appearance of radiopacities, lobular in nature, observed on a dental panoramic image of an edentulous patient. Upon questioning, the patient described a history of recently having hydroxylapatite‐based dermal filler placed in her right and left cheeks to reduce wrinkles and enhance cosmetic appearance. The localization and shape of the radiopacities were consistent with the placement of the dermal filler.     

Cerec CAD/CAM全瓷嵌体和高嵌体3年临床研究

目的：本研究描述和探索Cerec2计算机辅助设计和制作系统的临床应用各个环节,并对Cerec2嵌体／高嵌体的临床修复效果进行评价及分析。方法：本研究运用Vita MK Ⅱ系列瓷块共制作Cerec2嵌体／高嵌体59个,修复体用树脂粘结剂粘结完成。修复后每半年由两位医师按照改良USPHS标准对嵌体进行检查和评价。结果：通过Kalplan—meier生存率计算法计算嵌体／高嵌体使用3～4年的生存率为93％,修复体失败的原因为瓷破裂（4例）和脱落（1例）。结论：Cerec2系统可以制作全瓷嵌体,高嵌体,贴面和全冠多种修复体。它为牙医提供了一个独特的治疗方法,在一次就诊时间内完成了一种天然牙色的、高质量的全瓷修复体。     

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计算机辅助设计与制造（CAD／CAM）是将光电子技术、计算机技术与数控机械加工技术集成于一体的一门技术。随着计算机技术的飞速发展,CAD／CAM技术在口腔临床上的应用越来越广泛。目前主要使用的有CEREC系统、EVEREST系统、PROCERA系统、CERCON系统和国产爱尔创系统。本文就各系统的设备结构及应用原理和切削材料做一概述。     

The use of CAD/CAM in dentistry

Computer-aided design (CAD) and computer-aided manufacturing (CAM) have become an increasingly popular part of dentistry over the past 25 years. The technology, which is used in both the dental laboratory and the dental office, can be applied to inlays, onlays, veneers, crowns, fixed partial dentures, implant abutments, and even full-mouth reconstruction. This article discusses the history of CAD/CAM in dentistry and gives an overview of how it works. It also provides information on the advantages and disadvantages, describes the main products available, discusses how to incorporate the new technology into your practice, and addresses future applications.