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Computer-assisted milling of dental restorations using a new CAD/CAM data acquisition system

Jürgen Willer, Dr med dent,a Albrecht Rossbach, Prof Dr med dent,b and Hans-Peter Weber, DMD, Dr med dentc Center of Dental Medicine, University of Hannover, Hannover, Germany; and Harvard School of Dental Medicine, Boston, Mass. Background. Recent technologic innovations have created possibilities for restorative dentistry, such as
computer-aided design and computer-aided manufacturing (CAD/CAM).

Purpose. This article presents a new CAD/CAM process that has been developed for the fabrication of
dental restorations. Methods. This process uses an improved imaging technique, successfully applied in other industries. Imaging is accomplished with 2-dimensional line grids projected onto an object, which allows for a mathematical reproduction of prepared and unprepared tooth surfaces, including those that are outside the direct line of light. The relative position of the sensor to the surface of the object is controlled automatically. Conclusions. This system, which is undergoing clinical testing, allows the generation of various types of highly accurate dental restorations (inlays, onlays, crowns, and fixed partial dentures) from a number of different materials. Acquired digitized data points are directly translated from the sensor to the electronic controls of the milling machine to provide various manufacturing possibilities, including copy milling and accurate reproduction of occlusal tooth surfaces in various materials. (J Prosthet Dent 1998;80:346-53.)

Assuming continued improvements, CAD/CAM technology holds promise for being an important technology to fabricate dental restorations in the future. Consistent quality and precision are achievable in this process that should, at some point, be less labor intense and less expensive than techniques currently used. Various aspects of the CAD/CAM process still need improvement, such as the quality and the speed of intraoral imaging.


ong-term success of fixed single and multiple unit prosthodontic restorations depends, to a considerable extent, on the accuracy of fit between restoration and prepared tooth structure. With the commonly applied lost-wax-casting technique in the production of metal castings or frameworks, their accuracy is greatly influenced by the dimensional properties of investment and casting alloy.1-3 In addition, casting imperfections, such as porosities or impurities due to the presence of corrosion-prone mixed crystals, can cause the quality of cast restorations to be severely impaired. Likewise, poor solder joints, underdimensioned or nonhomogeneous metal frameworks can affect the quality and, thus, the long-term success of crowns and fixed partial dentures (FPDs). With the aid of x-ray defectography, it was possible to demonstrate that roughly a third of all cast restorations exhibit manufacturing-related deficiencies.4

Associate, Department of Prosthodontics, Center for Dental Medicine, University of Hannover Medical Center. bProfessor and Chair, Department of Prosthodontics, Center for Dental Medicine, University of Hannover Medical Center. cNagle Associate Professor and Chair, Department of Restorative Dentistry, Harvard School of Dental Medicine. 346 THE JOURNAL OF PROSTHETIC DENTISTRY

Milling of dental restorations from a block of base material, such as metal, ceramic or resin, is proposed as an alternative for fabricating restorations. This technology promises results of greater accuracy and structural homogeneity. With quality as the objective, the significant advantage in using milling technology lies in the fact that cold working of rolled structures and ceramic materials will always yield homogenous material structures. To produce milled restorations with accurate fit, digitization of the prepared tooth surface and converting the data into control signals for computer-assisted milling is requested. In this regard, computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry has encountered numerous problems, because the shapes of prepared teeth and dental restorations cannot be described with regular geometric methods because of their unlimited number of degrees of freedom. Therefore, when using current CAD/CAM technology, data acquisition has to be performed with digital mechanical scanning of the cast parts or by point-based optical systems.5-9 High-speed data acquisition with the aid of complex free-form surface geometry has so far been an unsolved problem. In addition, problems arise in the generation of cusVOLUME 80 NUMBER 3

crown interior is computed from the abutment surface data. Object to be measured is moved on rotatable table in front of sensor. Finally. Automatic measurement software determines how many views must be taken to reconstruct the object exactly. AND WEBER THE JOURNAL OF PROSTHETIC DENTISTRY tomized occlusal surfaces. the SEPTEMBER 1998 Fig. the COMET system uses stone dies fabricated from impressions. Steinbichler Optotechnik GmbH. The complex free-form surfaces of abutments and wax patterns are recorded with CAD to initiate a milling-based manufacturing process for crowns. Optical setup for data recording. 2. the surfaces of the abutments in the cast are digitized as well. and (3) milling of copings. or superstructures supported by implants. The various views are then linked together in the computer to form the tooth or prepared surface. Digitizing The COMET system is characterized by an optical sensor that is capable of capturing between 400. Three steps are involved: (1) digitizing data from the die surface or a wax pattern surface.18 which accelerates and simplifies the 3-dimensional representation of tooth shapes while allowing individual customization and correction in the visualized monitor image before milling. To do so. the software can compute the 3-dimensional coordinates directly. The planned restoration is then waxed and the surface of the completed wax pattern optoelectronically scanned and digitized. This technique provides opportunities for the fabrication of fixed dental prostheses. The final restoration is then milled or ground from any desired material by an associated milling unit. enable the creation of occlusal surfaces by transferring digitized data obtained from measurements of a reference denture or from recordings of mandibular joint movements. with or without the use of a wax pattern.WILLER. with varying amounts of effort. An impression is obtained of the prepared abutments in the patient and the master cast poured in diestone. which is fixed onto a rotatable plane table at a point that is about 30 cm in front of the point of intersection of the 2 lens projections. For the production of custom copings. it is sufficient to digitize the prepared abutment on the master cast. and FPD frameworks can be made of various metals or metal alloys. Thus. Neubeuern. ROSSBACH. (2) mathematical processing of data to program the milling machine. Three procedural options are currently feasible. partial denture structures. and the CCD camera records the resultant pattern. After removing the wax pattern from the die. from the geometric relationships in a triangle. The COMET system uses a pattern digitization and surface feedback technique. Evaluation of the projected pattern is performed with the phase-shift method. full-surface. the latter being a time-consuming process with considerable variations in precision. 3. The prepared abutment surface and contact and occlusal surfaces of the adjacent and opposing teeth on the master model are digitized. This sensor is automatically oriented onto the object. crowns. Through lines with equal distances from the optical sensor. depending on the resolution of the charge-coupler device (CCD) camera used. Some techniques. a sensor equipped with an integrated white-light projector and CCD camera is used (Fig. whereas. planes are formed that divide the object. high-speed digitization allows for model abutment surfaces and wax patterns of the final restoration to be recorded with speed and precision. or resin materials. The individual views are linked by special software. and implant abutments. ceramics. 1). Germany) described herein allows the generation of a 3-dimensional data record for each superstructure.17 Optical. single crowns. The white-light projector projects a line grid at a prescribed angle onto the object to be measured. A CAD program is used to generate the new crown surface. multiunit restorations.000 and 1 million data points simultaneously. Exterior and interior surfaces of the copings are computed by the software. the 347 . 1. The sensor permits rapid surface generation of objects and evaluation of the manufactured products. 1. Sensor consists of white light projector and CCD camera. onlays. By superimposing an observation light bundle onto a projection light bundle. As in conventional prosthodontics.10-16 The purpose of this article is to present a new CAD/CAM process that has been developed for the fabrication of dental restorations. inlays. THE COMET SYSTEM The COMET system (COordinate MEasuring Technique.17 and any ambiguities can be eliminated by rotating the grid during measurement.

By comparison. 2). by the pixel coordinates and the midpoint of the imaging lens. object coordinates for each individual pixel are determined (Fig. in contrast. 3). which describes the line of observation for the respective object point. Fig. If the angles a and b and the base b are known. the system automatically recognizes preparation boundaries without requiring these to be redrawn (Fig. Angle a. Roughness depth should not be less than the wavelength of the 0. with high scanning density and speed. The smaller VOLUME 80 NUMBER 3 . The surfaces to be measured must not be overly smooth to avoid undesirable light reflections. 3. Finish line has been clearly identified by sensor without necessity of tracing it on monitor. 4. After completion of this step. The process has many advantages. the sensor transmits precise coordinates. corresponding to 400. the distance between the projected grid point in the projection optics and the pixel in the imaging optics of the video camera. The point cloud describing the surface can be used directly to generate a CAD model and to describe milling paths (Fig. modeling errors can be detected and. thereby minimizing shadow areas and problems on object undercuts. Triangular measurement principle for recording object’s coordinates. The rotation of the grid will. Optical digitization enables consecutive. corrected by the CAD system. (3) The sensor provides absolute 3-dimensional coordinates that permit a complete shape description through automatic linking of different digitization views.THE JOURNAL OF PROSTHETIC DENTISTRY WILLER. ROSSBACH. contactfree determination of all 3-dimensional coordinates of the surfaces of wax and abutment patterns. (1) It possesses a high lateral density of measurement points (2) Steps in the object or various independent objects in the measurement space are digitized without ambiguity. The optical scanning and subsequent digitization permit determination of the 3-dimensional coordinates of points on the surface of an object without making contact. if necessary. AND WEBER Fig.000. 788 × 581 pixels (standard resolution) or 1024 × 1024 pixels (enhanced resolution) are available for digitization. is predefined by the sensor design and thus given.7 µm light source and should not exceed the desired precision. Surface roughness and transparency are of particular significance. In this situation. Angle b is determined for each individual pixel. The base b. 4). Insert enlargement of finish line. namely.000 measurement points. the pattern is removed and the die of the prepared abutment measured. respectively. (4) Despite a small selected base. The wax pattern remains on the die for optoelectronic measurements. the position of the object point is defined. namely. homogenous surfaces. generate an unambiguous coding of the lines within the space. Depending on the resolution.4 to 0.000 and 1. Optical properties of the cast surface are important 348 for optoelectronic digitization. With the use of surface feedback. Point cloud of COMET System. 2. is determined by the image location on the video camera. per view. the usual Moiré processes available on the market can only be used to capture contiguous. Fig.

sections comparable to tomograms are automatically laid through the object according to the x-y-z coordinates. the prepared tooth surface is digitized. computed. 349 . a feature of the software computes the nondigitized points and generates a 3-dimensional image of the surface of the object to be measured. 6). sensors available up to now have used angles of 30 degrees and greater. B. Fig. 6. the fewer are the problems caused by shadowed areas. This information is necessary for automatic manufacturing (Fig. 8. A. the triangulation angle is only 20 degrees. 7. Digitized anterior tooth crown (lateral view). Because only a finite number of points can be digitized optoelectronically. and shown on the monitor. Digitized FPD framework in graphic representation. the triangulation angle. AND WEBER THE JOURNAL OF PROSTHETIC DENTISTRY Fig. Information density is documented by large number of points. If no changes to the on-screen CAD design are made. (5) Automatic masking excludes uncertain or irrelevant areas from the data recording process. an additional program is available for customization of occlusal surfaces whenever it is useful to do so without a wax pattern (Fig. When manufacturing FPD frameworks. 5. Milled occlusal surface of molar as computed by CAD program. Shape of crown can be individually edited and altered on monitor. is linked by the computer to the various views of the wax pattern (Fig.WILLER. the surfaces of digitized SEPTEMBER 1998 wax patterns can be reconstructed as free-form surfaces and represented visually. For manufacturing copings. ROSSBACH. The pattern of the anchor tooth. which makes it possible to identify usable areas clearly. A through D). A and B). Data processing The surface of an object to be measured consists of a number of points. 7). and thus shows the contours. 5. Software program has superimposed wax pattern directly onto abutment die in master cast. To make single crowns. whereas. Digitized anterior tooth crown with milling mount (front view). the exterior contours are also generated by digitizing a wax pattern (Fig. A B Fig. The use of the phase-shift method enables direct recognition of the object surfaces illuminated by the projector. Thus. In the COMET process. also scanned.

A and B). The milling programs enable exact copies of the object to be made with marginal accuracies in the 10 µm range. All signals to control machining of crown’s exterior and interior surfaces are computed by means of these sections. 10). laid within smallest space. 9. The milling cube measures 120 mm per axis. Metal or ceramic raw materials come in the form of disks or blocks (blanks) VOLUME 80 NUMBER 3 . AND WEBER A B C D Fig. especially developed for dental applications. ROSSBACH. This milling machine. high-speed milling/drilling tool. Coping dimensions are then calculated and the finish line is verified (Fig. with 350 interchangeable cutters driven by computerized velocity and rotating at a maximum speed of 60. Sections. A through D. Horizontal and vertical sections through crown and abutment pattern. compute circumference of crown and perimeter of abutment.THE JOURNAL OF PROSTHETIC DENTISTRY WILLER.000 rpm. Milling Once the milling paths have been computed. As previously mentioned. the data are transferred to the system coordinates of the milling machine. the milling unit allows the generation of various restorations from any material used in restorative dentistry (Fig. is equipped with a multiple-axis. 8.

Experiments 351 . 9. B. In regard to the great demand for treatment with fixed dental prostheses. because marginal accuracy and crown margin gaps at the finish line are major factors that determine the quality of fixed prostheses. Göteborg. B Fig. is thereby possible. Contour of coping was generated by CAD program. Sweden) from the group of systems that use mechanical scanning. methods up to now have used mechanical scanning systems or point-based optical systems to obtain a point cloud describing the pattern for surface reconstruction. Raanana. Milling takes place in 4 steps: (1) rough milling of outside surfaces for bulk material removal. Allschwil. AND WEBER THE JOURNAL OF PROSTHETIC DENTISTRY A Fig. and DCS Production AG.32 From a milling standpoint. Without the risk of underdimensioning.31. Digitized abutment pattern and coping. indication-specific shape variations and more homogeneous workpieces from a material perspective than casting-related methods. (2) fine outside milling to finalize the outer contours and surfaces of the restoration. Milled FPD framework. Abrasive methods continue to allow more exact. which have advantages with respect to stability and offer considerable time savings in their manufacture compared with other methods. it is already possible to prepare single crowns and fixed partial dentures from metal or ceramics. Switzerland) and the Procera system (Nobel Biocare. because an abutment prepared for a crown has any number of degrees of freedom. This considerable advantage of milling is gaining significance in light of the increasing demands being made for quality control of dental prostheses. rough internal milling. high-precision SEPTEMBER 1998 machining is of particular significance.19-30 Moreover. such as high-performance ceramics. A more difficult area is that of object measurement and digitizing in regard to precision and/or speed. ROSSBACH. extension to all processable materials. For example. The most well-known are the Titan system (DCS Research and Development. DISCUSSION The CAD/CAM technology provides interesting perspectives for the future of reconstructive dentistry as a whole if current problems (outlined in the introduction) are resolved. A. Evaluations of the marginal fit of copings and crowns produced with these systems have demonstrated the potential for clinically acceptable results. The milling procedure can occur at any time after mathematical processing and can be programmed to run automatically. Insert enlargement of crown margin area. Israel. the CAD program can reduce the external contours of crowns and FPD structures to the extent required to construct these individually with veneer ceramic. and (4) fine inside milling to produce accurate internal fitting surfaces of restoration. 10. of various widths and are fixed on a mobile platform that is movable in 3 dimensions. including overnight. (3) after rotating the workpiece by 180 degrees.WILLER.

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