You are on page 1of 8

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.)

CLINICAL IMPLICATIONS
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.

L

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
aResearch

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.

5. 6.65:763(abstract 339). The second stage includes the generation of dental restorations with a CAD program without the need for a wax pattern after digitizing the prepared abutment indirectly from a stone die. Gelbard S. 15. Int J Prosthodont 1994. Duret F. The third stage permits direct data acquisition in the oral cavity. Effect of impression materials and techniques on the marginal fit of metal casting. Wichmann M. Resheff B. allows the generation of various types of highly accurate dental restorations (inlays. With the milling unit. REFERENCES 1. VOLUME 80 NUMBER 3 . The launch of the improved version. and monitor through display. Stern N.37:513-24. Gelbard S. Quintessence Int 1989. the marginal contour lines of the reconstruction have to be traced onto this picture. Persson M. because the optical system can only be used to capture contiguous.58:512-6. Lutz F. onlays. Samet N. US patent 4. Different modes of application are possible. Marginal fit of machinemilled titanium and cast titanium single crowns. At the current stage of development. Improvement of CAD to produce crown by considering occlusion. Bensheim. Stage 1 and 2 applications have already passed successful clinical tests (to be published). 10. J Can Dent Assoc 1993. Ceramic-fused-to-metal restorations with a new CAD/CAM system. according to the manufacturer. 2. This improvement in optoelectronics also provides the technical potential for a system able to record the removal of dentin. 13. and thus eliminates the need for impressions and their inherent inaccuracies. What is the state of the art? J Am Dent Assoc 1991. Barghi N. Dent Clin North Am 1993. 8. FPDs) from a number of different materials. Aoskar Y.73:457-63. including areas withdrawn from the direct line of light.12:190-5. including proximal and occlusal surfaces. Barbakow F. Multiple views of a patterns can be linked and represented in a common coordinate system. J Prosthet Dent 1987. there being no feature for rotating the grid. Dtsch Zahnärztl Z 1993.THE JOURNAL OF PROSTHETIC DENTISTRY WILLER. Gilbert J. J Prosthet Dent 1995. High-technology innovations–and limitations–for restorative dentistry.24:64-71. Computer-aided design and manufacturing in dentistry: a review of the state of the art. In its first application stage. Quality assurance by x-ray structure analysis [In German]. J Calif Dent Assoc 1996. Leong D. October 23. 16. Rekow ED. Dental CAD/CAM systems. J Prosthet Dent 1995. Duret B. 9. Rekow D. 14. the described technology electronically analyzes any wax pattern produced by a laboratory technician and transfers the data to a milling machine. Marginal accuracy and geometry of cast titanium copings. from copy milling to the generation of surfaces (including occlusal surfaces) from computer-generated information. single-tooth restorations in the form of inlays. Duret F. J Prosthet Dent 1994. This article introduces to the reader a newly developed CAD/CAM process with an improved optical sensor and a data analysis/transfer system that allows for various views of teeth or prepared abutment surfaces to be linked together for an accurate description of their shape and border lines. 11. 7. Blackman R.42-8. crowns.71:1-6. has succeeded in narrowing the marginal gap widths by more than 300 µm in some situations. Computer machined adhesive porcelain inlays: margin adaptation after fatigue stress. The accuracy of a high precision digitizer for CAD/CAM of crowns. Zalkind M.24:769-78. and veneers can be ground out of ceramic materials. CAD–CAM in dentistry. Chairside computeraided direct ceramic inlays. Takahashi J. SUMMARY CAD/CAM technology in dentistry continues to progress and is gaining in importance as an alternative to the traditional lost-wax-casting technique.59:445-6. AND WEBER undertaken with the Titan system yielded a mechanical digitizing accuracy of 3 to 5 µm. which is still too long to 352 achieve accuracies similar to those described for the stage 1 or 2 applications.14 Experiments on ceramic crowns produced with the Procera system yielded mean marginal accuracy values of 83 µm. Germany). Baez R. which in turn will form the final restoration by using any desired material. Van der Zel JM. The COMET system is being developed conceptually in 3 application stages. Andersson M. Blouin JL. 17. Rekow ED. which is currently undergoing clinical testing. Preston J.33-38 The currently best-known system that uses optical digitizing of prepared tooth surfaces is the Cerec system (Sirona. Mörmann W.122.74:223-9. use digital verification.177:715-20. crowns. The COMET system. J Prosthet Dent 1992. 3.39-49 In comparison.50 In addition to pulp-protective preparation. the marginal fit of final restorations ranged from 111 to 270 µm. The practical dental CAD/CAM in 1993. Chai J. this improvement in optoelectronics will allow geometries to be constructed that further enhance optical recording and subsequent CAD/CAM manufacturing processes. Dent Mater J 1993. ROSSBACH.48:682-6. 12.964.770. intraoral imaging requires approximately 20 seconds. CAD/CAM system for the production of metal copings for porcelain-fused-to-metal restoration. Duret B. Jans H. homogenous surfaces. Lautenschlager E.67:435-40. 1990. contrast-enhanced image. Process of making artificial teeth. With the use of a cursor.20:329-39. Brandestini M.7: 440-7. Performance of CAD/CAM crown restorations. Steinbichler H. Dental restorations from various solid materials can be generated with high accuracy while involving considerably reduced manual labor and potentially lower costs. Bergman B. J Dent Res 1986. Brandestini M. However. onlays. which generates an instant optical print and displays it on a monitor as a still. Quintessence Int 1993. Mörmann WH. Stern NA. Duret F. Tschernitschek H. the COMET system uses a combination of strip projection methods with triangulation enabling measurement of the coordinates of all measurement points recorded by a CCD camera not only with high precision but also at high speeds. 4. J Am Dent Assoc 1988. The working radius of the optical sensor has been designed with dimensions that permit the measurement of objects of the size of maxillae or mandible model. Lutz F. Cerec Mk II. Willer J. Sohmura T. Ferru A.

J Prosthet Dent 1986. Inokoshi S. 36. A review of methods and techniques to improve the fit of cast restorations.9:665-72. Symposium: CAD/CAM technology in restorative dentistry. Isenberg BP. Aquilino SA. Applications of computer-aided evaluation for holography and similar techniques. L’Estrange PR. Pelletier L. 21. J Prosthet Dent 1992. Larsen IB. 40. Scand J Dent Res 1986. Leinfelder KF. Composite cement thickness of Cerec CAD/CAM ceramic inlays. A new computer-assisted method for fabrication of crowns and fixed partial dentures. Vanherle G. Jedynakiewicz NM. P. US patent application 1990. Liu PR. Krejci I. MA 02115 Copyright © 1998 by The Editorial Council of The Journal of Prosthetic Dentistry. 29. Berry T.20:171-7. 32.70:296(abstract 245). Bailit H. 23. Giordano RA 2nd. Campbell S. Computer-designed inlays after 5 years in situ: clinical performance and scanning electron microscopic evaluation. A new all-ceramic crown. Andersson M. Wozniak WT. Bergman B. Richter WA.73:396(abstract 2353). Int J Prosthodont 1997. Quintessence Int 1995. 24. Garner FM. Postcementation marginal fit of a new ceramic foil crown system. Swed Dent J 1997. highpurity. Lambrechts P. A clinical examination of ceramic (Cerec) inlays.1:13-9. Clinical evaluation of restoration margins by an endoscopic microscope. glass ceramic. Optics Lasers Eng 1992. J Prosthet Dent 1985. 38. An in-vitro and in-vivo evaluation. Russell MM.71:516(abstract 3). Steinbichler H. Jörnéus L. Engstrom B. 44.71:516(abstract 6). and feldspathic porcelain. Schwartz IS. 34. Sanford C. A dense-sintered. Willems G. Heymann HO. Pober R. 10/1/91799 SEPTEMBER 1998 353 . ROSSBACH.26:757-63. Strudevant JR. Acta Odontol Scand 1992.51:5964. Hunter AJ. Blessing C. 33. Dwan A. 27. Leinfeleder KF.23:109-15.124:59-63. Roberson T. J Dent Res 1992. 20. A comparison of the marginal fit of In-Ceram.59:409-17. Evaluating CAD/CAM generated ceramic veneers. Holland GA. Marginal accuracy of indirect posterior composite and CAD/CAM inlays. Braem M. Nalbandian J. McFall WT Jr.76:619-23. Marginal accuracy of CAD/CAM inlays made with the original and the updated software. Effect of in vivo crown margin discrepancies on periodontal health. Ramsey DL.36:415-20. Aust Dent J 1991. Gingival and alveolar bone reaction to marginal fit of subgingival crown margins. Lovgren R. 48. Int J Oral Maxillofac Implants 1994. Andersson M. Razzoog ME. Hummert T. J Dent 1992. CAD/CAM etched ceramic veneer restorations. IPS Empress. Process of controlling crown-preparations and filling-cavities of teeth. Holmes JR. Yaman P.64:548-52. Three-year clinical evaluation of CAD/CAM restorations. 35. Andersson M. J Dent Res 1992.WILLER. Sjörgen G. 39.56:416-21. Part I: terminology and widths. Karlsson SL. Clinical evaluation of ceramic veneered titanium restorations according to the Procera technique. 46. Wilder AD. Bayne S. J Prosthet Dent 1988. 49. J Prosthet Dent 1991. 42. J Prosthet Dent 1996.00 + 0.65: 357-64. Pallesen U. Effect of restoration quality on periodontal health.65:75-9.68:766-70.76:187-93. Rozie RG. 31. Sulik WD.71:516(abstract 1). Essing ME. Bayne SC. J Dent Res 1992. Flexural strength of an infused ceramic. Thompson JY. J Prosthet Dent 1995. Bergmann M.4:173-6. and Procera crowns. J Prosthet Dent 1990. 0022-3913/98/$5. J Prosthet Dent 1996. Steinbichier H. 50.71:516(abstract 5). Isenberg BP. Acta Odontol Scand 1993. J Prosthet Dent 1989. H. Accuracy of machine milling and spark erosion with a CAD/CAM system. AND WEBER THE JOURNAL OF PROSTHETIC DENTISTRY 18. Wirthman GP. Belser UC. Effect of crown margins on periodontal conditions in regularly attending patients. Willer J. Stegersjon G. Persson M. Carlsson L. Reprint requests to: DR. Sorensen SE. Mörmann WH.94:109-14. 25. Arnold HN. Dahlmo K.53:14-9. Chai J. Dennison JB. Bergovist S. J Esthetic Dent 1992.21:1-10. Ekstrom PF. 28. Efficiency of an electric drive in the Cerec CAD/CAM unit. Heymann HO. 19. Odman P. 47. J Am Dent Assoc 1993. J Prosthet Dent 1991. Van Meerbeek B. WEBER DEPARTMENT OF RESTORATIVE DENTISTRY HARVARD SCHOOL OF DENTAL MEDICINE 188 LONGWOOD AVE BOSTON. 26. Mechanical properties of a new mica-based machinable glass ceramic for CAD/CAM restorations. Boss A. Barghi N. J Prosthet Dent 1985. et al. Considerations in measurement of marginal fit. Andersson B. Calamia JR. MacEntee MI. Hunter AR. Bader JD. J Prosthet Dent 1986. Carlsson GE. Clinical performance of CAD/CAM restorations. Molin M.53:24-9.56:279-83. A survey of crown and fixed partial denture failures: length of service and reasons for replacement. Walton JN. Kanoy BE.10:478-84. alumina coping with porcelain. J Dent Res 1991. 43. Bayne SC. Sulaiman F. Furrer O. 30. Odman P. 45. Agar JR. J Dent Res 1994. Felton DA. Jorgensen KD. Bayne SC. Jameson LM.73:411-8. J Dent Res 1992. Lang BR. 22. Martin N. Andersson B. Quintessence Int 1993. Marginal adaptation of porcelain margins in ceramometal restorations. Mechanical testing of super- 37. Odén A. Gingival crown margin configurations: a review and discussion.50:171-8. 41. Mörmann WH. Ödman P.62:405-8. structures on the CeraOne abutment in the Branemark system. Fit of three porcelain-fused-tometal marginal designs in vivo: a scanning electron microscope study. Grasso JE.