CAD- CAM (COMPUTER- AIDED DESIGN/

COMPUTER- AIDED MACHINING/MANUFACTURING)

CAD- CAM systems are systems that can design and produce restorations out of blocks or
blanks of ceramics with the aid of a computer. This technology allows the delivery of a well-
fitting, esthetic and a durable prosthesis for the patient. It uses subtractive processes (millling)
and additive processes (3D printing) to produce physical instances from 3D models. Chairside
CAD- CAM restoration differs from conventional dentistry in that the prosthesis is typically
luted/bonded the same day. An in- house CAD- CAM system enables the dentist to create a
finished prosthesis in as little as an hour in some cases.
History of CAD-CAM
 Dr. Patrick. J. Hanratty is called as FATHER OF CAD- CAM. He designed the first
numerically controlled CAD- CAM named as Pronto
 Iven Sutherland(1960’s) developed the CAD software (sketchpad)
 Introduction of CAD- CAM in dentistry begins with the work of Dr. Duret (in 1971)
 Mormann was the person who introduced first commercially designed CAD- CAM
system in the year 1985 at the University of Zurich and given the name CEREC.
 Dr. Andersson developed Procera system in the mid 1980s and worked on titanium as a
substitute of nickel chromium alloys.
 CEREC 2 was introduced in 1994 by Siemens
Types of CAD- CAM production
-is by 3 different ways
1. Chair side production:
 This involves taking an impression chair side and then producing the restoration
at the same time. It doesn’t require involvement of the laboratory and the patients
can have their restoration at the same appointment.
 Saves time
 Expensive and extra cost for patient
1. Laboratory production:
 Similar to conventional method
 Impression is made and sent to the lab where restoration is fabricated by the lab
technician
2. Centralized production:
 An impression is made and a master cast is digitized in the lab, then it sends to
outsource laboratory through internet. The final restoration is fabricated there and
is sent back to the dentist.
CAD- CAM systems use an optical camera to take a virtual impression by creating a 3D image
which is forwarded to a software program and the impression results in a computer- generated
cast on which the restoration is designed. All CAD- CAM systems contain
 An optical scanner or digitizer that captures the intra- oral or extra- oral condition
 Computer Software that can turn the captured images into a digital model to produce and
design the prosthesis
 Milling station: The system can be used chair- side or in a laboratory setting.
 Ceramic blanks: Typically CAD- CAM restorations are milled from solid blocks of
ceramic that matches the basic shade of the tooth. Metal alloys, including zirconia, can
also be milled.
 Furnace: forpost-sintering, ceramming etc.
 Stains and glazes can be added to the surfaces of the milled ceramic crown or bridge to
correct the appearance of the restoration.

Methods of data acquisition

a) Intra oral scanning
b) Contact and non-contact digitization
c) CT scan or MRI
Intra oral scanning:
3D virtual picture of the prepared tooth and adjacent structures, directly in the patient’s mouth is
taken. These images are transferred to the CAD for designing of prosthesis.
 Less patient discomfort
 Take less time
 No need for model pouring
Contact and non-contact digitization
This method involves taking an impression and after producing a model, transferring of that data
into CAD through probe digitization (contact) or laser light (non-contact).
A contact probe reads the anatomy of the model by following the contour of the physical
structure in contact digitizing
In non-contact scanning, physical contact with the model is not required.
CT scan or MRI
This can be used to take individual images and then can be transferred to CAD. CT scan utilizes
radiation for data acquisition
Scanner or digitizer: the dimensions of the prepared tooth are picked up and digitized in order
to create a 3-Dimage of the prepared tooth in the computer. This is achieved by scanning the
preparation or the die. The 2 types of digitizers currently employed are:
1. Probes- physically contacts the die as it moves along its surface while transmitting the
information to the computer.
2. Scanners- are optical devices. These include:
a. Intra-oral hand-held wands- these are chair side scanners. The intra-oral scanner
reflects light and captures it with a camera to create an optical impression of the
prepared tooth and adjacent structures. In some systems, a special powder is dusted
to reduce reflection and improve readability.
b. Laboratory scanners- are large devices that can scan the cast or die.
Computer: The restoration or the core is designed in the computer. The CAD process aids in
designing either the restoration, coping or the FPD substructure. The computer can automatically
detect the finish line. A recording of the bite registration (the imprint of the opposing tooth in a
wax-like or rubbery material) is also added to the data.
Milling station: The earlier models ground only the internal surface. The external surface had to
be manually ground. Current CAD-CAM machines can grind the external surface also. Signals
from the computer control the milling tool which shapes the ceramic block according to the
computer generated design.
To begin the process the ceramic block is attached to the machine via a frame or built-in handles.
Milling is performed by a diamond or carbide milling tool. The CEREC station uses 2 diamond
burs to grind the internal and external surface simultaneously. Other machines uses a single tool
that moves along multiple axis (3-5) and performs the milling action. The Everest (Kavo) Engine
is an example of a 5- axis milling action.
Ceramic blanks
A variety of ceramic blanks in various sizes, shades and shapes are available for milling. Multiple
units can be produced from the larger blocks. The time taken for milling depends on the size and
complexity of the restoration as well as the material used.
After milling, the structure is separated from the blank using water cooled cutting and grinding
disc or burs.
Sintering furnaces: a variety of furnaces are available depending on the type of blank used.

Network CAD-CAM production(Procera AllCeram)

The Procera system by Nobel Biocare is a unique system where restorations are produced using
information sent via internet. In this system impression is sent to a local Nobel licensed laboratory.
The coping is designed (CAD) and together with the dimensions of the scanned die, the
information is passed via internet.
Uses of CAD- CAM
Prosthodontics :
 RPD framework by using additive prototyping technique
 Crown and bridges- Zirconia is the widely used material. Also metal and porcelain
 Inlay, onlay and veneers
Implant dentistry
 Implant abutments and surgical guides for the placement of implants
Maxillofacial prosthesis
 Artificial ear
 Artificial nasal prosthesis
Advantages:
1. Improved quality of the prosthesis
2. High level of accuracy
3. Decreased chair time for patient
4. Ease and comfort for both dentist and dental lab technician
5. Restorations are more durable, more marginally adaptive, more esthetically pleasing and
faster fabrication.
Disadvantages
1. Expensive to buy
2. Scanning the preparation is technique sensitive

Commercially available CAD-CAM systems

Cerec, Sirona InLab, Everest, Cercon, Lava, Zeno, 5-tec etc