© 2018 IJSRSET | Volume 4 | Issue 8 | Print ISSN: 2395-1990 | Online ISSN : 2394-4099

Themed Section : Engineering and Technology

Latest trends in Digital Dentistry : A Review

Divyesh Ubale1 , R.V. Uddanwadiker2
1Junior Research Fellow, Mechanical Department, VNIT, Nagpur, Maharashtra, India
2 Associate Professor, Mechanical Department, VNIT, Nagpur, Maharashtra, India

ABSTRACT

CAD/CAM dental restoration is available as Chairside and Labside. There has been lot of developments in
dental materials and computer software technology which leads to the success of CAD/CAM technology.
Dental restoration can be done by two methods, both having its own advantages and limitations namely
Conventional Dental Restoration, Digital (CAD/CAM) Dental Restoration. A number of CAD-CAM systems are
developed for electronically designing and milling dental restorations. These systems lead to elimination in the
need for impressions, temporary prostheses, and laboratory assistance. Computer Aided Design (CAD) involves
use of Computers for creating projects with high accuracy. Computer aided manufacturing (CAM) process has
been developed to materialize virtual objects using CAD. Virtual file can be converted into a real object using
Computer Aided Manufacturing (CAM) which operates by a machine connected to a computer. This paper
gives a brief knowledge about the uses of CAD/CAM technology in the field of dentistry such as fabrication of
crowns, restoration. Developments in digital dentistry lead to better patient experience and improve the
productivity and economics of the dental practice.
Keywords : Restoration, fixed partial dental restoration, CAD/CAM, Digital Dental Restoration, Intra Oral
Scanner, Ceramics.

I. INTRODUCTION II. DENTAL RESTORATION

Two most common oral diseases in dentistry are tooth Dental restorations can be divided into two broad
decay and the periodontal disease like gum disease or types: 1) Direct restorations and 2) Indirect
pyorrhea. The restoration of teeth, extraction or restorations.
surgical removal of teeth, scaling and root canal
treatment are most common treatments. Dental When a soft or malleable filling is placed into a
restoration is a process of protecting the damaged prepared tooth cavity immediately, it is known as
tooth from further damage using dental restorative Direct tooth restoration. The material is then set hard
material. This helps to restore the function and till the tooth is restored. Direct restorations usually
morphology of missing tooth structure. The set quickly hence they are advantageous. But this type
replacement of missing tooth structure that is of restoration has less strength and not suitable
supported by dental implants is also known as Dental especially where filling become larger. This procedure
Restoration. requires single clinical visit. Based on the type and
location of the filling dentists choose the filling. For
example, for replacements near the tooth root or

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other areas which are not subjected to heavy pressure prostheses produced by 'milling technology'. The
from chewing, glass or resin, ionomers are often used. CAD/CAM technology in dental field was introduced
in 1970s (Klim). In the present world everyone
Indirect tooth restoration involves tooth replacements prefers to do the treatment in minimum time. In
in the form of crowns, inlays, onlays, bridges, dentistry CAD/CAM technology had made this
dentures, where restorations are fabricated outside possible with greater speed and accuracy. CAD/CAM
the mouth using the dental impressions of the tooth. gives new wing to dental field through which
The finished restoration is usually bonded patient’s get relief from the inconvenience of
permanently with dental cement. More than one conventional dental restoration and offers better
clinical visit is required in case of an indirect tooth aesthetic restorations in not more than two visits.
restoration as the fabrication of restoration takes time.
Variety of materials like metal, ceramics, composites IV. CAD/CAM RESTORATION STEPS
etc. can be used for making restoration.
CAD/CAM restoration involves three steps, first being
III. METHODS OF DENTAL RESTORATIONS image acquisition in which dentist scans the dental
arch by using intraoral scanner. Generated 3D image
There are two methods of dental restoration: is divided into number of facets (triangle). The
Conventional Dental Restoration and Digital intraoral scanners are the optical scanners that record
(CAD/CAM) Dental Restoration. Conventional Dental images of the dental arch with greater accuracy and
Restoration process is used from many decades in the speed. It reduces steps and overall time of restoration.
dental field. Dental restoration is the process of The next step is Design which will be performed with
replacement of the missing tooth structure with Computer Aided Design (CAD). With the help of
various types of restoration like crowns, inlays, onlays, CAD different types of designs can be carried out
etc. to restore the same function. Conventional such as copings and fixed partial denture (FPD)
Dental Restoration process mainly consists of frameworks, full anatomical crowns and FPD, inlays,
following four processes: 1) Tooth preparation 2) onlays, veneers, etc. It increases the productivity,
Taking the impression 3) Temporary crown quality of design and reduces the time. Manufacturing
placement and 4) Fabrication of dental restoration. is the last phase of the digital dental restoration
There are certain limitations of Conventional method: process which is defined as Computer Aided
1. Dental impression in conventional method is not Manufacturing (CAM). It consists of manufacturing
accurate and precise due to which the dental mold is the restoration from the CAD model into a physical
not prepared properly and error occurs in final part which may further undergo processing, finishing,
restoration. 2. Metals are used for the restoration and polishing before restoration into the patient’s oral
purpose using casting which is aesthetically not cavity (Duret et al., 1988).
acceptable. 3. Predictability of outcome is negligible.
4. Time taken for complete restoration process is very During the conventional dental restoration process,
long. To overcome all these limitations, Digital Dental most of the time impression taken is not accurate and
Restoration an upcoming technique, is suggested. sometimes the proper dental impression is not
Digital Dentistry is vastly developing in dental achieved in first attempt so repetitions are required
restoration field under the name CAD/CAM which consumes time of patient. Also patients have to
(computer-aided design/computer-aided bear the smell of impression material which feels
manufacturing) Dentistry. The term 'CAD/CAM' in them uncomfortable during the whole process. Thus
dental technology is basically a synonym for to eliminate this problems, intraoral scanners are

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introduced which take the digital impression of teeth provisional or for full anatomical long term
in less time with better accuracy and precision. temporary prostheses it is possible to use resin
materials directly as crown and FPD frameworks;
V. CAD/CAM PRODUCTION TYPES Silica based ceramics: Grindable silica based ceramic
blocks are offered by several CAD/CAM systems for
There are two different production types based on the the production of inlays, onlays, veneers, partial
location of the components of the CAD/CAM systems, crowns and full crowns; Oxide high performance
in dentistry: Chairside production: Fabrication of ceramics : Al2O3 :Aluminium oxide is used in the case
dental restorations can take place at chairside without of crown copings in the anterior and posterior area,
a laboratory procedure. The conventional impression primary crowns and three-unit anterior FPD
technique is replaced by digitalisation instrument frameworks; Yttrium stabilised zirconium oxide ZrO2
intra-oral camera, in most clinical situations. This Y-TZP: Zirconium dioxide is a high-performance
saves lot of time and restoration can be done only in a oxide ceramic with excellent mechanical
single appointment. Laboratory production: This type characteristics. It has high flexural strength and
of production is similar to the traditional working fracture toughness compared with other dental
between the dentist and the laboratory. A master cast ceramics. This leads to use of this material as
is fabricated first as soon as the dentist sends the framework material for crowns and FPDs, and, in
impression to the lab. The remaining CAD/CAM appropriate indications, for individual implant
production steps are carried out completely in the abutments. The addition of three molecules of Y2O3
laboratory. Three-dimensional data is produced with results in a stabilising tetragonal phase at room
the help of a scanner, on the basis of the master die. temperature (Beuer et al., 2008).
Suitable CAD software is used for further processing.
After the CAD process the data will be sent to a Various CAD/CAM technologies are developed for
special milling device that produces the real geometry deposition of materials. One of the technique is the
in the dental laboratory. Finally the exact fit of the evolution of a computer-aided design/computer-aided
framework is inspected and if there is any correction, manufacturing (CAD/CAM) process where ceramic
it will be corrected on the basis of the master cast paste is deposited in a layer-by-layer sequence
(Beuer et al. 2008). For selection of procedure to be (robocasting). This was done using a CNC machine to
followed, consideration should be given to esthetic build up core and fixed partial denture (FPD)
demands, chairside time, and laboratory costs, structures. Al2O3 or ZrO2 are blended into a 0.8%
number of visits and convenience and return on aqueous solution of ammonium polyacrylate in a ratio
investment associated with CAD/CAM equipment of approximately 1:1 solid: liquid. A viscosifying
(Prajapati et al. 2014). agent, hydroxypropyl methylcellulose, is added to a
concentration of 1% in the liquid phase, and then a
VI. MATERIALS FOR PRODUCTION OF CROWNS counter polyelectrolyte is added to gel the slurry.
There are two methods for robocasting crown
Several materials are used for production of crowns, structures (cores or FPD framework): First method
inlays, onlays. These are produced using Milling consists of the core to be printed using zirconia ink
machines. Some of the materials are: Metals without support materials. The stereolithography
(Titanium, titanium alloys, chrome cobalt alloys ): (STL) file generated is inverted (occlusal surface
The milling of precious metal alloys are not of resting on a flat substrate) and built. The second
interest, due to the high metal attrition and the high method uses a fugitive material composed of carbon
material costs.; Resin materials: For long-term black and ceramic material. During the sintering

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process, the carbon black is removed (Silva et al., and more accurate. In some cases, CAD/CAM
2011). technology provides patients with same-day
restoration (Davidowitz et al., 2011).
Dental biomaterials are used on large scale in all areas
of routine dental practice. There are mainly two For taking digital impressions 3D intraoral scanner
methods for their application. First method consists of with software integration has to be designed. The
placement of dental biomaterials into living tissues, main purpose is to gain high speed and accuracy. The
such as teeth, to fill the space. Second method main parts of the system are Intra-Oral Scanning
involves use of dental devices such as crown and (IOS) hardware, CPU and display monitor. The IOS
bridge restorations and dentures. These are fabricated hardware is designed using non-contact optical
using various materials to restore the morphology and technologies. This is based on the principle of
function of the dentition. Crown and bridge confocal laser scanner microscopy resulting in high
restorations are one of the main treatment methods speed scanning. The light intensity is detected by
used by general practitioners. There is also a greater photo-detection device, transforming the light signal
demand for all-ceramic restorations. Development of into an electrical one which is recorded by a
new materials such as highly sintered glass, computer and can be reconstructed. The software is
polycrystalline alumina, zirconia based materials and designed using merging of active triangulation
adhesive monomers, will provide great assistance to method, surface reconstruction and Image processing
dentists to meet this demand (Miyazaki et al., 2009). tools. This results in high accurate 3D image of oral
cavity, which will be displayed on the monitor screen
VII.RESTORATION USING CAD/CAM (Seok et al., 2015). The accuracy of digital
COMPONENTS AND VARIOUS TECHNIQUES impressions obtained from various digital impression
systems needs to be studied. The results of this study
A digital data is captured directly from the patient would provide a great help for the clinician to select
mouth. With this process the model making phase is an appropriate Computer-Aided Design/Computer-
avoided. Consequently, this digitization technique is Aided Manufacturing (CAD/CAM) scanner for digital
also referred to as digital impression (Miyazaki et al., impressions. Furthermore, the results carry
2009). For electronically designing and milling dental implications of whether digital impressions are
restorations a number of CAD-CAM systems are accurate enough to be used as an alternative to
being generated. Such systems eliminate the need for conventional impression techniques (Ali, 2015).
impressions, temporary prostheses, and laboratory
assistance. Furthermore, the entire procedure is For gaining accuracy detailed analysis on the present
completed in one appointment. There is very less methods and techniques for scanning, designing, and
information available about this new system. It is fabrication of CAD/CAM generated restorations along
observed that this new CAD-CAM device is capable with the new classifications of CAD/CAM technology
of fabricating a ceramic restoration in less than 20 has to be carried out. Advantages of CAD/CAM
minutes (Leinfelder, 1989). CAD/CAM technology technology include digital impressions and models,
was developed to solve three challenges. The first and use of virtual articulators. Currently, the design
challenge consists of ensuring that especially the software has more applications including complete
posterior teeth have adequate strength of the dentures and removable partial denture frameworks.
restoration. The second challenge was to create 5 axes milling units are used for attaining the
restorations with a natural appearance. The third accuracy of restoration fabrication. The 3D printing
challenge was to make tooth restoration easier, faster, technology has been incorporated into dentistry, but

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does not include ceramics and is limited to polymers. natural appearance to restorations. The duration of
Future study involves the use of ultrasound scanning and milling procedures will depend on the
impressions using ultrasonic waves which will replace size of the object, the number of objects processed
optical impressions, which have the capability to and the steps selected (CAM or CAD/CAM)
penetrate the gingiva non-invasively without (Bodereau et al., 2013).
retraction cords and not be affected by fluids
(Alghazzawi, 2016) There are various techniques developed in dental
restorations. A new device for scanning the dental
Dental CAD/CAM technology is gaining popularity profile and reconstructing 3D digital information of a
because of its benefits in terms of time consuming, dental model based on a layer-based imaging
materials savings, standardisation of the fabrication technique was designed. This technique is known as
process, and predictability of the restorations. The abrasive computer tomography (ACT). This new
number of steps required for the fabrication of a device was proposed for the design of custom dental
restoration is less compared to traditional methods. restoration. ACT scanned digital information was
Another benefit of CAD/CAM dentistry includes the then used for producing the fixed partial dental
use of new materials and data acquisition, which restoration by rapid prototyping (RP) and computer
represents a non-destructive method of saving numerical control (CNC) machining methods (Lee et
impressions, restorations and information that is al., 2008). The other tests involve use of Anderson-
saved in a computer and constitutes an extraordinary Darling test, Levene’s test and Mann-Whitney test for
communication tool for evaluation. The incorporation analysis of data. For this, the study was undertaken
of dental technology has not only brought a new for 20 patients to take their impressions. Crowns were
range of manufacturing methods and material fabricated from digital scans as well as silicone
options, but also some concerns about the processes impressions and the crowns were clinically evaluated
involving restorations’ fit, quality, accuracy, short and before cementing. It was concluded that the crowns
long-term prognosis (Brenes et al., 2016). Even from intraoral scans had better marginal fits than the
though the contributions of dental CAD/CAM crowns from silicone impressions. Also it was
systems are presently limited but they are promising observed that they had better interproximal contact
not only in the field of crowns and FPDs but also in area quality (Syrek, Andreas et al., 2010).
other fields of dentistry (Miyazaki et al., 2011)
Some applications of the use of intraoral scanning
Aesthetics of crown plays an important role in technology are to record hard and soft tissue
restoration using CAD/CAM system. Aesthetic morphology for the fabrication of a cast partial
dentistry is dedicated to imitate nature by removable dental prosthesis. An open source intraoral
maintaining the size, shape, colour and symmetry. scanner was used to scan the hard and soft tissues to
Development in technology leads to metal-free create a stereolithographic file. This STL file was
ceramic materials capable of reproducing a natural subsequently imported into a CAD software program
appearance. So traditional materials have been for the digital/virtual design of a partial denture
replaced by them. The yttrium partially-stabilized framework. Computer-aided design and computer-
zirconium oxide does not only have the advantage of aided manufacturing technology was then used to
being extremely resistant, but it is also highly fabricate a resin framework. This was then trial
translucent. It has a translucency that allows about placed to evaluate accuracy and for conventional
50% of the incident light to pass through. This investing and casting with a cobalt-chromium alloy.
characteristic is more important for providing a more The cast framework and prosthesis were judged to be

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clinically accurate in fit, stability, and retention dental restoration, the cost associated with this
(Kattadiyil et al. 2014). The objectives have to be is very high due to this reason most of the
decided to determine the validity and reproducibility dentists uses the conventional method.
on stereographic models and 3-dimensional digital 5. Therefore if the overall cost of this system can
dental models made with an intraoral scanner. For be reduced without affecting the end results,
this, study was undertaken which consisted of use of then dentists will be able to adopt this
ten dry human skulls. These skulls were scanned and technology. Very few researchers have studied
stereolithographic and digital models were made from the strength of restoration prepared by CAM
them. The measurements were taken by two technique.
observers four times. Arch length discrepancy and 6. CAE technique needs to be developed to know
tooth size discrepancy were calculated on the basis of the various stresses developed by tooth and to
measurements. It was found that there were avoid the tooth failure.
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