Dental CAD CAM July 2007

One thing is crystal clear: the world of digital technology is moving full speed ahead and it’s quickly changing the way laboratories operate and the services they offer, and the manufacturers are responding to the needs of the marketplace.

For instance, the price of a complete Dental CAD/CAM system can be cost prohibitive to many laboratory owners—some come with a $200,000 price tag—but more and more manufacturers are now offering stand-alone scanners, a less expensive alternative that allows the laboratory to buy only the scanner to scan and design its own restorations and then send the data off-site for fabrication.

Another example is the growing availability of CAD-generated implant abutments. An alternative to stock or laboratory-fabricated cast custom abutments, manufacturers tout this service as more economical, less labor intensive and more precise than traditional methods. Three manufacturers Atlantis Components, Nobel Biocare and U-Best Dental Technology—currently offer CAD-generated implant abutments and three more— 3M, Kavo and BioCAD—plan to launch the service this year. Although each manufacturer’s service works a bit differently, in general, the laboratory sends either a traditional or scanned model to the company, which mills the abutment out of zirconia or titanium then returns it to the laboratory.


HOT…BioCAD based out of Quebec Canada- The most comprehensive dental CAD/CAM with bar design, custom abutments, coping, crown and bridge design to be launch in September of 2007. The custom abutment module is due to be released October 2007 for Canada and January 2008 for the USA. BioCAD designed BEGO Medical GmbH CAD/CAM.

The concept of “open” systems STL —meaning digital data can be read by any manufacturer’s milling or rapid prototyping unit—was a recurring topic of the meeting. Laboratory owners are intrigued by this concept because it gives them more versatility. There are several open systems of the InVision® DP 3-D printer from 3D Systems bundled with 3Shape DentalDesigner CAD, the imagen™ system bundled with Evirsa/Cynovad CAD or 3Shape DentalDesigner CAD, LaserDenta 5 Axis Laser Scanner bundled with Evirsa/Cynovad CAD, Evisiontech DCP Printer, Objet Eden 3D Printer, Solidscape Benchtop T66 3D Printer, Stratasys, Inc Dimension 3D Printer, Geomagic Piano CAD/CAM and dental wings cad with 5 axis scanner. Additionally, 3D Systems’s V-Flash™ Desktop Modeler price tag of $9,900.00 and Desktop Factory 125ci price tag of $4,995.00 3D printing systems to be launched later this year (2007). Digital dental lab M-4D milling unit with DentMill from Delcam what an impressive milling unit for $60,000.00.

Another hot topic is digital impressions. This area of digital technology continues to generate excitement in the laboratory community. Digital impressions are coming to the forefront and initially there will be a hybrid of both traditional and digital impressions. How fast is it going to happen? There’s high interest from dentists, so probably faster than we think, and it can have a very positive effect on the C&B&I process in the laboratory. In 2006, 3M purchased Brontes Technologies, a developer of proprietary 3-D intraoral imaging technology 3M ESPE ISS.

Cadent iTero™ here’s how the system works: Once the digital impression is captured, it is reviewed on screen for accuracy and the margin is identified. Then it is emailed to Cadent’s manufacturing facility for milling into the physical model. That model is then sent to the laboratory for restoration fabrication.

Other 3D intra oral digital impression companies such as Hint-El, Dentsys 3D, SensRay (Dentsply and Glidewell Labs) and others are racing in that arena...

imagen™ system uses the 3D printing process (a type of rapid prototyping) invented at the Massachusetts Institute of Technology in the early 90s. Instead of milling down a block of material, the system creates a precious metal coping by adding powdered metal in layers and bonding them together (the process only uses the material it needs so there’s no waste as there is with milling). Once complete, the coping is sintered, then prepared for final porcelain as usual. The system can fabricate 100 single units a day and is an example of an open system—it can accept scanned data from a variety of manufacturers’ devices.

With this system, laboratories have two options: they can rent the complete system for $2,500 per month (which decreases on a sliding scale based on productivity); the print fee per unit is $10, the material cost is $30 per gram of finished product and the average price for an anterior unit is $28. Or, a lab can rent the scanner only and send the data to the imagen production center for fabrication; an anterior costs $50 and a posterior costs $65; both fees include metal finishing and one-way shipping.

The company also noted the exciting future potential of this technology: one day it will be used to produce full ceramic restorations, including zirconia, that have variable color and translucency built throughout the material because you will be able to selectively color and harden sections of the buildup during the layering process.

InVision® DP (Dental Professional) 3-D printer. 3D Systems Invision DP this rapid prototyping unit that uses scanned data to fabricate individual copings and up to 16-unit bridges in a light-cured resin. The user scans a model, designs a virtual waxup, then sends the data to the Invision DP printer that “prints” the waxup in layers; it is then ready to be cast or pressed with conventional techniques. Scanning and design take about two minutes, and the unit can print 20 units in about three hours and up to 150 in about five hours. In addition to outputting digital data to its own wax printer, the InVision DP scanner is another example of an open system—it can export data to any other open system. A different version of 3D Systems’ printer was formerly available through Cynovad as part of the Neo; this new version just completed beta testing and is now ready for sale. The scanner and design software cost $39,000 and the printer costs $80,000. The company is working on 3Shape Dental Designer software that creates a full crown waxup.

HOT … Envisiontech Dental Component Printer (DCP) which employs Digital Light Projection technology developed by Texas Instrument. The Perfactory DCP uses visible light from regular projection bulb to cure resins which are both biocompatible and can be used for burn out in a lost wax casting process. The Perfactory DCP is capable of producing anything from wax up crowns, caps, and surgical drill guides, to removable dental partials. Single or multiple parts can be produced in a little as 60 minutes from a 3D Solid Model data with less than 25 microns accuracy in Z direction. With a running operational costs as little as a $1 per hour, the average cost per crown is $0.10. There are two configurations available for the Perfactory DCP. The Perfactory Desktop at the cost of $40,000.00 can produce 20 crowns or copings in two hours for small to medium dental labs while the Perfactory Mini with ERM at the cost of $86,900.00 (or $65,900.00 without ERM) is capable of producing 60 caps or crowns for the medium to large size dental labs both with a 25 microns Z accuracy.


Prismatik CZ Clinical Zirconia™. Launched in 2006, Glidewell Laboratories’ system consists of a milling unit and software that works with a scanner made by 3Shape. “Our objective was to make a zirconia substructure at a PFM price,” said Mervyn Rudgley, an engineer Glidewell hired 2 years ago to spearhead digital manufacturing and Prismatik CZ’s development. The unit mills 12-15 units in three-and-a-half hours and the company offers three levels of partnership, including marketing materials: labs that send less than five units per day pay $59 per outsourced coping; at 5 to 25 units per day, a lab can become a remote design partner, meaning it purchases a scanner and software for $30,000, e-mails the data to Glidewell and pays $39 per unit; and at over 25 units per day, labs have the option to purchase the full system for $141,000 with an approximate per-unit cost of $15. The laboratory manufacturers its own zirconia block and, soon, its own pressable ceramic for zirconia.

Ceramill System. Amann Girrbach America’s in-house manual zirconia milling system offers an economical alternative to a digital CAD/CAM system. The Ceramill is based on the pantograph principle, or copy milling which, according to the company, “puts the material back in the hands of the technician.” To create a zirconia coping, the user applies a light-cured resin over a traditional die, attaches the resin buildup into a plastic plate and inserts it into the milling unit, side by side with a YTZP zirconia blank. The unit has two conjoined arms that hold the probe tip and the milling handpiece. The user manually traces the resin buildup with the probe tip while the other arm simultaneously mills a duplicate coping out of the zirconia block. The unit mills one coping from start to finish in 25-30 minutes for approximately $34, including labor costs. Three-unit bridges can be milled in 35-40 minutes; medium and large zirconia blocks are also available and can process a full 14-unit span. The complete system retails for $27,212 and includes the milling unit, suction device, sintering furnace, LED lamps, motion-sensored curing light, materials starter kit and two-day training course.
CeraSys. There have been several system developments in the last year. In addition to its three-axis scanner that scans one unit in seven minutes, CeraSys America’s new five-axis scanner takes two-and-a-half minutes per unit and is ideal for poor margin preps. The CeraDesign software now offers automatic connector placement and a complete pontic library. The CeraMilling unit, which initially only milled zirconia and wax, now features an all-purpose mill that the company says can “machine everything from A to zirconia” and has different cutting tools depending on which material you’re cutting. The CerasysZR material, which is 95% zirconium oxide, comes in two base colors, white and translucent; both can be stained to match any shade.

Cercon. Following the trend of manufacturers offering more affordable hardware options, Dentsply’s newest component is the Cercon Eye, a stand-alone scanner that allows laboratories to buy only an in-house scanner, then scan and send data to be milled at one of the company’s 220 milling sites. The Cercon Eye costs $13,500 and the Art software that drives the system is $7,100.

Etkon es1 system. A new version of the software, etkon visual 4 that features pontic and connector bar libraries, was launched in June of 2007. Labs can produce single crowns, inlays, onlays, Maryland bridges, and telescoping and fully contoured crowns in a new proprietary YZ material called Zerion. Additionally, EtkonUSA launched a new proprietary etkon milling machine from Germany, and additional software upgrades are in the works, including a full contour crown and bridge library as well as the ability to scan inlays using a waxup and scan function called CopyCad.

KaVo EVEREST® (Geomagic). A double scan feature and simultaneous 5-axis technology allow KaVo’s EVEREST users to mill implants, bars, slide attachments and more. The system’s implant capabilities will be broadened by an on-screen design function and a cooperation with implant provider NEOSS®, allowing EVEREST users to mill custom titanium or zirconia implant abutments for a broad range of implant brands. The company also unveils new EVEREST software architecture, based on modules by the software company, geomagic®. Coming soon: a remote scanner solution.

inLab®. Sirona Dental Systems’ new 2.9 software offers three additional features: a Manual Correction Mode allows the user to scan two different models and digitally overlap them to create a virtual matrix, a Reduction Mode allows restorations to be designed in full contour mode then reduced to accommodate the desired amount of porcelain, and a Margin Cementation Gap reduces space at the margins and allows you to profile unique fit requirements for each client. Also, various materials can now be milled using a Step Bur that has four cylindrical steps, a design that stabilizes the concentric milling action and eliminates the need to overmill; the infiniDent web-portal allows inEos and inLab users to upload files for fabrication. In the works: CAD-generated titanium and zirconium oxide implant abutments from Straumann, as well as metal frameworks.

Katana. Coming soon is a software upgrade: a dual scan technique where technicians can scan the prep and the waxup—a benefit for implant cases where virtual waxups are not ideal. Katana is manufactured by Noritake, marketed by Zahn, and distributed by Custom Milling Center (CMC).

Lava™. New from 3M ESPE in 2006, laboratories can purchase a stand-alone scanner, the $34,500 Lava Scan ST, and send the digital data to one of the nationwide authorized Lava milling centers. Lava currently fabricates single crowns and up to six-unit bridges; eight-unit bridge capability and an implant abutment service are coming this year.

Procera®. Now available from Nobel Biocare: longer-span Procera zirconia bridges (10 units up to 60mm long), and the first alumina one-piece bridge in up to four units. Procera abutments are also available for other implant systems, including Astra Tech in titanium and Camlog in zircona and titanium, and replacements for the Procera esthetic abutment kit can now be ordered using the scanner. Coming soon: the ability to scan Procera implant bridges in both titanium and zirconia using the Forte scanner.

TDS (Turbo Dent System). In the second half of 2007, the company will launch a new software module, Implant Smart, that uses CT scan technology to create a blueprint for the case in advance of the implants being placed. Implant Smart integrates the CT scan into the software and allows the dentist to select his implant of choice, review the CT scan for bone consistency and health, and then virtually place the implants. The software also allows the technician to provide clients with a complete solution: you can fabricate a surgical guide or stent for easy implant placement, the custom implant abutment in titanium or YZ material, the temporary crown, and/or the YZ /VM9 final restoration. Existing TDS customers will receive the software module first at no charge for beta testing with their doctors.

ZenoTec System (3Shape DentalDesigner CAD). Users of Wieland Dental Systems’ machine will soon be able to design copings in full contour by selecting from a full library. The file can then be split so the coping and full contour can be milled out of two different materials. For example, the coping can be milled out of zirconia and the full contour can be milled out of resin and then invested and over pressed. A hardware update will speed up the machine by approximately 20% and, rather than only milling the disc in the horizontal position, the unit will be able to tilt the disc during milling to maximize the unit-to-material ratio. Also to come will be “pre”-shaded zr-discs that no longer require dipping and are ready for any lighter shade of porcelain.

DentMill by Dellcam is a software solution for machining dental parts. Parts can be imported as models from standard dental design software or scanned images. Finished products, including copings, crowns, bridges, including full arch, and abutments, are produced on machines like the M-4D from Digital Dental Lab. DentMill automates the part orientation by automatically selecting stock sizes and holder pins to complete the setup for cap and bridge manufacturer. Digital Dental Lab system integrates a digital prescription for easy order tracking and processing and includes design software enhancement such as a virtual wax tool and automated pontic morphing and trimming to match gingival surface.

Hot - Geomagic Piano is a modular dental CAD/CAM software package with a built-in open-development platform. Clinically tested for over a decade by visionary dental equipment manufacturers, Geomagic Piano's proven technology enables the integration and creation of best-in-class turnkey solutions for the digital preparation and production of dental restorations.

Hot - 3Shape’s dental system is a complete and integrated CAD solution for dental restoration design and order management. The file output is completely open and therefore compatible with and open and suitable production equipment (CNC machines, sintering machines or 3D printers). The D-250, 3shape state-of-the-art 3D scanner, provides accurate, reliable and fast 3D scan of dental preparations, wax-up bridges, bite impressions, full casts and implant positions. DentalDesigner, the most advanced CAD program available, along with the AbutmentDesigner modules allows for design of complex restorations combining different techniques or materials within minutes. DentalManager is a unique application to manage orders throughout the production process, tracking delivery status as well as optimizing and planning manufacturing.