CAD/CAM dentistry stands for computer-aided design and computer-aided milling. CAD/CAM Dental or Dentistry represents an alternative digital workflow for traditional or conventional methods of doing dentistry. to illustrate, we use a computer to design and mill a dental restoration, but the use of dental technology does not stop there, there are a number of CAD/CAM base units on the market such as the Cerec System, E4D Dentist, iTero, and Lava Chairside Oral Scanner. Cerec and E4D have the ability to do in-office design and milling, and iTero and lava scanners are used for image acquisition only.

Our article focuses on the CEREC System, which features a handheld scanner that captures intraoral tissues digitally. A computer receives the resulting 2D and 3D images for designing and milling dental restorations. Using design software, dentists create restorations on a monitor, then mill them from materials like Feldspathic porcelain, Lithium Disilicate, Zirconia, and more. Alternatively, they can send digital impressions to a dental lab for processing.

CAD/CAM technology gives you options to fabricate Inlays, Onlays, Veneers, Crowns, FDPs, Implant Abutments/Crowns, and complete full mouth reconstruction, besides that it can even be useful in orthodontics and removable prosthodontics as well, the extent to which the provider wishes to use CAD/CAM is up to them.

CAD/CAM technology in dentistry represents a tool, an alternative way of doing things, and just like anything in dentistry it is important that we understand the best ways to use CAD/CAM dentistry so we can get the most out of it, but equally important is that we understand the limitations of CAD/CAM dentistry as well.

To illustrate, you get out of it what you put in, the quality is up to you, while using CAD/CAM technology things tend to snowball, it will either make good dentistry better or bad dentistry worse, to get the most out of CAD/CAM you have to do your best, when applying something new like CAD/CAM into your practice you have to understand there will be a learning curve and it requires you to learn new things to make it work for you and your patients.

What Are the Advantages of CAD/CAM?

• Time Efficiency: CAD/CAM has a potential to be faster than traditional methods, traditional methods for producing indirect restorations require PVS impressions and these must be sent to a dental lab for fabrication of the final restoration, while the restoration is being prepared at the lab the dental patient most likely has to have a temporary restoration until the final restoration is complete, and a minimum traditional methods require a two appointment approach.
• Access to Digital Impressions: If you know how to use the technology, digital impressions are faster than traditional impression techniques, every year this speed appears to get better and faster and faster, mill restoration technique is faster than traditional lab fabrication techniques for making a restoration without the need to send the case to a lab and thus you can speed up the entire process from start to finish of the case. All digital scans are stored on a hard drive and therefore take-up less space than traditional stone models, this could be very attractive for like an orthodontic practice where they are required to store models for many years after treatment, and if you desire you can fabricate physical models from the digital impressions in case if you have a 3D printer or access to a lab that has the ability to fabricate models from digital impressions. Many manufacturers make blocks of machinable ceramics or machinable composites, these materials are fabricated under ideal industrial conditions and so their physical properties have been fully optimized. CAD/CAM offers a wide variety of materials in various shades and translucency, these options give you every opportunity imaginable to make your restoration blend well in the mouth.
• Cost–Effectiveness: We talked about CAD/CAM and how it can be faster and related that to speed, there’s also the ability to fabricate same-day restorations, this eliminates the need for temporary restorations and local anesthesia is not required as often, these savings in time and labor have the potential to reduce overhead costs and offer patient satisfaction in a single visit.

Over time your dental team can be trained to design and mill restorations, to maximize efficiency in the dental clinic, dental providers should focus on the things that only they are trained to do, you can prepare the teeth and then a trained staff member can do the rest with your supervision, but the time you say by having a staff member trained can be invaluable and further add to the financial viability of the CAD/CAM technology. With a properly trained provider and staff, CAD/CAM technology can be easy to use and offer you quality comparable to traditional techniques.

Having said that, CAD/CAM is not as perfect as it seems; it also has some disadvantages. First and foremost are the startup costs—both the equipment and software can be expensive, with prices varying depending on the system you choose. You need to carefully consider whether this technology will provide a suitable return on your investment, especially if your practice requires a large volume of patients needing indirect restorations to make it worthwhile.

Moreover, visual workflows can make or break your productivity and when first implemented they will slow you down, you need to understand that a learning curve does exist and you should plan to give yourself and your team time to properly learn and implement the technology, it will take time to become proficient with the system especially if you hope to make it financially viable. Digital impressions require accuracy to make them work, when doing conventional PVS impressions you must have good soft tissue management to include hemostasis, moisture control and tissue retraction, this attention to detail also applies to CAD/CAM technology as well, it can be difficult to digitally capture a sub-gingival margin, attention to detail and maintaining quality standards will serve you well, but ignoring these recommendations can lead to inadequate and poor restorations.

In addition, learning to color-match CAD/CAM restorations can be challenging, you need to learn how to best use the system to do aesthetic restorations, we think starting on posterior restorations where aesthetics is less critical is a good idea, you can then progress to anterior restorations more predictably, mini CAD/CAM restorations are milled from monochromatic blocks of porcelain, this means that the shade is uniformed, if you’re trying to match a monochromatic block to natural teeth with a wide variety of shades with translucency and characteristics it can be very challenging, to overcome this multi chromatic blocks you can also use stains and characterize the tooth to make small shade adjustments. Single-unit restorations are easier to learn but when you start using CAD/CAM technology to design bridges or implant restorations, this will require more training and expertise, these type of restorations will make workflow productivity more challenging as with anything there is a learning curve and it will take time to make it work predictably and be profitable.

Conclusion

Now that you have a grasp of CAD/CAM technology and its advantages and disadvantages in dental practice, consider it as a valuable tool that can enhance your practice with proper training and implementation. Allocate time in your schedule to practice the new concepts of CAD/CAM dentistry; with time, it will become easier. CAD/CAM technology represents some of the most advanced tools available in dentistry today, and its digital workflow has the potential to revolutionize your practice. Ultimately, whether CAD/CAM digital dentistry is right for you is a decision that only you can make. We invite your comments and thoughts below!.