Dental Tribune Indian Edition

17Dental Tribune Indian Edition - January 2013 “Lecture theatre”—a new interactive concept—on chairside CAD/CAM dentistry An interview with Dr Michael Dieter, Ivoclar Vivadent, Liechtenstein To be held for the first time in South-East Asia, the seventh CAD/ CAM & Computerized Dentistry International Conference in Sin- gapore in October will offer a de- tailed overview of the latest CAD/ CAM technologies that are aimed at helping dentists achieve aesthetic and long-lasting all-ceramic resto- rations chairside. During a presen- tation in Cape Town, South Africa, Dental Tribune Asia Pacific had the opportunity to speak with Ivoclar Vivadent’s Dr Michael Dieter, head of the International Center for Den- tal Education, who will be hosting the lecture theatre together with Jörg Vogt, international CEREC trainer for Sirona. Dental Tribune Asia Pacific: Dr Dieter, your joint presentation with Mr Vogt in Singapore will be held in form of a lecture theatre. What is behind this concept? Dr Michael Dieter: Jörg Vogt and I developed this concept two years ago. When the organiser’s managing di- rector, Dr Dobrina Mollova, saw our performance at the sixth CAD/CAM & Computerized Dentistry Internatio- nal Conference in Dubai last year, she named it a “lecture theatre” because of its truly interactive nature. Jörg and I present in continuous dialogue with each other, which makes the lecture more interesting, not only for the au- dience but also for us. Additionally, case demonstrations with the CEREC AC will be performed live on stage. Primarily, our lecture is aimed at dentists who are interested in mini- mally invasive aesthetic treatment so- lutions or who simply want to get into dental CAD/CAM technology. Our goal is to provide a guideline clinical treatment sequence for predictable treatment using chairside CAD/CAM technology. However, the lecture is also suitable for any dentist who is in- terested in all-ceramics as a modern restorative treatment option. From my experience, I can say that many practitioners still have lit- tle knowledge of what all-ceramic material they are supposed to use for various clinical situations. With our lecture theatre, we aim to demonstra- te the main differences in terms of aesthetics, particularly for use in the anterior dentition, and the physical properties or strength of the various all-ceramic systems. What do you think the reason is for this lack of knowledge? Recently, we have seen the rapid development of materials and techno- logies. For the practitioner, it is so- metimes difficult to keep up with all these new developments. This is why continuous education is becoming more and more important. If we look at the increasing num- ber of all-ceramic systems on the market that manufacturers claim to be aesthetic, we can in fact perceive significant differences. The questions remain: what does “aesthetic” mean, and how suitable are these materials in clinical reality? This is exactly what we will be discussing in our lecture: translucency, opalescence and fluorescence—these optical pro- perties of the natural tooth can be re- produced in the patient’s mouth with select modern all-ceramic materials. While I will focus on the treatment sequence from a clinical perspective, Mr Vogt will provide insights into the CAD/CAM process using the CEREC AC and the latest software (version 4.03). He will demonstrate live, step- by-step, how to design the restorations and I will illustrate the related clinical cases. What are the most common mista- kes when choosing materials? Selecting the right material is not the only difficulty. The correct tooth- preparation technique remains a chal- lenge for many dentists because all- ceramics require an entirely different preparation design compared with the commonly used metal alloys or metal ceramics. If mistakes are made at the beginning, fracture of the restoration becomes much more likely. There- fore, preparation techniques for all- ceramics with regard to CAD/CAM application will be in focus as well. What impact has CAD/CAM techno- logy had on the usage of aesthetic re- storations in the dental practice? With CEREC, CAD/CAM technology has been available for chairside application for more than 27 years. So this is a well-documented procedure with long-term clinical success. Today, there are approxi- mately 34,000 CEREC units in use, which demonstrates impressively that this technology is still driving aesthe- tic dentistry in the clinical practice. The main indications are inlays, onlays, partial crowns, full crowns and veneers. In addition, up to four- unit posterior bridges are now pos- sible, either as a temporary solution with polymer blocks (e.g. Telio CAD, Ivoclar Vivadent) or as a permanent restoration with a high-strength zirco- nium dioxide/lithium disilicate mate- rial (e.g. IPS e.max CAD-on, Ivoclar Vivadent). What are the aesthetic limitations of chairside CAD/CAM? Generally, posterior restorations like inlays, onlays and crowns can be realised with good aesthetic results. With anterior restorations like crowns and veneers, the aesthetic outcome lar- gely depends on the adjacent teeth that we have to match intra-orally. Highly aesthetic colour gradients for CEREC restorations can be achieved with poly- chromatic blocks (e.g. IPS Empress CAD Multi, Ivoclar Vivadent) or by shading and staining monochroma- tic lithium disilicate blocks (e.g. IPS e.max CAD, Ivoclar Vivadent). All this can be carried out by the dentist chairside. If the adjacent teeth show visible internal structures like mamelons, dentists need the support of dental lab technicians to optimise aesthetics—this represents the aes- thetic limitation of chairside CAD/ CAM. Have restorations become more complex with chairside CAD/CAM? On the one hand, yes, the procedure has become somewhat more complex because the dentist is also responsible for the design, milling and surface finishing of the restoration. On the other hand, impressions and tempo- raries are no longer necessary, which makes restoration easier for both the dentist and the patient. What are the critical factors for achieving successful long-term clini- cal outcomes? In addition to the factors described above, cementation, particularly for glass-based ceramic restorations, is a clinical step of paramount importan- ce for long-term clinical success, sin- ce it is directly linked to the aesthetic outcome and the fracture strength of the final restoration. Which ceramics have to be bonded? Which ceramics can be cemented conventionally? How does one prevent post-operative sensitivity after cementation? All these questions will be answered in detail during the lecture. Many speak of CAD/CAM technolo- gies as the next revolution in denti- stry. Do you agree? I would say that the revolution will continue. I am still fascinated by the materials and the manufacturing process. All-ceramic restorations are not only aesthetically pleasing but also minimally invasive. Therefore, patients benefit not only from better looking teeth, but also from the fact that much less natural tooth substan- ce has to be removed compared with traditional restorative techniques and materials. The next few years will show what CAD/CAM manufacturers have kept in reserve, both chairside and labside. Materials manufacturers like Ivoclar Vivadent will continue to develop highly aesthetic and user-friendly all-ceramic systems that aim to fur- ther reduce the minimum material thickness—requiring even less inva- sive tooth preparations—to the bene- fit of the patient. Thank you very much for this inter- view.DT “...cementation is a very important factor and still underestimated by many dentists.” Dr Michael Dieter Christian organisation in the Philippines breaks dental world record Daniel Zimmermann DTI MANILA, the Philippines: Recen- tly, a medical and dental mission organised by the Church of Christ in Manila in the Philippines broke the world record for the most people involved in a dental health check. Over 4,100 people were examined within eight hours by the mission in the Philippines’ capital in the second weekend of July, according to Guin- ness World Records in London. The previous record was 3,377 people, checked during an oral health event organised by the Indian Dental Association and Wrigley in Mumbai in October 2009. With 66,322 people checked, India still holds the world record for the most people involved in a dental examina- tion in multiple locations since No- vember 2010. Guinness currently recognises a couple of dental records, including the longest tooth extracted and the oldest person to have received dental implants. In addition to the most dental checks performed on one day, the Manila mission also broke two other records in the most blood pressure readings and blood glucose level tests categories. According to Guinness representative Tarika Vara, it was the first time that three records were broken simultaneously. She remarked that the standard of the health checks was very high and of great benefit to all those involved. Over 1,000 medical and dental pro- fessionals are reported to have taken part in the event, which saw overall attendance by 100,000 people. The mission also provided medication, minor surgical treatment and relief food packs.DT Trends & Applications