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54 — issue 2016 Esthetic and Restorative Dentistry Article and restorative techniques that do not always offer predictable efficiency and quality. Based upon technology adopted from the aerospace, the automotive and even the watch-making industries, CAD/CAM is becoming widely accepted owing to its increased speed, accuracy and efficiency. Today’sCAD/CAMsystemsarebeingused todesignandmanufacturemetal,alumina and zirconia frameworks, as well as all-ce- ramic full-contour crowns, inlays and ve- neers that are stronger, fit better and are more esthetic than restorations fabri- cated using traditional methods. As den- tistry evolves in the digital world, the suc- cessful incorporation of computerization and new acquisition and manufacturing technologies will continue to provide more efficient methods of restoration fabrication and communication, while re- tainingtheindividualcreativityandartistry of the skilled dentist and technician. The utilization of these new technologies— alongwiththeevolutionfromhanddesign to digital design, with the addition of the latest developments in intra-oral laser scanning, materials, and computermilling and printing technology—will only en- hance the close cooperation and working relationship of the dentist–laboratory team. Morethan 20 different CAD/CAM sys- tems have been released as solutions for restorative dentistry. The introduction of digital laboratory laser-scanning technol- ogy, along with its accompanying soft- ware, has allowedthe dental laboratoryto create a digital dental environment to presentanaccurate3-Dvirtualmodelthat automaticallytakesintoconsiderationthe occlusal effect of the opposing and adja- cent dentition. With the model, the labo- ratory has the ability to design 32 individ- ual full-contour anatomically correct teeth at the same time.These systems es- sentially take a complex occlusal scheme and its parameters, condense the infor- mation and displayit in an intuitiveformat that allows dental professionals with basic knowledge of dental anatomy and occlu- sion to make modifications to the design, and then send it to the automated milling or printing unit. For the dental laboratory profession, the introduction of digital technology has effectively automated— and even eliminated—some of the more mechanical and labor-intensive proce- dures (waxing, investing, burnout, casting and/or pressing) involved in the conven- tional fabrication of a dental restoration, givingthedentistandtechniciantheability to create functional dental restorations with a consistent, precise method. “As dentistry evolves in the digital world, the successful incorporation of computeri- zation and new acquisition and manufacturing technol- ogies will continue to provide more efficient methods of restoration fabrication and communication.” Digital case Thepatientpresentedwithadesiretohave his anterior teeth restored and to have a more esthetic shape and color, while re- taining the natural color nuances of his posteriorteeth (Fig. 4). A comprehensive examination was performed to evaluate the patient’s periodontal and occlusal or functional needs, as well as his overall oral health. Despite extreme tooth discol- oration, the basic tooth structure was found to be satisfactory for restoration. After esthetic and functional evaluation, it was deemed necessary to use full- coveragepreparationsandrestorationsto restore both esthetics and anterior guid- ance andfunction. As with anyrestorative process that will change tooth shape, po- sition and function, a diagnostic workup (wax-up) was completed. After the pa- tient,dentistandtechnicianhadallagreed to the proposed changes, the clinical preparations were completed, and a copy of the wax-up was created forthe tempo- rary PMMA restorations forthe intra-oral evaluation. Once the provisional restora- tions had been approved, it became the technician’s responsibility to copy the temporary restorations in fabricating the finalIPSe.maxlithiumdisilicate(IvoclarVi- vadent) restorations (Figs. 5–23). Fig. 3 All-ceramic restorations showing three different types of fabrication meth- ods. Left: milled IPS e.max CAD restoration (Ivoclar Vivadent), with only enamel layering. Center: milled IPS Empress CAD Multi full-contour restoration (Ivoclar Vivadent), with surface stain and glaze. Right: zirconia coping, fully layered with several different dentin and enamel ceramics. Fig. 4 Patient’s pre-op condition, showing anterior wear and tooth discoloration. Fig.3 Fig.4 Article_McLaren_00-00.qxp_Layout 1 02.03.16 20:49 Seite 3 Article_McLaren_00-00.qxp_Layout 102.03.1620:49 Seite 3