issn 1616-7390 • Vol. 13 • Issue 1/2022 1/22 international magazine of dental laboratories technique Surface texture: Using horizontal and vertical lines to simulate natural tooth appearance industry news CEREC advances the restorative capabilities case report Production of complete maxillary and mandibular dentures using CAD/CAM technology

editorial | Magda Wojtkiewicz Managing Editor Preparing for a challenge What do implementing new technologies in your of- fi ce, meetings, running marathons, diffi cult patients and mothers-in-law have in common? They are challenges. A challenge is a situation or circumstance that could potentially trigger a negative emotional reaction in you. Challenges can be large or small, and they can vary greatly. We all have challenges, but they are very differ- ent and what might be a challenge for one person is not for another. Even if it sounds trivial, understanding what the challenge means to you is essential in order to prepare for it and set yourself up for success. Going digital by implementing technologies like CAD/CAM in the dental offi ce and laboratory is defi nitely a challenge. Transformation is always a challenge, often a major one, but it can be predictable, and you can prepare yourself and your team for this change. Most modern dental laboratories started as conventional dental laboratories and had operated with traditional workfl ows for many years before they started to use all the newest technologies, adopting these step by step. That might be your path too; you just need to be pre- pared for it. Preparation is a key to success, and some common stress management techniques can be very helpful here. Start by envisioning the challenge and developing a plan for how you might meet it. Then put the challenge into perspective and assess the risk. Ask yourself how you would feel about the challenge in an ideal world. Maybe you want to feel confi dent, content, engaged or some other positive emotion. No one wants to feel uncer- tain, angry or upset. Then practise feeling positively about the challenge. It might sound unnecessary but feeling positive is a skill that must be practised. Every time you begin to feel anxious about the challenge or start having doubts, you should stop and go back to the positive emo- tions you identifi ed fi rst. Negative feelings can ruin even the best prepared plan. As soon as you feel confi dent about the challenge, you can start the transformation. Digital technology is the signature of a brand-new ap- proach and often brings new opportunities. Digitalisation may also involve surprises and U-turns, but even if you can’t predict these entirely, you can be prepared for them. Therefore, don’t under-estimate the power of prepa- ration. Preparing for a challenge will save you a great deal of energy, might also save you money and more likely will turn the challenge into a success. What is your challenge? Are you going to respond reac- tively, or are you going to meet it proactively by preparation to shape its outcome? Enjoy this issue of CAD/CAM, which contains many well-documented and clearly illustrated clinical articles, as well as a great deal of useful information about the latest developments in the fi eld of digital dentistry. Sincerely, Magda Wojtkiewicz Managing Editor CAD/CAM 1 2022 03

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news | huge consequences for the rest of the body. It is our duty to arrest disease and prevent problems from happening. What other aspects of dentistry do you think will change or evolve in the future? I think that we are going to see a huge digitalisation of dentistry in the next ten years, similar to the rest of health- care. Many dentists already follow a digital workfl ow to allow for seamless communication with laboratory technicians through intra-oral scanning and CAD/CAM restorations. I think this is just the beginning. There is already so much research going into incorporating artifi cial intelligence and image recognition to help us diagnose and monitor dental and systemic diseases. I think this soon won’t be a thing of the future, but very much something we use to help us every day. I also think, and hope, that dental professionals will become more aware of how important saliva is and how much infor- mation it can give us not only of a patient’s dental health but also of their systemic health. I envisage that patients will start going to their dentist for saliva tests in the same way that they go to their doctor now for blood tests. We are already quite used to using the mouth as a site for testing, thanks to COVID-19, and I think this will become more common in the dental practice. We are now starting to understand that saliva can give a snapshot of the oral microbiome, be used for genetic testing and indicate enzyme levels, collagen breakdown, infl ammatory markers and even cancer markers. By diagnosing and monitoring dental diseases in a quantita- tive way, we will hopefully start to achieve better long-term outcomes for our patients. Unfortunately, we usually diag- nose dental disease when it is too late and destruction has already occurred—be it periodontal disease or dental caries. If we were able to screen patients for early signs of infl am- mation, microbiome dysbiosis, high levels of certain enzyme activity or collagen breakdown, we would hopefully be able to prevent the disease from happening. In your opinion, what can dental teams do to make sure they are prepared to adapt to changes in dentistry? They need to be open to change. Dentistry can be ex- tremely habitual and dental professionals often stick to what they are used to. When we have the health of our patients in our hands, it can be very daunting to try new things out, particularly when you think your own method already works. Whereas I don’t think we should be experimenting on our patients, we should, however, be open to trying new things to enhance our patient’s journeys and improve their treatment outcomes. For example, we use bleeding on probing as a diagnostic tool to diagnose infl ammation of the gums. This can be subjective and also inconclusive. If we were able to quantitatively diagnose infl ammation through looking at infl ammatory markers or looking for pathogenic bacteria in the mouth, our patients’ treatment outcomes would be improved since we would have a number to work with and a cause of the infl ammation to eradicate. We aren’t trying to reinvent the wheel, just make it better and more accurate! I also strongly recommend that dental professionals up- date their knowledge through regular reading of research papers and attending conferences. Our industry can be quite lonely, and it is important to keep your fi nger on the pulse by staying updated. What are you looking forward the most about the round-table discussion of GBT Summit—Virtual Edition? I am truly excited about having the opportunity to speak to like-minded professionals of such a high calibre on the future of dentistry. We are all practising dental professionals from different countries who will be able to share how we do things and what we expect the future to be like. We also all do very different things in practice but share a similar mindset. I am excited about being able to learn more about what they do and where they see dentistry going in the next fi ve years. I usually lecture alone so I am also looking forward to having fun and interactive discussions! Editorial note: At this year’s GBT Summit—Virtual Edition, Dr Sampson participated in a round-table conversation with Dr Steffen Rieger and dental hygienist Thuy Vu on the future of dentistry. The webinars of the GBT Summit are still available on demand at: https://www.swissdentalacademyonline.com/ webinar/gbt-live-treatment-learn-the-technique-in-detail Dr Victoria Sampson “Many dentists already follow a digital workfl ow to allow for seamless a digital workfl ow to allow for seamless communication with laboratory technicians through intra-oral scanning technicians through intra-oral scanning and CAD/CAM restorations.” CAD/CAM 1 2022 07

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interview | 2 Fig. 2: Dr Anthony Mak (left) and Dr Javier Tapia from Spain working on the case together. What did you enjoy most about the contest? I most enjoyed having the opportunity to connect with my patients more in-depth. When I was interviewing my patients, hearing their testimonials and checking whether their cases met the criteria for the competition, I found out exactly how the treatment had had an emotional impact on each patient’s life. It was a really meaningful and gratifying experience. Besides the prize, what did you obtain from your participation? It really gave me the confidence to share realistic cases with my patients who were considering this form of treat- ment. It helped them become aware that they were going to go through a life-changing journey. For the upcoming 2022 contest you will be a part of the jury. How does that make you feel? 3 Fig. 3: The patient looking at her final prosthesis immediately after the insertion. CAD/CAM 1 2022 11

case report | 7 8 9 (4) performing an immediate loading procedure. This clinical outcome was achieved in a single day with no complications. The patient was highly satisfied with the positive impact the treatment had on her quality of life owing to significantly improved aesthetics and recovery of masticatory function. mental stage in treatment planning to ensure that the patient’s needs and wishes are met and to achieve a successful outcome. The treatment workflow included the immediate placement of implants into the extraction sockets and immediate loading using computer-guided surgery and a flapless approach. Initial situation A systemically healthy 58-year-old female patient pre- sented to our office with the chief complaint of aesthetic dissatisfaction and impaired masticatory function caused by an unstable removable partial denture (Fig. 1). The initial comprehensive clinical evaluation revealed partial edentu- lism; a deep overbite, the mandibular incisors impinging upon the palatal gingiva; and increased overjet. The max- illary incisors were buccally tilted and presented tooth wear and mobility. Moreover, there was interference be- tween the lower lip and the anterior teeth in the smile position (Figs. 2–5). Intra-oral periapical radiographs showed approximately 50–75% alveolar bone loss (Fig. 6). In addition, the patient had an uneven smile line (Fig. 7). Treatment planning The benefits, risks and alternative treatment options were discussed with the patient and a decision was then reached in partnership with the patient. This is a funda- A suitable new removable partial denture was planned as a starting point. On the basis of the clinical documen- tation, a digital smile design preview was created. The dental technician then made a wax-up of the anterior teeth and a model of the posterior area of the future den- ture. This new set-up increased the vertical dimension to define an optimal vertical position for the anterior teeth (Figs. 8 & 9). The next step was to transfer this data to the patient’s mouth to verify its accuracy. Using a silicone mask created based on the wax-up and filled with flowable composite, a mock-up of the anterior teeth was made (Fig. 10). A model of the posterior teeth was added to the mock-up to complete the previsualisation of the proposed new smile (Fig. 11). The already created digital smile design drove the pro- posed shape and position of the teeth (Fig.12) In addition, the deep bite and the overjet were corrected, and the smile was improved. This prosthetic plan was discussed with the patient and then approved (Figs. 13–15). 10 13 11 14 12 15 CAD/CAM 1 2022 15

28 31 34 37 40 43 46 29 32 35 38 41 44 47 case report | CAD/CAM 1 2022 17 30 33 36 39 42 45 48

case report | 69 70a 70b Once obtained, the temporary prosthesis was seated and adapted on the master model with implant ana- logues and the corresponding screw-retained abutments (Fig. 34). In the final step, the occlusion was carefully adjusted (Fig. 35). Surgical procedure In the first phase, the hopeless teeth located in the planned implant sites were strategically extracted (Fig. 36) and the soft tissue removed with a punch for a flapless approach (Fig. 37). The remaining teeth were used to stabilise the guide with the aid of surgical pins as an- chorage (Fig. 38). After the optimal stabilisation of the guide, the implants were placed (Fig. 39) using the dedicated surgical kit, and the screw-retained abutments were placed on the implants (Fig. 40). The remaining teeth on the arch were then extracted and temporary abutments were placed on the screw-retained abutments (Fig. 41). The temporary prosthesis was screwed on to the copings and bonded with flowable resin (Fig. 42). Once the occlusion had been adjusted, the chimneys were filled with PTFE and covered with temporary composite. The patient was very satisfied with the functional and aesthetic outcome (Fig. 43). Radiographs were taken at the one-month follow-up visit (Fig. 44). Prosthetic procedure At the three-month follow-up visit, the patient reported no mechanical or biological complications. Moreover, the clinical examination showed uneventful healing and complete soft-tissue maturation (Figs. 45–48). At this point, the treatment already met the patient’s expectations, providing the desired aesthetic and functional clinical outcomes. To prepare the final restoration, the temporary prosthe- sis was removed, and the soft tissue was evaluated (Fig. 49). An optical impression with the Virtuo Vivo intra-oral scanner (Straumann) was taken, and a digital model was obtained and guided into occlusion with the maxilla (Figs. 50–52). The initial dental set-up (repre- sented in blue in Fig. 53) was then matched with the digital model, and minor adjustments were made (shown in white in Fig. 54). Before milling the zirconia framework, it is important to ensure optimal dental alignment. Therefore, a test drive was performed using a roughly milled resin prosthesis with the exact shape of the designed restoration that was then checked in the patient’s mouth (Figs. 55–57). The overall aesthetic outcome, smile line, emergence profiles of the teeth, lip support and occlusion were carefully verified. The zirconia prosthesis was then cre- ated accordingly (Figs. 58–62). For this, a full-contour zirconia prosthesis was milled, on to which Variobase copings (Straumann) were cemented (Fig. 63). The model was slightly adjusted and refined before delivery (Fig. 64). Treatment outcomes Finally, the prosthesis was screwed into the patient’s mouth. The treatment outcome fulfilled the patient’s aesthetic expectations in terms of natural appear- ance, harmony and beauty. Furthermore, she reported an improvement in her quality of life owing to the recovery of her masticatory function and self-esteem (Figs. 65–70). Acknowledgement A special thanks to DT Alessandro Giacometti, Genova, Italy, for his great lab work. about Dr Sergio Piano graduated with a DMD from the University of Genoa in Italy. He is director of his own private dental clinic in Genoa. He has lectured in more than 30 countries and written several scientific papers in the fields of implantology and aesthetics. Dr Piano is an active member of the Italian Academy of Osseointegration and Italian Academy of Esthetic Dentistry and an affiliate member of the European Academy of Esthetic Dentistry, as well as an International Team for Implantology fellow and Education Delegate of the Italian section’s leadership team. CAD/CAM 1 2022 19

case report | concerned, evolving from a predominantly manual into a predominantly digital task.4 The following case report describes the use of the CediTEC system (VOCO), which allows production of complete dentures in just a few appointments. Case description A 62-year-old female patient presented at our practice of her own volition, complaining of serious difficulties when chewing and speaking as a result of poorly fitting maxillary and mandibular dentures. From an aesthetic perspective, the patient also complained that her old dentures bothered her every day and confirmed that she was no longer happy with them at all. When asked about her medical history, she stated that she was undergoing treatment with bisphosphonates for diagnosed osteoporosis. Many years ago, the patient had also had five implants inserted into her lower jaw and two into her upper jaw, to which the existing removable dentures from her former dentist were attached. The patient’s request was for accurately fitting dentures again to improve both her appearance and her ability to chew and speak properly. Findings 5 Fig. 5: Digital maxillomandibular relationship registration and axiography. illary and mandibular dentures to be produced were designed using CAD/CAM technology. To do so, we decided for the sake of simplicity on the CediTEC system, in which all the necessary components are coordinated. The clinical, instrumental and radiographic findings re- vealed generalised horizontal and vertical bone loss in the edentulous regions. The mucous membranes did not appear to be irritated. The implant abutments, which had clearly been individualised multiple times, were inadequate for support of the removable dentures. All the implants displayed a degree of loosening and the peri-implant tissue appeared both slightly red and swollen. We found that the complete maxillary and mandibular dentures were inadequate and diagnosed peri-implantitis around all the implants. 6 Treatment planning The prognosis for the implants was not predictable at the time the findings were recorded, for which reason the implants were initially left as they were (Figs. 1 & 2). The treatment of the peri-implantitis would be initiated after production of the new complete maxillary and mandibular dentures. With special consideration of the patient’s existing condition and medication, replacement of the implants in the upper jaw with zygomatic and pterygoid implants at a later point in time might also have been conceivable. However, this will not be discussed in further detail at this point. 7 8 The patient requested that the functional impairments and aesthetic aspects be resolved as quickly as pos- sible. For cost and time reasons, the complete max- Fig. 6: Visualisation of digital maxillomandibular relationship registration. Figs. 7 & 8: Import into the exocad software after scanning of the individual impressions and dentures using the laboratory scanner. CAD/CAM 1 2022 21

case report | 12 13 Fig. 12: Modified wax try-ins (V-Print Try-In). Fig. 13: Try-in of modified wax try-ins. Another advantage is the uncomplicated and arbitrary reproducibility of the procedure thanks to the data being clinically generated initially and then subsequently digital- ised and stored.8 This allows the repeated production of further, identical dentures on the one hand and the export of the data sets to other software programs, for example for the planning of subsequent implant treatment as in this case, on the other. 14a 14b 15a 15b Figs. 14a & b: Printing of the denture base for the mandible (SolFlex 170 HD & V-Print dentbase). Figs. 15a & b: Printing of the denture base for the maxilla (SolFlex 170 HD & V-Print dentbase). CAD/CAM 1 2022 23

case report | 22 24 23 25 Fig. 22: Individualised, digitally produced complete maxillary and mandibular dentures in their finished state on the 3D-printed master models in the articulator (CediTEC). Fig. 23: Individualised, digitally produced complete maxillary and mandibular dentures in situ (CediTEC). Fig. 24: Individualised, digitally produced complete maxillary and mandibular dentures in situ, en face view, habitual bite (CediTEC). Fig. 25: Individualised, digitally produced complete maxillary and mandibular dentures in situ, smiling (CediTEC). bases. Using both additive and subtractive processes makes it possible to avoid dimensional changes resulting from polymerisation shrinkage. The reproducibility of the dentures for future replacements as mentioned is an- other advantage, as the digital data sets are available at all times and any location. The CediTEC system pre- sented here represents a consistent process for both dental practice and dental laboratory. CediTEC stands for CAD/CAM-enabled denture individual TEChnique. In this case, CediTEC DT (“DT” stands for “denture teeth”) was used in the scope of the milling technique for the computer-assisted production of the denture teeth. CediTEC DT is a special composite developed specifi- cally for CAD/CAM technology and available in four shades. In the case described here, the denture bases were produced using additive process technology with the aid of a 3D printer and the printing resin V-Print dentbase. The denture bases could alternatively have been manufactured subtractively, in which case they would have been milled from a PMMA disc (CediTEC DB). CediTEC DB is available in three different shades. Both CediTEC DB and CediTEC DT can be subsequently fur- ther customised in the scope of aesthetic dentistry with composite stains. Conclusion dentures so perfect in every way were possible in so few and such short appointments at that. In our opinion, nothing has changed in terms of the fundamental principles of the production of complete dentures, even when new and state-of-the-art CAD/CAM systems are utilised. Corresponding expertise in dentistry and dental technology remains the basis for time- and cost-effective treatment with digitally produced den- tures. Even in the future, handy software and hardware components will not be able to completely replace the expertise of dentists and dental technicians. Never- theless, applications in dental practices and dental laboratories will be joined by further new working steps in the interest of the digitalisation of clinical, patient-specific data and virtual planning of dentures. Editorial note: A list of references is available from the editor. contact Drs Francesco Zingari & Eleonora Carozzi Clinica Briantea Odontostomatologica Via Trento 41 20847 Albiate MB Italy The patient was very satisfied with both the aesthetic and the functional results. In addition, she was surprised that https://clinicabriantea.it/lo-studio/ CAD/CAM 1 2022 25

case report | patient came to the office for his annual check-up, and during initial examination, we discussed his problem of sleep apnoea and the fact that he felt uncomfort- able with his occlusion. The patient told us he did not suffer from muscle spasms nor from articular pain, but experienced increasing discomfort during mastication and difficulty placing his mandible cor- rectly. The extra-oral examination revealed a largely reduced lower face area. We noted the presence of a crown on tooth #46 and amalgam restorations on the molars. Initial evaluation revealed occlusal problems causing discomfort during mastication (Figs. 1 & 2). The crown would have to be removed, the root extracted and an implant placed. Based on the diagnosis, it was judged that treatment with KATANA AVENCIA Block would be within the scope of its indication, since the occlusal problem was a minor issue. Treatment plan The goals of the treatment were: – to use a biological and minimally invasive approach to the teeth (non-invasive), periodontium and occlusion (muscular and articular); – to maintain health in the long term (ease of hygiene); and – to re-establish effective function (mastication) without compromising aesthetics. To create the treatment plan, we always follow the same steps: – discussion with the patient to identify his or her wishes and limitations in terms of treatment; – occlusal planning and establishing of the appro- priate mandibular position in order to determine the quantity of destroyed dental tissue (done using a TENS machine); – periodontic diagnosis and support teeth. Treatment procedure We proceeded in the following manner for the treat- ment: – cleaning of all teeth; – creation of complete in-mouth mock-up for the mandibular arch; – leaving of the mock-up in the mouth in order to vali- date the new occlusion; – use of CAD/CAM technology to create the definitive prostheses, integrating the concept of minimally invasive dentistry—we used KATANA AVENCIA Block as the material for the overlays. 6 7 8 The mock-up was milled (Roland DG) in PMMA. Once the mock-up had been placed in the mouth, it was nec- essary to test the new occlusion and adjust if needed (Figs. 3 & 4). Tooth preparation was performed through the mock-up to be as minimally invasive as possible. The thickness was 1.5 mm for the occlusal and 1.0 mm for the buccal surface (Fig. 5). The overlays and crown on the implant were designed using 3Shape software and milled (Roland DG). The definitive restorations were created using two digital impressions. On the impression taking of the prepa- rations, the cervical limits were marked (Fig. 6). Next, CAD/CAM 1 2022 27

case report | 17 19 18 20 the software matched the two impressions by sub- traction and proposed the shape of the restorations to be milled (Fig. 7). These restorations are the exact copy (morphology) of what the patient wore in his mouth for two months. If the work is done by section, it is easier for the computer to match the impressions (Fig. 8). During the next step, KATANA AVENCIA Block was milled (Fig. 9) and then polished with CLEARFIL TWIST DIA (Kuraray Noritake Dental; Fig. 10). After that, the restorations were stained using a 3D-staining technique (Fig. 11). 3D staining involves a specific sequence in which 3D optical illusions are created. Staining gives excellent results (Fig. 12). Afterwards, the surfaces were rinsed and dried, and the adhesive PANAVIA V5 Tooth Primer was applied, left on for 20 seconds and then dried. The restorations were bonded one by one with PANAVIA V5 Paste. The excess was removed and the final photopolymerisation using glycerine was per- formed (Fig. 16). The restorations were then polished using CLEARFIL TWIST DIA (Figs. 17 & 18). The occlusion was verified in static position with cusp– fossa contact, then laterality, propulsion and finally mastication. To conclude, the definitive restorations showed good aesthetic integration (Figs. 19 & 20). As always, long-term follow-up was necessary to confirm the success of the treatment. A classic bonding procedure was followed using PANAVIA V5 (Kuraray Noritake Dental; Fig. 13). To begin, all KATANA AVENCIA Block restorations were tried in one by one for validation and adjustment and then all together to check the contact points. about A dental dam was placed on the mandible. The intra- doses of the restorations were blasted with alumina power and then K-ETCHANT GEL (Kuraray Noritake Dental) was applied and they were rinsed well and dried. A layer of silane (CLEARFIL CERAMIC PRIMER PLUS, Kuraray Noritake Dental) was applied for 60 sec- onds and then dried (Fig. 14). K-ETCHANT GEL was then applied for 30 seconds to the enamel (Fig. 15). Dr Cyril Gaillard is a dental surgeon and CEO of GAD Center, a private dental practice in Bordeaux in France. CAD/CAM 1 2022 29

technique | 6 7 8 9 10 11 12 Fig. 6: With long and close vertical lines, the tooth appears longer. Fig. 7: Distant vertical lines create a balanced expansion of the configuration of the tooth. Fig. 8: The horizontal lines make the tooth appear wider, and there is a progressive expansion of the shape connected to the length of the lines and the distance between them. Fig. 9: The oblique lines can change the directions of the texture, lending a narrow perspective to the tooth shape. Fig. 10: Combination of vertical and oblique lines: their different positions and design direction change the visual illusion. Fig. 11: Rounding the right lobe of the tooth by marking the texture surface with curved lines that become smaller towards the cervical third of the tooth. Fig. 12: Marked wavy vertical lines and small oblique segments of different directions create a detailed surface on the facial lobes. From the incisal edge towards the middle third of the tooth, the contrast between the rising and falling marks. This demonstrates the importance of the manner in which the texture is performed and this feature manually smoothed after glazing of the ceramic in order to obtain a suitable texture for the aesthetic restoration to be performed. Texture can be created with thicker and more subtle marks: the combination of these thicknesses allows for a variable texture result on the entire surface of the tooth (Figs. 3–5). 13 17 14 15 16 18 19 Fig. 13: Creation of vertical lines of different lengths. Fig. 14: Weaving horizontal lines. Fig. 15: Using an inverted cone to create texture differences. Fig. 16: Using a glass-paper cone to smooth the surface. Fig. 17: Using a sectioned rubber wheel to create an irregular smooth surface. Fig. 18: Polishing of the surface in order to obtain a better-quality texture. Figs. 19: Definitive restoration with all the texture details on the plaster model. CAD/CAM 1 2022 31

technique | 27 29 28 30 31a 31b Figs. 27 & 28: Internal texture. Fig. 29: Ceramic restorations finished with manual external texture creation procedures. Fig. 30: External texture with gold powder and surface details. Figs. 31a & b: Pre-op and post-op photographs of restorations #11 and 21. for the clinician to quickly find the correct position of the restoration in the mouth with no tilt (Figs. 24–26). Internal texture The internal texture is created after the first firing of the ceramic unit. The first step of this procedure is realised with a brush during the ceramic layering procedure. Several horizontal and vertical lines with some irregular areas are designed and created on the facial surface of the tooth. The ceramic unit at this point is ready for the first firing, and once the ceramic has been baked, other lines and superficial details are made using a bur to emphasise the quality of the internal texture. surface can determine different width details and appear- ance of tooth size. Both vertical and horizontal lines applied in combination will improve the appearance of the general tooth anatomy by creating a dynamic texture. Gold or the silver powder facilitates identification of natu- ral superficial characteristics and subsequent mimicking of the surface texture. The combination of internal and external surface texture design directly affects light reflection, refraction and transmission. Acknowledgements The author would like to thank Dr Domenico Massironi, Dr Alessandro Conti and Dr Erik Jan Muts for their clinical performance. Internal texture has an appearance different from that of external texture. The combination of these two different quality and design textures will allow dynamic refraction and reflection of light when it penetrates the ceramic ma- terial. This technique imparts a more natural appearance to the ceramic restoration (Figs. 27–31). about Discussion Surface texture can improve the appearance of general morphology through the orientation of its characteristics. Vertically and horizontally oriented lines applied to the Giuseppe Romeo is a master and clinical dental technician and practises at the Oral Design Center in Turin in Italy. He is also a clinical assistant professor in the Division of Restorative Sciences of the Herman Ostrow School of Dentistry of the University of Southern California in Los Angeles in the US. CAD/CAM 1 2022 33

case report | 3 4 Fig. 3: CBCT scan after the trauma. Fig. 4: Emergence solution. The use of a collagen matrix, as highlighted in the follow- ing clinical case, can be a valid alternative to the present gold standard approach. sustained slight damage to the incisal edge (Figs. 2a & b). The CBCT scan showed a fracture in both buccal bone plates in relation to the two maxillary central incisors (Fig. 3). Case presentation After an anterior trauma, a 24-year-old gummy smile patient lost tooth #21. Tooth #11 was palatally dislocated, and tooth #12 Immediate therapy Because I saw the patient for the first time three days af- ter the trauma, it was not possible to reimplant tooth #21. In order to support the soft tissue of this area (papillae 5 6a 6b 6d 6c 6e Fig. 5: Digital Smile Design. Fig. 6a: Initial STL model scanned. Fig. 6b: Smile Creator (exocad). Fig. 6c: Digital wax-up. Fig. 6d: STL model with the new morphology. Fig. 6e: Prototyped model and silicone index. CAD/CAM 1 2022 37

case report | 9a 9c 9b 9d Fig. 9a: Etching of the anterior teeth. Fig. 9b: Definitive bonding of the mock-up. Fig. 9c: Initial scan and use of the CEREC software to create the first provisional crown. Fig. 9d: Digital project of tooth #21. ality (Fig. 7), it was possible to define a four-step definitive treatment plan lasting eight months (Fig. 8). phase is to create a provisional restoration to condition the soft tissue while holding the biomaterial in the socket. The work process Step 1 Five days after the trauma, the goal was to regenerate the bone volume in area #21. The key to success in this It should be emphasised that the immediate insertion of an implant at this stage in this specific case was not possible, as it would not have allowed optimal primary stability. To obtain the provisional crown, following a dig- ital path, I proceeded as follows: 10a 10c 10b 10d Fig. 10a: Aesthetic result of the first step. Fig. 10b: Bone regeneration. Fig. 10c: CBCT scan after five months. Fig. 10d: Preliminary soft-tissue conditioning. CAD/CAM 1 2022 39

case report | graft in the following months, keeping the papillae stable. After five months, I obtained the necessary bone volume to be able to place an implant in the anterior edentulous area (Figs. 10a–d). Step 2 The objective of this second step was to insert an im- plant in the regenerated bone ridge and to restore the volume of the keratinised gingival tissue in the vestibular area around it and thus recreate an adequate vestibular gingival profile in harmony with the gingival profile of the adjacent teeth. Even at this stage, the aim was to create a second provisional crown with an appropriate emer- gence profile in order to further stabilise the soft tissue by conditioning it completely. I performed the following procedures: 1. Taking of a digital impression with an intra-oral scan- ner. The most important aspect during this first scan was the creation of the gingival mask, which entailed copying the previously conditioned soft tissue. This scan would guide us during the design phase of the emergence pro- file of the provisional crown. A proper emergence profile was certainly the key to success, and it would allow us to achieve, in a predictable way, correct conditioning of the tissue around the cervical third of the crown screwed into the implant. The maxillary master model would then be digitally cut in the centre of area #21 using a cutter tool (Fig. 11). 2. Design of the flap. The incision did not involve the cor- onal part of the papillae, as an incision of the bone peaks would inevitably have led to the loss of 1.0–1.5 mm of bone 15 16b 16d 16a 16c 17 Fig. 15: Suture. Fig. 16a: Digital planning of the second provisional crown screwed into the implant. Baseline (left), copy line (middle) and crown (right). Fig. 16b: Crown milled in PMMA. Fig. 16c: The second provisional crown screwed in. Fig. 16d: Healing at three months. Fig. 17: Soft-tissue appearance after removal of the provisional crown. CAD/CAM 1 2022 41

case report | Step 3 In this final phase, the case was prosthetically finalised following a chairside digital method. The key to this step is the biogeneric copy function that the prosthetic soft- ware makes available and through which it is possible to copy the morphology of the previously bonded mock-up and of the provisional crown screwed into the implant. With this approach, we share with the design software the shapes previously tested in order to create the defin- itive prosthetic restoration. it is possible to see that the gingival profiles were perfectly harmonious and natural thanks to the provisional crown. At this point, I performed the biogeneric copy of the anterior teeth, and after having unscrewed the provisional crown from the implant, I scanned the position of the papillae and gingival margin with an intra-oral scanner. And so doing, I created the gingival mask, at the same time, sharing the morphological information of the soft tissue with the CEREC design software which would go to creating the definitive prosthetic devices (Figs. 18a & b). 1. Creation of the gingival mask and biogeneric copy of the anterior teeth. Proper implant osseointegration was obtained after three months, and the conditioning of the soft tissue appeared to be optimal both in terms of tissue quality and in terms of reconstructed volume. In Figure 17, 2. Preparation of the anterior teeth. In the treatment plan, I had planned to create five veneers from tooth #13 to tooth #23, with the exception of area #21, for which I had planned to make a crown to be screwed into the implant (Fig. 19). 21a 21c 21e 21b 21d 22 Fig. 21a: Gingival mask and emergence profile crown on implant #21 definition. Fig. 21b: Drawing of the baseline, highlighting the finishing line preparation. Fig. 21c: Drawing of the copy line. Fig. 21d: Automatic project of the definitive restorations by the CEREC software. Fig. 21e: Morphological improvement with the digital tools. Fig. 22: Definitive prosthetic restorations milled. CAD/CAM 1 2022 43

case report | 24a 24c 24b 24d Fig. 24a: Definitive cementation. Fig. 24b: Try in paste. Fig. 24c: Preparation starting from the mock-up. Fig. 24d: Definitive restorations in the patient’s mouth. Another aspect to consider is the fact that the thinner areas, such as the cervical third, after adhesive cemen- tation, transfer the natural colour of the prepared tooth to the surface which, for example in this area of the thinnest enamel, is more chromatic. To remedy this, coloured cements are available on the market with which it is possible to modulate the final colour after cemen- tation (Fig. 23). 7. Adhesive cementation. This last step is very delicate, as if not managed properly, it could nullify the final re- sult from both an aesthetic and functional point of view. Avoiding going into details of the various phases that characterise this step, it is important to remember that the main aspects to be considered in order to obtain optimal stability of the prosthetic devices over time after their cementation are the following: 24e Fig. 24e: Impact of the new smile on the patient’s face. CAD/CAM 1 2022 45

REGISTER FOR FREE DT Study Club – e-learning community THE GLOBAL DENTAL CE COMMUNITY THE GLOBAL DENTAL CE COMMUNIT Y THE GLOBAL DENTAL CE COMMUNIT Y THE GLOBAL DENTAL CE COMMUNIT Y THE GLOBAL DENTAL CE COMMUNIT Y webinars / live operations / online CE events / CE credits www.dtstudyclub.com @DTStudyClub Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.

industry news | 2 Fig. 2: The fully crystallised lithium disilicate ceramic Initial LiSi Block is based on GC’s proprietary HDM technology, which has already proven itself in the Initial LiSi Press ceramic. (Image: © GC Europe) facturing process. In addition, a lithium aluminosilicate ceramic cannot be individualised by glaze firing in the furnace with conventional ceramics owing to the low coefficient of thermal expansion (CTE). In contrast, lithium disilicate ceramics, for example, can be characterised with ceramic-based paints. 3 Fig. 3: CAD/CAM-manufactured veneers made of lithium disilicate ceramic Initial LiSi Block (GC Europe). CAD/CAM 1 2022 49

interview | is not possible with the currently available materials. For example, the elasticity modulus of ceramic materials is too high and that of polymer-based materials too low. Compromises lead to other disadvantages. So, it’s always a balancing act. It is conceivable that thermoplastics will gain a higher pri- ority in the future, but currently, the aesthetic properties are limited. As far as aesthetics are concerned, ceramic materials are convincing and will remain so for years to come. If these ceramic materials could then be imple- mented in the 3D-printing process at some point, we would work much more economically in terms of material consumption and quick achievement of long-lasting restorations. The printing of dental ceramics is certainly not foreseeable in the near future in prosthetic dentistry, but it is a very conceivable scenario. Editorial note: Prof. Bogna Stawarczyk studied dental technology at the Osnabrück University of Applied Sciences in Germany after completing her dental tech- nician training. She completed her bachelor thesis at the clinic for dental prosthetics at the University of Bern in Switzerland and later her MSc in dental technology at the University for Continuing Education Krems (formerly Danube University Krems) in Austria. She is the former head of materials science research of the clinic for fixed and removable prosthodontics and dental materials science at the University of Zurich in Switzerland. Prof. Stawarczyk completed her doctorate and her post- doctoral qualification (Habilitation) at LMU Munich, where she was appointed head of materials science research in 2015 and extracurricular professor in 2020. She is also the vice president of the European Association of Dental Technology and teaches materials science at several dental technology master schools. She has over 350 publications to her name. In addition to applied research related to tooth-coloured materials, she takes time to continue researching the optimisation and new development of innovative dental materials and their manufacturing technologies. about Annett Kieschnick trained as a dental technician and journalist. Today, she works as a freelance copywriter and journalist specialising in dental topics. Kieschnick lives in Berlin in Germany. AD

industry news | 3 Fig. 3: Prof. Werner H. Mörmann (left) developed the CEREC system in the early 1980s together with electrical engineer and close friend, Dr Marco Brandestini. Prof. Mörmann: I had a technical solution in mind that would integrate data acquisition, design and form grind- ing into a small mobile unit. The solution needed a monitor and had to be a practical device that could be used chairside by the dentist. Dr Marco Brandestini, an electrical engineer and a good friend of mine, was also enthusiastic about the idea and saw it as a technical challenge for himself. Our first functional model of a form grinding machine actually self-destructed when the grinder sank into the ceramic! The solution was to use cylindrical plunge grinding along the mesiodistal inlay axis with a diamond-coated grinding wheel and a water turbine as the drive. This worked quickly at the chairside, but the occlusal surface was flat and dentists had to shape the fissures and cusps manu- ally by themselves after bonding. I am extremely pleased that inlays made in this way still work after 25 years or more. This solution—together with many clinical studies—confirmed that the clinical concept was viable. The full story of the technical and clinical emergence of the CEREC method is rather long, but those who are interested can download it free of charge from moermanncerecstory.com, in English or German. Dr Stähler, as CTO at Dentsply Sirona you are well versed in all matters relating to CEREC. How import- ant has the system become for the company? Dr Stähler: Dentsply Sirona and CEREC have been in- separably linked for many years. In 1985, when CEREC was launched, digitalisation in dentistry was still in its infancy, and scepticism and reservations about it were prevalent. As a company, however, Dentsply Sirona always believed in this idea and demonstrated its perseverance from the very beginning. Engineers from our company were in constant exchange with Prof. Mörmann and Dr Brandestini, and with CEREC users. Together, the parties continued to develop the system and to set new standards in digital dentistry. Today, the system is mature, and the quality of the clini- cal results are unquestionable. CEREC has had a huge impact on us as a company and continues to do so. Digital is now part of our DNA: we think, we act, and we live digitally. How would you describe the current significance of CEREC in dentistry? Dr Stähler: CEREC, as a system, is a fixed force in the market. The all-new CEREC includes Primescan and the CEREC Primemill, and it is now easier for an even wider circle of practitioners to decide how this modern digital technology can be used quickly and economically in individual dental practices. The individual components of CEREC, including the scan, the software, the milling and grinding machine and the material block, are optimally coordinated to provide a seamless workflow. Digital chairside dentistry is now faster, easier and more reliable than ever before. It has reached a new level of quality, and this provides for a noticeably more comfortable treatment experience for the patient. The use of 3D scanners is increasing dramatically. Where does the Primescan fit into the CEREC system? Dr Stähler: We developed intra-oral scanning in the context of CEREC and, by doing so, established a market for the technology. Today, we see the use of intra-oral CAD/CAM 1 2022 53

industry news | Prof. Mörmann: Foremost are the expectations of the patient. Whether he or she needs the perfectly aesthetic blending in of a single anterior tooth or a full rehabilitation of the dentition, the patient wants to have the treatment done with efficiency and the results of the restoration need to be pleasing and clinically and aesthetically dura- ble. Upgrades have led to the perfection and expansion of the application of the CEREC method, and the system itself has also benefited from advancements in technol- ogy. These developments go hand in hand. For example, I expect that the large number of digital CEREC resto- ration designs worldwide could be analysed using artifi- cial intelligence in order to develop assistance systems that would further improve restorative work. Dr Stähler: I agree, and I would add that the driving force behind innovation is the sum of many factors. Dentists and dental technicians wish to treat and care for patients in the best possible way, and our goal is to support them. Our focus on digital technologies has made dental treat- ment more accurate and more pleasant for patients, and it has resulted in workflows in laboratories being safer, more cost-efficient and more predictable. Our success in developing solutions that meet the needs of dentists worldwide is the result of a competitive spirit and talented employees who are committed to product innovation and high-quality service and training. Improv- ing clinical outcomes, workflows and patient satisfaction is a driving force in our daily efforts, and we are continu- ally investigating ways in which we can redefine the limits of what is possible. As you see, it is not just about technology; it is also about attitudes and emotions. What do you think the future holds for digital den- tistry and how will CEREC compete with other advancements, such as 3D printing? Dr Stähler: Digital technologies will always offer benefits. Diagnostics and planning can be implemented in a time- saving manner, and the patient can find out very quickly which treatment options are available and what the results will be. The treatment itself is also faster. The keyword here is single-visit dentistry and, ultimately, this will lead to even greater cost-efficiency for dental practices. The CEREC pro- cedure, which includes digital impressions and chairside manufacturing of restorations, plays an important role in this. A 3D printer could be a useful addition to the portfolio for use in applications in which milling and grinding ma- chines do not always provide an optimum result—such as in the use of composites. I believe that 3D printing is ready to take centre stage; it is ready to become a part of the daily workflow for clinics and laboratories alike. So, watch this space! fectly in digital practices and laboratories. I am certain that 3D printing will be used alongside CEREC for a long time to come and that both technologies will have their specific use cases. Prof. Mörmann: Anyone who is involved with digital technology knows: never say never. Forty years ago, we would never have dreamed of all the things that are now possible with CEREC. In this respect, as we consider the future, all dental professionals can look forward to being part of a very exciting process of development. “Forty years ago, we would never have dreamed of all the things that are now possible with CEREC.” Finally, Prof. Mörmann, what gives you the most satisfaction as the inventor of CEREC? Prof. Mörmann: For me, it is the fact that the method, as it is today, is more fascinating than ever. It has increased the enjoyment of restoring teeth, be it with single inlays, onlays, overlays of any form and size, half and full crowns, endocrowns, veneers, anterior and posterior crowns, tabletops, implant crowns, quadrant treatments, three- and four-unit bridges or complex full-mouth rehabilitations. Restorations are automatically generated with individual biogeneric occlusal morphology using habitual bite or virtual functional registration. Drilling templates can be fabricated. To sum up, CEREC provides dentists with a vast choice of high-tech, highly aesthetic ceramic, hybrid ceramic and composite restorative block materials with suitable strength. Everything runs smoothly, quickly, easily and with high precision: the scanning, the restoration design and the machining. And the result is first fit, at the margins as well as at proximal and occlusal contacts. We are talking about a system that was launched in 1985. To me, this represents an awesome and truly fantastic success, and for this, I would like to thank the developers at Dentsply Sirona! It is wonderful to realise how many colleagues around the world are successfully using CEREC in their practices and providing patients with excellent clinical care. Without a doubt, at age 37, CEREC advances the restorative capabilities of dentists as never before. However, CEREC and 3D-printing technology are not mutually exclusive. They complement each other per- Editorial note: The name CEREC is derived from Chair- side Economical Restoration of Esthetic Ceramics and also from the initial letters of ceramic reconstruction. CAD/CAM 1 2022 55

interview | The handling is extremely simple and comfortable. SCANTIST 3D is applied evenly to the surface of the scan object at a distance of 5 to 10 cm. The spray cans are equipped with a special valve with a very fi ne nozzle. This makes handling easy and effi cient, as the spray is applied with pinpoint accuracy and precision. The coat- ing has a layer thickness of about 2 µm and adheres to all materials, even to very smooth surfaces. “SCANTIST 3D eliminates the fundamental application problems of conventional 3D scan sprays and thus greatly increases effi ciency and productivity within the digitising process.” SCANTIST 3D is the fi rst evaporating extra-oral 3D scan spray. Why is this a crucial advantage for dental laboratories? Conventional extra-oral 3D scan sprays are based on ground white colour pigments. The disadvantage is that the applied coating must be removed again after scanning. The cleaning process is very tedious, costly and time-consuming. Unlike conventional sprays, the coating of SCANTIST 3D VANISHING evaporates about 20 minutes after applica- tion. The spray does not contain pigments and thus avoids the pigment-contamination of sensitive areas, such as laboratories, equipment and users. You can even apply SCANTIST 3D VANISHING directly, on the spot, without taking any costly precautions to avoid pigment-contamination. Overall, SCANTIST 3D eliminates the fundamen- tal application problems of conventional 3D scan sprays and thus greatly increases effi ciency and productivity within the digi- tising process. This new scanning spray is free from titanium dioxide. Why is this important? In a scientifi c opinion issued on 14 Sep- tember 2017, the Committee for Risk Assessment of the European Chemicals Agency proposed the classifi cation of tita- nium dioxide as a Category 2 carcinogen Dental 3D scan sprays form a matt, white and homogeneous coating when applied. This reduces refl ections and other inhomogeneities and thus creates excellent scanning conditions. (Image: © SCANTIST 3D) by inhalation. Based on this opinion, titanium dioxide has now offi cially received its carcinogenicity classifi ca- tion according to the EU Classifi cation, Labelling and Packaging Regulation. The classifi cation as a carcino- gen by inhalation applies to mixtures in powder form containing 1% or more of titanium dioxide which is in the form of, or incorporated in, particles with an aerodynamic diameter ≤ 10 μm. This criterion is met by many of the sprays used for scan- ning containing titanium dioxide. Based on this drastic change, I expect that many dental laboratories will be looking for less harmful spray alternatives. Is the product globally available, and how can technicians order it? We are currently building our global reseller network and are therefore very happy about dealer inquiries. Dental technicians can contact their usual sources and den- tal retailers and make them aware of SCANTIST 3D. Editorial note: More information about SCANTIST 3D can be found online at www.scantist3D.com. New 3D scan spray developed for extra- oral CAD/CAM applications in dentistry. oral CAD/CAM applications in dentistry. (Image: © SCANTIST 3D) CAD/CAM 1 2022 57

industry news | hand, the greatest advancement is that AG.Live connects the growing global network of dental professionals who are operating digitally. This bridges the interdisciplinary gap between dentists and dental technicians and facil- itates future-oriented cooperation. Furthermore, within this network of optimised and new partnerships, partic- ipants can focus on their strengths and better position themselves on the market. Extending the digital Ceramill CAD/CAM workfl ow to the dentist The Ceramill DRS Connection Kit is the basic entry-level option, with which dentists and laboratories can al- ready take full advantage of digitisation. It consists of a Ceramill Map DRS intra-oral scanner, the associated scan software and the connection to AG.Live. Any order data, including all the required information, can therefore be shared with the laboratory seamlessly and in real time via AG.Live. This eliminates the need for handwritten job sheets and conventional impressions. All that is neces- sary is the physical delivery of the restoration to the den- tal practice, and this is possible on the same day in cases of simple restorations. Such timely delivery can lead to a better dental experience for the patient and could ulti- mately attract new patients to the practice and generate more orders for the laboratory. In an additional step—which can provide patients with their prostheses even faster—the system in the dental practice can be upgraded at any time with the Ceramill DRS Produc- tion Kit. This allows simple restorations to be fabricated in the practice and placed in the patient’s mouth in a single session. All Ceramill DRS Kits are currently available for pre- ordering within Germany, and the High-Speed Zirconia Kit is already available to laboratories. Early bird DRS users benefit from particularly close support from the DRS specialists at Amann Girrbach. For further information and to pre-order, visit www.ceramill-drs.com. Free online presentation about the innovative Ceramill DRS In this online presentation, Amann Girrbach explains why it places the dental laboratory at the centre of the prosthetic workflow and ensures the highest possible quality and patient satisfaction through close integration and digital exchange with the dentist. Even with the basic version, the Ceramill DRS Connection Kit and the link to the AG.Live digital platform, the practice and laboratory can connect in a unique manner and take full advantage of the bene- fits of digitisation. The presentation also explains interdis- ciplinary collaboration for restorations in a single session or on the same day, using the upgrades to the Ceramill DRS Production Kit and the DRS High-Speed Zirconia Kit. If the preferred material is zirconia, the High-Speed Zirconia Kit, consisting of Zolid DRS zirconia and a cor- responding Ceramill Therm DRS sintering furnace, can optimally support the laboratory in fabricating straight- forward zirconia restorations on the same day. The full presentation can be accessed, free of charge, in various languages from Amann Grirrbach website, https://academy.amanngirrbach.com/en/webinar/ceramilldrs- the-roi-of-digital-transformation/3606. The Ceramill Direct Restoration Solution enables dental practitioners and technicians to work as an interdisciplinary and future-oriented team and makes same-day prosthesis fabrication possible. 59

manufacturer news | 3Shape Dental System 2021.2 released For your laboratory, being a strong digital partner means more than designing great restorations. It is about customer service, transpar- ency and being there when your customers need you. your profile so clinics can find you in our Unite Store is as easy as it can be. You simply log on to Communicate and fill in the desired fields. The new 3Shape Dental System 2021.2 along with the recently launched 3Shape Unite platform for dental practices delivers a best- in-class workflow and transparent connection between your labora- tory and dental practices. It offers new communication and workflow tools that will allow you to provide not only terrific restorations but also first-class customer service. We have optimised the workflows and added exciting new tools like real-time communication with chat, an auto case status update timeline, and a do-it-yourself profile builder for your laboratory on the 3Shape Unite platform. Now you can market your laboratory directly to the over 30,000 dentists who will come to use the 3Shape Unite platform. You can enrich your Unite profile with a business logo, photos, videos and a detailed descrip- tion of your laboratory including the products and services you offer. By building your profile, you make your laboratory instantly search- able in the Unite Store. Clinics will now be able to find your laboratory with ease, and your presence on Unite ensures exceptionally easy communication for the design, production and order tracking of treat- ments. Receiving case files is no longer fragmented, and there is no longer any need to switch platforms for separate workflows. Building Another new functionality in the Dental System 2021.2 notifies you when practices request permission to connect with your laboratory. When you accept, all relevant practice details are automatically populated in your 3Shape Communicate. The new 3Shape Dental System 2021.2 is about much more than unleashing your laboratory’s creative potential with our industry- leading CAD design software. It allows you to provide first-class service as a strong and seamlessly connected digital laboratory partner. Dental System 2021.2 key features include: – increased productivity and aesthetics with improved implant bridge design; – options for complete and partial denture design using the same workflow and tools in order to boost productivity; – artificial intelligence technology to eliminate workflow steps like tooth segmentation and the preset of the occlusal plane; – pre-installed integration with 3Shape Automate, which facilitates uploading and downloading 3Shape Automate designs and making changes to them; and – significantly sharper imaging with the “enhance detail” setting in the E4 laboratory scanner. www.3shape.com CAD/CAM 1 2022 61

How to send us your work submission guidelines | Xxxxxx | m o c . k c o t s r e t t u h S / s l i e x p 2 3 © Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: · the complete article; · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much infor- mation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use under- lining. Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing programme you are using help you do this formatting au- tomatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word processing pro- gramme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail or share the files in our cloud storage (please contact us for the link). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Image requirements Abstracts Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your ar- ticle wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). · We require images in TIF or JPEG for- mat. · These images must be no smaller than Questions? 6 x 6 cm in size at 300 DPI. · These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com CAD/CAM 1 2022 65

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