issn 1616-7390 • Vol. 14 • Issue 2/2023 2/23 international magazine of dental laboratories industry news Post-COVID recovery fuels success of cost-conscious solutions interview Zero-bake technique: A simplifi ed approach to zirconia aesthetics case report Restoration of a fractured ceramic crown with a digital work ow

editorial | Magda Wojtkiewicz Managing Editor To mill or to print? That is the question The introduction of CAD/CAM milling and 3D-printing technologies to dentistry has signifi cantly reduced the possibility of inaccuracies in the fi tting of prosthetic resto- rations. These new technologies have gained the appreci- ation of dental professionals as well as patients, who have realised that they no longer have to tolerate the unpleasant aspects of conventional impression taking or attend several appointments for a restoration. Patients enjoy the benefi ts of receiving a permanent crown in a single visit and dental professionals the shorter, cleaner and more predictable work ow. Many dentists, laboratory owners, dental assis- tants and dental technicians agree that digital impressions and digital technologies for design and manufacture will soon replace conventional methods of fabricating den- tures, splints, bridges, crowns and even veneers. Increas- ingly, it is not just milling but also 3D-printing technology that is being used to produce CAD/CAM dental resto- rations. How does a laboratory or dentist know which is better: milling or 3D printing? The answer depends on what do you need the most—speed, exceptional accuracy and aesthetics, or lower costs? The fi rst aspect to consider is the material from which the fi nal restoration is to be made. Milling uses many different materials (e.g. titanium alloy, cobalt–chromium–molybdenum alloy, PEEK, and other polymers, and PMMA and other resins) but ceramic materials, such as leucite and lithium disilicate glass-ceramics, which are the most natural-looking replace- ments for missing tooth substance and are available in a wide range of shades and translucencies, give most predict- able, durable and highly aesthetic results. 3D printing works with a vast number of different materials too, including non-precious metal alloys (e.g. cobalt–chromium and tita- nium alloys), composite resins and ceramics—however, these are single-coloured, so the printed restorations may require more fi nishing than milled restorations. dental professionals, 3D printing is easier to use than milling, but this is a very subjective opinion and largely depends on the work ow the user is accustomed to. Many dentists who own chairside milling machines use them only in easier cases where a single crown or inlay is required and send orders for other restoration types to the dental laboratory for more reliable and detailed results. Another important factor is accuracy. In this regard, 3D printers do not have a clear advantage over milling. However, milling tools are limited as milling machines cannot be made smaller than the tools they use. Because milling is a removal process and printing is an additive process, 3D printers are better able to create curves, holes, and very small and complicated shapes than milling machines are. Cost is usually important for both dental professionals and patients. 3D printers are becoming increasingly af- fordable, which is great for technology-minded dentists and laboratory owners. Industrial 3D printers are still ex- pensive, but the average cost of each product fabricated is cheaper compared with milling. In addition, 3D printing enables the fabrication of multiple parts at once, and it produces little or no waste. The possibilities of using 3D-printing technology in dentistry seem endless, but there is still much to discover and learn. Milling is still the most predictable technology to use for permanent fi xed restorations, guaranteeing consistency and enabling the highest aesthetics. We can expect that as 3D-printing technology continues to evolve, this method of fabrication will play an ever greater role in transforming the fi eld of dentistry. Sincerely, The second thing to consider is convenience. Nowadays, 3D printing is faster than milling, and according to many Magda Wojtkiewicz Managing Editor CAD/CAM 2 2023 03

O r t R e h o d o s t o r n t i c s a t i v e D e n S t l e e p u r e s I m p l a n t Simplify expand your practice NEW DEXIS IS 3800 Expand your treatment offerings DEXIS™ IOS Solutions seamlessly expansion. Say hello to more time for what really matters — your patients. Find out more at dexis.com © 2023 Dental Imaging Technologies Corporation. All rights reserved; DXIS00275 /RevA dexis.com

Anatomically shaped , individualised PEEK gingiva formers and impression posts Features Made of biocompatible PEEK dataset as a “gingiva former + impression post set” camlog.com/en/products/cadcam The individual DEDICAM PEEK gingiva formers and impression posts are offered for the CAMLOG®, CONELOG®, iSy®, CERALOG® and BioHorizons® implant systems. Only open impression posts can be ordered for BioHorizons®. DEDICAM® services are not available in all countries. Please ask your local Camlog / BioHorizons® representative if you have access to our CAD/CAM services. DEDICAM®, CAMLOG®, CONELOG®, iSy® and CERALOG® are registered trademarks of CAMLOG Biotechnologies GmbH. BioHorizons is a registered trademark of BioHorizons. All rights reserved. Not all products are available in all countries.

news | Will a scan aid actually help with intra-oral implant scans? New research suggests using scan aids has both pros and cons By Dental Tribune International The use of intra-oral scanners for full-arch digitisation of edentulous arches with multiple implants has not been recommended, owing to signifi cant errors. A study by researchers in Freiburg and Berlin in Germany compared the accuracy of intra-oral scans for multiple implants with and without the use of a scan aid. The goal was to understand the potential improvements the scan aid could provide in the context of edentulous arch scans, assessing parameters such as linear deviation, precision and software recognition of scan bodies. The fi ndings highlight the role of scan aids in improving registration of scan bodies and reducing linear deviation in intra-oral scans. Having less distinct anatomical surface morphology, the edentulous jaw makes it diffi cult to stitch intra-oral scan images accurately to form a complete virtual model, and the intra-oral environment can introduce additional inaccuracies. Efforts to overcome these issues have included devices that create an optical bridge or increase the scannable surface, aiming to minimise stitching errors, but require additional time-consuming steps that add complexity to the process. Nonetheless, these devices have been shown to improve scanning accuracy. A prior study introduced an optical bridge for universal use that can be adjusted chairside and is easy to handle. It tested three different designs and materials for true- ness, precision and clinical applicability. The most user- friendly and accurate scan aid had an irregular design and a grey colour. The aim of the current study was to evaluate the accuracy of this universal 3D-printed scan aid in vivo. The study used a case–control format, scanning implants in the edentulous jaw with and without the universal scan aid. Twenty-two participants with an edentulous arch and at least three implants were selected. The patients had received CAMLOG SCREW-LINE, SICace (SIC invent) or Straumann Standard Plus implants, and system-specifi c scan bodies were used. Two types of intra-oral scanners, the CS 3600 from Carestream Dental (CS) and TRIOS 3 from 3Shape (TR), were employed. The scans were capped at 9 minutes, because it has been found that repeated scanning does not increase accuracy in areas with minimal surface morphology. Failure to register the scan body during scanning was reported for 25% of Straumann, 20% of Camlog and 8% of SIC scan bodies. For the CS scanner, 83% of scan bodies were successfully scanned with the scan aid and 70% without, compared with 96% and 86%, respectively, for the TR scanner. The scan aid statistically signifi cantly minimised the total mean linear deviation when using the CS scanner. However, for the TR scanner, there was no difference. As for precision, statistically signifi cant differences were found between the two scanners when the scan aid was not used. The scan aid decreased precision signifi cantly for the TR scanner. Other parameters showed increased variability, particularly regarding precision within each group of scan bodies, suggesting that the scan aid’s usefulness might be in uenced by the specifi c scanning technology used. For instance, the CS scanner uses active triangulation, which may be more prone to errors in edentulous arch scans and could benefi t more from the scan aid than the TR scanner, which uses confocal microscopy. The use of the scan aid also improved the software’s recognition of scan bodies for both scanners. The authors cautioned about the interpretation of accuracy regarding the results, owing to inherent errors in extra-oral reference models and potential deviations related to scan body height. They concluded that, while the scan aid can signifi cantly improve linear deviation with the CS scanner and enhance software recognition of scan bodies, it may also lead to increased variability in precision. Editorial note: The study, titled “Enhancing intraoral scanner accuracy using scan aid for multiple implants in the edentulous arch: An in vivo study”, was published in the August 2023 issue of Clinical Oral Implants Research. m o c . k c o t s r e t t u h S / t i k t e v © CAD/CAM 2 2023 09

Gain the power of dual model scanning Minimize hands-on time with the intuitive place-and-scan design. Provide a completerange of quality services to your clinics with ease. Stay on top of your caseload with fast automated scan-to-design workflows. More efficiency. More versatility. More speed. www.3shape.com/f8

The most prominent difference between premium, value and discount implant solutions is the cost, premium brands costing several times more than value or discount brands. These price differences not only re ect research and development and quality assurance expenses, but also include additional costs such as the inclusion of training programmes, dental practice support and extended service from the man ufacturer. Owing to the high cost of dental treatment and limited coverage, cost-effectiveness has been always at the forefront of the dental industry, and the permanent crisis era of post-COVID recovery has only fuelled the need for lower-cost implants. Dental insurance cover- age remains limited and is usually provided under an employment benefi ts package. While the overall market growth will continue to be constrained by re- imbursement and unemployment rates, the lack of it, to some extent, will drive the need for cost-sensitive and affordable treatment. Historically, premium dental implant companies have dominated the competitive landscape in Europe, but they have recently faced increased competition from value and discount brands. In addition, the premium segment market is mainly shared by four main com- panies: Dentsply Sirona, Envista Holdings Corp., the Straumann Group and ZimVie. The growing prevalence of local manufacturers and an increasingly cost- sensitive consumer demographic have contributed to overall price depreciation in the total dental implant market that has been fuelled by a growing share of the value and discount segments in the total dental implant market value. The combined market share of the value and discount segments is projected to be over half of the total dental implant market value by the end of the forecast period. Similar to the dominance of premium implants, stock abutments have historically prevailed as the pre- dominant segment of the fi nal abutment market. Recent improvements in manufacturing capability and product affordability have resulted in the rapid growth of the CAD/CAM abutment segment relative to the stock abutment and custom-cast abutment segments. CAD/CAM abutments offer signifi cant improvement in aesthetics and clinical outcomes. The segment be- came the largest segment in the total fi nal abutment market in 2022, closely followed by the stock abutment segment. Digital dentistry Further development and adoption of digital den- tistry will continue to drive the growth in the dental implant and bone grafting material markets. Driving industry news | Chart 8-2: Leading Competitors, Dental Implant Market, Europe, 2022 Chart 3: Leading Competitors, Dental Implant Market, Europe, 2022. the CBCT scanner market is the development of computer-guided surgery software for treatment planning and implant placement. Based on the treat- ment plan, the dentist also has the option of using a surgical guide to assist in placement of the implants. CAD/CAM technology is increasingly being used to manufacture customised fi nal abutments as well, thereby creating a more stable and aesthetic resto- ration. Dental manufacturers invest in the digital dentistry transformation via collaborations with start-ups, edu- cation centres and other companies globally to expand technological capabilities, outreach and local experi- ence. The Straumann Group, for example, has invested in China to establish a Straumann manufacturing, innovation and education centre by 2029. The com- pany also founded a new technological and innovation centre in Switzerland. Open-architecture systems enable integration with other components, even those from different manu- facturers. Companies producing CAD/CAM abutments are opening their systems to make the process of sending a scan easier for dental professionals. Nobel Biocare’s system, for example, can now receive CAD fi les from 3Shape scanners too. Dentsply Sirona too has opened its CEREC software to support compati- bility and a smooth work ow. Closed systems used to be the only option in the early days of CAD/CAM development, limiting the dentist’s choice of components to a single manufacturer. The shift towards open CAD/CAM systems makes the process of ordering CAD/CAM abutments more accessible to the market and is therefore expected to increase the demand in volume for CAD/CAM products. In addition, it allows for cross-promotion of a broader range of products from different manu- facturers. CAD/CAM 2 2023 13

© MIS Implants Technologies Ltd. All rights reserved. ONE-TIME SOLUTION TISSUE-LEVEL SCREW-RETAINED SYSTEM MAKE IT SIMPLE The MIS CONNECT is a stay-in abutment system which enables avoiding interference with the peri-implant gingival seal. It offers doctors the ability to maximize the tissue-level restoration concept, enabling the entire prosthetic procedure and restoration to occur far from the bone, and at any level of the connective tissue. Learn more about MIS at: www.mis-implants.com CO ECT

Your formula for quality dentures CediTEC Denture Base V-Print CediTEC or + + dentbase Adhesive CediTEC Denture Teeth = CAD / CAM SOLUTION FOR PERMANENT DENTURES Complete CAD/CAM system for the fabrication of removable dentures Flexible choice of denture base – 3D printed with V-Print dentbase or milled with CediTEC DB High-quality materials for long and high wearing comfort Individual dentures – reproducible at any time and customisable CAD / CAM VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Freecall 00 800 44 444 555 · www.voco.dental

industry report | Recently, some resin brands have launched new materi- als marketed as ceramic restorative materials. While these materials contain ceramic particles as fillers, they technically are still lightly filled composite materials with strengths that do not exceed 150 MPa. High-strength milling materials for CEREC, such as glass-ceramic, zirconia and highly filled composites, however, have three to six times greater strength (530–850 MPa).1 These types of milling materials are backed by clinical evidence that demonstrates their suitability for use in definitive dental restorations. By nature of the DLP printing requirements, 3D-printing materials lack comparable long-term durability, making 3D printing most suitable for (complex) temporary applications, such as surgical guides, bite splints, models and other plastic appliances. At the current stage of technology and given the lack of solid clinical evidence, caution is warranted for the printing of permanent crowns, even if advertisements for these materials imply the production of ceramic restorations. They remain, in fact, composite resin crowns. Milling and 3D-printing technologies can be combined to reduce labour and increase predictability in clinical procedures. For example, to restore an edentulous space with an implant, a printed surgical guide and provisional restoration can be fabricated with a 3D printer, and the definitive crown can be manufactured in the CEREC milling machine—all within one digital treatment plan. Implementing CEREC in a practice follows a well-established workow with a history of more than 35 years. When employing in-office 3D printing, it is important to con- sider the complete process, involving printing, cleaning and polymerising. Conventional 3D printing requires the use of chemicals such as isopropanol for cleaning. Safe use of isopropanol necessitates a fume hood for venti- lation and personal protective equipment to protect the operator. Additionally, to ensure patient safety, special dental polymerisation units must be used in order to guarantee complete polymerisation of the printing resin. Advanced printing solutions automate printing and post-processing to ensure staff safety and save valuable staff time. Economic factors ultimately drive the adoption of tech- nologies in dental practices. Both CEREC and in-office 3D printing are highly attractive for dental practices owing to the improved practice efficiency, supporting the business case for investment in this technology. Both technologies serve different indications, and dentists’ decision to invest should be based on the benefits to their practice. CAD/CAM 2 2023 19

Y R T S I T N E D F O E R U T U F E H T G N I L I E V N U 28 & 29 JUNE 2024 DIGITAL DENTISTRY SHOW Register at www.dds.berlin Digital Dentistry Show In collaboration with Digital U N V E I L I N G T H E F U T U R E O F D E N T I S T R Y

interview | How did you integrate digital technologies, including 3D printing and CAD/CAM, into your laboratory? It was definitely through trial and error. Especially in the early days, which was just a few years back, 3D printing was not well optimised for a dental workow. Interfaces to materials, software and other workow requirements have not been coordinated well between different manu- facturers. This has led to the formation of a highly active international community of dental technicians who ex- change through social media what they have learned. Personally, I’ve learned a lot from my peers around the world, and I’m equally giving back to the community and the manufacturers. Dentistry is at the intersection of multiple disciplines, and we need to have good commu- nication to make progress. The rate of innovation in digital dentistry is extremely high. We now see manufacturers coordinating much better and creating more accessible ecosystems that are much easier to use. At the same time, most of the potential is still untapped and will become apparent as we undergo significant transformations within our industry. Having worked with digital technology for over a decade now, what benefits do you see of using dental technology, especially 3D printing, in a dental laboratory? To me, dental technology is about combining the best of two worlds: analogue and digital. We still need and will continue to need traditional craftsmanship to meet the high requirements for individualised aesthetics in complex cases. At the same time, the holistic digital workow works well in an increasing number of areas, enabling significant increases in efficiency while maintaining or improving overall quality. Digital fabri- cation in particular enhances production speed and reproducibility. Dentistry is constantly evolving. What lies ahead for dentistry, and what dental technology is most likely to shape its future? In my view, we are now at a point where most of the industry understands and embraces the vast potential of digital technologies. At the same time, we are just about to move from an early adopter stage to the early majority stage when it comes to the adoption of digital tech - nologies. In Germany, for example, only 15% of dental practices are using intra-oral scanners, much less than in the US. However, the trend towards digital impressions is accelerating fast! We are undergoing a paradigm shift in dentistry be- cause digital technologies are fundamentally changing the dynamics of our industry. We will see entirely new business models, and together we will establish new standards of care. It is an exciting time, and for those who embrace this change, there will be many oppor- tunities. CAD/CAM 2 2023 23

interview | During this evolution, I also developed a relationship with the counterpart that was working with Ivoclar on the digital dentures, a company named 3Shape. 3Shape produces desktop and intra-oral scanners as well as dental design software for all types of den- tal restorations. As part of the collaborative Ivoclar– 3Shape team, I also helped develop scanning strat- egies for the TRIOS intra-oral scanners, so I’ve been able to see the journey of digital dentures all the way from conception through to more widespread use and to being a valued component in any dental facility that prides itself on employing the latest tech- nology in the field. Have these digital denture workows changed in the years since? One of the best features of digital dentures from a train- ing and implementation perspective is that when mov- ing from analogue to digital, the clinical workow can remain the same. While there are more efficient work- ows that allow for greater exibility, dental professionals who are providing removable prosthetic therapy do not need to change their current workow when they switch to digital dentures. The biggest change that comes with digital dentures is data acquisition, how the data captured clinically is rendered in the design software, the manufacturing methodology, and the process that supersedes it. However, for those who want to overcome the chal- lenges of conventional workows, there are various methods for the delivery of dentures in two appointments rather than the traditional three to five appointments that may be necessary with more conventional methods. To capture that efficiency, the biggest change we’ve seen is the process and workow for immediate den- tures. With an intra-oral scanner, dental professionals can scan the patient’s oral cavity, render a design and then deliver the dentures at the next appointment when the teeth are being extracted. This technology has been revolutionary both on the clinical side and on the lab side, because we can now digitally visualise where a patient’s natural teeth were and where the new teeth will be. This truly provides unparalleled results for the clinician and the patient. Another revolution of digital denture technology is the ability to deliver the final denture at the try-in stage. In the conventional analogue process, dental professionals have to perform a wax try-in, where all of the teeth are individually set in wax. This is a very labour-intensive and technique-sensitive process that requires extreme care and is prone to human error as well as material deficien- cies, which can result in extensive and expensive cor- rective measures. In contrast, with digital dentures, you can deliver that same quality—or even higher quality— dentures for a fraction of the cost to the clinic and in a fraction of the time at that try-in appointment. More- over, if the denture isn’t completely correct, mak- ing adjustments is efficient, effective and predictable by applying the changes via the software with a few keystrokes and mouse clicks. Today, at our Aspen Dental locations that offer digital dentures, there is an over 80% success rate at that denture delivery appointment. Just think: if you fit 100 dentures a month and 80% of the time you deliver those dentures successfully, you will have gained 80 appointments in your schedule that month. That means new and existing patients aren’t waiting as long resulting in an increase in more avail- able chair time that can be used to deliver high quality removable therapy to more patients. “For dental laboratory technicians, digital dentures offer consistency in the design process and greater customisation.” What benefits does the digitalisation of the denture process bring for the clinician, the dental laboratory technician and the patient? First and foremost, the most significant benefit for all three parties is the ability to electronically preserve the patient’s initial data acquisition, whether that is a scan of the teeth, dentures or edentulous oral cavity, as well as the preservation of the final design file of the restoration. For the patient, the electronic pres- ervation of that data means that, if a patient loses a denture, a replacement denture can be fabricated within 24–48 hours without having to take another im- pression or come in for any additional appointments. That’s simply not possible with conventional den- tures. In addition, digital dentures have greater reten- tion, stability and strength than dentures produced in the analogue manner. It’s important to note that digitally manufactured prostheses have a uniform thickness feature that provides the patient with true physiological comfort. For dental laboratory technicians, digital dentures offer consistency in the design process and greater customisation. For clinicians, the improved workow, efficiency and accuracy of digital dentures reduce CAD/CAM 2 2023 25

interview | “The biggest change that comes with digital dentures is data acquisition, how the data captured clinically is rendered in the design software and the manufacturing methodology.” and knowledge to help shepherd Aspen through the digital transformation. This was a great opportunity, so I agreed. I very quickly fell in love with the organisation, not just because of its commitment to digital technology, but also because I was able to convey my clinical knowledge and skills to our dentists through our various onboarding programmes and learning and develop- ment initiatives. I helped establish the curriculum alongside our vice president of clinical support, Dr Andrew De La Rosa, and when we first delivered the learning programme, I asked every dentist in the room how many dentures they had done in dental school. In the room of 30 dentists, the average had made just two dentures. That’s when I realised, in an organisation where we do half a mil- lion dentures a year and someone can graduate and go into an office and do up to 100 dentures a month with very little experience, I could have an enor- mous impact on hundreds of thousands of patients and hundreds of dentists. Our chief clinical officer, Dr Arwinder Judge, asked me whether I wanted to make a change and come join Aspen Dental full time on the clinical team. Without hesitation, I decided to sell my private practices and join Aspen full time, not just to help lead the digital transformation, but also to improve the quality of the removable prostheses we deliver here at Aspen Dental, irrespective of whether those are produced digitally or using ana- logue methods. Ultimately, it was the organisation’s mission and the clinical support team that attracted me, but the ability to provide countless dentists, den- tal technicians and team members with the training they need to deliver the best possible removable pros- thetic experience to patients is what made me fully commit to Aspen Dental. I am honoured to be part of the clinical support team here at Aspen Dental and truly changing the way we deliver care to millions of patients every year! CAD/CAM 2 2023 27 After over a decade in private practice, why did you choose to join Aspen Dental? Before I joined Aspen, I was an industry leader lec- turing at some of the most prestigious conferences in the world, as well as publishing articles, working on various research and development projects and co-authoring textbooks. I truly valued private prac- tice and loved working in research and development and, most importantly, treating patients with remov- able therapy. Fast-forward to January 2021, when Aspen Dental decided to go digital with its dentures. Dr Sundeep Rawal, the senior vice president of implant support at Aspen and a long-time colleague, asked me to come on board as a consultant to use my skills

interview | 2 Fig. 2: Integration of the micromorphology with a round-ended straight carbide bur. used for the interproximal areas of bridges (with virtually no pressure), a round-ended straight carbide bur (fine), Panther stones and a zirconia-blade carving instrument. However, any set of instruments that feels comfortable in the hands of the user may be selected for this task. Taking into account the volumetric shrinkage during sintering and the final pol- ishing and glazing, the structure created is ideally slightly over-contoured and clearly defined. It is definitely worth in- vesting time in this preparatory step, as it will make our work much easier later in the process. After surface texturing, selected colours of Esthetic Colorant for KATANA Zirconia— specific dyeing liquids designed for the imitation of natural optical effects—are applied to the surface. Do you have any recommendations on how to proceed with this set of liquids? Just follow the colour reproduction of the adjacent natural teeth. With Esthetic Colorant, we want to create 3 Fig. 3: Basic chromatic map for individualisation in the anterior region. CAD/CAM 2 2023 29

interview | 8 Fig. 8: Example of a dentine core restoration. The surface morphology was refined with a Panther stone. protocols are not affected by the effect liquids—and this is true for all types of zirconia from the KATANA Zirconia Multi-Layered series. Once sintered and cooled, the sur- face of the restoration is finished with a set of polishing instruments. My tip in this context is to be careful not to destroy the micromorphology created in the pre-sintering step. To add the final gloss and natural uorescence, the surface is treated by sandblasting for the application of CERABIEN ZR FC Paste Stain, fixed in a single glaze firing procedure. Does the technique also work without glazing? Yes, it is definitely possible to do without this step. In that case, however, the restoration will not offer a uorescent effect. Whenever a restoration is finished without glazing, the surface must be perfectly polished. If completely smooth, the hardness of the material will not cause any harm to the opposing dentition. What are the main indications for the zero-bake technique? Personally, I use it most often in the context of complex restorations and in the posterior region, especially when the available space is limited. It allows for minimal wall thick- nesses, and the surface is—when well polished—more an- tagonist-friendly than a lithium disilicate surface. In other cases, and depending on budget, digitally produced dentine core crowns are a great option. The dentine core is milled from KATANA Zirconia YML and the enamel added using CERABIEN ZR Luster porcelains. Esthetic Colorant, CERABIEN ZR Internal Stains and CERABIEN ZR FC Paste Stain may be added for individual effects. Compared with tradi- tional full porcelain layering, this concept is quicker, involves a lower shrinkage, offers a high stability due to the specific framework design and requires a thinner wall thickness (e.g. 0.6 mm dentine core plus 0.6 mm porcelain). Why is it important to develop new design and finishing concepts nowadays? To my mind, a lack of time is the greatest issue of modern dental technology. Owing to a lack of skilled personnel and an expected decrease in the number of dental laboratories in many countries around the globe, we have to keep look- ing for concepts that help us reduce the time pressure and make our work easier. While simplifying procedures, however, we need to provide for the same or even higher- quality outcomes. This is exactly what I wanted to achieve when starting to develop the zero-bake technique. My personal gain is more free time. Why do you share your ideas with others by working as an instructor and lecturer? I simply enjoy interacting with my peers, equipping them with knowledge and helping them benefit from good ideas. about Giuliano Moustakis has more than 30 years of expertise as dental technician. He was born in Greece but currently resides in Germany, where he has a laboratory in Falkensee. He studied dental technology in Athens in Greece and over the years has completed further studies in Germany and Japan, including the maxillofacial prosthetic technician programme of the International Association for Surgical Prosthetics and Epithetics, advanced education in functional diagnostics of the temporomandibular joint and the implant prosthetics curriculum for dental technicians of the Deutsche Gesellschaft für Zahnärztliche Implantologie (German association of dental implantology). He has been a global instructor at Kuraray Noritake Dental since 2019. CAD/CAM 2 2023 31

would be achieved with a mock-up for advanced aes- thetic dentistry permitting controlled preparation, that is, preparation that is calibrated on the different thick- nesses of the mock-up. This basis would be used to create semi-indirect veneers for space closure (Type IIB veneers according to Magne and Belser).1 Treatment During the first appointment, photographs (Figs. 1–3) and alginate impressions of the dental arches were taken. After photographic study of the case, the nec- essary aesthetic and functional corrections were per- formed by means of an analogue diagnostic wax-up phase. The wax-up was transferred to the patient’s mouth in the form of a mock-up that he tested in his mouth for a few days prior to the operative session. At the following appointment, this was used as a work- ing mock-up for calibrated preparation, that is, a mock- up-guided approach for extremely minimally invasive, controlled tooth reduction. To simulate the final result as already seen with the an- alogue wax-up as accurately as possible, the waxed-up model was scanned.2 For moulding the mock-up from the wax-up (Figs. 4a & b), a silicone index was created on the wax-up (Fig. 4c). Composite (Structur 3, VOCO) was injected into this silicone key to create the mock-up. The diagnostic mock-up was temporarily cemented (Provicol QM Aesthetic, VOCO) in the patient’s mouth for a few days until the operative session. At the next appointment, the mock-up took on the role of a working guide for controlled preparation. Controlled- thickness reduction grooves were made in the mock-up for orientation, as they were used to determine the depth of the preparation and thus the desired material thickness of the veneers (Fig. 5). For providing clear ori- entation, the guiding grooves were marked with a pencil (Fig. 6). Where the residual mock-up remained, the tooth was intact (extremely minimally invasive preparation). Only in the areas where the mock-up had been com- pletely ground down was there an effective preparation of the tooth structure (Fig. 7). Compared with conventional veneer preparation, for which the dentist grinds the tooth structure directly from the beginning, this procedure allowed for much more conservative tooth reduction. It was decided not to intervene in the lateral and protru- sive movement. The first step was to perform window or Walls, Steele and Wassell Type A preparations,3 meaning that the preparations were only carried out on the vestibu- lar aspect, without finishing margins and without any reduction of the incisal edge. However, an incisal butt joint margin was carried out to cover the incisal edge without any vertical reduction in the palatal area. It has case report | 4a 4b 4c Fig. 4a: Analogue wax-up on the gypsum model, palatal view. Fig. 4b: Analogue wax-up on the gypsum model, vestibular view. Fig. 4c: Silicone index for moulding the mock-up in composite for the provisional restoration. been shown that such a covering of the incisal edge achieves a higher survival rate than preparations with a palatal chamfer.4, 5 5 6 7 Fig. 5: Operative phase in which the mock-up acted as a guide for highly conservative, controlled preparations. Fig. 6: Guide grooves marked with pencil for calibrated preparation primarily on the composite. Fig. 7: Mock-up removed with pencil marks where the preparation would continue directly on the tooth (sacrificing the mock-up spared healthy hard tissue). CAD/CAM 2 2023 33

case report | 11 a glycerine gel was applied to all margins prior to polymerisation (Liquid Strip, Ivoclar). By means of this oxygen inhibition gel, a significant improvement of the adhesive margins could be achieved. The glycerine was rinsed off, and at the end of the setting time of approx- imately 3 minutes, it was then possible to proceed with elimination of the excess material using a metal instru- ment and dental oss, interproximally. The interproximal contact zones were finished using abrasive strips. After checking the occlusion and making corrections in accordance with conventional functional concepts, normal finishing and polishing was performed using diamond polishers (Dimanto, VOCO). The patient was completely satisfied with the significant improvement in his smile (Figs. 18–22). Discussion Based on an analysis of the scientific literature concern- ing the closure of anterior diastemas, a semi-indirect approach using nano-hybrid composite veneers was chosen.6 The clinical indication of diastema closure clas- sifies the veneers used for this case as Type IIB according to the Magne–Belser classification.1 Since feldspathic ceramic veneers were outside the patient’s budget, such an indirect technique was ruled out. The direct layering technique was ruled out because the patient had high aesthetic expectations. It was decided to use veneers 16 12 13 14 15 17 Fig. 11: Isolation of the operative field using a dental dam, frontal view. Fig. 12: Isolation of the operative field using a dental dam, occlusal view. Fig. 13: Isolation using PTFE and appearance of the sandblasted surfaces. Fig. 14: Orthophosphoric acid etching of a substrate that was still enamel thanks to the extremely minimally invasive approach adopted. Fig. 15: Application of the adhesive luting agent to the surfaces to be bonded. Fig. 16: Bifix QM luting system (VOCO) applied to the tooth #21 stump and PTFE tape covering the adjacent teeth. Fig. 17: Insertion of the veneers. CAD/CAM 2 2023 35

THE GLOBAL DENTAL CE COMMUNITY REGISTER FOR FREE DT Study Club – e-learning community 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.

case report | 4a 4c 5 4b 4d 6 Figs. 4a–d: 3D-printed models with the new layered zirconia bridge. Fig. 5: Internal and external surfaces of the zirconia bridge. Fig. 6: Post-op view of the cemented restoration. One week later, a digital impression was taken using an intra-oral scanner (DEXIS IS 3800; Fig. 3) and sent via the DEXIS IS Connect platform to the dental laboratory. In the laboratory, the design and milling of a new zirconia bridge were performed. Four days later, the new layered zirconia bridge was sent to the practice along with 3D-printed models (Fig. 4). The final zirconia bridge emphasises the quality and precision of a digital workow (Fig. 5). about After the try-in, the final restoration was cemented in the mouth using glass ionomer cement (Fuji I, GC). Six weeks later, the patient came back for a postoperative check-up, during which perfect contact points and good adaptation with the soft tissue were seen (Fig. 6). Editorial Note: Please scan this QR code for more information about digital workflow with DEXIS. Dr Joseph Sabbagh obtained his master’s degree in restorative dentistry and his PhD in biomaterials from the Université catholique de Louvain in Belgium. He worked as an associate professor at the Faculty of Dental Medicine of the Lebanese University in Beirut in Lebanon for a number of years and now practises This case demonstrates the successful integration of cutting-edge dental technology, precise craftsmanship and meticulous care in providing our patient with a durable, functional and aesthetically pleasing zirconia bridge, ultimately improving her oral health and comfort. in Beirut and Brussels in Belgium. Dr Sabbagh is active in clinical and in vitro research, having a particular interest in biomaterials, aesthetic dentistry and endodontics, and has had over 25 scientific papers published in indexed journals. He is a member of various associations and boards. CAD/CAM 2 2023 39

case report | 6 7 8 Fig. 6: Occlusal view of the pulp chamber and cavity after preparation for the milled endocrown. Fig. 7: Tooth #46 before the intra-oral scan. Fig. 8: Clip F temporary filling to allow the patient to rest during the milling process. Case presentation Case history A 58-year-old female patient came to the dental prac- tice for a routine dental appointment and had lost an amalgam restoration the previous day. The patient was apparently in good health and had no systemic con- ditions. Her dental history revealed that about 16 years previously root canal therapy had been performed on tooth #46, and the tooth had subsequently been treated with an amalgam filling. Pointing to the tooth, she said that she must have broken the tooth and lost a little piece of it the day before. When asked whether she had “The advantages over direct restorations described here are better aesthetic results, exibility and easy handling [...].” any symptoms, she replied that she had no complaint regarding any of her teeth. 9a 9b 9c Figs. 9a–c: Creation of the CAD for the endocrown (a). Grandio blocs A3 LT block ready for milling (b). Endocrown milled from Grandio blocs (c). CAD/CAM 2 2023 41

case report | selective-etching technique on the enamel. The pre- cautionary etching step was followed by application of the adhesive agent Futurabond U (VOCO), which was applied to both the enamel and dentine. The direct restoration of tooth #45 used the light- polymerising, nano-hybrid composite Grandio. We rebuilt the distal wall, initially with Grandio, in order to convert the Class II configuration into a Class I cavity design (Fig. 4). This strategy was chosen to make the handling of the proximal and occlusal filling easier. To achieve this, a regular incremental layering technique was used (Fig. 5). Finally, we performed finishing and polishing of the occlusal surface of tooth #45. For the endocrown on tooth #46, we first revised the pulp chamber using ultrasonic tips (Helse Ultrasonic) and then the tooth cavity with various rotary instru- ments. We performed minimal shoulder preparation in accordance with the conventional rules for ceramic res- torations, avoiding undercuts and preserving minimum thicknesses (Fig. 6). An intra-oral scan of the revised surfaces was performed with the TRIOS intra-oral scanner (3Shape; Fig. 7). After that, a temporary filling with Clip F (VOCO) was prepared for the time needed for chairside manufacture of the indirect restoration (Fig. 8). The next step was the creation of the digital design for the endocrown with inLab CAD Software (Dentsply Sirona) and 10-minute endocrown fabrica- tion using a low-translucency Grandio blocs block (A3 LT) processed with the CEREC MC XL milling machine (Dentsply Sirona; Fig. 9). After the endo- crown had been milled (Fig. 10), it was pretreated and chromatic characterisation was performed with FinalTouch characterisation material (VOCO) for a more natural result. 14 Fig. 14: Securing the endocrown by applying slight pressure allowed excess luting material to ooze out at the preparation margins. According to the manufacturer’s instructions for use, since Grandio blocs is made of a nano-hybrid com- posite, there is no indication for etching with hydro- uoric acid or phosphoric acid. Instead, the pretreatment was performed with 25–50 μm aluminium oxide particles to sandblast the inner surfaces of the restoration to be luted and the occlusal grooves and fissures for sub- sequent chromatic characterisation. The oxide dust produced was removed using a suction device, and an ultrasonic bath was used to clean the pretreated restoration, which was then dried with oil-free air, followed by final cleaning with medical alcohol (optional). After pretreating the occlusal grooves and fissures and the application of Futurabond U, a maximum layer 15a 15b Figs. 15a & b: Light polymerisation after removal of the excess luting material. CAD/CAM 2 2023 43

case report | “[...] milled CAD/CAM composite resin endocrowns are not only a more conservative approach but also more stable [...].” The chemical setting time is 3 minutes. Once we had removed the excess Bifix QM with a foam pellet (Pele Tim, VOCO) and a disposable brush (Single Tim, VOCO), it was possible to considerably reduce the polymerisation time using additional light polymeri- sation. This light setting was performed at the luting margins with the Celalux 2 for 20 seconds from the vestibular side and a further 20 seconds from the lingual side (Figs. 15). 19a 19b Figs. 19a & b: Comparison of the pre- and post-treatment radiographs. Initial periapical radiograph characterised by an overcontoured dental filling in tooth #45 and endodontic underfilling in tooth #46 (a). Final periapical radiograph confirming the good adaptation of both restorations (b). Results and discussion The fully aesthetic and functional results were remark- able and were achieved in a single chairside session, to the full satisfaction of both patient and dentist (Figs. 16–19). This new approach using CAD/CAM-fabricated endo- crowns reduces the disadvantages associated with endocrowns produced in laboratories or those made of ceramic materials. Conclusion This patient was treated with an endocrown because of the impossibility of a direct restoration owing to the insufficient thickness of the remaining walls 16 years after root canal treatment. This helped avoid unneces- sary loss of healthy tooth structure, was time-saving, as post-endodontic treatment with a build-up followed by a regular ceramic overlay would have required multiple sessions, and it had a lower cost of the treatment for the patient. Restoration with an endocrown posed a lower risk of chemical failure owing to fewer adhesive interfaces. In the case of a build-up and overlay, we would have had two adhesive interfaces (dental tissue to build-up and build-up to crown or overlay), instead of just one (dental tissue to endocrown). Similarly, there was a lower risk of biomechanical failure of an endocrown than with more invasive preparation, for example with metal posts. The most recent scientific evidence demonstrates that milled CAD/CAM composite resin endocrowns are not only a more conservative approach but also more stable over time than ceramic indirect restorations. When restoring endodontically treated teeth, endo- crowns produced using composite resin materials showed more uniform stress distribution and higher fracture resistance. Acknowledgement The authors would like to thank the patient for her efforts and willingness to allow us to solve the case with this new approach. One week later, her husband underwent the same treatment with a Grandio blocs CAD/CAM-fabricated endocrown. about Dr Lucas J. Echandia is an associate professor in clinical prosthodontics at the Universidad Católica de Córdoba in Córdoba in Argentina. He can be contacted at Centro Odontológico, Echandía-Meloni, José Pacifico Otero 2090, X5009HSX Córdoba, Argentina, lucasechandia85@gmail.com. Dr Martin I. Ibañez is an associate professor in oral implantology at the Universidad Católica de Córdoba in Córdoba in Argentina. He can be contacted at martin.ibanez@ibaimplantes.com. CAD/CAM 2 2023 45

case report | 6 7 Fig. 6: Intra-oral scan STL file. Fig. 7: Virtual design of the dental prostheses. In the dental practice, the first step was to take a digital impression and photographs of the patient. A facial analysis similar to Digital Smile Design (DSD) was per- formed to define important points, such as the midline and the incisal edges (Fig. 3). To incorporate the dental anatomy of the granddaughter, her smile was recorded in 2D and 3D using photographs and a digital impression of her dental arches (Fig. 4). A 2D pattern was drawn from the photographs and integrated into the grandmother’s DSD (Fig. 5). The treatment plan was then validated by the patient, and the information and impressions were sent to the dental laboratory. “[...] the patient agreed to have her prostheses created based on her granddaughter’s dental anatomy.” In the dental laboratory, the dental technician created a virtual assembly of the patient’s dental arches. The missing posterior teeth were replaced by creating a prosthetic base with commercial teeth. For the anterior teeth, the DSD was used to determine the position of 8 Fig. 8: 3D-printed try-in prostheses. CAD/CAM 2 2023 47

case report | 12 13 Fig. 12: Close-up with the 3D-printed provisional prostheses. Fig. 13: Lateral views with the 3D-printed provisional prostheses. surgery, which preserved the bone crests, and re- tention and support were confirmed. The aesthetics exceeded the expectations of both the patient and her granddaughter, both of whom had not imagined that such a high level of technical performance was pos- sible. The dentist–prosthetist duo were thrilled by the satisfaction expressed by the patient and her grand- daughter (Fig. 14). “The aesthetics exceeded the expectations of both the patient and her granddaughter [...].” Conclusion Transmitting a legacy to one’s descendants is a pro- foundly human and natural act. It can encompass a lifetime’s accumulated wealth, exceptional knowledge or fundamental moral values, among many others. However, when this transmission occurs in the opposite direction, from descendants to ancestors, it becomes particularly remarkable, especially when it involves passing on a smile. Typically, a child possesses a unique anatomical signature of their smile, making it challenging to determine the inuence of the father or the mother. However, in this clinical case, a grand- daughter transmitted the anatomical characteristics of her smile to her grandmother. This legacy enabled the patient to regain youthfulness in the most natural way possible. This transmission was made possible solely by the capabilities of modern technological tools, allowing for digital copy–paste procedures. The dentist–prosthetist duo can now replicate an individual’s smile with aston- ishing precision and seamlessly apply it to another individual. When the donor and recipient are connected by family ties, the crown becomes a precious legacy that is passed between the generations. Disclosure The author did not report any disclosures. Acknowledgement The author wishes to thank certified dental technician Benoit Garrault of Laboratoire SERAZIN in France and his team for their skills. 14 Fig. 14: Post-op situation. about Dr Yassine Harichane graduated from the former Paris Descartes University in France and conducted a number of research projects there. He is an author of numerous publications and a member of the cosmetic dentistry study group at the University of Paris. He can be contacted at yassine.harichane@gmail.com. CAD/CAM 2 2023 49

case report | 6 7 Fig. 6: Maxillary and mandibular prostheses designed with Ivotion libraries. Fig. 7: The R5 is compatible with the unique Shell Geometry of the Ivotion disc. etc., in contrast to external milling centres, which frequently standardise production protocols, limiting applications. The dentistry department of the IRCCS Ospedale Sacro Cuore Don Calabria, a hospital in Negrar in Italy, has been investigating clinical care models for dental pa- thologies that clinicians will face in the coming years. Understanding and comprehending these emerging diseases means developing tools that are capable of addressing the needs of future patients, and the treat- ing team needs to be able to handle these new methods of addressing patient needs and diseases. The following are some important emerging fields of interest: – applying artificial intelligence for diagnosis, previewing, 3D modelling and treatment simulation; – restorative approach to same-day dentistry in terms of materials and methods; “Clinicians can now achieve ultrathin restorations using the current generation of hybrid composites (…).” – compromised masticatory ability; – spontaneous oral pain; – recurrent infections of the mouth and oral tissue; – deterioration of the dental system; – periodontal disease; and – xerostomia. – treatment of severe oral pathology in pre-geriatric patients involving same-day dentistry; Changes in physical appearance are an important com- ponent of modern ageing, especially for people over 65. – dental malocclusions and orthodontic treatment with aligners; – treatment of severely worn dentition with in-house procedures; and – risks of and clinical strategies for clear aligner therapy. Description Adult patients with severe or extremely severe oral disease compromising the functions of the stomatog- nathic system are becoming increasingly prevalent. Unlike in the past, these patients are fully integrated into society. The lifestyle and dietary habits of these patients, even when they are older than 75 or 80, are com- parable to those of younger adults, particularly in terms of their expectations. Clinically, these patients present with severe signs and symptoms that are frequently seen in other systemic diseases, including: 8 Fig. 8: Denture in the vhf CAM software module for the R5. CAD/CAM 2 2023 51

case report | “Production of complete prostheses with this digital workow is 100% accurate and predictive regarding timing.” precise milling details, compatible with a same-day dentistry regimen, is the R5 five-axis milling machine (vhf camfacture). Clinical case A 75-year-old female patient in good mental and phys- ical health presented with an implant-supported denture in the maxillary arch with widespread peri-implantitis and burning mouth syndrome (Figs. 1–3). In the lower jaw, she presented with a removable complete denture, abraded teeth and incongruence between the base and alveolar process. The patient reported pain and bleeding in the maxillary arch with compromised stability of the mandibular denture. The 3D files of the prostheses were exported to the Ivotion denture system’s specific CAM module (Ivoclar Vivadent Manufacturing; Figs. 4–6). The prostheses were milled using the Ivoclar-exclusive Shell Geometry processing capability of the R5 (Figs. 7–9). In 4 hours, the complete maxillary and mandibular prostheses had been fabricated (Fig. 10). For the maxillary prosthesis, we immediately relined it after removing the framework that had been screwed to the prosthesis and then screwed it in (Fig. 11). Re-evaluation with a digital facebow and data comparison were made possible by remote control (Figs. 12 & 13). Conclusion Full-mouth restoration in a single session was made possible by the method of intra-oral scanning of the arches, immediate prosthetic design and milling of the Ivotion discs using the R5. Based on our clinical find- ings, this technique optimises time as well as expenses for the complete rehabilitation procedure in the same- day dentistry protocol. Production of complete pros- theses with this digital workow is 100% accurate and predictive regarding timing. The latest technology allows for highly precise evaluations of the accuracy of occlusal determinants, release planes and simulation of masticatory movement. The patient receives rehabil- itation of both arches and accurate reconstruction in a single day. 12 13 11 Fig. 11: Denture in situ. Fig. 12: Extra-oral situation at the four-week check-up. Fig. 13: Detail of the morphology and texture of the anterior teeth at four weeks. about Dr Mauro Fazioni graduated with a DDM from the University of Verona in Italy in 1992. Since 2005, he has been a consultant in the research and development department of some of the most important digital dentistry companies on the topics of intra-oral scanning, prosthetic design software, guided surgery and machinable materials applied in fixed prosthodontics and implant restorations. In 2017, he founded MCD Consulting, a company specialising, among others, in digital head and neck investigations, clinical protocols for head and neck reconstructions, and head and neck laboratory prototypes. In 2020, he founded the Accademia Italiana di Odontostomatologia Digitale (Italian academy of digital dentistry), an independent study group on digital applications in dentistry and maxillofacial surgery. He began collaborating with the digital dentistry department of IRCCS Ospedale Sacro Cuore Don Calabria, a hospital in Negrar in Italy, in 2020. He speaks and publishes on same-day dentistry and protocols in digital dentistry. He can be contacted at mauro@fazioni.com. www.mcdconsulting.it www.aiod.it Nicolò Surico and Rita Consolaro are oral and facial 3D design specialists. Dr Stefano Orio is the director of the dental centre of the IRCCS Ospedale Sacro Cuore Don Calabria, a hospital in Negrar in Italy. CAD/CAM 2 2023 53

practice management | l y d n e a V n o s a J © Johari window. Are there enough formal moments, like meetings, where you can go over responsibilities? These are moments when it is clarifi ed who has responsibility for what and who can step in when needed into which task or role. Meetings should not be long and boring or one-way communication. Involve your team members, for example by having them present some aspects of their job so that others learn from it too or share some patient success stories as well as how they dealt with some challenging situations. This gives opportunity for great fun and moments of growth. “Talent wins games, but teamwork and intelligence win championships.” — Michael Jordan Open feedback culture Do you have a clear framework for which communication tools are to be used in which context (e-mail, phone, chat, Teams, in person, etc.)? I have seen in many teams that this framework is often not clear. Nothing is as important for a well-oiled team as having an open feedback culture. Feedback should not be kept only for offi cial occasions, like evaluations, but should be given on a daily basis. Here are some tips on how to do this: Are there enough informal moments for team commu- nication, like sharing lunch together? We need time at work where we cultivate the relationship between the team members in a way that is not always related to work. A great example is the social custom of fi ka in Sweden and Finland, when work or other daily activities are interrupted in order to get together, drink tea or coffee, or eat something. It happens at a scheduled time and is deliberately used to pause and socialise. Conversations around work are consciously avoided, and the intention is to enhance team spirit and relationships. – Find a balance between positive and constructive feed- back. People really become demotivated if they do not know how their work is being perceived. Giving compli- ments from time to time creates wonders. Not getting feedback often is a cause of demotivation and people leaving the company or practice. – Receiving occasional constructive feedback is also crucial. If we are not told what we can improve, then we cannot grow and might risk making the same mistakes. We need to be aware that most people have the intention to do their job well, and yet we need to give feedback sometimes. That means “Effective teamwork begins and ends with communication.” —Mike Krzyzewski CAD/CAM 2 2023 55

practice management | 8. Support and communicate throughout the entire delegation process. 9. Provide feedback on the results at the end of the task or project. Wrap-up Team members are precious; it is important to foster a wonderful relationship with them. They often have more contact with the patients than you have, so value them, give them responsibilities, be honest with them, inspire them, motivate them and let them make their own choices too. Every day, I work with teams in the corporate world and in dental clinics, and to determine whether the business or practice is thriving it is enough to see how the team is doing. If they are bonded, aligned, open, proactive, the clinic will thrive; however if there is not a strong team, one can feel it in the clinic and see it in the results. Therefore, investing in your team and enabling your team to invest in themselves and each other might be a great resolution for the next year! “Delegation requires the willingness to pay for short-term failures, in order to gain long-term competency.” —Dave Ramsey about Jerko Bozikovic is a specialist in communication skills, emotional intelligence, time and stress management, leadership and change management. He is fascinated by human behaviour and finds working with people on personal development to be a daily challenge and blessing. He speaks seven languages and has Editorial note: This article was first published in aligners— international magazine of aligner orthodontics, Vol. 2, Issue 1/2023 and an edited version is provided here. offered his training courses in four languages since 2001. He embraces and embodies the motto “Love the life you live; live the life you love”. He can be contacted via LinkedIn. AD ROOTS SUMMIT IS COMING TO ATHENS register at www.roots-summit.com THE GLOBAL DENTAL CE COMMUNIT Y 18.5 continuing education credits CAD/CAM 2 2023 57

manufacturer news | DEXIS IOS Solutions expands its portfolio and ecosystem New end-to-end digital work ows for dental practitioners DEXIS IOS Solutions is pleased to announce the expansion of its portfolio and ecosystem through new digital end-to-end work- ows. The new and enhanced work ows are designed to align with the objective of DEXIS IOS Solutions to support dental prac- titioners in accelerating their work ows, resulting in increased productivity and an improved patient experience. To reinforce this objective, DEXIS IOS Solutions is focused on three crucial prin ciples: ease of use, productivity and practice expansion. Practitioners can now easily expand their range of services through aligner and denture treatments, as well as in-house printing, offering their patients personalised and innovative care. The new prescriptive work ows are being developed concurrently with ongoing innovations in the broader portfolio of Envista Holdings Corp., beginning with a new orthodontic work ow in combination with Ormco’s Spark clear aligners that enables practices to easily add aligner therapy to their treatment options. A new patient engagement app within DEXIS IS ScanFlow enables practitioners to show patients a simulated outcome of their orthodontic treat- ment, enabling them to visualise the treatment outcome chairside. Integrated digital transfer of the data sets to the Spark software streamlines the process, facilitating prompt treatment. “By further integrating DEXIS IOS Solutions into the broader Envista offerings, we are providing dentists with the solutions they need to provide exceptional and personalised care for their patients. We are committed to helping dental practitioners improve patient outcomes and grow their practice through digital innovation,” said Amir Aghdaei, president and CEO of Envista. DEXIS IOS Solutions has also col laborated with SprintRay’s 3D-printing ecosystem for defi nitive ceramic crowns to simplify in-offi ce printing and make same-day restorations a reality. SprintRay Cloud Design leverages artifi cial intelligence to streamline the design of crowns, appliances and surgical guides within minutes. Practitioners can scan their patients with any DEXIS intra- oral scanner and upload the data set directly from either DTX Studio Clinic or IS ScanFlow to the SprintRay portal, eliminating the need to manually select fi les, enter redundant patient information and design the restoration or appliance. “By combining DEXIS intra-oral scanners with SprintRay’s ecosystem, dental prac- titioners can offer same-day delivery of crowns and appliances, increasing their produc tivity by completing more pro cedures in a shorter amount of time,” said Aghdaei. “Offering same-day restorations can give practi- tioners a distinct competitive advantage, as patients often prefer the convenience of single-visit appointments, enabling dental practitioners to expand their services and attract patients seeking fast and convenient dental treatment.” To further enhance the capabilities of the DEXIS IOS Solutions portfolio, IS ScanFlow (Version 1.0.9) now includes a denture scanning work ow that streamlines the treatment planning pro- cess by combining the capture of the bite registration and pros- thesis along with the edentulous and denture scans, eliminating the manual process of matching and aligning data sets by the laboratory. The software also provides embedded scan tips to optimise and simplify the edentulous data acquisition. In addition, DEXIS IOS Solutions is introducing the IS 3800 wired scanner, which offers the same high-speed performance as the award- winning IS 3800W wireless scanner. The IS 3800 wired scanner is highly ergonomic and weighs just 190 g without the cable, making it one of the lightest intra-oral scanners available. It complements the IS 3800W scanner, which weighs only 240 g and is the lightest wireless intra-oral scanner in the industry. The latest DEXIS IOS Solutions innovations provide dental prac- titioners with access to intuitive technology that simplifi es and streamlines treatment, thereby boosting productivity. With an extended ecosystem and diverse range of new treatment options, practitioners can partner with Envista for access to prescriptive end-to-end work ows or opt for open work ows, which enable collaboration with their preferred laboratory or manufacturer. The new work ows further align with Envista’s intention to digitise, person- alise and democratise dental care, support- ing dental practitioners in the provision of optimal patient care through en- hanced productivity and predictability of treatment. For more information about DEXIS IOS Solutions’ products and services, visit our website. www.dexis.com CAD/CAM 2 2023 59

meetings | All about the patient: The 2024 ITI World Symposium By ITI Foundation The ITI World Symposium is back and better than ever. In Singapore from 9 to 11 May 2024, more than 50 world-renowned speakers will present at the world’s largest scientific implant dentistry event. Building on the highly successful online edition, the 2024 ITI World Symposium will once again put patients at the centre of the action. Over three days, more than 4,000 participants will experience real patients and their stories on stage. The speakers will discuss various treatment op- tions based on the latest scientific evidence. Addi- tionally, world-class clinicians will provide commen- tary on exclusively recorded clinical procedures live on stage. “With our unique, patient-centred programme, we aim to combine practical, clinical insights with the dis- cussion of scientific findings,” explained International Team for Implantology (ITI) President Dr Charlotte Stilwell. “We ran a survey in our community last year to identify the topics of greatest relevance currently, and these form the core of our scientific programme: soft- tissue management, guided bone regeneration/bone augmentation, immediate implants, peri- implantitis and the digital workow.” Registration for the ITI World Symposium is open at worldsymposium.iti.org. ITI members as well as those who register early will benefit from significant discounts. CAD/CAM 2 2023 61

meetings | The Escobar is an extension of the Badeschiff that includes a covered bar area. research evidence, the scientifi c programme will feature presentations by prominent opinion leaders, including Drs Henriette Lerner, Alessandro Cucchi, Mirela Feraru, Howard Gluckman, Fabrizia Luongo and Setareh Lavasani, and cover a wide range of topics, such as artifi cial intel- ligence, the digital work ow in maxillofacial surgery and full-arch rehabilitation, and digital bone surgery. Attendees will have the opportunity to earn valuable continuing education credits. Besides a strong educational aspect, the 2024 Digital Dentistry Show will serve as a social hub for dental experts, professional organisations, manufacturers and publishers who are looking to form or expand their network of like-minded, future-oriented individuals. To be hosted at one of Berlin’s industrial pearls, the unique event location offers a rich history and a distinctive modern feel. The adjacent Escobar and the Badeschiff spaces will enhance the relaxed and jovial atmosphere, underlining the informal and engaging nature of the show. The 2024 Digital Dentistry Show is expected to attract over 2,000 eminent dental professionals from around the world. You are invited to be one of them! More information on registration and the scientifi c programme can be found online at the event’s offi cial website at dds.berlin. Attendees will also have access to the Sonnendeck of the Escobar, where they will be able to enjoy delicious food and drinks. CAD/CAM 2 2023 63

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 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 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. · We require images in TIF or JPEG for- · · mat. These images must be no smaller than 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!). Questions? Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com CAD/CAM 2 2023 65

Anything goes. The smart milling and grinding machine from vhf. 5 Axes 10 Discs 60 Blocks 16 Tools Dry Wet Mill Grind Auto Clean CAM Software incl. The R5 from vhf thrills even the most experienced dental technician. Why? Because it manufacturer – no matter if it’s blocks, discs, or prefab blanks for titanium custom abutments. And also the easy to operate DENTALCAM software is included – with no extra license fees. So you get a machine that leaves nothing to be desired – all on a vhf.com/R5