Innovative treatment options with full contour zirconia in cases of limited space or bruxismFull contour zirconia has become a very popular material in dental offices due to its high flexural strength, biocompatibility and tissue-conserving preparation.This workshop gives an overview of the material-specific aspects with regard to crown, bridge and implant restorations. Moreover, characterization options are discussed, with a focus on shade design. 

1^st IADDM Corporate Vision Lecture Digital Dentistry and Structural Development in the Dental Community

The digital development has long reached the dental environment. The way we take X-rays , take impressions with Intra oral scanning, doing patient analysis, prepare prostheses in the dental laboratory with desktop scanning, 3D print and milling or are already common practice and are integral part of the way we practice dentistry today and more so in the future.

It is changing rapidly not only the way we practicing dentistry but also the way we are communicating, educating and also running our offices.
Digital support systems will help dentists to guide safer, faster and more efficient through their treatments. At the same time increasing the need to educate, stay up to date and make choices which influence the flow, efficiency and profitability of the office.

The way we stay informed and the way we will chose and purchase products, demand ways to find this information speedily and effectively.

The community of group practices is increasing steadily with the increased need for efficient connectivity.

What choices will dentists have to make in the future to be competitive with globalisation and patient awareness.
The digitally interconnected office and the digitally interconnected community as well as the digitally connected patient offer challenges in the future, change behaviour and certainly offer opportunities for better dentistry and better oral health in the future.

Digital Communication / The Implant- Prostho Connection

Modern techniques and materials can be useless if the final outcome does not live up to the patient esthetic expectations.
It has always been a challange to create a smile design that the final result would be precisely predicted from day one.. in some cases the dentists do built this design by themselves directly in the patients mouth, however some leave it to the ceramist that they work with.. however more importantly this smile design should also match with the patient’s functional, biological and emotional needs…

To obtain such results we need an interdisciplinary team work. Every member of the team (including the specialists, lab technicians and the patient) should be aware of the treatment planning and the end result from the beginning . Having all the above done correctly, major component for the success remains “communication”. The key to the aesthetic excellence requires patient communication as well as the communication with the laboratory and the specialists from the beginning of the case till the end.

This becomes even more challenging if the team ( dentist, specialists and the ceramist) do not physicaly work together in the same place. The protocol that is presented will improve the esthetic diagnosis, the interdisciplinary communication and the predictability of anterior aesthetic implant restorations.

Today, it souldn’t be a problem wether the lab, the specialist ect. that you work with is close to your clinic or it is in another country, the digital communication makes everyone work as a synergistic team. 

Edentulous Surgery with Digital Implantology Workflow

This presentation shows a fully digital workflow that is used to fabricate immediate dentures before extractions, perform computer-guided flapless implant placement, convert a denture into a provisional restoration for immediate loading, and fabricate a final restoration in edentulous patients, without the use of conventional impressions and model casting.

Recently, computer-aided design and computer-aided manufacturing (CAD-CAM) technology has been used to fabricate complete dentures and final prosthesis. The information needed for a CAD-CAM restoration in edentulous jaws is acquired extraorally from an impression or from a stone cast using laboratory scanners. This technique has the same deficiencies as conventional impressions and stone casts. To avoid errors in the CAD-CAM production workflow, digitalizing directly from the patient’s mouth using intraoral scanners would be more practical.

This presentation shows how to get digital impressions of edentulous arches without the use of conventional impressions or stone casts. It also shows how to perform computer-guided flapless implant placement in the edentulous patients without the use of conventional impressions, models or a radiographic guide. Digital data for computer-guided flapless implant placement are acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The digital data are then used to design a prosthetically-driven implant position, surgical template, and CAD/CAM-fabricated dental prosthesis.

At the same time, this presentation shows a simple, practical technique to make provisional restorations immediately after implant placement. Finally, it shows a digital workflow for final restorations. 

Digital diagnosis, planning, treatment, and monitoring in TAD orthodontics – what are the current perspectives?

Digital technology has changed the way we work in multiple ways also in orthodontics. Orthodontic study plaster models were the center of treatment planning. Nowadays, digital models are gaining popularity due to their advantages over plaster in storing, retrieving, and sharing.

Digital technology has changed also the possibilities especially for the use of TADs (temporary anchorage devices). Nowadays, digitally controlled insertion of TADs is possible. If it comes to the treatment and manufacturing of orthodontic appliances, the way we can communicate with our orthodontic labs is much faster using digital technology.

Additionally, orthodontic appliances can be CAD/CAM manufactured without any impressions. Last but not least, orthodontic treatment effects can now be monitored three-dimensionally.

Game-Changing Solutions, Guided Implant Placement and Digital Implant Impression

As all we know, location, depth and angle of dental implant is so important.

Because most of time, it is impossible to change and also affects final result, long term success, and maintenance.
Recently, many clinicians are using CT-based static surgical guide not only for implant placement but also for simulation before implant placement.

Static guide still have some errors and limitations but better than ‘free-hand placement’ and also can be used for flapless approach and immediate loading in limited cases. The digital impression device has become more accurate and popular, so digital Impression of Implants is widely has been used.

For digital impression of implants, there are many different ways to do. We can use scan bodies instead of impression coping or to scan prefabricated abutment directly in the oral cavity that has already registered in CAD/CAM software library in simple case.

The impression using coded healing abutment has also been introduced for a long time ago. The advantage of this method is that it is possible to make prosthesis during the period of waiting for osseointegration because the timing of impression scan of coded healing abutment is more free than other methods.

In this presentation, I would like to introduce and share digital implant workflow from clinical cases of guided implant placement and various implant digital impressions. 

The Digital Evolution in 15 Years of Implant Supported Zirconia Based Full Mouth Rehabilitations. What are the Digital Keys for Success?

Since 2001 we are using implant supported full arch zirconia frameworks for the oral rehabilitation of edentulous patients. The workflow has dramatically changed from a more or less analog orientated procedure to a nearly full digital operated prosthodontic treatment concept.

Retrospectively it is of outmost importance to understand and to anticipate the physical properties of the material zirconia. To control the distribution of strain within the framework, to avoid the devastating effects of malocclusion is mandatory. Especially this holds true if a fixed implant based full mouth rehabilitation is the goal of the treatment.
The digital workflow is of superior precision if technological aspects have to be considered. Otherwise there is no doubt, that in regard to biological demands the analog fortification of the digital workflow is one of the keys of success in a complex oral rehabilitation.

Interestingly a new understanding of the neural implications of tooth loss connects neuroscience with the digital dental world and supports strongly the synthesis of a technical-digital and a biological -analog approach in all ceramic full mouth rehabilitations.

Several variables are influencing the long-term outcome of oral rehabilitations. A comprehensive prosthodontic planning of the outline of the framework, the passive fit of a zirconia framework in a sealed gap construction, a perio-prosthetic design for optimal cleansability, a functional pre-treatment concept to avoid functional casualties and the comprehensive digital evaluation and adjustment of the static and the dynamic occlusion have shown to be important in regard to the long-term success of zirconia based full mouth rehabilitations. 

Bone Grafting and Reconstructive Surgery Protocols using Three-Dimensional Technologies

As there are so many different reasons for bone loss in the maxilla and mandible, there is often limited bone volume for the placement of implants. Therefore the Surgeon is at a crossroad: bypass the obstacle using short or angled implants or reconstruct the bone defect to achieve the necessary bone height and width for implant placement.

Today’s new diagnostic technologies that are based on CT/CBCT imaging modalities combined with interactive surgical planning softwares and stereolithographic anatomical biomedical models can create the actual size, shape, and duplicate of a patient’s specific jaw-bone to study, plan, and simulate prior to the surgery. Using these technologies the reconstructive surgery will be more simple, fast and safer helping to choose the correct choice of surgical invasiveness. In fact, many times a more invasive reconstructive surgery allows us to place implants of appropriate diameter and length in a correct angulation to coincide with the restorative requirements, and often with a better prognosis over time.

This presentation will define and illustrate a series of new surgical protocols along with the fabrication of novel surgical guides to approach various clinical situations such as sinus augmentation, harvesting bone grafts from donor sites and placement of autologous bone blocks, and also the planning and insertion of zygomatic implants.

Following these protocols will help guide the surgical procedures first in simulation and planning, and then in the execution of every step through advanced and extraordinary technologies to achieve excellent results for our patients. 

 Guided Surgery and Narrow Implants: How to be Less Invasive

Nowadays, minimally invasive approach plays a crucial role in dentistry, especially oral surgery. When we talk about implants and regenerative surgery, we must understand and be able to perform the classical techniques such as sinus lifts, ridge splits and bone block grafts. To do this, adequate knowledge of anatomy and proper surgical skills are essential.

Additionally, less invasive options exist with current technology that can increase the probability of patient acceptance while still providing quality dental care.

For this reason, we are going to analyze guided surgery and immediate loading with a prosthesis on implants in a single step. Recent advances in digital applications for implant dentistry have focused on the integration of the diagnostic phase, surgical implant placement and prosthetic reconstruction. Three-dimensional data is collected prior to treatment initiation that can be used throughout the course of treatment by fusing digital data capture of the intra-oral situation and the patient’s anatomic structure. By doing this, crucial information is available to help in arriving at a correct diagnosis and formulate a treatment plan. Subsequent planning is executed without the need for additional CBCT scanning. The prosthetic reconstruction can be planned for in advance, and implants can be delivered precisely using CT based guiding systems.

The result is a workflow that mimics how conventional treatment is delivered, while ensuring a better outcome at less cost. Finally, we will demonstrate the use of narrow diameter implants in the place of performing bone augmentation surgery to accommodate larger diameter implants. The use of these narrow diameter implants allows surgical solutions that reduce time and trauma to the patient, as well as versatility in prosthetic rehabilitation. The purpose of our surgery is delivery a correct final prosthesis from the esthetic and functional point of view .

In a traditional rehabilitation on natural abutments we have to follow a rigid protocol for obtaining a correct preparation of the natural abutment and also for the preparation and finishing of sub gingival margins well shaped and non traumatic with the preservation of the soft tissues, as well in implant rehabilitation we have to know some prosthetic concepts fundamental to achieve a good outcomes. Therefore the use of Guide surgery and Narrow implant grant us much more solutions not only in implant surgery but also in prosthetic rehabilitation.

Minimally Invasive Full-Mouth Rehabilitation Adapting Digital Dentistry

Lately, favorable results are seen in many esthetic & functional rehabilitation cases with minimally invasive techniques. This became possible due to the development of bio-mimetic, advancement in bonding technique, and treatment using the etiological-based approach. In addition, the use of microscope has allowed us to obtain precise and predictable outcomes of my clinical cases.

The future prospective of minimally invasive full-mouth rehabilitation adapting digital approach would require the following clinical discussions:

1) There are multiple of clinical cases reported on the shift from MI to None-invasive treatment by maximize the preservation of sound tooth structures but does the tooth reduction necessary at all? Or what is the necessary designed location of the finishing line and marginal morphology? Is it a full-veneer or an additive veneer restoration? What will be the amount of tooth reductions needed for respective restoration materials?

2) In case of Bonded Porcelain Restoration (BPR), the accuracy is the essential to maximize its predictability but what would be key points in the clinical work-flow to maintain this high predictability when the digital technology replaces the traditional restoration work?

3) What will be the appropriate material selection guidance to all relevant materials between the traditional and Digital restorative works?

4) In case of the full-mouth rehabilitation treatment to grant occlusions, the test drive of a provisional restoration considering both functional and aesthetical are mandatory. However, what would be keys for the In-direct Bonded Restorations which does not suppose retention and resistance factors?

The speaker wishes to explain all of the above through his clinical cases. 

Modern Trends In Implant Dentistry: Standardization – Individualization – Digitization

Recent developments in digital technology in implant dentistry now enable dentists to plan, place and restore dental implants with increased safety, accuracy and predictability.

In this context, the expectation of patients receiving implant reconstructions has exceeded functionality. Patient-centered outcomes are gaining importance in dental therapy concepts: clinical success of the overall treatment is assumed as self-evident; convenience-oriented strategies are in the focus of the patients with their growing claims.

Rather esthetic factors and economic aspects are in the foreground of the implant treatment concept. Today, the team of clinician and dental technician can choose from a variety of possibilities of individualized and prefabricated abutments in combination with dental materials, such as titanium or zirconium dioxide and various fabrication techniques.

Nevertheless, a long-term success of implant-supported reconstructions is dependent not only on the material-specific properties and manufacturing procedures, but also on a concise treatment planning including the safe implementation of all clinical therapy steps under consideration of the use of original-to-original implant components.

Make or Buy: Cost Analysis and Pro & Cons of In-House Production

As part of the final exam for my Business Administration Degree, I conducted a feasibility study for a typical traditional dental laboratory located in central Germany, to define at which point (with a special focus on current and target volumes of production) it would be economically of interest to invest in a compact CNC milling machine, in an industrial
milling machine or even to outsource part of the production.

I have compared several offers for milling machines, as well as compiled and analyzed a list of material costs, together with the (very often hidden) production costs to be expected for such an investment.

Through the introduction of a real-life example, I would like now to provide you with practical tools adapted to the fields of dental technology & dentistry, which you can apply in turn to your own situation to define the expected impact, the specific advantages & inconvenients, as well as the most economically adequate option to provide your lab / surgery with a competitive advantage.

To do so, I will intend to cover the 3 following questions:
1. What are the pros & cons of in-house production and outsourcing?
2. Does it make sense at all to invest in in-house production?
3. And if so, which offer is the most cost-efficient one for the size of your laboratory?” 

Anterior and Posterior Restorations: The Chairside CAD/CAM Experience

Today’s dentist has a wide choice of restorative materials available when replacing missing or damaged tooth structures. Since introduction in dentistry of composite resins, those materials have undergone a tremendous development and their adhesive properties on both enamel and dentin have been constantly improved, allowing a more conservative approach during the tooth preparation. Patients’ demands for a more aesthetic and metal-free restoration on posterior and anterior teeth increased during the last decade focusing the interest of the dental profession towards aesthetic restorations with composite resins.

The continuous improvement of the digital CAD-CAM technology is revolutionizing the dental profession in both laboratory and dental office.

Today is possible with the chair-side CAD-CAM restorations to restore teeth in a single session saving time for the patient and dentist as well.

Numerous type of glass ceramic and composite block are nowadays available; partial and full crown restorations can be fabricated directly in dental office by the dentist.

However, it is vital that the treating clinician have a thorough understanding of the principles that lead to a successful outcome.

Naturally appearing and problem free outcome can be achieved if certain rules are followed by a conscientious operator.

The Real First Twenty Years of Dental CAD / CAM. 1970-1990 or the Time of the Pioneers.

The medical (and dental) artificial intelligence was introduced for the first time in my DDS in 1973 “Optical Impression”. The dental CadCam is just a part of it. This part was also launched at the same time iin USA. The result was 10 years friendly struggle between France and USA and more than 50 lectures and publications but also 5 theses approached the matter.

It has been only with the realization of the first extrados (Paris – 1983) and then the first crown in the mouth (ADF – 1985) outside laboratory and in congress that I was able to demonstrate the veracity of my invention. After these 15 years of work, the first Cerec (1985) appeared, which milled the intrados of inlay, the Celay (1986) machining a complete inlay by palpation and Procera (1987) for copings.

All the other teams (Rekow, Tsutsumi … only had laboratory results).

The first CAD / CAM system entered the dental offices in November 1987 (Hennson Int.) In the current Chairside configuration: camera, CAD / CAM and small machining center. While other systems were still in their infancy (Cerec, Procera) or did not exist (3M, 3 Shapes, Dental Wings), Hennson already realized crowns, bridges, inlay, onlay … in Static and dynamic occlusion … and the first implants and ODF brackets.

It will take another 20 years and 2010 to regain the same level of perfomance.