CEREC Zeitung

No. 9 June 2007 International Edition

MEGA-TREND

GREAT EXPECTATIONS

TECHNICAL INNOVATION

CAD/CAM solutions
were a major highlight
PAGE 2
at IDS 2007

Initial studies confirm

the durability of lithium
PAGE 3
disilicate

CEREC makes aesthetic

dentistry available to a
PAGE 4
wider audience

Ceramics are not a luxury

Many patients
regard healthy and
attractive teeth as
something of a luxury. They often associate a visit to the
dentists surgery with
lost time, considerable expense, and physical pain. Given the
choice, most people would prefer to
spend money on a new car or a foreign
holiday. The results are plain for all to
see: discolored teeth, inflamed and
retracted gums, exposed metal margins,
amalgam fillings, and unsightly gaps to
quote just a few examples. The only consolation is that all these provisionally filled cavities, defective composite fillings
and deep-seated caries are not visible
from a distance.
Is there no alternative? Will all-ceramic inlays, onlays and crowns remain an
exclusive privilege for high wage earners?
The answer is a clear No! Computermanufactured, single-visit restorations are
available in different aesthetic and price
categories. They offer undisputed advantages over conventional restorations in
terms of biocompatibility and durability
(in many cases). In their pure uncharacterized state all-ceramic restorations are
much more aesthetic than their metal or
resin counterparts. The metal era is over.
Ceramic is the new state of the art.
Instead of resisting change its now
time to face up to new realities. Putting
your head in the sand only gives a false
sense of security.

Dr. Wilhelm Schneider,

Head of CEREC marketing at Sirona

CEREC crowns for everyone

Adhesive bonding
or cementing?

SUPERIOR DENTAL CARE. The universal CEREC crown for everyone combines the economic and clinical
advantages of metals and ceramics respectively. There are now fewer and fewer reasons to choose
metallic restoration materials.

BONDING TECHNIQUES. The

stability and durability of a
restored tooth depend on the
quality of the bond.
dhesive bonding is an absolute
A
must for inlays, onlays, partial
crowns and veneers made of silicate

Clinically proven, aesthetic and cost effective: The CEREC crown for everyone is just what the doctor ordered.

hese universal CEREC crowns are

Tusing
created directly at the chairside
the new CEREC MC XL milling system. Constructed of a highly
aesthetic lithium disilicate glass
ceramic developed by Ivoclar Vivadent, these molar restorations are
extremely strong and thus suitable
for conventional cementing.
The production process is tailored
exactly to the requirements of dental
practices. In other words, dentists
can create and place these CEREC
restorations during a single appointment. The sum total of the product
benefits makes impressive reading:
Given the choice, most patients
opt for ceramic as opposed to
metal, provided that the costs
are roughly comparable. Key
factors are the biocompatibility
and the natural appearance of
modern dental ceramics.

Compared with a conventional

metal restoration, the preparation
process takes only slightly longer. Thanks to the pronounced
chameleon effect of the ceramic
material, the preparation margin can be located above the
gum line. In other words, it is
not necessary to hide the metal
margins.
A further argument in favor of a
CEREC restoration is the fact
that treatment can be performed
during a single appointment.
CEREC eliminates the need for
a conventional impression. Dentists frequently underestimate
the number of patients who suffer from a strong choking reflex
when impressions are taken.
CEREC also eliminates the need
for a temporary restoration, thus
saving time and trouble for the

dentist and the patient. Studies

have shown that poor-quality
temporaries have a significant
influence on the survival rates of
permanent restorations.
Designing the restoration is so
simple that the patient could
accomplish the task himself,
given the necessary guidance.
News of CEREC and its unique
advantages is spreading quickly
by word of mouth.
The contact points on the occlusal surface are created using the
worlds best articulator the
patients mouth.
The outstanding precision of the
new CEREC MC XL milling
machine is geared to traditional
cementing techniques. Placing a
CEREC crown takes no longer
CONTINUED on page 2

CEREC MC XL: Precision for the universal CEREC crown

Published by: Sirona Dental Systems GmbH,

Fabrikstrae 31, 64625 Bensheim, Germany,
Tel.: +49 6251-16-0, Fax: +49 6251-16-2591,
contact@sirona.de, www.sirona.de
Responsible for content:
Dr. Wilhelm Schneider,
Sirona Dental Systems GmbH
Editorial team: Wilhelm Schneider, Hans-Georg
Bauer, Antje Casimir, Birgit Mller, Manfred Kern,
Andrea Hamacher, Christoph Nsser. E-mail:
info@cerec-zeitung.de
Design and production:
ergo Kommunikation, Kln/Frankfurt a.M., Berlin
www.ergo-pr.de
Printing: Sieprath Druckservice GmbH,
Karl-Friedrich-Strae 76, 52072 Aachen, Germany
CEREC Zeitung is published every three months.
A 91100 - M41 - A849 - 01 - 7600

ccording to the dental textbooks, conventionally cemented restorations should display tolerances in the region of 50 m. The marginal
fit is a key criterion in clinical success. For this reason the CEREC MC XL has been designed to deliver maximum precision. Compared with
its forerunner, the milling steps are two to four times smaller. The motor control system has been completely redesigned as have all the other
precision-relevant components of the CEREC MC XL.
Building a precise machine is not particularly difficult. However, special know-how is required to make this machine fast, quiet and affordable. It is exactly these qualities that allow the CEREC MC XL milling unit to be easily integrated into dental practices. Affordable and quiet
are self-evident. Fast requires a bit more explanation. Precision
and speed are two conflicting demands and a lot of effort is
required to reconcile the two. Why is speed of such importance? As
a rule the CEREC MC XL is deployed directly at the chairside. It is
important that the dentist does not have to wait for the milling unit
to complete the restoration. Most CEREC users start treating the
next patient and leave the CEREC MC XL to operate in the background. The restoration should be finished during this 15 - 20 minute period. In other words: the quicker, the better especially in
cases where the dentist wants to place two adjacent inlays in the
course of one appointment. Speed is also of the essence when
placing the new CEREC crowns for everyone. It takes approximately 25 minutes to crystallize IPS e.max CAD LT. Hence it is essential
that CEREC MC XL is in a position to machine the ceramic material
quickly and precisely.

ceramics. The permanent forcelocked connection with the residual

tooth tissue cause less tensile stress
and cracking can be virtually ruled
out. In short, adhesive bonding significantly enhances the mechanical
resilience of the restoration.
In cases where little or no enamel remains (e.g. when crowns and
crown abutments are attached to
a circular preparation of the dentine) adhesive bonding can lead to
clinical problems.
Therefore, frameworks of highstrength oxide ceramics or lithium
disilicate are produced that can be
conventionally cemented. Compo- Prof. Dr. Matthias
mers are contra- Kern, Kiel.
indicated due to
their tendency to swell up.
Adhesive bonding is indicated for
anterior restorations requiring a high
degree of translucency and for short
crowns with a low degree of mechanical retention. Etching with hydrofluoric acid does not enhance the
retention of oxide ceramics. The restoration needs to be pre-treated before the silane coupling agent is
applied (silicon oxide must be present in order to facilitate docking).
The adhesion effect can be enhanced
by applying silicate or silane to the
inner surfaces of the crown. Alternatively, the retention surface can be
sand-blasted (50 m corundum; 2.5
bar pressure) and then conditioned
using a special oxide ceramic primer.
A further possibility is to use a phosphate monomer adhesive.
Self-adhesive phosphate monomer luting agents have proved
themselves in practice. These create
a non-water-soluble bond. To this
end the enamel and the dentine
must be treated with a primer. Alternatively, self-adhesive luting composites can be deployed. In this case
the tooth tissue does not need to be
primed. However, various scientific
studies involving prolonged immersion in water at differing temperatures have indicated a reduction in
adhesion compared to traditional
adhesive bonding systems.
Prof. Matthias Kern

Photo: Kern

EDITORIAL

2 CEREC Zeitung

No. 9 June 2007

CEREC 3 achieves laboratory-standard precision

entists who are on the point of
D
adopting the CEREC procedure
can now choose between two different milling units: the proven,
compact and competitively priced
CEREC 3; or the fast, precise and
quiet CEREC MC XL. From the

Step bur for filigree structures: at the tip

the shank diameter is down to only one
millimeter.

outset the new CEREC MC XL unit

has been designed to mill conventionally cementable crowns. By
contrast, the CEREC 3 was originally intended for adhesively bonded
restorations only. The accuracy of
the CEREC 3 system depends on
the resolution of the CEREC camera (25 m) and the reproducibility
of the CEREC 3 milling unit. After
user-induced factors such as preparation, anti-reflective powdering
and imaging technique have been
discounted, CEREC 3 achieves an
accuracy of 55 m. A major step
forward was the introduction of a
step bur, which measures a mere
one millimetre at the tip.

Assistants are just as good at

designing as experienced dentists
In a multi-centre study carried out
at seven US universities (Tennessee,
Louisville, Kentucky, Minnesota,
Carolina, Iowa und Boston) lab-

than placing a conventional laboratory-made restoration.

The aesthetics of the molar
crowns can be easily adapted in
accordance with the patients
requirements and financial resources. Various options are
open: glazing (no extra work
involved); shading (can be delegated to an assistant); or ceramic veneering (can be performed by a
dental technician in the in-house
lab).
The same applies with regard to
the bonding of the restoration.
Either the dentist can choose traditional cement, which is cheap
and fast, but leads to inferior
aesthetic results. Or he can opt
for the modern, self-adhesive
luting system Multilink Sprint
(made by Ivoclar Vivadent),
which is just as fast and delivers
perfect clinical and aesthetic outcomes.
These benefits coupled with
CERECs convincing efficiency gains
boost patient satisfaction and ensure
that the practice is recommended to
third parties. For a minimal input of
time and money (a ceramic block
costs less than 20 euros) the dental
practice can generate additional earnings on a par with those of a dental
laboratory. Whats more the CEREC
procedure saves valuable time. The
dentist can dispense with conventional impressions, as well as a second
appointment.
To sum up, CEREC crowns for
everyone can be created at an affordable price and in accordance
with the specific clinical, aesthetic
and financial circumstances. Regardless of which ceramic material
is chosen, CEREC restorations offer
perceptible advantages clinical,
organizational and economic over
comparable metal-based alternatives. CEREC crowns are a genuinely universal solution for every

tually identical. The margins of the

lab-produced crowns were somewhat wider (69.1 26.9 m), but
this was not statistically significant.

Under ideal conditions CEREC 3

allows traditionally cemented
crowns
The CEREC 3 system comes close
to achieving a marginal gap width
of 50 m, thus complying with
university standards. This means
that under ideal preparation conditions the CEREC 3 system can
be deployed in order to create universal CEREC crowns with a minimal degree of risk. This risk can be
minimized further if the crowns
are placed with the aid of the selfadhesive Multilink Sprint (Ivoclar
Vivadent) bonding agent. This also
has aesthetic advantages. To be on
the absolutely safe side dentists
should opt for the new CEREC MC
XL milling machine, which has
been designed specifically for the
production of traditionally cemented CEREC crowns for everyone. I

Adhesive joint between enamel (above)

and ceramic (SEM image).

PD AO Dr. Sven Reich, Leipzig:

To test the CEREC MC XL milling unit partial crowns were placed on 16 different
models corresponding to clinical situations.
These partial crowns replaced the buccal
and distobuccal cusps. Minimal mean
discrepancies of 35 m (standard deviation: 19 m) were observed in the area of
the distobuccal step preparation of the
replacement cusps.
This area lends itself to effective preparation, as it is easy to create an even
and clearly defined step. This preparation
design appears to offer optimum conditions for creating precisely fitting restorations. This aspect is also of interest with
regard to crown restorations, which ideally
should display a similar, circular design.

Sustained trend towards CAD/CAM

CONTINUED from page 1

The CEREC crown for everyone

produced crowns and CEREC

crowns were compared with reference to their marginal and interior
fit. Experienced CEREC users and
dental assistants (who had received
only brief instruction on the basis
of a CD-ROM) each designed ten
molar crowns on the basis of standard models. These restorations
were then milled out of VITA Mark
II and Ivoclar ProCAD blocks. As a
basis for comparison, dental laboratories linked to each of the seven
test centres were asked to manufacture Empress crowns using the
same standard model. Each of
these crowns were placed using
Variolink (Ivoclar Vivadent) and
then cut along the buccolingual
plane through the mesial and distal
cusps. Following this, the marginal
fit was determined for each restoration. The results achieved by the
non-users were surprisingly good.
The marginal precision of the dentist-produced crowns (61.6 27.9
m) and the assistant-produced
crowns (60.8 20.5 m) were vir-

Photo: Dr. Reich

PROGRESS. The marginal fit of CEREC restorations has improved

dramatically with each new generation of milling machine.

patient and for every practice.

There are fewer and fewer reasons
to resort to metal restorations.

IDS 2007. Never before were so many CAD/CAM systems on display at the International Dental Show.
technology has unCThisAD/CAM
leashed a revolution in dentistry.
process began in 1985 with the

IPS e.max CAD LT

Material
Lithium disilicate glass ceramic with a
strength rating of 360 MPa; easy to
mill on the CEREC system; milled
crown needs to be crystallized (30
minutes); crystallization shrinkage:
0.2 percent (allowed for automatically during the milling process).
Indication
Fully anatomical anterior and posterior crowns.
Placement
Conventional cementing or adhesive/
self-adhesive bonding.
Aesthetics
Perfectly adjusted translucency; 13
basis shades; characterization by
means of shading, glazing or ceramic
layering (single firing process).
Production process
Optical impressions in the patients
mouth; marking of the preparation
margin; selection of the appropriate
tooth database; automatic adaptation of the occlusal and proximal contacts; automatic milling; shading and
crystallization.

Photo: Kurbad

launch of the CEREC system and

reached a new high at this years International Dental Show in Cologne.
All the major dental equipment companies now have CAD/CAM solutions and NC-machinable materials
in their product portfolios. The number of different systems has reached
an all-time record. These set new
standards in terms of cost-effectiveness, user-friendliness and restoration quality. With the help of digital
technology it is now possible to create
dental restorations three times faster
than is the case with conventional
methods. Lab-produced restorations
are ready within one day, while their
chairside equivalents can be designed, manufactured and placed in the
course of a single appointment.
Todays dentists and dental technicians now have no choice but to get
to grips with CAD/CAM technology.

CEREC leads the chairside market

There are various competing
CAD/CAM concepts. The chairside
procedure pioneered by CEREC has
become well-established. CEREC is
the only market-ready system of its
kind and has reached an advanced
stage of development. Made of a
lithium disilicate ceramic material,
the new CEREC crown for everyone
opens up a new dimension in aesthetics and strength. Following
completion of the milling process
the strength of the material increases
by crystallizing in a sintering furnace. It is now possible to create
cementable molar crowns without
framework during a single appointment. A further highlight at this
years IDS was the biogeneric
design function now incorporated
in CEREC 3D. The software detects
the natural morphology of the residual tooth tissue and then proposes

The Sirona presentation was a magnet for visitors: strong interest was shown in the new
software features and the new CEREC MC XL and inLab MC XL milling machines.

individually designed occlusal surfaces for inlays and onlays.

Diverse array of labside systems

CEREC restorations have also become established in the laboratory
segment in the face of broad competition. Zirconium oxide crowns
fabricated by inLab or infiniDent
have proved themselves in practice
over a period of many years. Numerous CEREC users now order their
dental prosthetics from laboratories equipped with the inLab system. The diverse range of labside
applications indicates the extent to
which CAD/ CAM procedures have
taken root in the marketplace.
There is now a diverse array of competing systems designed to scan
extraoral plaster models. It is now
possible to scan everything from
single teeth to complete jaws and to
determine the relations between
upper and lower jaw models with
the necessary degree of accuracy.
The CAD/CAM data is then processed in-house or else sent to an
external production facility, where
the restorations are made to order.
Significant progress has been
made in terms of the effectiveness

and user-friendliness of the software. The design process has been

streamlined enormously, thanks to
three-dimensional visualization of
cavities and the introduction of
sophisticated modelling functions.
A few years ago the assumption
was that wax-up models were the
stepping-stone to CAD/CAM technology. Today, it is possible to perform the design process much
more quickly and accurately on the
computer screen than on real-life
models. As a general rule the
design programs have become
easier to use. In the past a lot of
user input was required in order to
define wall thicknesses and coping
margins, to place cusps and contact
points, to design the occlusal surfaces, and to integrate auxiliary prosthetic components. This has now
changed: IDS 2007 indicated a clear
trend towards automated design.
Intraoral imaging a defining feature of CEREC 3D entered a new
phase at IDS 2007. Several companies alongside Sirona are exploring
this technology with the aim of
using optical impressions in place
of conventional physical moulding
I
techniques.

CEREC Zeitung 3

No. 9 June 2007

Durability on a par with PFM crowns Lithium disilicate crowns in a single appointment
more than a decade chairside
Fonorrestoration
procedures centred
all-ceramic inlays, onlays,
veneers and partial crowns. For allceramic crowns the preferred material was layered aluminium oxide
(Al2O3), which was either computer-milled in a dental laboratory or
press-sintered in an external production facility. The reason for this
division of labour was the need to
deploy high-strength materials
capable of withstanding high chewing forces. Such materials require
subsequent glass infiltration and
sintering. Veneered crowns with
aluminium oxide (Al2O3) and zirconium oxide (ZrO2) frameworks
have achieved a high degree of
sophistication, with a correspondingly high survival rate. For example, dman established a survival
rate of 93.5 percent for press-sintered Al2O3 crowns after ten years.
According to Prbster, 97.9 percent of glass-infiltrated Al2O3
crowns were still functioning perfectly after six years.
After an observation period of
ten years ZrO2 crowns are not
prone to framework fractures.

So far, only CEREC 3 offers

the possibility of creating allceramic crowns directly at the
chairside and during a single
appointment. These feldspar
crowns dispense with a separate
framework and are anatomically
sized, i.e. they do not require subsequent veneering. The software
retrieves suitable restoration proposals from a database, designs the
occlusal surface and then positions
the cusps and the contact points
with reference to the antagonists.
The new lithium disilicate material
presented at IDS 2007 offers
outstanding aesthetics, as well as
a high degree of flexural strength
(360 MPa), which is achieved by
means of subsequent sintering.
On account of their strength and
precision crowns made of this new
material are suitable for conventional cementing or adhesive bonding.

Lithium disilicate awakens great

expectations
According to Bindl and Mrmann,
classically prepared all-ceramic
crowns from feldspar created on

L O N G E V I T Y O F C E R E C R E S TA U R AT I O N S
Survival rate
1

0,9

0,8

0,7

0,5

Years
0

10

with dentine adhesive

12

14

16

18

20

without dentine adhesive

Source: Dr. Reiss

0,6

In a study Dr. Reiss from Malsch/Germany reported that adhesively bonded CEREC chairside restorations show a survival rate of approximately 90 percent after 16 years.

Hence oxide ceramic crowns display

a survival probability equivalent
to porcelain-fused-to-metal (PFM)
crowns, which have a failure rate of
1.0 1.3 percent per year, as established by Walton. However, all of the
above-mentioned procedures necessitate temporaries, as well as the
involvement of a dental laboratory.

the CEREC 3 system and adhesively bonded achieve a survival

rate of 94.6 percent (molars) and
97 percent (premolars) after five
years. This conforms to the gold
standard. The material properties
of a crown made of lithium disilicate are expected to achieve an
equally favourable survival rate.

CEREC Club: free software

upgrade for members
If you encounter a CEREC user at a
congress or elsewhere during the
next few days, you may wonder why
he or she is looking so pleased. The
answer: the dentist in question is
probably a member of the CEREC
Club and is looking forward to
receiving the latest software upgrade
free of charge. The CEREC 3 user
interface has been streamlined and
is visually much more appealing.
The occlusal surfaces can now be
designed on the basis of a biogeneric
tooth model. This saves time and virtually eliminates the need for manu-

al reworking. The price of the software upgrade alone justifies joining

the CEREC Club. There is no cheaper alternative for obtaining the latest
versions of CEREC 3D. Its no coincidence that more than 7,500 dentists worldwide are now reaping the
benefits of CEREC Club membership. In the USA virtually every new
CEREC purchaser joins the Club
from the outset. The free competition between US dentists provides a
strong motivation to stay right up to
date in the interests of dental
I
practices and their patients.

INTERVIEW. Dr. Gerhard Werling, who is based in Bellheim near Landau/Pfalz, trained as a dental
technician before studying dentistry in Frankfurt. Together with his sister, Ursula Werling, he now operates a practice that specializes in implantology and cosmetic dentistry. He uses CEREC 3 as well as the
inLab system. Since 2004 all-ceramic crowns have formed part of his treatment portfolio.
colored, plaque-resistant and biocompatible. And they last as long as
their metal-based equivalents.

CEREC Zeitung: And what are the

economic benefits of the CEREC
crown?

All Photos: Dr. Werling

CLINICAL STUDIES. Various authors have demonstrated that allceramic CEREC crowns achieve the gold standard exemplified by
PFM crowns.

CEREC Zeitung: Dr. Werling, what is

your practice concept and why did
you decide to purchase the CEREC
system?
Dr. Werling: I have always attached
top priority to conserving as much
tooth tissue as possible. In prosthetic dentistry there is a tendency to
sacrifice healthy substance in order
to realize technically durable restorations. This is why I decided to
train as an implantologist. Implant
crowns avoid the necessity of grinding down abutment teeth in order
to attach a bridge. Our second mainstay is aesthetic dentistry. I was fascinated by the possibilities offered
by adhesively bonded all-ceramic
partial crowns as an alternative to
metal-based restorations, which
lead to significantly greater losses
of tooth tissue. I wanted to offer my
patients ceramic restorations in a
single appointment and without
the inconvenience of temporaries.
And I also wanted to reduce my
external laboratory costs. All these
factors led me to CEREC.

glass ceramic, feldspar and zirconium oxide crowns using the CEREC
and inLab systems. 98 percent are
still in a clinically perfect condition.
The few failures are attributable to
clinical problems, which also affect
conventional restorations. Recently I have been giving preference to
lithium disilicate. Key factors here
are outstanding aesthetics, enhanced strength, the various translucencies and shading possibilities, and
the choice of traditional cementing
or adhesive bonding.

Dr. Werling: They are very convincing. The rapid break-even of the
CEREC unit persuaded us to buy an
inLab system for our in-house dental laboratory. As is the case with
most dental practices, external lab
costs accounted for 30 percent of
our total revenues. Following the
integration of CEREC and inLab
this figure has fallen to less than 15
percent. Single-tooth crowns, in
particular, boost our job satisfaction
and generate an appropriate level of
fee income. This helps to secure
jobs, as well as the long-term existence of our dental practice.

CEREC Zeitung: Can you be more

specific?
Dr. Werling: We charge an average
of 650 euros for a white molar
crown. The patients contribution
is approximately 450 euros. We do
not incur any external lab costs

CEREC Zeitung: Have your

expectations been fulfilled?
Dr. Werling: We create all our
inlays, onlays and partial crowns
and around 80 percent of our
crowns using all-ceramic materials.
It was definitely the right decision
to adopt the CEREC procedure.
CAD/CAM is faster than conventional methods. And Im in a position to select the appropriate material and bonding technique for
each individual patient.

CEREC Zeitung: How does the

patient benefit from CEREC?
Dr. Werling: Thanks to CEREC he
does not have to suffer the discomfort of a conventional impression
for example, he doesnt have to suppress the choke reflex. He doesnt
need a temporary. In a little over an
hour the crown is finished and
placed. Time is a precious commodity for our patients. They do not
want to spend their free time at the
dentists surgery.

CEREC Zeitung: How durable are

CEREC crowns in your experience?
Dr. Werling: Over the past three
years we have created around 450

CEREC Zeitung: A material that

paves the way to CEREC crowns for
everyone?
Dr. Werling: Yes, indeed. The
CEREC crown costs the same as a
conventional FM equivalent. Depending on the specific diagnosis,
the public health insurance system
contributes towards the cost. CEREC
crowns are easily affordable. Whats
more, they are metal-free, tooth-

for a CEREC crown; we issue an

internal receipt for 350 euros. By
contrast a PFM crown incurs external lab costs of approximately
360 euros. After allowing for amortization costs, CEREC is very costeffective. We use the surpluses to
invest in the future of our dental
practice.

CEREC Zeitung: Thank you for

talking to us today.

4 CEREC Zeitung

No. 9 June 2007

the past aesthetic dentistry

Icalndepended
not so much on techniinnovation as on the craft skills
of individual dental technicians.
The striving for maximum verisimilitude led to the creation of
works of art, which perhaps
deserved a better fate than to end
up in the patients mouth. Unfortunately, the available materials
suffered from durability problems.
The situation is different today.
New procedures and materials now
allow dentists to make allowance
for aesthetic aspects during the
treatment planning stage without
incurring any disadvantages. With
the help of all-ceramic CAD/ CAM
restorations every dentist is now in
a position to offer the average
patient solutions that are clinically
effective and take account of the
patients individual appearance.
However, this does not mean that
cosmetics should take priority over
good medical practice. Likewise
works of art should not be seen as

the norm. Thanks to CEREC it is

possible to raise the average aesthetic level of dental practices. In
this connection CEREC fulfils
three necessary conditions:
1. The restorations must fulfil clinical quality standards. Numerous studies carried out in dental
practices and universities indicate that CEREC restorations are
more durable than those made
out of conventional materials.
2. The dentist must be in a position to work cost-effectively.
CEREC restorations should be
reasonably cheap to produce.

Photo: Dr. Werling

TECHNICAL INNOVATION. Aesthetic dentistry is now available

to a broad spectrum of patients.

A nicer smile with CEREC crowns.

The investment in a CEREC system should pay for itself within

a reasonable period of time. The
necessary time input amounts to
only a few minutes. The reward
is the invoice from the inhouse dental laboratory.
3. A sufficient number of patients
should be motivated to opt for
CEREC. The overall package
must make a convincing impression. This is obviously not the
case with highly aesthetic inlays
and veneers produced in the
laboratory. The fact is that too
few patients choose ceramic restorations. Hence it is essential to
communicate the unique benefits of CEREC (aesthetics, biocompatibility, treatment in a single appointment, no impressions, no temporaries) and to
make these benefits available at
an acceptable price.
CEREC caters for the following
indications: inlays, onlays, partial
crowns, full anterior and posterior
crowns, veneers, long-term temporaries, plus bridges with up to four
units. In this context inlays, onlays
and the universal CEREC molar
crowns for everyone have proved to
be the most cost-effective soluI
tions.

Four easy steps to the CEREC

crown for everyone
DESIGN. The latest CEREC software speeds up the creation of universal CEREC crowns for everyone.
ptical impressions of the preO
pared tooth and the antagonist
are the first step for designing a
crown on the computer screen. This
means that the patient does not have
to endure the discomfort of a conventional impression and you save
time and money. On the basis of
these optical impressions the software computes the crown and
adapts it automatically to the adjacent teeth and the antagonist. Prior
to this the CEREC user has to mark
the preparation margin and select an
appropriate tooth from the builtin dental database. The user can
choose between ready-made teeth
supplied by VITA and Ivoclar
Vivadent. Alternatively he or she can
select a database specially developed
for CAD/CAM applications by the
American dental technician Lee
Culp. This database caters for three
different degrees of abrasion.
Following this, the database
tooth is adapted automatically to
the opposing dentition. Using a

biomimetic technique the CEREC

software rotates and moves the
occlusal surface of the database
tooth until it is stably aligned with
the opposing occlusal surface. The
software then moves each cusp in
turn in order to fine-tune the occlusal contacts. It also adjusts the
strength of the two proximal contacts. The restoration is now ready
to be milled. Despite the rapid
design process, the finished crown
offers convincing quality with
regard to the preparation margin
I
and the occlusal surface.

Quick and convincing: designing crowns

with the help of CEREC 3D.

Turbo crown geared to the

requirements of dental practices
M-362-76-V0

CAD /CAM SYSTEMS | INSTRUMENTS | HYGIENE SYSTEMS | TREATMENT CENTERS | IMAGING SYSTEMS

EXCHANGE OF EXPERIENCES.
The 8th CEREC Conference
presented various updates for
CEREC 3D and inLab users. The
lithium disilicate crown for
everyone evoked a high degree
of approval.
peaking on behalf of Ivoclar
Sscribed
Vivadent Professor Kappert dethe features of the new
lithium disilicate ceramic material
to the 400 conference attendees in
Neuss. Post-sintering increases the
flexural strength of the material to
360 MPa without causing shrinkage or any change in its thermal expansion coefficient. For this reason
the material is ideal for single-tooth
crowns. Thanks to its strength and
dimensional accuracy, lithium
disilicate lends itself to conventional cementing. The crowns can be
individualized, either with the aid
of staining products or by applying
a ceramic veneer (cut-back method).
Prof. Arnetzl from Graz University/Austria explained how a
favorable preparation design can
eliminate fracture-inducing tensile
stresses in the ceramic material. A
rounded stump preparation has the
effect of transforming the chewing
forces into compressive stress.
Measures have indicated that a 12
degree conical stump permits a 30
percent increase in the chewing
forces.
Dr. Bindl from Zurich University/Switzerland outlined the

It will be a
great day.
With Sirona.
You have a fascinating job.You have the feeling of doing
the right thing in the right place. Sirona supports you
with products, ideas and real passion. We will help you
start each and every day with the right motivation.
It will be a great day. With Sirona.

biogeneric occlusal design function which has been incorporated

into the latest CEREC 3D upgrade
(for a detailed description see
CEREC Zeitung No. 8). Dr. Kurbad
(Viersen/Germany), Dr. Ostermann (Hanover/Germany) and
dental technician Kurt Reichel
(Hermeskeil/Germany) reported
on their experiences with CEREC
and lab-produced restorations.

Photo: Kern/AG Keramik

Affordable aesthetics

Professor Kappert, Dr. Bindl, Dr. Kurbad

and Professor Arnetzl (from left to right)
spoke about new developments in
CAD/CAM restoration.

Ceramic facings for ZrO2 crown

and bridge frameworks require an
anatomical cusp support in order to
prevent fractures. A new timesaving method is to mill the facing
out of lithium disilicate and then
sinter it to the ZrO2 framework. All
the speakers were confident about
the future potential of the new lithium dioxide turbo crown. It can
be created and placed during a single appointment and is subsidized
by Germanys public healthcare
system. This means that it is easily
I
affordable for most patients.

COMING SOON
1/5 August 2007 SADA Congress Sun City (South Africa)

www.sirona.com

T h e

D e n t a l

21/22 September 2007 Advanced CEREC User Course, London (UK)

C o m p a n y

24-27 October 2007 FDI Dubai (United Arab Emirates)

8/9 November 2007 Advanced CEREC User Course, Bensheim (Germany)

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01.06.2007 8:45:38 Uhr