THE GREAT TEETH, IT’S FABRICATION USING MODERN TECHNOLOGY (CEREC/INLAB MODULAR SYSTEM

This is an address proposed to be delivered by the author at the annual general meeting of association of dental technologists of Nigeria (ADTN). It is a good read please happy reading Saad Drealking 8:15am Oct 3 THE GREAT TEETH, IT’S FABRICATION USING MODERN TECHNOLOGY (CEREC/INLAB MODULAR SYSTEM) BYSSGT SAAD UMAR FARUK (R.D.T.)PGDPA MIIPS MNODIS A perfect set of great pearly whites can be yours, if you put your money where your mouth is. That means a regular visit to the dentist (twice a year).And if don’t, then your great teeth will definitely bring you to us, in the hard way. If you have ever dreamt that your great teeth are falling out or crumbling away, don’t be scared, it is quite a common nightmare. A friend once told me that whenever he has this dream, it usually means a visit to the dentist two days later to repair a broken tooth. But for most people dreams about loss of teeth are far from prophetic. Dreams analysts suggest that they may be associated with feelings such as embarrassment, weakness, passivity, impotence, fear of ageing and the general diminution of one’s powers. This is according to Montague Ullman MD and Nan Zimmerman, authors of working with dreams. Modern dental technology is constantly making things less painful for both the patient and the practitioner as well. The traditionally dental drill phobic is been replaced with laser which means the reduction of usage of local anesthesia injections. Although the introduction of fluoride toothpastes and greater knowledge about oral hygiene means that more people keep their great teeth much longer, even the toothless are benefitting from this modern dental technology. Dentures, bridges and single tooth can now be fixed permanently to the jaw bone by means of implant (Titanium pegs). If you lose your great teeth in an accident don’t rush to throw it off, you can save your great tooth and your money if you are sharp enough. Dash down to the nearest dentist with the great tooth within 30 minutes to 1 hour, the dentist can fit your great tooth back into the gum and it will be rebond with the help of a temporary splint.(Xplanatn about pt himself doing it). It seems that, No matter what blow nature dealt you, the perfect set of the great pearly whites can be yours, but, at a price. Cosmetic dentistry is booming with veneering, whitening, capping, crowning, straightening, cleaning and polishing all on offer because they not covered the NHIS. Of course the most important thing is to prevent decay in the first place. Proper brushing, flossing and the regular six monthly visit to the dentist are vital. If your gums are not healthy, your great teeth are not going to be happy residing in them. INTRODUCTION The CEREC3D, INLAB3D and the INEOS are computerized machines used in the various manipulation processes of producing all ceramic restorations both in clinical and dental laboratory practices in contemporary times. CEREC as the name implies means Ceramic Reconstruction, which involves the processes of optical impression acquisition methods with the dental optical camera, Ineos or the laser scanner. This is done by capturing these pictures of the prepared tooth or teeth in the mouth of the patient or on models sent to the dental laboratory from the surgery. These acquisition processes eliminate the impression taken procedures that have been in use in dentistry for a very long period and equally saves time in that, it gives the patient the opportunity in 98% cases to visit the dentist once and he or she goes home with a restoration already fitted in the mouth. Therefore, it brings into near perfection the practice of dentistry, since the milling is system computerized; mistakes and excesses are almost eliminated. Better bonding procedures and materials are equally produced and are effectively and perfectly applied alongside these computerized processes and procedures of ceramic restoration production, hence, the durability rate of CEREC produced restorations such as Inlays, Onlays, Crowns and Bridges etc, is estimated to have about 90% durability rate while those of gold and other metallic alloys used in restorative dentistry are estimated to have about 50% failure rate. Color contrast with the natural teeth can only be appreciated with all ceramic restorations coupled with the ingenuity of the computerized milling unit which produces an exact color match or appearance with the natural standing teeth in the mouth especially if the CEREC block used is perfectly selected and the finished restoration is adequately glazed or polished before bonding. The all ceramic restorations have eliminated the possibilities of galvanic shock often experienced by patients who have more than one restoration of different metals or alloys in their mouths. Equally eliminated is the lengthy procedure of production and fabrication of a restoration e.g., a crown which involves the clinical impression taking procedures, impression casting to produce the cast or model, the waxing up process which requires the technical know-how of the technologist, investing the wax work, burning out, casting, trimming, porcelain application and the finishing. This procedure could take weeks or months, especially in a busy clinic and laboratory. All ceramic restorations have equally eliminated the filling procedures in clinical practice in its entirety, be it amalgam, composite etc, etc.Onlays, Inlays and Crowns compensate for fillings. A BRIEF HISTORY OF CEREC The CEREC machine was developed by Dr.Werner Mormann and Engr.M.Brandestini in 1980 at the University of Zurich. In 1986, Siemens medical division acquired the licence from the inventors to further develop and market the product, which they did in the same year. This product was named CEREC ONE which was eventually sold to several dental practitioners in Europe and the Americas.Cerec one was driven by a hydraulic drive. In addition, CEREC one was a great success and it changed the practice of dentistry for better in the nearest future. The quest to further develop the cerec machine the more led to the replacement of the hydraulic drive of cerec one to electronically driven motor in 1991. In 1994 CEREC TWO was developed and introduced into the dental market with more modifications. 1997, witnessed the sale of SIEMENS DENTAL DIVISION, hence, the metamorphosis of the SIRONA DENTAL COMPANY, with the Headquarters situated in BENSHEIM Germany. It was an era where more modifications on the machine were carried out. It equally saw the complete computerization of the system with software for the production of posterior and anterior crowns. CEREC three was developed and produced in the year 2000 with compact windows based on CAD/CAM system. On the other hand, the INLAB and INEOS were developed in 2001 and 2003 respectively, while new milling units such as the cerec MCXL, INLAB MCXL, software upgrade such as CEREC 3D V3.00, INLAB 3D V3.00, new materials such as CEREC blocs, INCORIS and a breakthrough in the sintering procedure with the development of the large chamber INFIRE HTC sintering furnace in 2007. THE CEREC MODULAR SYSTEM The CEREC modular system is made up of the ACQUISITION UNIT or CAMERA, THE COMPUTER SYSTEM, and the CEREC MILLING UNIT. THE MODULAR COMPUTER AIDED DESIGN AND COMPUTER AIDED MANUFACTURE {CAD/CAM} INLAB SYSTEM. A modular system is that which the modules work independently and at the end of the operation they produce one unique result, therefore, the modular CAD/CAM INLAB system consists of the following modules: 1. The Computer system 2. The Ineos 3. The Inlab Milling Unit 4. The Inlab MCXL Milling Unit 5. The Infire HTC Sintering Unit FUNCTIONS 1.THE COMPUTER SYSTEM: The computer machine as we all know is a multi-functional machine which is basically made up of a) the hardware such as the CPU,Monitor, keyboard etc and the software which are used in executing the various programmes which are in tandem with the functions of the INLAB and INEOS systems. 2. THE INEOS SCANNER: The Ineos dental scanner used in the dental laboratory has been described as a top performer in more ways than one .Some of its defining features includes: 1. Fast scanning times 2. Outstanding precision 3. User friendliness 4. Allows the user to scan a complete range of models 5. Record scanning speed of ten seconds 6. Fast acquisition of the antagonist. Therefore, the Ineos is versatile in the acquisition of data on the model, aids complete design of crowns and bridges with the aid of the inlab3D software which allows the restoration to be milled either by the INLAB or MCXL milling machine. THE INLAB SYSTEM The Inlab is a computer aided design and manufacture (CAD/CAM) machine which offers the right milling for every piece of work for each user. Some of its features include: a) Tandem diamond burs for creating ultra-fine structures b) Soft touch monitoring control system c) Minimum tool wear due to in-built water cooling system d) Can mill a maximum of three unit bridge and individual crowns,Onlays and Inlays etc. e) It has two milling motors. f) It is precise. THE INLAB MILLING CENTER EXTRA LARGE (MCXL) The Inlab MCXL is a bigger CAD/CAM milling unit used in milling dental restorations in the dental laboratory.Some of its defining features includes: a) High productivity rate i.e. specially designed to fulfill the requirements of large and busy dental laboratories b) Gigantic capacity i.e. caters for up to eight unit bridge and ceramic block measuring up to 85*40*22mm c) It has four milling motors d) It is designed to have maximum precision irrespective of the material. e) High speed during the milling process f) The four milling motors are configured for round the clock operation. In the event of failure of one of the diamond burs during the milling process, the other set of motors can work independently to complete the milling operation without any interruption. g) It is designed to cater for large and busy dental laboratories and the deployment of a 20mm step bur which eliminates the risk of the burs jamming. THE INFIRE HTC SINTERING FURNACE The Infire HTC Sintering Machine is a compact high temperature furnace for sintering ceramic materials milled as framework for either crowns or bridges made of zirconium oxide, aluminum oxide, feldspar, or glass ceramics etc, etc. The sintering process involves heating the ceramic at a preset temperature which gradually builds up to attain a maximum of about 1530oc or 1440oc within a limited time of 6-8hrs. The sintering process adds maximum strength to the fragile all ceramic bridge or crown framework. Some of the features of the Infire HTC Sintering oven include: a) .Programmed pre-set for all inlab sintered ceramics. b) Large size chamber (double capacity) c) Clearly structured display and easy to use menu d) Economical overnight sintering. ADVANTAGES OF THE CEREC/INLAB MODULAR SYSTEMS a) The process of the production of restorations is digitized from the beginning to the end. b) All restorations are produced in ceramic materials. c) Impression taking procedures are eliminated. d) The use of a cast or model is reduced. e) Mistakes or excesses are grossly minimized or eliminated since the milling process is computerized. f) Color contrast is better with all ceramic restorations. g) Ceramic restorations are more durable because of the production and bonding processes used in present day dental practice. h) It takes less time to digitally produce a restoration. i) A restoration can be fitted in a patient’s mouth in just one visit. j) More restorations can be produced in one day. k) With CEREC/INLAB there is no need for a temporary crown. l) CEREC crowns have no metals in them, so they are fairly elastic. m) CEREC materials and technology can also be used for filling (filling procedures are eliminated. n) The CEREC/INLAB systems are made to suit needs of the Doctor/Technologist. o) It delivers unrivalled flexibility and precision in that it has 1) software for various indications 2) wide range of materials e.g; ceramics, polymers, metals.3) Access to INFINIDENT centralized production facility. INDICATIONS FOR THE USE OF THE INLAB SYSTEM. The INLAB modular CAD/CAM system has a broad spectrum of activities: 1) The inlab 3d software can automatically calculate the connectors on the basis of the chosen material e.g: zirconium oxide, aliminium oxide. 2) Crown copings/Bridge frameworks made of metal: The INLAB milling units are designed to machine completely combustible plastic materials the basis for creating cast metal copings/bridge frameworks. 3) Inlays/Onlays are easily designed with the 3D software and milled out in all ceramic products 4) Single Piece Mono-ceramic crowns are cost effective alternatives to cast metal crowns /pfms crowns.e.g:fespar ceramic, Glass ceramics. 5) Polymer restorations for temporary crowns and bridges can be designed and fabricated from VITA CAD blocs a high quality polymer material, to produce anatomically sized temp. Crowns and bridges. 6) The inlab system allows you to create ultra thin veneers made of ceramics. 7) The inlab system allows you a complete range of wax-ups models and creates a variety of wax patterns which could be used to produce different restorations. THE INLAB FABRICATION PROCEEDURE 1) The inlab receives an impression and pours model using a laser visible stone/stone plaster 2) The stone sets and it is scanned with a laser automatically scanner or INEOS scanner. 3) The image and dimensions of the models are displayed on the screen. 4) The software automatically waxes-up the coping based on the kind of prosthesis you want to fabricate. 5) The choice of material is then made by the Dentist/Technologist, and then inserted in the milling unit. (CEREC/INLAB). 6) Milling is carried out automatically by the machine. 7) The milled coping is tested for “FIT” and adjusted if need be, and sent for sintering. 8) Sintering is carried out at 1530/1140oc, depending on the material used with the sintering oven for 6-8hrs. This adds more strength to the sintered material. 9) Porcelain is then built on the sintered zirconium material. THANK YOU FOR LISTENING