CAD/CAM Restorations

Applications-inlays, onlays, veneers, crowns, bridges, implants, and implant prostheses    

Stages of fabrication
 
CSD-computerized surface digitization
CAD-computer-aided (assisted) design
CAM-computer-aided (assisted) machining
CAE-computer-aided esthetics (currently theoretic)
CAF-computer-aided finishing or polishing (which are currently theoretic steps)

Classification

Chairside or in-office systems

(1) Cerec (Siemens system)-inlays, onlays, veneers
(2) Sopha (Duret system)-inlays, onlays  (and Crowns)

Laboratory systems

(1) DentiCAD (Rekow system)-inlay, onlays, veneers, crowns
(2) Cicero (Elephant system)-porcelain fused-to-metal crowns

 
Materials

a. Feldspathic oorcelains (Vita)
b. Machinable ceramics (Dicor MGC)
c. Metal alloys limited use)

Cementing

- Etching enamel and/or dentin for micromechanical retention
- Bonding agent for retention to etched surface
- Composite as a luting cement for reacting chemically with bonding agent and with silanated surface of restoration
- Silane for bonding to etched ceramic (or metal) restorations and to provide chemical reaction
- Hydrofluoric acid etching to create spaces for micromechanical retention on surface or restoration

Properties

1. Physical properties

a. Thermal expansion coefficient well matched to tooth structure
b. Good resistance to plaque adsorption or retention

2. Chemical properties-not resistant to acids and should be protected from APF

3. Mechanical properties

a. Excellent wear resistance (but may abrade opponent teeth)
b. Some wear of luting cements but self-limiting
c. Excellent toothbrush abrasion

4. Biologic properties-excellent properties
 

Mouth Protectors

Use - to protect against effects of blows to chin, top of the head, the face, or grinding of the teeth

Types

o    Stock protectors-least desirable because of poor fit
o    Mouth-formed protectors-improved fit compared with stock type
o    Custom-made protectors-preferred because of durability. low  speech impairment, and comfort

I. Components

a. Stock protectors-thermoplastic copolymer of PYA-PE (polyvinyl acetate-polyethylene copolymer)
b. Mouth-formed protectors-thermoplastic copolymer
c. Custom-made protectors- thermoplastic copolymer, rubber. or polyurethane
2. Reaction-physical reaction of hardening during cooling
3. Fabrication

Alginate impression made of maxillary arch. High-strength stone cast poured immediately. Thermoplastic material is heated in hot water and vacuum-molded to cast .

Mouth protector trimmed to within ½ inch of labial fold, clearance provided at the buccal and labial frena, and edges smoothed by flaming. Gagging, taste, irritation. and impairment of speech are minimized with properly fabricated appliances

4. Instructions for use

a. Rinse before and after use with cold water
b. Clean protector occasionally with soap and cool water
c. Store the protector  in a rigid container
d. Protect from heat and pressure during storage
e. Evaluate protector routinely for evidence of deterioration

Properties

1. Physical-thermal insulators
2. Chemical-absorbs after during use
3. Mechanical-tensile strength, modulus, and hardness decrease after  water absorption, but elongation, tear strength, and resilience increase
4. Biologic-nontoxic as long as no bacterial, fungal, or viral growth occurs on surfaces between uses
 

Mercury hygiene

• Do not contact mercury with skin
• Clean up spills to minimize mercury vaporization
• Store mercury or precapsulated products in tight containers
• Only triturate amalgam components-in tightly- sealed capsules
• Use amalgam with covers
• Store spent amalgam under water or fixer in a tightly sealed jar
• Use high vacuum suction during amalgam alloy placement, setting, or removal when mercury may be vaporized
• Polishing amalgams generally causes localized melting of silver-mercury phase with release of mercury vapor, so water cooling and evacuation must be used

Tooth Polishing and Cleansing Agents

1. Cleansing-removal of exogenous stains, pellicle, materia alba, and other oral debris without causing undue abrasion to tooth structure
2. Polishing-smoothening surfaces of amalgam, composite, glass ionomers, porcelain, and other restorative materials

Factors influencing cleaning and polishing

-    Hardness of abrasive particles versus substrate
-    Particle size of abrasive particles
-    Pressure applied during procedure
-  Temperature of abrasive materials

Structure

 Composition

-contain abrasives, such as kaolinite, silicon dioxide, calcined magnesium silicate, diatomaceous silicon dioxide, pumice. Sodium-potassium
-aluminum silicate, or zirconium silicate; some pastes also may contain sodium fluoride or stannous fluoride, but they have never been shown to produce positive effects
 

Reactions-abrasion for cleansing and polishing

Properties -  Mechanical
 
- Products with pumice and quartz produce more efficient cleansing but also generate greater abrasion of enamel and dentin
-Coarse pumice is the most abrasive
-The abrasion rate of dentin is 5 to 6 times faster than the abrasion rate of enamel, regardless of the product
-Polymeric restorative materials, such as denture bases, denture teeth, composites, PMMA veneers, and composite veneers, can be easily scratched during polishing
-Do not polish cast porcelain restorations (e.g., Dicor) that are  externally characterized or the color will be lost
 

Properties-improve with filler content

Physical

Radiopacity depends on ions in silicate glass or the addition of barium sulfate (many systems radiolucent)
Coefficient of thermal expansion is 35 to 45 ppm/C and decreases with increasing filler content
Thermal and electrical insulators

Chemical

Water absorption is 0.5 % to 2.5% and increases with polymer level)
Acidulated topical fluorides (e.g., APF) tend to dissolve glass particles, and thus composites should be protected with petroleum jelly (Vaseline) during those procedures
Color changes occur in resin matrix with time because of oxidation, which produces colored by-products

Mechanical

Compressive strength is 45,000 to 60,000 lb/ in2, which is adequate
Wear resistance-improves with higher filler content, higher percentage of conversion in curing, and use of microfiller, but it is not adequate for some posterior applications
Surfaces rough from wear retain plaque and stain more readily

Biologic

Components may be cytotoxic, but cured composite is biocompatible as restorative filling material

I . Procedure for single casting :

A 2.5 mm sprue former is recommended
for molar crowns 2.0 mm for premolars & partial coverage crowns .

II . Procedure for multiple casting :

Each unit is joined to a runner bar .

A single sprue feeds the runner bar

4 . SPRUE FORMER DIRECTION
Sprue Should be directed away from the delicate parts of the pattern
It should not be at right angles to a flat surface .(leads to turbulance  porosity .)
Ideal angulation is 45 degrees .

5 . SPRUE FORMER LENGTH

Depends on the length of casting ring .. Length of the Sprue former should be such that it keeps the wax pattern about 6 to 8 mm away from the casting ring. Sprue former should be no longer than 2 cm. The pattern should be placed as close to the centre of the ring as possible.

Significance

Short Sprue Length:

The gases cannot be adequately vented to permit the molten alloy to fill the ring completelyleading to Back Pressure Porosity.

Long Sprue Length:

Fracture of investment, as mold will not withstand the impact force of the entering molten alloy.

Top of wax should be adjusted for :

6 mm for gypsum bonded investments .

3 -4 mm for phosphate bonded investments .
TYPES OF SPRUES

I . - Wax . II . Solid

- Plastic . Hollow
- Metal .