Same-Day Restorations with CAD/CAM (CEREC)

CAD/CAM stands for Computer-Aided Design / Computer-Aided Manufacturing. An intraoral camera records a 3D image of the mouth, the shape of the filling or crown is designed in the software, and the restoration is produced in the clinic from a ceramic, composite-ceramic or monolithic zirconia block.

The system has been in use since 1985 and took its present form through research at the University of Zurich. In its early years the equipment was bulky and very costly, which limited its use; technological progress has since made it far more practical for everyday clinical work.

No putty impression material is placed in the mouth. Instead, a small camera is moved over the teeth and the 3D data are transferred to the computer, which is particularly helpful for patients with a strong gag reflex.

• Errors caused by an impression stretching as it is removed, or by air bubbles or saliva trapped inside it, are avoided.
• Transfer errors that can occur when an impression is sent to a laboratory and modelled are reduced.
• Because the restoration is made quickly, temporary fillings or crowns are usually unnecessary, so there is no risk of a temporary coming loose or breaking.
• When treatment is completed in one visit, no further anaesthesia is needed for follow-up appointments; in many cases the work is finished before the anaesthetic wears off.

Inlays and onlays (ceramic fillings)

Large cavities involving two or three surfaces of a tooth are difficult to restore with conventional fillings; if the matrix band placed around the tooth does not fit well, food can become trapped between teeth or the gum may become swollen. In teeth with little healthy structure left, CAD/CAM inlays and onlays can, in suitable cases, avoid the need for a crown or even an extraction.

Crowns

A single crown can be placed in approximately 30–60 minutes.

Bridges and veneers

Bridges and porcelain veneers can also be scanned and designed digitally. More detail is given in the prosthodontics section.

Implant abutments

In aesthetically demanding areas, the connecting part that fits into the implant, known as the abutment, can be made to the length and width that suit the patient's mouth. Avoiding repeated abutment try-ins helps protect the surrounding gum and bone.

CAD/CAM restorations are made from metal-free, tooth-coloured materials such as Empress, e.max and monolithic zirconia. These materials are biocompatible and are also suitable for patients with metal allergies.

• Empress and e.max contain neither metal nor zirconia, so they transmit light more like natural teeth and offer a highly natural appearance.
• Zirconia is very strong and straightforward to use, although it is less translucent than glass ceramics.
• Being metal-free, the restorations allow the tooth underneath to be assessed more easily on future X-rays.

Where a metal-framework porcelain bridge is preferred for a very long span, the impression can still be taken digitally. The precision of digital scanning and laser-sintered metal frameworks considerably shortens the try-in stages.

Porcelain fillings, inlays and onlays, single crowns, veneers, zirconia work and bridges usually take 3–7 days with a conventional laboratory process. With CAD/CAM, the same work can be completed on the same day, sometimes within 1–2 hours, or on the following day, depending on the type of restoration and the material.

For patients travelling for dental treatment in Denizli, Turkey, fewer appointments can make planning easier. Which restorations can be completed in a single visit is decided after an examination, based on the condition of the tooth, the chosen material and the extent of the work.