International Journal of Computerized Dentistry, 04/2015

In the age of digital dentistry, virtual treatment planning is becoming an increasingly important element of dental practice. Thanks to new technological advances in the computer- assisted design and computer-assisted manufacturing (CAD/CAM) of dental restorations, predictable interdisciplinary treatment using the backward planning approach appears useful and feasible. Today, a virtual smile design can be used as the basis for creating an esthetic virtual setup of the desired final result. The virtual setup, in turn, is used to plan further treatment steps in an interdisciplinary team approach, and communicate the results to the patient. The smile design concept and the esthetic analyses required for it are described in this article. We include not only a step-by-step description of the virtual smile design workflow, but also describe and compare the several available smile design options and systems. Subsequently, a brief discussion of the advantages and limitations of virtual smile design is followed by a section on different ways to integrate a two-dimensional (2D) smile design into the digital three-dimensional (3D) workflow. New technological developments are also described, such as the integration of smile designs in digital face scans, and 3D diagnostic follow-up using intraoral scanners. Keywords: smile design, CAD/CAM, facial analysis, esthetic, intraoral scanning, virtual follow-up

Objectives: To address the controversy, in which indications average value articulation is suitable or to what extent individual registrations, especially using the facebow, should be applied, a quantification of the variability of relevant anatomical landmarks is necessary. The goal of this study was to investigate the mean and natural bandwidth of the parameters describing articulation. Methods: Significant landmarks were measured on three-dimensional (3D) cone beam computed tomography (CBCT) scans of 120 arbitrarily selected individuals. The bandwidth and mean values of the anatomical relations were calculated. Results: The mean arm length of the Bonwill triangle was 103.3 mm, with a range of 90.2 mm (minimum) to 117.9 mm (maximum), and a mean base length of 99.6 mm, with a range of 85.2 mm to 112.6 mm. There was a high correlation between the length of the left and right arms, but not between the arms and the base. The mean height of the Bonwill triangle, measured between the condyles and the occlusal plane, resulted in 34.3 mm, with a range of 21.0 mm to 47.2 mm. The mean value of the Balkwill angle was 20.4 degrees, with a range of 9.0 degrees to 27.6 degrees. The angle between the Camper's line and the occlusal plane averaged around 7 degrees. Conclusions: This study presents the bandwidth of anatomical relations necessary for articulation systems. The results are specific for males and females. The relevant parameters offer a high symmetry between the right and left sides. Additionally, the results show that the Bonwill triangle is more likely to be isosceles than equilateral. Clinical significance: The knowledge of the anatomical bandwidth of temporomandibular joint (TMJ) positions in relation to the dentition allows the simulation of software- controlled virtual articulators and the substitution of facebows. Keywords: Bonwill triangle, anatomical landmarks, Camper's plane, articulator, occlusal plane

Introduction: The load-carrying behavior of the human mandible can be described using finite element simulation, enabling investigations about physiological and pathological skeletal adaption. "Anatomical simulation" implies a stepwise approximation towards the anatomical reality. Method: The project is structured in three steps. In Step 1, the preprocessing, the simulation model is provided. Step 2 is the numerical computation. Step 3 is dedicated to the interpretation of the results. The requirements of the preprocessing are: a) realization of the organ's individual anatomy, namely its outer shape; b) the tissue's elastic properties, thus its inner consistency; and c) the organ's mechanical loads. For physiological mandibular loading, these are due to muscles, temporomandibular joints, and tooth forces. Meanwhile, the reconstruction of the macroscopic anatomy from computed tomography data is standard. The periodontal ligament is inserted ex post using an approach developed by the authors. The bone is modeled anisotropically and inhomogeneously. By the visualization of the individual fiber course, the muscular force vectors are realized. The mandibular condyle is freely mobile in a kind of simplified joint capsule. For the realization of bite forces, several approaches are available. Results: An extendible software tool is provided, enabling the user - by variable input of muscle and bite forces - to examine the individual patient's biomechanics, eg, the influence of the periodontal ligament, the condition of the temporomandibular joints, atrophic processes, or the biomechanical situation of dental implants. Discussion: By stepwise approximation towards the anatomical reality, the mandibular simulation will be advanced to a valuable tool for diagnosis and prognosis. Keywords: mandible, biomechanics, finite element method, simulation, stress/strain behavior, mechanical loading, periodontal ligament, temporomandibular joint, masticatory muscles, skeletal adaption

As is the case in the field of medicine, as well as in most areas of daily life, digital technology is increasingly being introduced into dental practice. Computer-aided design/ computer-aided manufacturing (CAD/CAM) solutions are available not only for chairside practice but also for creating inlays, crowns, fixed partial dentures (FPDs), implant abutments, and other dental prostheses. CAD/CAM dental practice can be considered as the handling of devices and software processing for the almost automatic design and creation of dental restorations. However, dentists who want to use dental CAD/CAM systems often do not have enough information to understand the variations offered by such technology practice. Knowledge of the random and systematic errors in accuracy with CAD/CAM systems can help to achieve successful restorations with this technology, and help with the purchasing of a CAD/CAM system that meets the clinical needs of restoration. This article provides a mechanical engineering viewpoint of the accuracy of CAD/ CAM systems, to help dentists understand the impact of this technology on restoration accuracy. Keywords: accuracy, dental CAD/CAM, digital dentistry, geometric approximations, geometric defects

Until now, the ability to fabricate definitive Cerec bridges for the posterior region was less a question of the capabilities of the Cerec software than the availability of ceramic materials with sufficient strength for these indications. With the launch of the somewhat translucent inCoris TZI zirconia, Sirona has made possible the computer-assisted design and computer- assisted manufacturing (CAD/CAM) of monolithic bridges using Cerec dental software. In this article, the possibilities and limitations of inCoris TZI, as well as inCoris TZI C (a recently introduced further development from Sirona), will be demonstrated, based on two clinical cases. Keywords: Cerec bridges, zirconia, esthetics with zirconia, inCoris TZI, inCoris TZI C