CAD/CAM blocks are used in CAD/CAM dentistry, which is revolutionising dental work and gradually growing in popularity.

Computer-aided design (CAD) and computer-aided manufacturing (CAM) started to be used in dentistry back in 1985. However, there has been a relatively low uptake of CAD/CAM in UK dentistry, with just 8-12% of practitioners using it in their clinical workflows.

This guide will examine how to choose CAD/CAM blocks and introduce some of the best manufacturers in the business. First, we will take a broader look at CAD/CAM in dentistry.

What is CAD/CAM?

CAD allows you to design 3D models of dental prosthetics, while CAM uses this information to create them.

There are many elements to CAD/CAM, such as the milling tools, scanners and computer software. However, the material used to create the prosthetics is a vital element. Different types of material have different qualities, including strength and appearance.

These materials are provided as solid CAD/CAM blocks or discs, which are then milled into shape.

What is the process for using CAD/CAM in dentistry?

1. Preparation of the teeth: the dentist prepares the site of the prosthetic. This may involve removing parts of the tooth
2. Intraoral scanning: a scanner is used inside the mouth to create a 3D image of the target tooth or teeth and those surrounding it
3. Design: using this information, the prosthetic will be designed on the computer
4. Milling: a CAD/CAM block will be placed in a milling machine. This is then milled down into the shape designed using CAD
5. Firing: the prosthetic may require firing in a ceramic furnace for crystallisation and sintering. However, this is not required with all materials
6. Staining and glazing: the prosthetic is then stained and glazed to give it similar aesthetics to the rest of the teeth
7. Cementing, bonding and adjusting: the prosthetic is then cemented or bonded into place. It can then be adjusted as needed. 

Digital workflow

A dental digital workflow is a repeatable process used to achieve a specific outcome. It allows for the whole process of scanning through to manufacturing to be accomplished in one computerised process.

Digital workflows can be handled in one place, rather than separately and by people with different disciplines. It is also faster and more accurate than traditional workflows.

Importantly, it also allows patients to influence the design process.

Dental digital workflows all follow three steps:

• Scanning/impressions: the first stage directly involves the patient. The most efficient way to do this is using an intraoral scanner. This will immediately capture a 3D model of the patient’s teeth. If using impressions, they will be taken and then a 3D model will be created in a laboratory
• Design/treatment planning: this stage involves the design of the new treatment, for example, a restoration. This stage allows the input of the patient, to ensure the treatment matches their expectations
• Manufacture: the CAD/CAM blocks are now milled into the shape designed in the previous step. These could be crowns, bridges, dentures or any other treatment product. Following this, the resulting product can be used for the patient’s treatment.

What equipment do I need?

• Scanner: an intraoral scanner is needed to capture a 3D model of the mouth
• Software: restoration planning software is required to design the prosthetic
• Milling machine: this machine grinds and mills CAD/CAM blocks into the shape of the prosthetic designed using restoration planning software
• Furnace: furnaces are needed for the firing and sintering of some types of CAD/CAM blocks following milling.

Is CAD/CAM good value for money?

The equipment needed to provide CAD/CAM treatments costs money – and, potentially, quite a lot of it. However, it can also lead to longer-term savings.

• Lab costs: milling prosthetics in-house saves money on sending designs to a laboratory for manufacturing
• Shipping: milling and firing in-house also means money can be saved on the physical shipping of materials between practice and lab
• Speed: CAD/CAM digital workflows are faster and more efficient than using traditional methods. This means you can see more patients and make more money than you might do otherwise

What are the advantages of CAD/CAM?

• Comfort: intraoral scanners are far more comfortable for patients than taking impressions of teeth. Impressions mean patients biting into alginate or other materials. This may be uncomfortable should the patient be experiencing tooth pain. It can also cause mess and be a generally unpleasant experience. Recent technological advances mean that intraoral scanners can be small and feel less intrusive
• Shorter treatments: CAD/CAM makes it possible for the scan, manufacture and placement of prosthetics to take place in a single patient visit. Recent technological developments mean that scanning, milling and firing are far faster than they once were. This has obvious benefits for the dentist and patient
• Natural feel and appearance: the CAD/CAM process allows for lifelike restorations that look just like real teeth. The shape and colour can be matched to surrounding teeth
• Ease of use: technological developments have made the CAD/CAM process quicker and easier than ever. Newer intraoral scanners are small and lightweight and take scans quickly. CAD software is also increasingly intuitive and easy to master.

What are the disadvantages of CAD/CAM?

• Initial costs: the latest intraoral scanners, milling machines, software and CAD/CAM blocks can come with a hefty price tag. This is especially true for dentists looking to expand into CAD/CAM for the first time. However, faster treatments and savings in other areas, such as laboratory work, can mitigate these expenses
• Training: as with any new technology, each aspect of the CAD/CAM process will require additional training for practitioners. This can be difficult for time-poor staff.

What are CAD/CAM blocks?

CAD/CAM blocks are the materials used to create dental restorations and prosthetics. They are solid blocks that are then milled into shape.

The design for the milling is done digitally. The milling process then generally takes less than half an hour, meaning the prosthetic can be placed during a single patient visit.

CAD/CAM blocks can be made of a variety of materials, each with different qualities. The most popular include:

• Zirconia: zirconia is durable and strong. It is suited to posterior crowns and bridges. Its resistance to wear also makes it useful for molar restorations. Recent technological developments have improved the aesthetics of zirconia-based CAD/CAM blocks and discs. However, its main benefits come from its long-lasting resistance to fracture
• Lithium silicate: lithium silicate CAD/CAM blocks are often used for anterior restorations, such as veneers and crowns. Lithium silicate balances aesthetics with strength. It can be used to mill prosthetics with an enamel-like translucency
• Polymer-based composites: polymer-based composite CAD/CAM blocks tend to be used for more short-term restorations. They are more easily milled and cheaper. They may be used to provide a temporary restoration while longer-term prosthetics are fabricated.

Buying guide

Directa Dental

Directa Dental manufactures a range of consumables, materials, and electronics. Among these is its range of Ceramir CAD/CAM blocks. Its team of more than 200 professionals works across dental markets in 90 countries.

Directa products are developed, tested and evaluated by its highly qualified and renowned team of Swedish and international dental professionals.

Ceramir CAD/CAM blocks are made of a new type of CAD/CAM material. The blocks are manufactured using advanced patented laser sintering technology. This creates a single glass phase material embedded in a hybrid matrix.

Ceramir CAD/CAM blocks have the strength of particle-infiltrated ceramics (lithium disilicate) and aesthetics comparable to feldspathic glass ceramics. They have a flexibility of 20 GPa, similar to dentin, meaning they do not have the brittleness of pure ceramics. This reduces tension during masticatory load and creates a shock-absorbing effect, decreasing occlusal stress.

Ceramir CAD/CAM blocks have a homogeneous glass-like structure, resulting in natural translucency. They reflect light and, after a short polishing, have a high gloss surface that resembles natural teeth.

They also offer a unique combination of strength, flexibility and aesthetics and can be used for a wide range of indications. These include crowns, inlays, onlays and veneers.

A key advantage of Ceramir CAD/CAM blocks is that they can be milled to very thin margins while maintaining high edge stability. A full crown will need a thickness of 1.5mm in areas with cusps and occlusal contacts.

And veneers can be milled down to as little as 0.3-0.5mm. This allows them to maintain a smooth edge to enable as little gap formation as possible.

Due to the composition of the material, restorations made with Ceramir CAD/CAM blocks can be easily repaired with composite in the mouth, if necessary.

Speed

Ceramir CAD/CAM blocks have unique properties that allow shorter milling times compared to other brands. This reduces chairside time and saves money because the milling burs last longer.

Ceramir CAD/CAM blocks also eliminate the need for additional firing, saving even more time and equipment.

Types, sizes and colours

Available in standard size: 12 x 14 x 18mm.

Ceramir CAD/CAM T-blocks

Ceramir CAD/CAM C-blocks

Ceramir CAD/CAM i-blocks

Ceramir CAD/CAM T-blocks are highly translucent and mimic the natural enamel. This universal T-block can be individually colour matched through cementation. This can simplify the clinical procedure, leading to less inventory stock needed.

Ceramir CAD/CAM C-blocks are chromatic blocks. They correspond to shades A0, A1, A2 and A3.

Ceramir CAD/CAM i-blocks are used for precise and reliable fabrication of implant-supported restorations. They fit precisely onto titanium base or similar attachments so that the final restoration can be placed in the same appointment to save time and cost and to improve the patient’s experience.

Precise and reliable

Ceramir CAD/CAM blocks are used for precise and reliable fabrication of implant-supported restorations. They fit precisely onto titanium base (ti-base) or similar attachments so that the final restoration can be placed in the same appointment. This helps to save time and costs, while improving the patient’s experience.

Ceramir i-blocks can be used as screw-retained single abutment crowns as well as for mesostructure (abutment) and final crowns.

The antibacterial properties and form, which maintain a good mucosal seal, help to prevent biofilm and bacteria growth on the restoration surface. The composition of the material creates a shock-absorbing effect, comparable to that of a natural tooth, to withstand occlusal stress.

Ceramir i-blocks are compatible with all systems that provide a ti-base interface.

Strength

• Flexural strength biaxial: 320 MPa
• Flexural strength three point: 200 MPa
• Compressive strength: 550 MPa
• Flexural modulus: 20 GPa
• Surface hardness: 100 HV.

Non-toxic and antibacterial

Ceramir CAD/CAM blocks are proven free of bisphenol A. They are non-toxic and cause no irritation to skin or mucosa.

The antibacterial properties of Ceramir CAD/CAM blocks come from zinc oxide and fluoride in the material. These prevent biofilm and bacterial growth on the surface of the restoration.

All Ceramir CAD/CAM blocks are available in standard size: 12 x 14 x 18mm.

Key features

• Strong and flexible
• Highly aesthetic appearance
• High edge stability
• Cost effective
• Easy handling
• Can be repaired in the mouth.

3M

3M is a science-based technology company. It has been listed as a World’s Most Ethical Company for nine years in succession. It has more than 60,000 products in its portfolio.

3M was launched more than a century ago. It started as a small-scale mining venture in Northern Minnesota, Minnesota Mining and Manufacturing Company. Today, it is a leading global brand.

3M Lava Ultimate Restorative

The Lava Ultimate Restorative by 3M is the world’s first resin nano ceramic restorative with the benefits of both glass ceramic and resin materials. Lava Ultimate Restorative gives chairside CAD/CAM dentists better edge quality and smooth margins. This advance improves productivity and creates a better restorative experience for patients.

Scientists and engineers at 3M have combined nanotechnology with a proprietary curing treatment. This created a unique material with the benefits of both glass ceramics and resins.

• Cerec
• Restoration types: inlay, onlay, veneer
• Fast and easy to mill
• No firing needed
• Resin nano ceramic material
• Eight shades, two translucencies
• Strength of 800 MPa
• Flexural strength of 2 MPa
• Block sizes of 12 and 14
• Shades: A1, A2, A3, A3.5, B1, BL, C2, D2
• Long lasting polish.

Coltene

Coltene is a worldwide and innovative developer, manufacturer and provider of dental consumables. Its mission is to ‘upgrade dentistry’.

Coltene’s Brilliant Crios

Coltene’s Brilliant Crios is a reinforced composite bloc for the fabrication of permanent, indirect restorations using a CAD/CAM grinding process. Two translucencies with a total of 13 shades offer a broad spectrum for aesthetic single-tooth restorations, both in the anterior and posterior regions. Brilliant Crios is the ideal CAD/CAM material for daily use in the dental practice.

• Reinforced composite block
• Combines advantages of an innovative submicron hybrid composite material with those of a CAD/CAM fabrication process
• No firing process
• Two sizes
• Two translucencies
• Comes in 13 shades. Low translucency: C2, B3, B2, B1, A3.5, A3, A2, A1, B. High translucency: A1, A2, A3, B1
• Recommended for anterior and posterior single-tooth restorations
• Shock-absorbing qualities make blocks ideal for restorations for patients with bruxism or implant-supported crowns
• Can be modified or repaired
• Three-point flexural strength: 198 MPa
• Biaxial flexural strength: 262 MPa
• Compressive strength: 426 MPa
• Multimodal composition: dental glass and amorphous silica in combination with a reinforcing resin matrix

Dentsply Sirona

US-headquartered Dentsply Sirona invests more than $125 million a year in advancing its dentistry technology and innovation. It works with practices, clinics and dental laboratories around the world, and has over 4,000 staff providing customer service.

The Cerec Tessera CAD/CAM block

The Cerec Tessera CAD/CAM block from Dentsply Sirona promises speed, strength and aesthetics.

Cerec Tessera CAD/CAM blocks are the strongest glass ceramic blocks available on the market. They feature two complementary crystal structures within a glassy zirconia matrix. This provides ideal levels of translucence, florescence and opalescence. 

Advanced lithium disilicate is a material ready to be integrated into your digital workflow as your go-to glass ceramic block. It can also work in combination with Cerec MTL Zirconia for a complete Cerec block offering.

Key features:

• Cerec
• Advanced lithium disilicate
• Strongest glass ceramic blocks on the market
• Biaxial strength of more than 700 MPa
• Dual crystal structure
• Indicated for use for single-unit full contour crowns, inlays, onlays and veneers
• Rod-shaped crystals increase density of material and help protect against cracking
• Full-coverage crowns, inlays, onlays and veneers
• High strength even at wall thickness of 1.0mm
• Simplified shade selection: true shade blocks match final restoration
• Firing in 4.5 minutes in a CEREC Speedfire furnace
• Fast cooling.

GC

GC was founded in 1921. It has more than 600 products that are sold in over 100 countries worldwide, many of which are ‘household’ names in the dental industry. GC materials are popular in dental laboratories. Its product ranges such as Initial continue to be products of choice for dental technicians around the world.

Initial Lisi

GC’s Initial Lisi block is a fully crystallised lithium disilicate block that delivers optimal physical and aesthetic properties without firing. The unique block features GC’s proprietary high-density micronisation technology for CAD/CAM dentistry. This delivers high-wear resistance, smooth margins and aesthetic results.

The unique ultrafine crystal makes it easy to grind and can be quickly milled in its fully crystallised stage. High gloss and natural opalescence can be obtained in just minutes through polishing. The restoration is then ready for luting. The aesthetics of your restoration will be maintained over time.

Initial Lisi Block is available in four aesthetic shades and two translucencies. When more characterisation is required, the Initial ceramic line comprises fully synergistic aesthetic solutions.

• Specialised ceramic for lithium disilicate
• Highly aesthetic feldspar veneering ceramic adapted to the light-dynamics of lithium disilicate frameworks
• Thermal expansion (CTE)
• Low firing temperatures
• Maximum stability even after multiple firings
• Excellent aesthetics on lithium disilicate frameworks
• Comprehensive shade and layering system
• Specially designed and adapted to the light-dynamics of lithium disilicate frameworks
• Quick, aesthetic and economical results.

Ivoclar

Ivoclar is a family business that dates back to 1923. It is now one of the world’s leading dental companies. It collaborates with major universities, research institutes and dental experts from around the world to take dentistry to the next level.

IPS E. Max ZirCAD Prime

Ivoclar’s IPS E. Max ZirCAD Prime blocks allow cerec dentists to produce high-strength and aesthetic restorations sintered faster than ever before.

Quickly sinter your restorations in just 15 minutes using a sintering furnace such as the Programat CS6.

It promises 1,100 MPa of strength and lower wall thickness of 0.8mm for posterior crowns.

Cement it with conventional cement or use the self-adhesive or adhesive cementation protocol.

• Cerec
• High strength
• Highly aesthetic: progression of shade and translucency from the dentin (3Y-TZP zirconia material) to the translucent incisal area (5Y-TZP zirconia material)
• Sintered in just 15 minutes
• 1,100 MPa strength
• Lower wall thickness: 0.8mm (posterior crowns)
• Variety of shades for zirconia crown restorations: BL1, 0*, A1, A2, A3, B1, C2
• Easy cementation.

Vita Zahnfabrik

Vita Zahnfabrik, a family-owned company headquartered in Bad Säckingen in the tri-border region of Germany, France and Switzerland, was founded in 1924. Its priority has always been the needs of dental technicians, dentists and patients. Its products are used by people in more than 150 countries. Its products include veneering materials, CAD/CAM blocks, furnaces and other dental materials. Vita offers the most comprehensive portfolio of CAD/CAM materials in the world.

Vita Enamic

The Enamic is a monochromatic CAD/CAM block from Vita. It is available in three translucency levels. It is the perfect inlay, onlay or tabletop material for your daily practice.

Its chewing force-absorbing material properties ensure gentle protection for the antagonists. The hybrid ceramic enables non-invasive/minimally invasive design with precise wall thicknesses.

And its secure dual network structure results in stable edges and precise and secure reconstructions.

Key features include:

• Unique dual network structure
• Monochromatic
• Three translucency levels: T, HT, ST
• Hybrid ceramic
• Precise wall thickness
• Recommended indicators: anterior and posterior crowns on implants, anterior and posterior crowns, inlays, onlays, partial crowns, table tops and veneers.

Conclusion

This guide has discussed the many factors involved in choosing the right CAD/CAM blocks for you. You will need to make your decision based on factors like their intended use and the required machinery.

You can dramatically boost your productivity and income using CAD/CAM solutions in dentistry. Making an informed choice on components like CAD/CAM blocks can maximise their impact on your practice.