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CEREC 3D Manual Operator’s Manual Author: Dennis J. Fasbinder, DDS, MAGD, ABGD i CEREC 3D Manual Table of Contents 1.0 Page Number CEREC 3D Program . 3 1.1 Installation and Set-up . 3 1.2 Starting a New Restoration 5 1.3 Select the Restoration . 7 1.4 Select the Design Technique . 8 1.5 Select the Tooth to be Restored 8 2.0 Cavity Preparation . 8 2.1 Cavity Designs – Inlay/Onlay . 8 2.2 Cavity Designs – Crowns 11 3.0 Optical Impression . 12 3.1 Powder Application . 12 3.2 Optical Impression . 13 3.21 Acquire Single Optical Impression 14 3.22 Acquire Multiple Optical Impressions 17 4.0 Virtual Models.21 4.1 Preparation Virtual Model . 21 4.2 Occlusion Virtual Model .25 4.3 Antagonist Virtual Model . 26 5.0 Virtual Restoration Edit Tools . 27 5.1 Design Window 27 5.11 Edit Icon 27 5.12 Drop Icon 31 5.13 Scale Icon 33 5.14 Shape Icon 36 5.15 Rotate Icon 38 5.16 Position Icon 40 5.2 Cut Window . 42 6.0 Dental Database Design Program – Inlay. 44 Design

Overview . 44 6.1 Acquire Optical Impression 45 6.2 Virtual Model . 47 6.3 Trim Adjacent Teeth 48 6.4 Margin Line . 50 6.5 Virtual Restoration . 53 6.6 Editing the Virtual Restoration. 54 6.7 Contact Icon .55 6.8 Milling Preview . 56 6.9 Milling . 57 ii CEREC 3D Manual 7.0 Dental Database Design Program - Onlay. 58 Design Overview . 58 7.1 Acquire Optical Impression. 59 7.2 Preparation Virtual Model 61 7.3 Trim Adjacent Teeth. 62 7.4 Margin Line 64 7.5 Virtual Restoration. 65 7.6 Editing the Virtual Restoration. 66 7.7 Milling Preview. 68 7.8 Milling. 68 8.0 Dental Database Design Program/Antagonist – Posterior Crown 69 Design Overview . 69 8.1 Optical Impression . 70 8.2 Virtual Model . 71 8.3 Trim Adjacent Teeth 72 8.31 Correct Optical Impressions 73 8.4 Margin Line . 75 8.5 Virtual Restoration . 76 8.6 Editing the Virtual Restoration. 77 8.61 Antagonist Icon77 8.7 Milling Preview . 80 8.8 Milling . 82 9.0 Correlation Design Program – Onlay . 83 Design Overview . 83

9.1 Optical Impression . 84 9.2 Virtual Model . 86 9.3 Trim Adjacent Teeth 86 9.4 Margin Line . 87 9.5 Proximal Contact Line . 88 9.6 Copying Line . 92 9.7 Virtual Restoration . 94 9.8 Editing the Virtual Restoration. 94 9.81 Occlusion Icon 95 9.82 Edit Icon96 9.83 Scale Icon 96 9.9 Milling Preview . 98 9.10 Milling 98 10.0 Multiple Restorations 99 Design Overview . 99 10.1 Optical Impressions 100 10.2 Preparation Virtual Model 101 10.3 Trim Adjacent Teeth 102 iii CEREC 3D Manual 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 Margin Line 103 Virtual Restoration. 104 Milling Preview - First Restoration. 105 Milling – First Restoration. 105 Design Change.106 Insertion Axis. 110 Center 111 Trim Adjacent Teeth for Second Restoration. 113 Margin Line 113 Second Virtual Restoration.114 Milling Preview – Second Restoration. 115 Milling – Second Restoration. 115 11.0 Additional Design Overviews . 116 11.1 Dental Database with Antagonist – Onlay 117 11.2

Correlation with Antagonist – Onlay 118 12.0 Parameters . 119 13.0 Drop-down Menus . 120 14.0 Window References . 123 iv CEREC 3D Manual About this Operator’s Manual This manual is designed to introduce the CEREC 3D software program and provide the operator with sufficient information to confidently create CEREC restorations. The design process, functions, menus, and editing tools will be presented through a series of example restorations. The example restorations are designed for the standard typodont model of CEREC preparations (“Blue Model”). These restoration designs are also included in the CEREC 3D program The example restorations are for educational purposes and are not expected to optimally fit every Blue Model unless optical impressions of a specific Blue Model are substituted for those on the program disk. Working through the example restorations in an orderly manner will facilitate the learning process as the designs become more complex and involved.

Prior CEREC users will understand many of the new developments intuitively and welcome the significant step forward CEREC 3D represents for CAD/CAM dentistry. Manual Conventions and Abbreviations The following conventions and abbreviations will be used throughout the manual. Conventions The term “select” will refer to choosing or “clicking” on a particular program icon. The term “left click” will refer to depressing the button to the left of the trackball and releasing. Similarly, the term “right click” will refer to depressing the button to the right of the trackball and releasing. The term “2-click” or “double click” will refer to quickly depressing the button to the left of the trackball two times with no pause between successive depressions. The term “click and hold” will refer to depressing the button next to the trackball and holding it down. This is usually done while rotating the trackball (“dragging”) to move a particular object on the screen.

Software icons will be identified by bold, italicized print to identify them as buttons to select in the software program. Placing the cursor over an icon on the toolbar will make the text identifying the icon appear. Abreviations L-click = Left Click R-click = Right Click L-click & hold = Left Click and Hold R-click & hold = Right Click and Hold 2-Click = double click OI = Optical Impression ML = Margin Line PCL = Proximal Contact Line CL = Copying Line 2 CEREC 3D Manual 1.0 CEREC 3D Program 1.1 Installation and Set-up The CEREC 3 unit will be installed and set-up by a CEREC Specialist. The CEREC Specialist will install the software program on the CEREC 3 Acquisition Unit, download it to the Milling Chamber, and verify communication between the Acquisition Unit and Milling Chamber. The camera will be calibrated to the CEREC 3D software program to ensure accurate optical images to the computer. The calibration device for the CEREC 3D camera is unique to the CEREC 3D

program. Older versions of the camera calibration device will not work with the CEREC 3D program. To install the CEREC 3D software program on the CEREC 3 Acquisition Unit, insert the CD in the CD/DVD drive. The set-up program should start automatically, if not, run the Setup.exe file in the root directory of the CD A screen will appear prompting selection of the installation language. The software licensing agreement is presented for review. If the license agreement is accepted, the program will begin the installation sequence. Two installation options are presented; standard and user-defined. In a standard installation, CEREC 3, SIROCAM (and Zoomer) and CEREC 3D will be installed in the selected installation language. The camera components for the 3D camera are also installed. In a user-defined installation, another language can be selected for the CEREC software to be installed. The ReadMe file may be displayed after the installation is complete. This file contains up-to-date

information about the CEREC software. Prior to milling a restoration, the software must be downloaded to the Milling Unit. See the operating instructions for the Milling Unit for more detailed instructions on downloading software. Two program icons will appear on the desktop of the Acquisition Unit; the CEREC 3D Icon and the CEREC Icon. (Figure 1-1 and 1-2) The CEREC 3D Icon opens the new 3D version of the CEREC program. The CEREC Icon will open the R1000 version of the software and is an updated version of the previous CEREC software which can access prior restoration designs (from R600 through R980). Double-clicking the program icon will open the desired program. Figure 1-1: CEREC 3D program icon as found on the desktop. Figure 1-2: CEREC R1000 program icon as found on the desktop. 3 CEREC 3D Manual When the CEREC 3D program is opened, the Design Window appears on the desktop. See Figure 1-3 for identification of the components that will appear on the Design Window when

designing a 3D restoration. Drop-down Menu Bar View Window Window Title Tool Bar Orientation Compass Scale (1.0 mm) Design Window Status Bar Figure 1-3. Design Window for the CEREC 3D software program Along the left side of the Design Window is the Tool Bar containing a number of program icons. Figure 1-4 identifies the program icons The Tool Bar can be dragged to any location on the screen by L-clicking and hold, then moving the trackball to the desired location. It can be docked on any edge of the screen that is preferred. Create a New Restoration Acquire the Preparation One design step forward (Next) Load a Restoration Acquire the Occlusion One design step back (Undo) Save a Restoration Acquire the Antagonist Figure 1-4. Tool Bar icon descriptions 4 Start Milling process CEREC 3D Manual The Scale located in the lower left area of the Design Window measures 1.0 mm As the magnification of the design is altered in the Design Window, the relative size of the scale

also changes, maintaining a 1.0 mm scale regardless of the design magnification. The Orientation Compass located on the right side of the Design Window maintains the relationship of the three axes in relation to the current view of the Virtual Model. (Figure 1-5) The buccal-lingual axis is red, the mesial-distal axis is green, and the occlusal-cervical axis is blue. The Orientation Compass will change orientation as the 3D view of the Virtual Model changes in the Design Window. The color of the Orientation Compass complements the color wheels in the Editing Icons and can be used as an aid in directional edit changes. This relationship will be discussed in greater detail when the Editing Tools are presented. Orientation Compass Figure 1-5. The Orientation Compass and color wheel; red is buccal-lingual, blue is occlusal-cervical, and green is mesial-distal. This compass is always visible while designing the restoration as an aid to assessing the model orientation 1.2 Starting a New

Restoration Select the New Icon from the icons in the left toolbar. This opens the Select patient for new restoration Window. (Figure 1-6) Select a patient listed or select New to register a new patient to the software program. Figure 1-6. Selecting New Restoration Icon, opens the window for selecting the patient 5 CEREC 3D Manual After the CEREC New Patient Window opens, enter the patient’s last name in the first box and first name in the second box. (Figure 1-7) Then either the patient’s birth date or card index number must be added. The birth date format (DD/MM/YY, MM/DD/YYYY, etc) must conform to the date settings in the computer operating system program for it to be accepted. The card index number can be any number that is unique to the patient. After the information has been input, select OK to proceed to the next screen. Figure 1-7. Creating a new patient file 6 CEREC 3D Manual 1.3 Select the Restoration Four different types of restorations may be designed with

the CEREC 3D program. (Figure 1-8) They include: • Inlay, Onlay, Partial Crown = this includes a wide variety of inlay and onlay restorations characterized by having part of the cavosurface margin associated with internal wall segments of the cavity preparation and part of the cavosurface margin not associated with internal wall segments of the cavity preparation. • Occlusal Inlay = this includes Class I, Class III and Class V restorations. They are characterized by having cavosurface margins entirely above wall segments of the cavity preparation. • Veneer = this includes veneer preparations. • Crown = this includes crown preparations. Figure 1-8. Select the Restoration, Design Technique, and Tooth to initiate the restoration design 7 CEREC 3D Manual 1.4 Select the Design Technique Two different design techniques are available with the CEREC 3D program. (Figure 1-8) They are Dental Database and Correlation Dental Database Design Program The Dental Database design program

utilizes the data captured in the optical image of the cavity preparation to create the Virtual Model of the preparation to construct the restoration design. Data for determining cusp height, marginal ridge height, and restoration contours are proposed by the program after comparing data from adjacent teeth and the database of dental anatomy contained within the software program. This proposed anatomy can be customized to the specific requirements of the clinical case. Correlation Design Program The Correlation design program utilizes a Virtual Model of the cavity preparation as well as a Virtual Model of the pre-operative condition (tooth or cast) to construct the restoration design. Data for determining cusp height, marginal ridge height, and restoration contour is copied from the Occlusion Virtual Model (pre-treatment condition) to improve the accuracy of the restoration design. 1.5 Select the Tooth to be Restored The specific tooth to be restored is selected in the lower portion

of the New Restoration for Patient Window. (Figure 1-8) After the information has been input, select OK to proceed to the next step. 2.0 Cavity Preparation General Information The cavity preparation for a CEREC restoration must allow for an accurate optical impression and provide the foundation for longevity of the ceramic or composite material. This dictates a cavity preparation with a single path of insertion that can be isolated well for the optical impression and adhesive cementation process. 2.1 Cavity Designs – Inlays and Onlays The internal walls of an inlay or onlay restoration should have a single path of insertion with a 6o- 8o taper. (Figure 2-1) The internal walls of the cavity preparation should be well-defined and smooth. Clinical situations may lead to the creation of an undercut in an internal wall of the cavity preparation. If a single Optical Impression is used, the undercut will not be recorded by the camera and it will not be present in the Preparation Virtual

Model. However, if multiple Optical Impressions are captured from different angles, the undercut will be replicated in the Preparation Virtual Model. This may seem problematic for the design of the restoration except that the Margin Line dictates the lateral extent of the restoration, and an undercut in an internal wall of the Preparation 8 CEREC 3D Manual Virtual Model will not be duplicated in the milled restoration. Roughness, sharp edges, or steps in the internal walls may lead to problems in seating the restoration or potential areas of stress that may initiate fracture lines. o Figure 2-1. Internal walls of the preparation should have 6o-8o of taper. o 6 - 8 taper Proximal box walls should be smooth, without steps or undercuts, and should be tapered 6o- 8o. The exit angle of a proximal box should be 90o to the outer surface of the tooth to ensure a strong edge of material at the proximal surface of the box. (Figure 2-2) It is very easy to make the exit angle of a

proximal box too acute when extending the box in a facial or lingual direction while trying not to encroach on the remaining cusps. However, this leads to an acute exit angle that will be prone to fracture. o 90 o 90 9 Figure 2-2. Exit angles of proximal box walls should approach 90o to the outer surface of the tooth. CEREC 3D Manual An undercut in the wall margin of a proximal box will be replicated in the Preparation Virtual Model since it is visible to the camera regardless of whether single or multiple Optical Impressions are captured. (Figure 2-3) And since the Margin Line dictates the lateral extent of the restoration, the milled restoration will have the same undercut milled into the wall margin of the box preventing it from seating. Undercut Tapered Figure 2-3. Undercut in the wall margin of a proximal box will be visualized by the camera leading to an undercut in the Preparation Virtual Model. This will prevent seating of the milled restoration. Ceramic

materials are brittle and require a uniform thickness of material to ensure strength. This equates to 20 mm of tooth reduction over functional cusps and 1.5 mm of tooth reduction over nonfunctional cusps as well as at least 1.5 mm thickness through the central fissure area of the occlusal surface (Figure 2-4) Figure 2-4. Occlusal reduction should be 2.0 mm over functional cusps and 1.5 mm minimum reduction in the central fissure. 2.0 mm 1.5 mm Rounded shoulder or chamfer margins, at least 1.0 mm thick, ensure a strong edge of material to prevent fracture of the restoration. Thin areas at the margins, such as light chamfers or bevels, are predisposed to fracture and are not recommended. All margins should be smooth and well-defined to ensure accurate reproduction in the optical impression and Preparation Virtual Model. 10 CEREC 3D Manual The occlusal outline form should be smooth and flowing. Sharp or acute angles should be avoided as they lead to interferences in seating the

restoration as well as stress points which predispose the restoration to fracture. The inclusion of buccal or lingual developmental grooves in the restoration design should be prepared similar to a proximal box. The walls of the extension should have 6o-8o taper and be in the same path of insertion as the rest of the cavity design. The extension will be milled more predictably if it converges in shape as it exits the tooth. Cavity preparations should be smooth and well-defined. This is predictably achieved with tapered, flat-end diamond burs. The completed cavity preparation should be finished with a smooth grit diamond. Attempts to finish the cavity preparation with a sharp carbide bur lead to sharp internal angles which are not reproduced well by ceramic restorations. 2.2 Cavity Designs – Crowns The functional cusps should be reduced 2.0 mm, nonfunctional cusps should be reduced 1.5 mm, and the central fissure area should be reduced at least 1.5 mm to ensure adequate strength to

the crown In addition, axial reduction of the tooth should be a minimum of 1.2 mm The facial and lingual walls of the crown preparation should be done in two planes to avoid thin areas in the milled restoration. (Figure 2-5) Figure 2-5. Recommended occlusal reduction for crown preparations. 2.0 mm 1.5 mm Rounded shoulder or chamfer margins, at least 1.0 mm thick, ensure a strong edge of material to prevent fracture of the restoration. A sloped shoulder (90o-120o) ensures a strong edge of material while providing a good transition of translucency and shade between the tooth and crown at the margin area. Thin areas at the margins, such as light chamfers or bevels, are predisposed to fracture and are not recommended. All margins should be smooth and well11 CEREC 3D Manual defined to ensure accurate reproduction in the optical impression and Preparation Virtual Model. All internal line angles should be smooth and rounded. Roughness, steps, or acute angles in the preparation may lead

to problems in seating the milled crown. These internal stress points may also lead to the initiation of cracks and fracture of the crown during clinical service. 3.0 Optical Impression 3.1 Powder Application An Optical Impression of the cavity preparation is used by the CEREC 3D program to design the restoration. Data captured in the optical image forms the basis for the designed restoration. Accurate recording of the cavity preparation is essential to an accurate restoration. An Optical Image of the tooth is recorded with the CEREC 3D camera. The camera projects an invisible grid onto the field of view to record the dimensions of the cavity preparation. As the grid is reflected off the tooth surface, the camera interprets distortions in the grid as differences in height (Z values). The camera’s field of view must have a uniform reflective surface to accurately record the height values of the cavity preparation. To create a uniformly reflective surface, a thin layer of titanium

dioxide powder (CEREC Powder) is applied to the surface of the teeth and adjoining soft tissues. This layer of titanium dioxide powder ensures an accurate determination of the Z values of the cavity preparation. CEREC Imaging Liquid is a polysorbate liquid that creates a sticky surface on the surface of the teeth and soft tissues. (Figure 3-1) It is liberally applied with a brush to the surfaces of the cavity preparation as well as any other surfaces within the field of view of the camera. This generally includes the adjacent teeth, gingival tissues, rubber dam surface, and rubber dam clamp. The Imaging Liquid is dried to a thin layer with an air/water syringe and serves as a sticky film for the powder to adhere to the surfaces. Figure 3-1. Imaging Liquid on the left and titanium dioxide powder on the right 12 CEREC 3D Manual A uniform coating of powder is applied to all surfaces within the camera’s field of view. (Figure 3-2) The powder should be applied at an obtuse angle to

the tooth surfaces with extra attention to vertical surfaces as horizontal surfaces are generally the easiest to powder. Adjacent teeth and soft tissues should be powdered first and the preparation should be powdered last as the overspray from powdering the adjacent teeth and tissue surfaces may inadvertently lead to piles or clumps of powder on the cavity preparation. Care should be taken to avoid clumps or piles of powder as this would lead to inaccurate portions of the captured image. Adequate powder is required to ensure a good contrast to the captured optical image. Areas that appear very dark in the optical impression are generally a result of inadequate powdering. Once the field of view has been adequately powdered, it is ready for the Optical Impression. Figure 3-2. Cavity preparation and adjacent areas after powder application. 3.2 Optical Impression General Information: The CEREC 3D software allows the operator to capture several Optical Impressions to include the

preparation, the pre-treatment condition, or a bite registration of the antagonist teeth. There are three different Image Icons found on the toolbar that may be used to record optical images. They include: Preparation Icon Occlusion Icon Antagonist Icon The Preparation Icon captures images of the cavity preparation to create the Preparation Virtual Model. It is used for both Dental Database and Correlation design techniques. The Occlusion Icon is unique to the Correlation design program and captures images of the pre-operative condition from either the tooth or a cast to create the Occlusion Virtual Model. This data can then be used to duplicate the contours in the Virtual Restoration. And the 13 CEREC 3D Manual Antagonist Icon captures images of a bite registration to create the Antagonist Virtual Model of the occlusal surfaces of the antagonist dentition. This data can be used to refine the occlusion of the Virtual Restoration relative to the opposing dentition. It is an

optional image for both Dental Database and Correlation design techniques. A single image, or multiple images, may be captured and saved for each image icon. The maximum number of images possible for each image icon is determined by the performance of the CEREC 3 Acquisition Unit computer. However, the processing speed of the design program is also very dependant on the number of images recorded. It is recommended to use a single Optical Impression for each image icon unless there is a specific reason to utilize additional images. 3.21 Acquire a Single Optical Impression To acquire an Optical Impression of the cavity preparation, first position the cursor over the Acquire Preparation Icon. (Figure 3-3) To capture an Optical Impression (OI), place one’s foot under the front edge of the CEREC 3 Acquisition Unit and lift up and hold the foot-switch. This activates the camera to display a live digital video image on the monitor. The image brightness is automatically controlled and

additional light is not required. The dental operating light should not be used to illuminate the cavity preparation. Position the camera over the cavity preparation in the path of insertion of the planned restoration. All margins should be clearly visible When the foot-switch is released the OI is captured to the monitor. The camera should be held steady until an audible “beep” is heard indicating termination of image recording. Figure 3-3. Acquire the Optical Impression of the preparation by positioning the cursor over the Acquire Preparation Icon. 14 CEREC 3D Manual The Optical Impression should be well aligned and have sharp focus. (Figure 3-4) The angle of viewing of the image should be in the path of insertion of the cavity preparation. The taper of the cavity walls should be similar throughout the image. The image should also display good contrast without dark areas due to a lack of powder. The cavity margins should be displayed as sharp, distinct lines that are easily

traced around the cavity preparation. Margins should be distinct and separate from adjacent teeth as well as gingival tissues. Areas of the margin that must be “estimated” will not consistently result in accurate margins. For most cases, the image of the cavity preparation should be centered in the screen. Figures 3-5 to 3-7 are examples of inaccurate Optical Impressions. Figure 3-4. Accurate Optical Impression. Figure 3-5. Defective optical impression due to lack of focus from camera movement. 15 CEREC 3D Manual Figure 3-6. Defective optical impression as margins are not visible due to poor angulation of the camera. Figure 3-7. Defective optical impression as tooth is poorly aligned. Verify the accuracy of the image on the computer monitor before proceeding. If the OI is NOT acceptable, it can be deleted and recorded again simply by lifting up the foot switch and recording a new OI. Once the Preparation Optical Impression has been accepted it is stored in the Preparation

Image Catalogue. (Figure 3-8) If a single OI will be used for the design, select Virtual Model. (Next Icon) and proceed to the creation of the Preparation Figure 3-8. Single optical impression as saved to the Preparation Image Catalogue window. 16 CEREC 3D Manual 3.22 Acquire Multiple Optical Impressions The option to use multiple optical impressions for a restoration should be selected only if there is a specific need, such as to visualize specific obscured margins of a single cavity preparation. Multiple optical impressions are also required to create a larger Virtual Model to restore multiple teeth or to evaluate adjacent tooth contours. If multiple Optical Impressions will be used, the cursor must be maintained over the Acquire Preparation Icon. After the first Optical Impression is captured, quickly lift up the foot switch (quick click) to transfer the first Optical Impression into the Preparation Image Catalogue. This also clears the screen for the next OI. This makes the

capture of multiple images very easy as one does not have to let go of the camera, just merely reposition it between images. Alternatively, Optical Impressions can be moved to the Image Catalogue by L-clicking, but this usually requires removing the camera from the mouth and is not particularly useful. This process is similarly repeated when capturing multiple images for the Occlusion Icon and the Antagonist Icon. All the Optical Impressions captured with the Preparation Icon are stored within the Preparation Image Catalogue. (Figure 3-9) Note that the first image is marked with a red border. This is the Reference Optical Impression, which determines the path of insertion for the restoration. By default, this is the first optical image recorded. Another image within the Image Catalogue can be selected as the Reference Optical Impression. To change Reference images, 2-click on the desired image and the red border will shift to the selected image. The new Reference Optical Impression

will then determine the path of insertion of the restoration. Figure 3-9. Images saved to the Preparation Image Catalogue. Note the red border around the first image indicating the image from which the path of insertion is determined. 17 CEREC 3D Manual Multiple optical images can also be captured for the Occlusion Icon and the Antagonist Icon. (Figure 3-10 and 3-11) The images for these icons are similarly stored in their respective Image Catalogues. The optical images captured for each image icon are automatically correlated to create the Virtual Models unique to each image icon. Figure 3-10. Occlusion Optical Impression with multiple images in the Image Catalogue. Figure 3-11. Antagonist Optical Impression with multiple images in the Image Catalogue. If one of the images saved to the Image Catalogue is judged unacceptable, L-click and hold on the image and drag it into the recycle bin in the Image Catalogue to delete it. A new optical image can then be captured 18 CEREC

3D Manual All the images captured and saved for each image icon will automatically correlate to create the Virtual Model for each image icon. The ability of the software program to process the multiple images into a single Virtual Model is dependant on unique data that remains unchanged between successive images. In general, at least one-third of each image should duplicate areas of the prior image so there is adequate image data for the software program to automatically correlate and create the Virtual Model. When using multiple images of a single cavity preparation, the camera angle should not change more than 200 between successive images. This provides adequate unchanging data to accurately combine the images. When capturing multiple images for a number of different cavity preparations in order to assemble a number of teeth into a single Virtual Model, at least one-third of the camera viewing area (8 mm) should contain unique data that does not change between images. This will

require a step-wise capture of a series of images The first tooth to be restored should be recorded first as the initial Optical Impression defines the path of insertion of the Preparation Virtual Model. Additional Optical Impressions can be captured by moving in a step-wise fashion both mesially and distally from the initial Optical Impression. This ensures adequate image data duplication for the software program to automatically create the Virtual Model. This also means that a bite registration used for the Antagonist Icon must be trimmed free of the adjacent teeth to provide an adequate amount of unchanged, unique data between images. It is possible to re-project saved images in the Image Icon window by placing the cursor over the saved image in the Image Catalogue. By Rclicking on the saved image, the height value of the image can be reviewed in the Image Icon window. (Figure 3-12) Figure 3-12. Height image view of the preparation image. R-click on the image in the Image Catalogue

to activate the height image view. R-click a second time to deactivate the height image view. 19 CEREC 3D Manual It is possible to change the size of the images in the Image Catalogue by selecting different ratios for viewing. Use the ratio box in the upper right area of the Image Catalogue to change viewing ratios. (Figures 5-4 and 5-5) Figure 4-44. Occlusion Image Catalogue with a 1:4 image ratio for viewing. Note the date and time stamp on the images. Figure 4-45. Occlusion Image Catalogue with a 1:8 ratio for viewing. 20 CEREC 3D Manual 4.0 Virtual Models General Information: Once the Optical Impressions have been captured to the Image Catalogues, the CEREC 3D program processes the data to create a threedimensional virtual model. A unique Virtual Model is created from each Image Catalogue; a Preparation Virtual Model, an Occlusion Virtual Model, and an Antagonist Virtual Model. The restoration design is then completed using the appropriate Virtual Models. 4.1

Preparation Virtual Model The preparation Virtual Model is created from the Optical Impression (single or multiple) in the Preparation Image Catalogue. This model is obviously required for both Dental Database and Correlation design techniques as it replicates the cavity preparation of the tooth. After the Optical Impression is accepted, select (Next Icon) and the Preparation Virtual Model is calculated and displayed on the screen. (Figure 41) Figure 4-1. Preparation Virtual Model created from Optical Impression in Figure 3-8. Note text identifiers for buccal, lingual, mesial, and distal directions. 21 CEREC 3D Manual Viewing Orientation The Preparation Virtual Model can be evaluated in several views. (Figure 4-2) • The Virtual Model can be infinitely rotated about a point in the X, Y, and Z axis by holding the L-click down while rotating the trackball. Release the L-click to hold the position. The Compass Axis arrows located on the right of the screen are color-coded to orient

buccal-lingual (red), mesialdistal (green), and occlusal-gingival (blue) axis. • The Virtual Model can be quickly positioned to mesial, distal, buccal, lingual, cervical and occlusal views by selecting the buttons displayed in the View Window. Views are color-coded to text (distal, buccal, mesial, lingual) around the Virtual Model. (Figure 4-3) • The entire Virtual Model can be moved within the viewing screen by an Rclick and hold and rotating the trackball, then release when it is in the position desired. • The Virtual Model can be magnified or reduced in size by using the plus and minus buttons in the View Window. If the Virtual Model is NOT acceptable after evaluating it, select the (Undo Icon). New Optical Impressions may be redone to correct the Virtual Model. Figure 4-2. Preparation Virtual Model. View Window is in upper right aspect of screen. Note color-coded compass axis on right side of screen as a guide for model orientation 22 CEREC 3D Manual Figure 4-3. Note

color-coded arrows correspond to Compass Axis and text directions and colors on the screen. The Preparation Virtual Model and the restoration design can be viewed in an Opaque and Transparent view. Select Window from the drop-down menus at the top of the design screen and scroll down to Display Options. This opens the Display Options window on the design screen. (Figure 4-4) The Display Options window has two columns with boxes that can activate or deactivate a particular image and whether it will be opaque or transparent. Note that the Occlusion Virtual Model and Antagonist Virtual Model can also be selected when these images are to be utilized. The Display Options window can be activated any time during the design process to alter the view from opaque to transparent. Figure 4-4. Display Options window opened. 23 CEREC 3D Manual Figures 4-5 and 4-6 show a variety of transparent and opaque options that are possible. Figure 4-5. Transparent preparation and opaque Virtual

Restoration. Figure 4-6. Transparent Virtual Restoration design and opaque Virtual Model. 24 CEREC 3D Manual 4.2 Occlusion Virtual Model The Occlusion Virtual Model is unique to the Correlation design technique. An Optical Impression of the pre-operative state of the tooth is captured and is used to create the occlusion Virtual Model. (Figure 4-7) The pre-treatment condition of the tooth, a cast, or a diagnostic wax-up are several alternatives that can be used to create the Occlusion Virtual Model. The occlusal portion of the Occlusion Virtual Model can be copied onto the design of the restoration duplicating the occlusal anatomy and occlusal relationships. The application of the Occlusion Virtual Model will be discussed in detailed under the discussion of the Correlation design technique. Figure 4-7. The Occlusion Virtual Model superimposed over the cavity preparation. 25 CEREC 3D Manual 4.3 Antagonist Virtual Model The Antagonist Virtual Model is an optional model that

can be used with both the Dental Database and Correlation design techniques. An Optical Impression of a bite registration is used to create the Antagonist Virtual Model of the occlusal surfaces of the opposing dentition. (Figure 4-8) It can be applied in the design process to refine the occlusal contacts with the opposing dentition. It is probably of more value with the Dental Database design technique as there is no data relative to the occlusal relationships in the Preparation Virtual Model. The Correlation design technique utilizes the Occlusion Virtual Model to replicate the pre-treatment occlusal anatomy and relationships, so the Antagonist Virtual Model may offer limited additional information. Figure 4-8. The Antagonist Virtual Model visualizes the bite registration. 26 CEREC 3D Manual 5.0 Virtual Restoration Edit Tools A number of tools are available for both the Dental Database and Correlation design techniques to refine the contours and contacts of the restoration. The

function and capability of each tool will be reviewed in this section and their application will be presented in the example cases to follow. 5.1 Design Window The Design Window contains six edit tools that can be used to refine the designed restoration. The tools are: Edit, Drop, Scale, Shape, Rotate, and Position. 5.11 Edit Icon Selecting the Edit Icon in the Design Window turns the Virtual Restoration transparent and highlights several design lines in color. (Figure 51) The Margin Line is blue, the Proximal Contact Line is pink, the Marginal Ridge Line is turquoise, and the Fissure Line is green. Figure 5-1. Transparent Virtual Model with design lines visible after selecting the Edit Icon in the View Window. 27 CEREC 3D Manual All the design lines are active for editing simultaneously. The various design lines may be redrawn by 2-clicking somewhere along the line, redrawing the line, and then 2-clicking on the line a second time. (Figure 5-2) To correct a mistake as the line

is being redrawn, an R-click deletes the last cursor placement and allows the correction. Figure 5-2. Correction of the Marginal Ridge Line by redrawing the line. 28 CEREC 3D Manual A note of caution in redrawing the design lines is that the orientation of the Virtual Restoration is critical to the resultant line. Generally, width and breadth (X,Y axes) changes are done from the occlusal view (Figure 5-3) and height (Z axis) changes are done from a lateral view. (Figure 5-4) The ability to view the design in 3D offers a tremendous advantage in line editing. Occasionally, redrawing a line around line angles (multiple planes) will result in undesirable contour changes. This is especially true of more complex designs with extensive design lines. Figure 5-3. Proximal Contact Line edited laterally (X, Y axes) from the occlusal view. Figure 5-4 Proximal Contact Line edited vertically (Z axis) from the buccal view. 29 CEREC 3D Manual The end points of the various design lines are

identified with red dots along the Margin Line. These end points may be repositioned by L-click and holding on the red dots, and then rotating the trackball to move the red dot. Release the red dot to fix the position on the Margin Line. Figure 5-5 demonstrates an undesirable buccal-lingual orientation to the Proximal Contact Line. Figure 5-6 shows that the orientation was corrected by sliding the red dot of the Proximal Contact Line higher on the Margin Line. Figure 5-5. Undesirable buccal-lingual orientation of the Proximal Contact Line. Figure 5-6. Proximal Contact Line end-points correctly repositioned. 30 CEREC 3D Manual 5.12 Drop Icon (Smoothing Function) The Drop Icon provides the opportunity to alter a small area of the Virtual Restoration contour by adding 50 microns per L-click. It adds contour to the restoration in a discreet location. This would be similar to adding wax, drop by drop, to a waxed restoration. (Figure 5-7) Figure 5-7. Note defect in the mesial marginal

ridge contour at the lingual aspect of the box. Select the Drop Icon and the arrow cursor changes to a waxing symbol. Position the waxing symbol over the area where material is to be added. Every L-click adds 50 microns of additional material to the Virtual Restoration contour. (Figure 5-8) The waxing symbol can be moved to different locations between L-clicks as long as the Drop Icon remains selected. 31 CEREC 3D Manual Figure 5-8. Select the Drop Icon to correct the deficiency by adding material to the Virtual Restoration. A second function is available for the Drop Icon. Depressing the space bar while the Drop Icon is activated changes the waxing symbol to a hand symbol that can remove 50 microns of material from the Virtual Restoration contour and create a smoother contour. This is the “smoothing function” (Figure 5-9) Removal of material may proceed until such time that a flat area is created in the contour. Select the Drop Icon a second time to deactivate the addition

or removal of material to the restoration contour. Figure 5-9. Select the space bar while the Drop Icon is activated to change to the Smoothing or Blend Function to refine the contour. If the new contour is NOT acceptable, select the (Undo Icon) to delete the change in contour and redo the desired design change. 32 CEREC 3D Manual 5.13 Scale Icon The Scale Icon provides the opportunity to edit selected areas of the Virtual Restoration. This tool divides the restoration into large areas that allow the edit process to be uniform and consistent with the entire tooth contour. Selection of the Scale Icon immediately visualizes the design lines if they have not already been selected by using the Edit Icon. At the same time, one of the following areas will have a whiter appearance relative to the remaining transparent Virtual Restoration to indicate this area has been selected: • Occlusal Table = select by L-clicking on the Fissure Line; highlights the occlusal surface to the

Marginal Ridge Line. (Figure 5-10) • Marginal Ridge = select by L-clicking on the Marginal Ridge Line; highlights the proximal half of the occlusal surface through the marginal ridge to the height of the Proximal Contact Line. (Figure 5-10) Depending on where the Marginal Ridge Line is selected, may select the buccal or lingual half or the mesial or distal half. • Proximal Surface = select by L-clicking on the Proximal Contact Line; highlights the proximal surface. (Figure 5-11) The entire circumference of the proximal surface can be selected by selecting F7 after L-clicking on the Proximal Contact Line. • Half Tooth = select by L-clicking on the Margin Line in the Cervical Segment; highlights the restoration from the center of the occlusal table to the cervical margin. The entire crown can be selected by selecting F7 after L-clicking on the Margin Line. (Figure 5-11) • Cusp = select by L-clicking on the small dot on the Marginal Ridge Line over a specific cusp; highlights the

cusp including the triangular ridge and proximal contour down to the Proximal Contact Line. This option is available only for Onlay or Crown restoration designs in Dental Database. (Figure 5-10) 33 CEREC 3D Manual Figure 5-10. Selected areas of the Virtual Restoration using the Scale Icon. Occlusal Table MRL Distal Half MRL Buccal Half Cusp Figure 5-11. Selected areas of the Virtual Restoration using the Scale Icon. PCL PCL + F7 Circumference ML ML + F7 Entire Crn Once an area has been selected, it can be moved in any of the six directions indicated by the Edit Buttons in the Design Window. Note that the colors on the Edit Buttons correspond to the same colors indicated by the text directions adjacent to the Preparation Virtual Model. (Figure 5-12) One L-click on a color will move the selected area 25 microns in the desired direction. 34 CEREC 3D Manual Figure 5-12. Edit Buttons with corresponding colors and directions. Example: The Virtual Restoration has an open

distal contact in Figure 5-13. To correct the contact, select the Edit Icon in the Design Window. Select the distal Proximal Contact Line on the Virtual Restoration and it will highlight the distal proximal surface (Figure 5-14). Then use the green area of the Edit Wheel to move the highlighted proximal area distally to correct the contact (Figure 5-15). Figure 5-13. Virtual Restoration with open distal contact. 35 CEREC 3D Manual Figure 5-14. Scale Icon selected, then distal Proximal Contact Line selected. Figure 5-15. Distal proximal contact corrected with Edit Wheel. 5.14 Shape Icon The Shape Icon provides the opportunity to edit selected areas of the Virtual Restoration by the addition and subtraction of discreet amounts of material. Select the Shape Icon in the Design Window This converts the arrow-shaped cursor to the drawing cursor (“+”). Double click on the Virtual Restoration and outline the area of the restoration where material will be added or removed. Double

click back on the starting point of the line to complete the outline. Figure 5-16 demonstrates the facial cusp triangular ridge outlined (The second view of the lateral aspect of the tooth is for illustration purposes only) 36 CEREC 3D Manual Figure 5-16. Buccal cusp triangular ridge outlined for adjustment. (Lateral view for illustration only) If the outline drawn is not acceptable, 2-click again and the outline will be deleted so it may be redrawn. The line may not cross itself (similar to a figure eight) while outlining an area or the program will not accept the outline and it will need to be redrawn. The line defining the area may extend beyond the margin onto the tooth, however the contour of the tooth will not be altered, only the Virtual Restoration. Once the area is outlined, the plus or minus sign in the Shape Icon box is depressed to add or remove material from the Virtual Restoration. One click of the plus or minus sign is equivalent to 50 microns of material.

Material is added or removed in the plane of the computer monitor and is not dependant on the angle of viewing. For this reason it is useful to view the area to be adjusted in a lateral view to better visualize the amount of material added or removed from the Virtual Restoration. Once the desired amount of material is added to the circumscribed area, the space bar may be depressed to activate the smoothing function that will automatically flatten the added material. When the adjustment is completed, select the Shape Icon again to deactivate the function. 37 CEREC 3D Manual Figure 5-17. Triangular ridge with added height using the Shape Icon. (Lateral view for illustration only) An alternative use of the Shape Icon is to draw a line that does not close on itself, similar to a fissure line. Activation of the plus or minus sign in the Shape Icon will raise or lower the line in a vertical direction. This technique is particularly useful for creating anatomical grooves within the

Virtual Restoration. When the adjustment is completed, select the Shape Icon again to deactivate the function. 5.15 Rotate Icon The Rotate Icon is only available for use with full crown restoration designs. Selection of the Rotate Icon in the Design Window will allow the crown to be rotated on the Preparation Virtual Model. Click on the Rotate Icon to activate it. The colored Orientation Compass indicates three colored axis; blue = occlusal-cervical, red = buccal-lingual, and green = mesial-distal. (Figure 5-16) By selecting the appropriate color on the Rotate Icon, the crown can be rotated around the desired axis. The crown may appear to have a poor margin adaptation after rotating the Virtual Restoration, however the software program will correct the discrepancy after the icon is deactivated. Select the Rotate Icon a second time to deactivate it. 38 CEREC 3D Manual Orientation Compass Figure 5-18. The Orientation Compass is located on the right side of the design window. Red

is buccallingual, blue is occlusalcervical, and green is mesial-distal. This compass is always visible while designing the restoration as an aid to assessing the model orientation. Figure 5-19. Using the Rotate Icon to rotate the Virtual Crown around the occlusalcervical (blue) axis. Note the Orientation Compass on the right side of the screen. 39 CEREC 3D Manual Figure 5-20. Using the Rotate Icon to rotate the Virtual Crown around the mesial-distal (green) axis. Note the Orientation Compass on the right side of the screen. Figure 5-21. Using the Rotate Icon to rotate the Virtual Crown around the buccallingual (red) axis. Note the Orientation Compass on the right side of the screen. 40 CEREC 3D Manual 5.16 Position Icon The Position Icon is only available for use with full crown restoration designs. Selection of the Position Icon in the Design Window will allow the crown to be shifted laterally or vertically on the Preparation Virtual Model. Click on the Position Icon to

activate it. The colored Orientation Compass illustrates the three colored axis; blue = occlusal-cervical, red = buccal-lingual, and green = mesial-distal. (Figure 5-16) By selecting the appropriate color on the Position Icon, the crown can be shifted along the desired axis. The crown may appear to have a poor margin adaptation after adjusting the Virtual Restoration, however the software program will correct the discrepancy after the icon is deactivated. Select the Position Icon a second time to deactivate it Figure 5-22. Using the Position Icon to shift the Virtual Crown along the mesial-distal (green) axis. Note the Orientation Compass on the right side of the screen. 41 CEREC 3D Manual Figure 5-23. Using the Position Icon to shift the Virtual Crown along the buccal-lingual (red) axis. Note the Orientation Compass on the right side of the screen. Figure 5-24. Using the Position Icon to shift the Virtual Crown along the occlusal-cervical (blue) axis. Note the Orientation

Compass on the right side of the screen. 42 CEREC 3D Manual 5.2 Cut Window The Cut Icon makes successive serial cross-sections through the Virtual Restoration and Preparation Virtual Model which can be used to evaluate the restoration design. The Cut Window is initially not present in the design window and is opened by selecting Window from the drop-down menus at the top of the screen and scrolling down to Cut. The Cut Window appears in the design window. (Figure 5-25) Select the Cut Icon to make it active Select the plus sign or minus sign in the Cut Icon and the Virtual Model and restoration design will be sectioned. Using the plus sign and minus sign in the Cut Icon will move the level of cut through successive serial cross-sections. Figure 5-25. Cross-section from occlusal view using the Cut Window. 43 CEREC 3D Manual The orientation of the cut sections is determined by the oriented view of the Virtual Model prior to selecting and activating the Cut Icon in the Cut

Window. The serial cross-sections will be oriented within the plane of initial viewing prior to selecting the Cut Icon. To alter the plane of the cross-sections, first select the Cut Icon and deactivate it. Then alter the orientation of the Virtual Model to provide the desired plane of cross-section. Then select the Cut Icon a second time to review the cross-sections in the new plane. (Figure 5-26) Once the Cut Icon has been selected, the plane of the cross-sections has been determined. The view of the Virtual Model can be changed (occlusal, buccal, lingual, mesial, etc) to view the cut sections from different angles, however the oriented plane of the cut sections will not change until the Cut Icon is selected a second time. Figure 5-26. Cross-section from buccal view using the Cut Window. 44 CEREC 3D Manual 6.0 Design Overview – Dental Database – Inlay 1 – Select New Restoration Register the patient; choose the restoration, design technique, and tooth 2 – Optical

Impression Capture Preparation Image 6 – Virtual Restoration Select Next Icon to create Virtual Restoration 7 – Evaluate Virtual Restoration Contours – Edit and Scale Icons 3 – Preparation Virtual Model Select Next Icon to create Virtual Model Contacts – Proximal (Contact Icon) Details – Shape and Drop Icons 4 – Trim Preparation Virtual Model Trim the adjacent teeth for direct visual access to proximal margins. 8 – Mill Preview Select Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the cavosurface margin, start with cervical segment, 2-click for transition 9 – Mill the Restoration points between wall & cervical segments Select material and block size; insert block in milling chamber and mill. 45 CEREC 3D Manual 6.0 Dental Database Design Program – Inlay 6.1 Acquire the Optical Impression To initiate the design process, select the New Icon from the Tool Bar and proceed to register the patient in the program. When the New

Restoration Window opens, select the restoration to be designed, the design technique to be used, and the tooth to be restored. (Figure 6-1) Select OK to proceed with the design process. This will make the Image icons available for capturing Optical Impressions. Figure 6-1. Select the Restoration, Design Technique, and Tooth to initiate the restoration design 46 CEREC 3D Manual Position the cursor over the Acquire Preparation Icon to capture an Optical Impression (OI) of the inlay preparation. The Optical Impression should be well aligned and have sharp focus. (Figure 6-2) The angle of viewing of the image should be in the path of insertion of the cavity preparation. Verify the accuracy of the image on the computer monitor before proceeding. If the OI is NOT acceptable, it can be deleted and recorded again by lifting up the foot switch and recording a new OI. Figure 6-2. Single Optical Impression as saved to the Image Catalogue window. When the Optical Impression is judged to be

acceptable, select Icon), and have the program create the Preparation Virtual Model. 47 (Next CEREC 3D Manual 6.2 Preparation Virtual Model After the Optical Impression is accepted, a Preparation Virtual Model is calculated and displayed on the screen. (Figure 6-3) The Preparation Virtual Model can be viewed from any number of angles by rotating the model or using the directional arrows in the View Window. (See Section 41 for more details) Figure 6-3. Preparation Virtual Model. Note text identifiers for buccal, lingual, mesial, and distal directions. If the Virtual Model is NOT acceptable after evaluating it, select the (Undo Icon). New Optical Impressions may be redone to correct the Virtual Model. If the Preparation Virtual Model is acceptable, proceed to trim the teeth adjacent to the cavity preparation. 48 CEREC 3D Manual 6.3 Trim the Adjacent Teeth When the Preparation Virtual Model is initially displayed, the Trim Function is activated. The teeth adjacent to the

cavity preparation can be temporarily hidden from view as an aid in the designing process. The drawing cursor should be positioned over the Preparation Virtual Model and a 2-click is used to initiate the trim line. The 2-click must be started somewhere on the Virtual Model. Trace the trim line across the Virtual Model between the preparation and the adjacent tooth. (Figure 6-4) Figure 6-4. Placement of the Trim Line to mask the adjacent tooth. 49 CEREC 3D Manual If the drawing cursor is positioned over a particularly steep area of the adjacent tooth while tracing the trim line, a warning sign will flash indicating the line cannot be placed in this location. If the trim line is incorrectly drawn prior to completing it, an R-click can delete the last cursor placement and allow correction of the line. End the trim line on the Virtual Model by 2-clicking. This will hide the adjacent tooth from view and allow direct visual access to the proximal surface of the prepared tooth. (Figure

6-5) Repeat the process to hide the opposite adjacent tooth if the other proximal contact will be restored. Figure 6-5. Adjacent teeth trimmed and temporarily hidden from view. If the trimmed portion of the Virtual Model is NOT acceptable, select the (Undo Icon) to delete the trim line and then redraw it. If both adjacent teeth have been trimmed, both trim lines will have to be redrawn. When the trimmed portion of the Preparation Virtual Model is acceptable, select the (Next Icon) and proceed to the next design step. 50 CEREC 3D Manual 6.4 Margin Line The next step in designing the virtual restoration is to trace the Margin Line (ML). The Margin Line is composed of the entire cavosurface margin of the preparation. For inlays, and some onlay preparations, the Margin Line is composed of Cervical Segments and Wall Segments. (Figure 6-6) • A Cervical Segment is a portion of the Margin Line that is a portion of the cavosurface margin not associated with a vertical component of the

cavity preparation. It may also be considered a portion of the margin on the perimeter of the preparation when the tooth is viewed from the occlusal. Examples include the cavosurface margin of a proximal box or the cervical margin of a crown preparation. • A Wall Segment is a portion of the Margin Line that is a portion of the cavosurface margin associated with a vertical component of the cavity preparation. It may also be considered an internal portion of the margin when the tooth is viewed from the occlusal. Examples include the vertical margins of a proximal box and the margin of an occlusal isthmus. (Figure 6-6) This distinction between Margin Line segments is important as these areas must be properly identified for the software while tracing the Margin Line. Figure 6-6. Cervical Segment vs Wall Segment. Note red dots at transition points between segments. The tracing of the Margin Line must be started by drawing a Cervical Segment first. The Margin Line is started with a

2-click at the junction of a Cervical Segment and a Wall Segment and the Cervical Segment is drawn first. When a transition point is reached to a Wall Segment this point is identified with a 2-click. Similarly, another 2-click is used to identify the transition from a Wall Segment to a Cervical Segment. The Margin Line is completed with a 2-click at the starting point. (Figure 6-6) 51 CEREC 3D Manual The tracing line will tend to “jump” to the correct margin placement as the software locates the margin with the Automatic Margin Finder. The Margin Line can be fixed in position by using an L-click. It should be noted that if significant distance is placed between successive L-clicks, the Margin Line may “jump-off” the desired margin location. The closer the L-clicks are placed along the margin, the more control the operator is assuming in locating the Margin Line. Generally, only a few L-clicks will be needed to fix the line in position as the operator must only be within

3-5 pixels of the margin for the Automatic Margin Finder function to accurately determine the correct line placement. It is recommended to maintain the drawing cursor axial (or pulpal) to the margin when allowing the Automatic Margin Finder to determine the correct placement. Occasionally, an area of the Margin Line may be obscured in the Preparation Virtual Model which will hinder the Automatic Margin Finder function. The first solution to this problem is to re-evaluate the powder-picture sequence to improve the Optical Impression and create an accurate Preparation Virtual Model. The last option is to deactivate the Automatic Margin Finder by depressing the space bar. This also opens an Intensity Screen with additional magnification of the margin to be drawn. (Figure 6-7) The operator can then manually trace the Margin Line using the Intensity Screen as a guide. Depressing the space bar a second time will reactivate the Automatic Margin Finder. Figure 6-7. Automatic Margin Finder

disabled with view of Intensity Image window. Note how Margin Line changes from green to white line without the Automatic Margin Finder activated. As soon as the Margin Line is completed with the final 2-click, the Automatic Margin Finder is deactivated. If at this point, the Margin Line is to be edited, 2-click on the Margin Line, redraw the area of the line that is inaccurate, and then 2-click back on the line to complete the edit. In general, the Automatic Margin Finder function will be more accurate in locating the margin than doing so manually. 52 CEREC 3D Manual The Margin Line should generally be traced while viewing the preparation from the occlusal. (Figure 6-8) This corresponds to the path of insertion of the Virtual Restoration. However, slight adjustment of the Virtual Model orientation to visualize the margin directly may also be beneficial for tracing the vertical components of a proximal box margin. (Figure 6-9) Figure 6-8. Margin Line tracing from occlusal view.

Start drawing the Margin Line with a Cervical Segment. . Figure 6-9. Rotation of Virtual Model to facilitate tracing the Margin Line. Note green color of leading edge of the Margin Line indicates the Automatic Margin Finder is active. When the Margin Line is completed select the with the design of the restoration. 53 (Next Icon) to proceed CEREC 3D Manual 6.5 Virtual Restoration The Virtual Restoration will be proposed based on the information from the Margin Line, Preparation Virtual Model, and the anatomical database in the software program. (Figure 6-10) The restoration can be viewed without the adjacent teeth by selecting the Trim Icon in the View Window. (Figure 6-11) Selecting the Trim Icon a second time will return the adjacent teeth to the design window. Figure 6-10. Virtual Restoration proposed by Dental Database design program. Figure 6-11. Virtual Restoration with adjacent teeth temporarily trimmed from the Preparation Virtual Model. 54 CEREC 3D Manual Height

values of the Preparation Virtual Model and the restoration design can be seen in the lower right corner of the status bar. (Figures 6-11) There are three values located in the lower right area of the status bar: Thickness, Fissure Height, and Height. • Thickness is the relative thickness of the restoration design at the location of the cursor. This value is only present when the cursor is directly over the restoration design. This value may be influenced by the angle at which the Virtual Restoration is viewed. Viewing the Virtual Restoration at an angle to the surface may result in inadvertently larger thickness values • Fissure Height is the occlusocervical thickness of the restoration design directly under the Fissure Line. This would generally be the thinnest portion of the restoration. This value remains constant unless the Fissure Line is edited. • Height is the relative height value of the Preparation Virtual Model and restoration design directly under the location of the

cursor. 6.6 Editing the Virtual Restoration After the Virtual Restoration has been proposed by the CEREC 3D program the Design Edit Tools can be applied to refine the contours of the restoration. The program allows considerable flexibility in selecting which Edit Tools to be used and in what sequence they are used. Operators are encouraged to evaluate the size of the area and the degree of change to be made prior to initiating the edit sequence. The Virtual Restoration should be evaluated in a systematic manner to minimize the amount of time devoted to the edit sequence. Consider the following sequence: • First, evaluate the entire Virtual Restoration for changes in the alignment of the restoration relative to adjacent teeth. Changes in the restoration alignment can be made with the Rotate Icon and the Position Icon. This is only active for full crown restorations • Then, evaluate portions of the Virtual Restoration for changes in the contour and contacts. Changes to selected

portions of the Virtual Restoration can be made with the Edit Icon and the Scale Icon. • Finally, evaluate discreet areas of the Virtual Restoration for small changes. These small changes can be made with the Drop Icon and the Shape Icon. Edits that are made to larger sections of the Virtual Restoration are more efficient. Conquer the tendency to spend inordinate amounts of time on very small changes in restoration contour. 55 CEREC 3D Manual 6.7 Contact Icon The Contact Icon can reveal the degree of contact the Virtual Restoration has with the adjacent teeth. A series of colors indicating increased penetration of the restoration design into the adjacent tooth is used to evaluate the tightness of the contact. The size of the colored area can be used to evaluate the size and location of the proximal contact. Select the Contact Icon in the View Window to evaluate the proximal contacts. The adjacent teeth should be trimmed (select the Trim Icon) and the proximal surface visible,

to see the effect of the Contact Icon. One can either rotate the Virtual Model with the trackball or use the mesial or distal arrows in the View Window to correctly position the proximal surface to be evaluated. Four colors are used to evaluate the degree of contact with the adjacent tooth. • Blue indicates that the surfaces are within 1 mm of each other, but not in direct contact. • Green indicates that the restoration design penetrates the adjacent tooth contour from 0 - 50 microns. • Yellow indicates that the restoration design penetrates the adjacent tooth contour from 50 - 100 microns. • Red indicates that the restoration design penetrates the adjacent tooth contour in excess of 100 microns. The color indicates the degree of penetration of the adjacent tooth while the size of the area of the color indicates the area of contact with the adjacent tooth. (Figures 6-12 and 6-13) Generally, contacts in the yellow-green range require minimal adjustment for cementation. Red

contacts require considerably more adjustment and polishing prior to cementation. Figure 6-12. Proximal contact area indicated in blue (close but no contact), green and yellow. 56 CEREC 3D Manual Figure 6-13. Proximal contact indicated in blue (close but no contact), green, yellow, and red (excessive contact). Once the edits to the restoration design are complete, select the (Next Icon) to proceed to the Milling Preview Window. 6.8 Milling Preview The Milling Mode and Sprue Location can be selected in the Milling Preview Window. (Figure 6-14) Choose between the 16 mm milling diamond and the 1.2 mm milling diamond depending on the topography and complexity of the restoration to be milled. The Endo Milling mode is discussed in detail in Section 8.7 Figure 6-14. Milling Preview window 57 CEREC 3D Manual 6.9 Milling Select the Mill Icon to automatically display the Select Block Window. (Figure 6-15) The type of material as well as the size of the milling block is selected.

The block is then inserted into the milling chamber where the software program directs the milling diamonds to mill the final restoration. Figure 6-15. The Select Block Window automatically opens to select the type and size of block for the restoration. 58 CEREC 3D Manual 7.0 Design Overview – Dental Database - Onlay 1 – Select New Restoration Register the patient, and choose the restoration, design technique, and tooth 6 – Virtual Restoration Select Next Icon to create restoration 7 – Evaluate the Virtual Restoration Contours – Edit and Scale Icons 2 – Optical Impression Capture the Preparation Image Contacts – Proximal (Contact Icon) 3 – Preparation Virtual Model Select Next Icon to create Virtual Model Details – Shape and Drop Icons 4 – Trim Preparation Virtual Model Trim the adjacent teeth for direct visual access to proximal margins. 8 – Mill Preview Select Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the

cavosurface margin, start with 9 – Mill the Restoration cervical segment, 2-click for transition Select material and block size; insert points between wall and cervical block in milling chamber and mill. segments 59 CEREC 3D Manual 7.0 Dental Database Design Program – Onlay 7.1 Acquire the Optical Impression To initiate the design process, select the New Icon from the Tool Bar and proceed to register the patient in the program. When the New Restoration Window opens, select the restoration to be designed, the design technique to be used, and the tooth to be restored. (Figure 7-1) Select OK to proceed with the design process. This will make the Image icons available for capturing Optical Impressions. Figure 7-1. Select the Restoration, Design Technique, and Tooth to initiate the restoration design 60 CEREC 3D Manual Position the cursor over the Acquire Preparation Icon to capture an Optical Impression (OI) of the onlay preparation. The Optical Impression should be well

aligned and have sharp focus. (Figure 7-2) The angle of viewing of the image should be in the path of insertion of the cavity preparation. Figure 7-2. Single Optical Impression as saved to the Image Catalogue window. When the Optical Impression is judged to be acceptable, select Icon), and have the program create the Preparation Virtual Model. 61 (Next CEREC 3D Manual 7.2 Preparation Virtual Model After the Optical Impression is accepted, a Preparation Virtual Model is calculated and displayed on the screen. (Figure 7-3) The Preparation Virtual Model can be viewed from any number of angles as previously discussed in Section 4.1 Figure 7-3. Preparation Virtual Model. Note text identifiers for buccal, lingual, mesial, and distal directions. If the Preparation Virtual Model is NOT acceptable after evaluating it, select the (Undo Icon). New Optical Impressions may be redone to correct the Virtual Model. If the Preparation Virtual Model is acceptable, proceed to trim the teeth

adjacent to the cavity preparation. 62 CEREC 3D Manual 7.3 Trim the Adjacent Teeth When the Preparation Virtual Model is initially displayed, the Trim Function is activated. The teeth adjacent to the cavity preparation can be temporarily hidden from view as an aid in the designing process. Trace the trim line across the Preparation Virtual Model between the preparation and the adjacent tooth. (Figure 7-4) End the trim line on the Virtual Model by 2clicking This will hide the adjacent tooth from view and allow direct visual access to the proximal surface of the prepared tooth. Figure 7-4. Placement of Trim Line to mask an adjacent tooth. 63 CEREC 3D Manual Repeat the process to hide the opposite adjacent tooth if the other proximal contact will be restored. (Figure 7-5) Figure 7-5. Adjacent teeth trimmed and temporarily hidden from view. If the trimmed portion of the Virtual Model is NOT acceptable, select the (Undo Icon) to delete the trim line and then redraw it. If both

adjacent teeth have been trimmed, both trim lines will have to be redrawn. When the trimmed portion of the Preparation Virtual Model is acceptable, select the (Next Icon) and proceed to the next design step. 64 CEREC 3D Manual 7.4 Margin Line The next step in designing the virtual restoration is to trace the Margin Line (ML). The Margin Line must be started by tracing a Cervical Segment Ensure that transition points between Cervical Segments and Wall Segments are demarcated with a 2-click (red dot). Figure 7-6. Cervical Segment vs Wall Segment. Note red dots at transition points between segments. Wall Segment Cervical Segment As soon as the Margin Line is completed with the final 2-click, the Automatic Margin Finder is deactivated. Rotate the model to verify the Margin Line is accurately traced. If the Margin Line is to be edited, 2-click on the Margin Line, redraw the area of the line that is inaccurate, and then 2-click back on the line to complete the edit. In general, the

Automatic Margin Finder function will be more accurate in locating the margin than doing so manually. When the Margin Line is completed select the with the design of the restoration. 65 (Next Icon) to proceed CEREC 3D Manual 7.5 Virtual Restoration The Virtual Restoration will be proposed based on the information from the Margin Line, Preparation Virtual Model, and the anatomical database in the software program. (Figure 7-7) The restoration can be viewed without the adjacent teeth by selecting the Trim Icon in the View Window. (Figure 7-8) Selecting the Trim Icon a second time will return the adjacent teeth to the design window. Figure 7-7. Virtual Restoration proposed by Dental Database design program. Figure 7-8. Virtual Restoration with adjacent teeth temporarily trimmed from the Virtual Model. 66 CEREC 3D Manual 7.6 Editing the Virtual Restoration After the Virtual Restoration has been proposed by the CEREC 3D program the Design Edit Tools can be applied to refine

the contours of the restoration. Operators are encouraged to evaluate the size of the area and the degree of change to be made prior to initiating the edit sequence. The Virtual Restoration should be evaluated in a systematic sequence to minimize the amount of time devoted to the edit process. Consider the following sequence: • First, evaluate the entire Virtual Restoration for changes in the alignment of the restoration relative to adjacent teeth. Changes in the restoration alignment can be made with the Rotate Icon and the Position Icon. This is only active for full crown restorations • Then, evaluate portions of the Virtual Restoration for changes in the contour and contact. Changes to portions of the Virtual Restoration can be made with the Edit Icon and the Scale Icon. • Finally, evaluate discreet areas of the Virtual Restoration for small changes. These small changes can be made with the Drop Icon and the Shape Icon. Edits that are made to larger sections of the Virtual

Restoration are more efficient. Conquer the tendency to spend inordinate amounts of time on very small changes in restoration contour. 67 CEREC 3D Manual Select the Contact Icon in the View Window to evaluate the proximal contacts as described in Section 6.7 The adjacent teeth should be trimmed (select the Trim Icon) and the proximal surface visible, to see the effect of the Contact Icon. The color indicates the degree of penetration of the adjacent tooth while the size of the area of the color indicates the area of contact with the adjacent tooth. (Figures 7-9) Figure 7-9. Proximal contact indicated in blue (close but no contact), green, yellow, and red (excessive contact). When the all editing to the Virtual Restoration is complete, select the (Next Icon) to proceed to the Milling Preview Window. 68 CEREC 3D Manual 7.7 Milling Preview The Milling Mode and Sprue Location are selected in the Milling Preview Window. (Figure 7-10) Figure 7-10. Milling Preview window. 7.8

Milling Select the Mill Icon to automatically display the Select Block Window. (Figure 7-11) The type and size of mill block is selected and is inserted into the milling chamber. The Milling Chamber is activated to mill the final restoraton Figure 7-11. The Select Block Window automatically opens to select the type and size of block for the restoration. 69 CEREC 3D Manual 8.0 Design Overview – Dental Database with Antagonist – Crown 1 – Select New Restoration Register the patient, then choose the restoration, design technique, and tooth 2 – Optical Impression Capture the Preparation Image 7 – Virtual Restoration Select Next Icon to create restoration 8 – Evaluate Virtual Restoration Alignment – Position & Rotate Icons Capture the Antagonist Image Contours – Edit and Scale Icons 3 – Preparation Virtual Model Select Next Icon to create Virtual Model Contacts – Proximal (Contact Icon) and Occlusal (Antagonist Icon) 4 – Trim Preparation Virtual Model

Trim the adjacent teeth for direct visual access to proximal margins. Details – Edit and Drop Icons 5 – Trim Antagonist Virtual Model Trim excess material for improved visual access to the occlusal surface. 8 – Mill Preview Select Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the cavosurface margin 9 – Mill the Restoration Select material and block size; insert block in milling chamber and mill. 6 – Select Dental Anatomy Database 70 CEREC 3D Manual 8.0 Dental Database Design Program – Crown The Dental Database design technique will be combined with the Antagonist Virtual Model to allow greater control of the occlusal contact relationships of the final restoration prior to milling. 8.1 Optical Impression The Optical Impressions for the Preparation Icon and Antagonist Icon are made as previously described. The Optical Impression of the bite registration for the Antagonist Icon can be made prior to or after the cavity preparation is

completed. (Figure 8-1 and 8-2) Figure 8-1. Acquire the Optical Impression of the Preparation. Figure 8-2. Acquire the Optical Impression of the Antagonist. 71 CEREC 3D Manual Multiple Optical Impressions were used in this case to create a Virtual Model with more complete teeth compared to a single Optical Impression. This provides additional data of use in evaluating the contours of the final crown restoration relative to the adjacent teeth. When the occlusion images and/or antagonist images are acceptable, select the (Next Icon) to proceed to the next step. 8.2 Virtual Model After the optical impression is accepted, a Preparation Virtual Model is calculated from the data and displayed on the screen. (Figure 8-3) Figure 8-3. The Preparation Virtual Model. The Preparation Virtual Model can be evaluated in several views by rotating the Preparation Virtual Model or using the View Window as described previously in Section 4.1 If the Preparation Virtual Model is NOT acceptable

after evaluating it, select the (Undo Icon). New Optical Impressions may be redone to correct the Preparation Virtual Model. If the Preparation Virtual Model is acceptable, proceed to trim the teeth adjacent to the cavity preparation. 72 CEREC 3D Manual 8.3 Trim the Adjacent Teeth The teeth adjacent to the cavity preparation can be trimmed and temporarily hidden from view as described previously in Section 6.3 Prior to completion of the trim step, the Correct Optical Impression Window is active. This window is accessed from the drop-down menu bar under Design. (Figures 8-4 and 8-5) Figure 8-4. Access the Correct Optical Impression Window from the Design Menu. Figure 8-5. The Correct Optical Impressions Window is opened. 73 CEREC 3D Manual 8.31 Correct Optical Impressions The Correct Optical Impressions Window has several options available. Any one of the three Virtual Models may be selected for correction; Preparation, Occlusion, or Antagonist. There are two editing

options available; Edit Inside and Edit Outside. These options refer to which area of the Virtual Model will be deleted after drawing the edit line (a closed loop or circle) on the Virtual Model. This provides an opportunity to remove extraneous material from the Virtual Model that may hinder the design process. A third edit technique is also available. This is the “Smooth Inside” technique option This refers to the ability of the software to correct small discrepancies in the Virtual Model by drawing a closed loop or circle around the discrepancy. The software program utilizes extrapolated data from the neighboring area of the Virtual Model to “smooth” the discrepancy. Figures 8-6 through 8-8 demonstrate the selection of the Antagonist Virtual Model from the Correct Optical Impressions Window, drawing the edit line, and the corrected Antagonist Virtual Model. Figure 8-6. The Antagonist Virtual Model is selected from the Correct Optical Impression Window which visualizes the

entire model of the bite registration. To cancel the correction of the Virtual Model once it has been chosen, select “Correct optical impressions” a second time from the Design Menu. The Undo Icon is not active once the Correct Optical Impressions Window has been initially selected so it cannot be used to cancel the correction. 74 CEREC 3D Manual Figure 8-7. The area of the Antagonist Virtual Model to be maintained is circumscribed with the drawing line Figure 8-8. The Antagonist Virtual Model has been corrected to remove extraneous material from the model that may hinder visibility during the design process. When the trimmed portion of the Preparation Virtual Model is acceptable, select the (Next Icon) and proceed to the next design step. 75 CEREC 3D Manual 8.4 Margin Line The Margin Line is traced along the cavosurface margin of the preparation. (Figure 8-9) The Intensity Screen can be viewed for areas of the Margin Line that may be difficult to trace using the

Automatic Margin Finder function. The Margin Line was previously described in more detail in Section 6.4 Figure 8-9. The Margin Line is drawn along the cavosurface margin of the preparation. When the Margin Line is complete select the with the restoration design. 76 (Next Icon) to proceed CEREC 3D Manual 8.5 Virtual Restoration Following completion of the Margin Line and selection of the Next Icon, the Select Dental Database Window will open on the desktop. This list contains the variety of anatomic forms that the software can use to construct the restoration. The ability to select a specific anatomical database exists only for crowns. A single anatomical database is used for inlays and onlays based on data measured from the Preparation Virtual Model. Figure 8-10. The Select Dental Database Window automatically opens onto the desktop after completing the Margin Line and selecting the Next Icon. Select the desired anatomical database from the list presented and the software

will automatically complete the construction of the Virtual Restoration. Figure 8-11. The Virtual Restoration is created from the selected anatomical database. 77 CEREC 3D Manual 8.6 Editing the Virtual Restoration After the Virtual Restoration has been proposed by the CEREC 3D program the Design Edit Tools can be applied to refine the contours of the restoration. Operators are encouraged to evaluate the size of the area and the degree of change to be made prior to initiating the edit sequence. The Virtual Restoration should be evaluated in a systematic sequence to minimize the amount of time devoted to the edit process. Consider the following sequence: • First, evaluate the entire Virtual Restoration for changes in the alignment of the restoration relative to adjacent teeth. Changes in the restoration alignment can be made with the Rotate Icon and the Position Icon. This is only active for full crown restorations • Then, evaluate portions of the Virtual Restoration for

changes in the contour and contact. Changes to portions of the Virtual Restoration can be made with the Edit Icon and the Scale Icon. • Finally, evaluate discreet areas of the Virtual Restoration for small changes. These small changes can be made with the Drop Icon and the Shape Icon. Edits that are made to larger sections of the Virtual Restoration are more efficient. Conquer the tendency to spend inordinate amounts of time on very small changes in restoration contour. 8.61 Antagonist Icon The Antagonist Window is opened by selecting the Antagonist Icon from the View Window. (Figure 8-12) The Antagonist Virtual Model can then be used to refine the occlusal relationships of the restoration design. Figure 8-12. The Antagonist Window is opened by selecting the Antagonist Icon in the View Window. 78 CEREC 3D Manual The Antagonist Virtual Model of the opposing dentition bite registration can be superimposed over the Virtual Restoration to visualize the occlusal contacts. (Figure

8-13) Use of the up and down arrow buttons in the Antagonist Window can raise or lower the Antagonist Virtual Model to evaluate the occlusal relationship. Figure 8-13. The Antagonist Virtual Model of the bite registration is superimposed on the Virtual Restoration. Note the perforations in the Antagonist Virtual Model indicating points of occlusal contact. Of particular usefulness in refining the occlusal contacts on the Virtual Restoration is the use of the Interocclusal Clearance button on the Antagonist Window. (Figure 8-13) A similar four color indication of the area and intensity of the occlusal contact with the opposing dentition is registered. Figure 8-14. The oclusal contact positions highlighted by the use of the Interocclusal Clearance button on the Antagonist Window. 79 CEREC 3D Manual Four colors are used to evaluate the degree of contact with the adjacent tooth. • Blue indicates that the surfaces are within 1 mm of each other, but not in direct contact. • Green

indicates that the restoration design penetrates the adjacent tooth contour from 0 - 50 microns. • Yellow indicates that the restoration design penetrates the adjacent tooth contour from 50 - 100 microns. • Red indicates that the restoration design penetrates the adjacent tooth contour in excess of 100 microns. Generally, contacts in the yellow-green range will require minimal adjustment and polishing to finalize the occlusal contacts after the restoration has been adhesively cemented. All the editing icons previously discussed are available for use in refining the occlusal contacts in combination with the Antagonist Virtual Model. (Figure 8-14) Figure 8-14. Use of the Cut Window with the Antagonist Virtual Model to evaluate the occlusal contacts. When editing of the Virtual Restoration is complete, select the Icon) to proceed to the Milling Preview Window. 80 (Next CEREC 3D Manual 8.7 Milling Preview There are two parts to the Milling Preview Window; the Milling Mode and

the Sprue Location. The Milling Mode allows for the selection of the 16 mm or 1.2 mm cylinder milling diamond or the Endo Milling Mode Figure 8-15 indicates the comparative appearance of the internal aspect of the Virtual Restoration based on the selected Milling Mode. In general, the milling process will remove as little material as possible, but enough to properly seat the restoration on the preparation. In rough areas of preparations, this may lead to slightly more material being removed internally as the milling diamonds accommodate the rough surface. The Endo Milling Mode does not remove excess material to accommodate the size of the milling diamonds relative to the surface roughness. However, this may lead to discrepancies in seating of the restoration. The Endo Milling Mode more closely follows the internal topography of the preparation, but requires a smooth preparation to work well. It is primarily indicated for Endocrown restoration designs in which the pulp chamber or post

space is incorporated into the crown design. Figure 8-15. Appearance of internal aspect of the Virtual Crowns based on the selected Milling Mode. 1.6 mm Endo 1.2 mm The second section of the Milling Preview Window provides an opportunity to select the location of the “sprue” on the Virtual Restoration. One of the four lateral surfaces can be selected. Selection of the buccal or lingual surface may lead to the need for a larger block size to mill the restoration. 81 CEREC 3D Manual A useful feature of the Milling Preview Window can be set in the Parameters Window under the Settings Menu on the menu bar. (Figure 8-16) Figure 8-16. Select Parameters from the Settings Menu to set the Display Thickness Threshold at 1500 µm. The Display thickness threshold can be set between 0 qnd 2000 microns in increments of 25 microns. By setting it to 1500 microns (15 mm), any area of the Virtual Restoration less than 1.5 mm thick will be displayed in red in the Milling Preview Window.

(Figure 8-17) This will serve as a warning to correct thin areas of the restoration prior to milling it. It is an effective means to preventing restorations of inadequate thickness which would tend to fracture. Figure 8-17. Preview Milling Window with Display thickness threshold set to 1500 µm (1.5 mm). Note that red area is less than 1.5 mm in thickness and should be corrected before milling the restoration. 82 CEREC 3D Manual When the choice of Milling Mode and Sprue Location is complete, select the (Mill Icon) to proceed with milling the restoration design. 8.8 Milling The Select Block Window automatically opens after selecting the Mill Icon to prompt the selection of the type and size of block for the restoration. (Figure 8-18) The selected block is then inserted in the milling chamber, the start button selected, and milling commences. Figure 8-18. The Select Block Window automatically opens to prompt the selection of the block composition and size for the restoration. 83

CEREC 3D Manual 9.0 Design Overview – Correlation - Onlay 1 – Select New Restoration Register the patient, then choose the restoration, design technique, and tooth 6 – Edit the Proximal Contact Line 7 – Edit the Copying Line 2 – Optical Impression Capture the Preparation Image 8 – Virtual Restoration Select Next Icon to create restoration Capture the Occlusion Image 9 – Evaluate the Virtual Restoration Contours – Edit and Scale Icons 3 – Preparation Virtual Model Select Next Icon to create Virtual Model Contacts – Proximal (Contact Icon) Details – Shape and Drop Icons 4 – Trim Preparation Virtual Model Trim the adjacent teeth for direct visual access to proximal margins. 10 – Mill Preview Select Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the cavosurface margin, start with cervical segment, 2-click for transition 11 – Mill the Restoration points between wall and cervical Select material and block size; insert

segments block in milling chamber and mill. 84 CEREC 3D Manual 9.0 Correlation Design Program – Onlay General Information: The basic premise of the Correlation Design program is that the pretreatment condition of the tooth is to be copied and integrated into the design of the new restoration. The pre-treatment condition may be the existing tooth anatomy or a model of the new anatomy, such as a diagnostic wax-up. Correlation is often used to capture existing occlusal relationships and copy them into the new restoration design. There are several general concepts that should be considered to ensure the success of the Correlation process. The Image Catalogues to be used for the case (the Preparation Image Catalogue and the Occlusion Image Catalogue) should cover the same number of teeth. In addition, all the Image Catalogues to be used should contain some areas of the dentition that do not change between the catalogues. It is generally recommended that at least onethird of the

occlusal surface of the teeth mesial and distal to the cavity preparation should be included in each of the Image Catalogues. If this is not possible, then at least one-half of the occlusal surface of the tooth either mesial or distal to the cavity preparation should be included in each of the Image Catalogues. This should provide sufficient unique data that does not change between the Image Catalogues for the software to correlate the Virtual Models. 9.1 Optical Impression The Optical Impression of the cavity preparation is recorded with the Acquire Preparation Icon. (Figure 9-1) Figure 9-1 Optical Impression of the cavity preparation. 85 CEREC 3D Manual The Optical Impression of the pre-treatment condition using the Acquire Occlusion Icon can be recorded either before or after the Optical impression of the cavity preparation. If it is recorded after the cavity preparation, a cast of the teeth must be made pre-operatively. (Figure 9-2) Figure 9-2. Occlusion Impression of the

pretreatment condition for the Occlusion Virtual Model. Similar areas of the dentition should be recorded for both the cavity preparation and occlusion images in order for the program to consistently correlate the two Virtual Models. Refer to Section 32 for additional information on the use of Optical Impressions. When the occlusion images and preparation images are acceptable, select the (Next Icon) to proceed to create the Virtual Models. 86 CEREC 3D Manual 9.2 Virtual Model After the optical impressions are accepted, a Preparation Virtual Model is calculated from the Preparation Image Catalogue and displayed on the screen. (Figure 9-3) Figure 9-3. Preparation Virtual Model. Note text identifiers for buccal, lingual, mesial, and distal directions. If the Preparation Virtual Model is NOT acceptable after evaluating it, select the (Undo Icon). New Optical Impressions may be redone to correct the Preparation Virtual Model. If the Preparation Virtual Model is acceptable, select

the the cavity preparation. (Next Icon) to proceed to trim the teeth adjacent to 9.3 Trim the Adjacent Teeth The teeth adjacent to the cavity preparation can be trimmed and temporarily hidden from view as described previously in Section 6.3 When the trimmed portion of the Preparation Virtual Model is acceptable, select the (Next Icon) and proceed to the next design step. 87 CEREC 3D Manual 9.4 Margin Line The Margin Line must be started by tracing a Cervical Segment. Ensure that transition points between Cervical Segments and Wall Segments are demarcated with a 2-click (red dot). The Margin Line is completed at the starting point with a 2-click. (Figure 9-4) The Margin Line was previously described in more detail in Section 6.4 Figure 9-4. Margin Line completed. As soon as the Margin Line is completed with the final 2-click, the Automatic Margin Finder is deactivated. Rotate the model to verify the Margin Line is accurately traced. If the Margin Line is to be edited, 2-click

on the Margin Line, redraw the area of the line that is inaccurate, and then 2-click back on the line to complete the edit. In general, the Automatic Margin Finder function will be more accurate in locating the margin than doing so manually. When the Margin Line is completed select the with the design of the restoration. 88 (Next Icon) to proceed CEREC 3D Manual 9.5 Proximal Contact Line Following completion of the Margin Line and selection of the Next Icon, the software will propose the Proximal Contact Line (PCL). The Proximal Contact Line represents the lateral height of contour of the restoration design as well as the proximal contacts with the adjacent teeth. The adjacent teeth will initially appear to be trimmed from the Virtual Model. The Proximal Contact Line (pink line) can be visualized with the adjacent teeth by selecting the Trim Icon in the View Window. Selecting the Trim Icon a second time will trim the adjacent teeth from the Virtual Model. (Figures 9-5 and 9-6)

Figure 9-5. Proximal Contact Line (pink line) proposed by the software program with the adjacent teeth trimmed from the Virtual Model. Figure 9-6. Proximal Contact Line proposal relative to adjacent teeth. Note overcontoured mesial proximal contact. 89 CEREC 3D Manual Initial correction of the PCL can be done by 2-clicking on the PCL, redrawing the line, and then 2-clicking back on the PCL. (Figure 9-10) Figure 9-10. Editing the PCL by redrawing. The Preparation Virtual Model can be evaluated from different perspectives by selecting the direction of viewing in the View Window. The ability to rotate the Preparation Virtual Model to view it from any perspective is not active at this time in the design using the Correlation program. 90 CEREC 3D Manual Figure 9-11 illustrates the lingual view of the restoration design with the PCL located low on the lingual contour of the preparation. The PCL can be raised by positioning the cursor over the red dot at the end of the PCL,

L-click and hold, and use the trackball to slide the red dot along the Margin Line to the desired position. (Figure 9-12) Figure 9-11. Proximal Contact Line is positioned too far cervically. Figure 9-12. The red dot at terminus of the Proximal Contact Line has been elevated, raising the height of contour of the restoration design. The contour of the PCL can also be evaluated by comparing it to the contour of the Occlusion Virtual Model. The Occlusion Virtual Model can be superimposed over the Preparation Virtual Model by selecting the Occlusion Icon in the View Window. This will project a transparent image of the 91 CEREC 3D Manual Occlusion Virtual Model over the cavity preparation and the contour of the PCL can be compared to that of the Occlusion Virtual Model. (Figure 9-13) Select the Occlusion Icon a second time to remove the transparent image of the Occlusion Virtual Model. Figure 9-13. Transparent image of the Occlusion Virtual Model superimposed over the Preparation

Virtual Model. Note the discrepancy in contour at the distolingual line angle between the PCL and Occlusion Virtual Model. When the Proximal Contact Line is complete, select the proceed with the restoration design. 92 (Next Icon) to CEREC 3D Manual 9.6 Copying Line Following completion of the Proximal Contact Line and selection of the Next Icon, the software will propose the Copying Line (CL). The Copying Line (green line) represents the area of the Occlusion Virtual Model that will be captured and replicated in the design of the Virtual Restoration. (Figure 9-14) As a general rule, the Copying Line should be kept within the boundary of the Proximal Contact Line. This is the only time in the design process that the Copying Line can be edited. The Copying Line will be visible when using various editing tools during the remainder of the design process, however, no editing of the Copying Line is permitted. To edit the Copying Line at a later time in the design process, the (Undo

Icon) must be used to return to this step, edit the Copying Line, and then proceed back through the design process. Figure 9-14. Copying Line (green line) is proposed with the Occlusion Virtual Model superimposed over the cavity preparation. 93 CEREC 3D Manual The cavity preparation is hidden from view as an opaque Occlusion Virtual Model is initially projected by the software. To visualize the Preparation Virtual Model of the cavity preparation, from the Window Menu select Display Options. This opens the Display Options Window Select the On box for Preparation to visualize the Preparation Virtual Model. (Figure 9-15) The Preparation Virtual Model can also be activated and visualized by selecting the Trim Icon in the View Window. The Trim Icon will also trim the adjacent teeth from the Preparation Virtual Model. Select the Trim Icon a second time to have the adjacent teeth reappear. The Preparation Virtual Model will have a speckled appearance when projected with the Occlusion

Virtual Model. This speckled appearance indicates that the two virtual models are coincidental in these areas and the correlation of the two virtual models is well aligned. At this point in the Correlation Design program, the ability to rotate the Virtual Model about a fixed point is active. Place the cursor over a position on the Virtual Model, L-click and hold, and rotate the trackball to the desired viewing angle. Figure 9-15. Occlusion and Preparation Virtual Models displayed. Note the speckled appearance of the Preparation Virtual Model which indicates a good match between the two models. When the Copying Line is complete, select the with the restoration design. 94 (Next Icon) to proceed CEREC 3D Manual 9.7 Virtual Restoration Following completion of the Copying Line and selection of the Next Icon, the software will calculate and project the Virtual Restoration. (Figure 9-16) Figure 9-16. Virtual Restoration proposed by the Correlation design program. 9.8 Editing the

Virtual Restoration After the Virtual Restoration has been proposed by the CEREC 3D program the Design Edit Tools can be applied to refine the contours of the restoration. The program allows considerable flexibility in selecting which Edit Tools to be used and in what sequence they are used. Operators are encouraged to evaluate the size of the area and the degree of change to be made prior to initiating the edit sequence. The Virtual Restoration should be evaluated in a systematic sequence to minimize the amount of time devoted to the edit process. Consider the following sequence: • First, evaluate the entire Virtual Restoration for changes in the alignment of the restoration relative to adjacent teeth. Changes in the restoration alignment can be made with the Rotate Icon and the Position Icon. This is only active for full crown restorations • Then, evaluate portions of the Virtual Restoration for changes in the contour and contact. Changes to portions of the Virtual Restoration

can be made with the Edit Icon and the Scale Icon. • Finally, evaluate discreet areas of the Virtual Restoration for small changes. These small changes can be made with the Drop Icon and the Shape Icon. 95 CEREC 3D Manual Edits that are made to larger sections of the Virtual Restoration are more efficient. Conquer the tendency to spend inordinate amounts of time on very small changes in restoration contour. 9.81 Occlusion Icon Selecting the Occlusion Icon from the View Window displays the Occlusion Virtual Model over the Virtual Restoration. A speckled appearance of the images indicates that there is close approximation of the surfaces of the Occlusion Virtual Model and the Virtual Restoration. The two virtual models are coincidental in the speckled areas and the correlation of the two virtual models is well aligned (Figure 9-17) Figure 9-17. Superimposition of the Occlusion Virtual Model and the Virtual Restoration. Note speckled appearance indicates good approximation of the

surfaces of the two models. 96 CEREC 3D Manual 9.82 Edit Icon Selection of the Edit Icon in the Design Window will show the design lines and make them active for editing. (Figure 9-18) Only the Margin Line and Proximal Contact Line can be edited in a Correlation design. The Copying Line is visible, but unable to be edited. To edit the lines, 2-click along the line, redraw the desired change, and 2-click back on the design line. Figure 9-18. Selection of the Edit Icon activates the design lines for editing. Note visible Copying Line, but unable to edit it. 9.83 Scale Icon The Scale Icon provides the opportunity to edit selected areas of the Virtual Restoration. The Scale Icon differs somewhat for Correlation designs compared to Dental Database designs. The tool divides the restoration into large areas that allow the edit process to be uniform and consistent with the entire tooth contour. Selection of the Scale Icon immediately shows the design lines if they have not already been

selected by using the Edit Icon. At the same time, one of the following areas will have a whiter appearance relative to the remaining transparent Virtual Restoration to indicate this area has been selected: • Proximal Surface = select by L-clicking on the Proximal Contact Line; highlights the tooth surface from the Margin Line to the Copy Line on half of the tooth. The tooth can be sectioned either buccolingually or mesiodistally. (Figure 9-19) • Half Tooth = select by L-clicking on the Margin Line in the Cervical Segment; highlights the restoration from the center of the occlusal table to the cervical margin. The tooth can be sectioned either buccolingually or mesiodistally. (Figure 9-20) • Cusp = this area is not available in Correlation as there is no Marginal Ridge Line to select. 97 CEREC 3D Manual • Entire Tooth = after selecting one of the lines, select F7 to highlight the entire circumference of the restoration. Figure 9-19. Proximal Surface highlighted by

selecting the Proximal Contact Line. Figure 9-20. Half Tooth highlighted by selecting the Margin Line. Once an area has been selected, it can be moved in any of the six directions indicated by the Edit Buttons in the Design Window. When design editing is complete, select the Preview Window. (Next Icon) to proceed to the Milling 98 CEREC 3D Manual 9.9 Milling Preview The Milling Mode and Sprue Location can be selected in the Milling Preview window. (Figure 9-21) Figure 9-21. Milling Preview window. 9.10 Milling The Select Block Window automatically opens after selecting the Mill Icon to prompt the selection of the type and size of block for the restoration. The block is then inserted in the milling chamber, the start button selected, and milling commences. Figure 5-25. The Select Block Window automatically opens to select the type and size of block for the restoration. 99 CEREC 3D Manual 10.0 Design Overview – Multiple Restorations - Dental Database 1 – Select New

Restoration Register the patient; choose the restoration, design technique, and tooth 7 – Open second task window, reopen design of first restoration, select Design Change 2 – Optical Impression Capture multiple Preparation Images to create a larger model 8 - Virtually insert the First Restoration 3 – Preparation Virtual Model Select Next Icon to create Virtual Model 9 – Change the Insertion Axis for the second restoration 4 – Trim first preparation and trace Margin Line 10 - Trim second preparation and trace Margin Line 5 – First Virtual Restoration Select Next Icon to create Virtual Restoration and edit design 11 – Second Virtual Restoration Select Next Icon to create Virtual Restoration and edit design 6 - Mill the First Restoration Select material and block size; insert block in milling chamber and mill 12 - Mill the Second Restoration Select material and block size; insert block in milling chamber and mill. 100 CEREC 3D Manual 10.0 Multiple

Restorations A new feature of the 3D software program is the opportunity to complete multiple restorations within a single Preparation Virtual Model. There are several portions of the program that are applicable to this function that are not utilized for single restorations. 10.1 Optical Impression Multiple Optical Impressions are required to record sufficient teeth in the quadrant to create a Preparation Virtual Model. The Virtual Model should minimally include the teeth to be restored as well as one-half of the teeth at the distal and mesial to the teeth to be restored. The first image recorded is, by default, the Reference Optical Impression. This should be a tooth to be restored in the center of the area to be recorded. This defines the path of insertion of the first restoration as well as the center point and path of insertion of the entire Virtual Model. After the Reference Optical Impression is recorded, L-click with the trackball or quickly single click with the foot switch to

transfer the first Optical Impression to the Image Catalogue. The screen is cleared and ready for the next OI. Subsequent Optical Impressions should proceed in a step-wise fashion distally and mesially from the Reference OI. Each subsequent Optical Impression should overlap the previous OI by 8 mm. This generally represents one-third of the camera’s field of view. Unchanged data must be captured between subsequent Optical Impressions in order to create a Preparation Virtual Model of sufficient size. The example case is to restore teeth #14 and #15 with #14 used as the center point for the Reference Optical Impression (Figure 10-1) Figure 10-1. Multiple Optical Impressions in the Image Catalogue. Note overlap of data points to create larger Virtual Model. When the Optical Impressions are acceptable, select the to proceed to the next step. 101 (Next Icon) CEREC 3D Manual 10.2 Preparation Virtual Model The Preparation Virtual Model is created from the multiple Optical Impressions

with a path of insertion determined by the Reference Optical Impression. (Figure 10-2) The path of insertion was determined in the example case by tooth #14. Figure 10-2. Preparation Virtual Model for multiple restorations. Note path of insertion of model is set by Reference Optical Impression of tooth #14. 102 CEREC 3D Manual 10.3 Trim Adjacent Teeth Trim the adjacent teeth to provide direct visual access to the first tooth to be restored. After completing the first trimming line, the section of the Virtual Model to be restored may be hidden from view. (Figure 10-3) Double-click on the hidden portion to make it reappear and mask the other portion. (Figure 104) Figure 10-3. Area of Virtual Model to be restored is temporarily hidden from view. Figure 10-4. Tooth #14 made visible by 2clicking on it. 103 CEREC 3D Manual Figure 10-5. Adjacent teeth trimmed from view. When the trimmed Preparation Virtual Model is acceptable, select the (Next Icon) to proceed to the next step.

10.4 Margin Line Trace the Margin Line starting with a Cervical Segment using 2-clicks at transitions between Cervical Segments and Wall Segments. (Figure 10-6) Figure 10-6. Margin Line traced on the Preparation Virtual Model. When the Margin Line is acceptable, select the proceed to the next step. 104 (Next Icon) to CEREC 3D Manual 10.5 Virtual Restoration Once the Virtual Restoration has been created, the editing tools are available to refine the contours, proximal contacts, and occlusal contacts. (Figure 10-7) See previous sections detailing the editing tools and their functions for additional information. Figure 10-7. Completed Virtual Restoration for tooth #14. When the Virtual Restoration is acceptable, select the proceed to Mill Preview Window. 105 (Next Icon) to CEREC 3D Manual 10.6 Milling Preview – First Restoration The Milling Preview Window opens and the Milling Mode and sprue location is selected for milling. (Figure 10-8) Figure 10-8. The Milling Preview

Window for the Virtual Restoration for tooth #14. 10.7 Milling – First Restoration Select the Mill Icon to automatically display the Select Block Window. (Figure 10-9) The type and size of mill block is selected and is inserted into the milling chamber. The Milling Chamber is activated to mill the restoration Figure 10-9. The Select Block Window automatically opens to select the type and size of block for the restoration. 106 CEREC 3D Manual 10.8 Design Change The Design Window for tooth #14 must remain open while the restoration is milling so that the Acquisition Unit and Milling Chamber may communicate the data for milling the restoration design. To design the second restoration while the first one is milling, the CEREC 3D program is opened a second time, creating a second Design Window or Task Window. The restoration design can be loaded in three ways: (Figure 10-10) • Select the Load Icon from the Tool Bar. • Select Restoration from the Menu Bar, and then select Load

• Select Restoration from the Menu Bar, and then select the numbered design in the list shown Figure 10-10. Selecting Restoration from the Menu Bar offers two ways to load the restoration. The Load Icon is hidden by the drop-down menu. 107 CEREC 3D Manual Once the .cdt file for the first design (tooth #14) is loaded to the second Design Window, the second cavity preparation can be restored. The first restoration should be part of the contour of the Preparation Virtual Model for the second restoration to be accurately designed. Select Design from the Menu Bar, and then select Change. (Figure 10-11) Figure 10-11. The restoration design for tooth #14 has been opened a second time. From the Design menu, select Change. 108 CEREC 3D Manual The Design Change Window offers two options: (Figure 10-12) • Delete and redesign the restoration. This deletes the entire restoration design and allows the option to redo it in the same or another design technique. • Seat the designed

restoration virtually. This displays the designed restoration as if it were part of the Preparation Virtual Model. Figure 10-12. The Design Change Window allows the option to virtually seat the designed restoration on tooth #14. After selecting to virtually insert the previous restoration design, a patient must be selected for the new restoration. (Figure 10-13) Figure 10-13. After selecting to virtually seat the restoration, the Select patient for new restoration window is used to select the patient for the second restoration design. 109 CEREC 3D Manual After selecting the patient, the type of restoration, design technique, and tooth to be restored is selected. (Figure 10-14) Figure 10-14. The type of restoration, design technique, and tooth to be restored are selected for the second design. The contours of the initial restoration are preserved on the Preparation Virtual Model as an accurate guide to the design of the second restoration. (Figure 10-15) Figure 10-15.

Restoration of tooth #14 has been virtually seated on the new Preparation Virtual Model for tooth #15. 110 CEREC 3D Manual 10.9 Insertion Axis Once the Preparation Virtual Model is created for the second restoration, it should be noted that the path of insertion of the second cavity preparation will not be accurate. The initial path of insertion for the Preparation Virtual Model was determined by the Reference Optical Impression for the first restoration (tooth #14). The path of insertion for the second restoration can be altered by selecting the Design Menu from the Menu Bar, and then selecting Insertion axis. (Figure 10-16) Figure 10-16. Select Insertion axis from the Design Menu on the Menu Bar to alter the path of insertion of the Preparation Virtual Model. 111 CEREC 3D Manual The Preparation Virtual Model can be rotated into an improved path of insertion for the second restoration by using a L-click and hold while rotating the trackball. Once it is positioned in the

desired path, it is fixed in position by selecting the Fix Button. (Figure 10-17) Figure 10-17. The Preparation Virtual Model can be rotated to align the path of insertion for the second restoration and then it is set using the Fix Button. When working with quadrant Virtual Models, it is useful to have the rotation point of the model within the confines of the cavity preparation being designed. The rotation point is set by the Reference Optical Impression When the Axis of Insertion is changed for the second restoration, it may be convenient to change the rotation point for the model as well. To change the rotation point, from the drop-down menu bar select Design, then Center. (Figure 10-18) Figure 10-18. Select Center under Design on the dropdown menu bar to change the Virtual Model center of rotation. 112 CEREC 3D Manual The Center Window will open and the operator can select the cavity preparation that should serve as the center of rotation of the Virtual Model. Select Fix in

the Center Window to complete the change. (Figure 10-19) Alteration of the Preparation Virtual Model center of rotation should be considered a change for convenience rather than a mandatory change that will affect the accuracy of the restoration design. Figure 10-19. Alter the center of rotation of the Virtual Model by clicking on the preparation to be designed. When the Preparation Virtual Model for the second restoration is acceptable, proceed to trim the teeth adjacent to the cavity preparation. 113 CEREC 3D Manual 10.10 Trim Adjacent Teeth for Second Restoration Trim the adjacent teeth to provide direct visual access to the second tooth to be restored (Figure 10-20) Figure 10-20. Adjacent teeth trimmed from view. When the trimmed Preparation Virtual Model is acceptable, select the (Next Icon) to proceed to the next step. 10.11 Margin Line Trace the Margin Line starting with a Cervical Segment using 2-clicks at transitions between Cervical Segments and Wall Segments.

(Figure 10-21) Figure 10-21. Margin Line traced on the Preparation Virtual Model. 114 CEREC 3D Manual When the Margin Line is acceptable, select the proceed to the next step. (Next Icon) to 10.12 Second Virtual Restoration Once the Virtual Restoration has been created, the editing tools are available to refine the contours, proximal contacts, and occlusal contacts. (Figure 10-22) See previous sections detailing the editing tools and their functions for additional information. Figure 10-22. Completed Virtual Restoration for tooth #15. When the Virtual Restoration is acceptable, select the proceed to the next step. 115 (Next Icon) to CEREC 3D Manual 10.13 Mill Preview Window – Second Restoration The Milling Preview Window opens and the Milling Mode and sprue location is selected for milling. (Figure 10-23) Figure 10-23. The Milling Preview Window for the Virtual Restoration for tooth #15. 10.14 Milling – Second Restoration Select the Mill Icon to automatically

display the Select Block Window. (Figure 10-24) The type and size of mill block is selected and is inserted into the milling chamber. The Milling Chamber is activated to mill the restoration Figure 10-24. The Select Block Window automatically opens to select the type and size of block for the restoration. 116 CEREC 3D Manual 11.0 Additional Design Overviews A number of preparation designs have been presented during the course of this manual to illustrate the Dental Database and Correlation design techniques. The following flow chart illustrates the options available Design Technique Dental Database Preparation Virtual Model Correlation Preparation Virtual Model Occlusion Virtual Model Mill Dental Database + Antagonist Preparation Virtual Model Antagonist Virtual Model Correlation + Antagonist Preparation Virtual Model Occlusion Virtual Model Antagonist Virtual Model The use of the Antagonist Virtual Model (bite registration) to refine the occlusal contacts can be applied

to either Dental Database or the Correlation design techniques. The following pages present additional design flow-charts not previously presented in the manual. 117 CEREC 3D Manual 11.1 Design Overview – Dental Database with Antagonist - Onlay 1 – Select New Restoration Register the patient, then choose the restoration, design technique, and tooth 2 – Optical Impression Capture the Preparation Image 6 – Virtual Restoration Select Next Icon to create Virtual Restoration 7 – Evaluate Virtual Restoration Contours – Edit and Scale Icons Capture the Antagonist Image Contacts – Proximal (Contact Icon) and Occlusal (Antagonist Icon) 3 – Preparation Virtual Model Select Next Icon to create Virtual Model 4 – Trim Preparation Virtual Model Trim the adjacent teeth for direct visual access to proximal margins. Details – Shape and Drop Icons 8 – Mill Preview Select Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the cavosurface

margin, start with 9 – Mill the Restoration Select material and block size; insert cervical segment, 2-click for transition block in milling chamber and mill. points between wall and cervical segments 118 CEREC 3D Manual 11.2 Design Overview – Correlation with Antagonist - Onlay 1 – Select New Restoration Register the patient, then choose the restoration, design technique, and tooth 6 – Edit the Proximal contact Line 2 – Optical Impression Capture the Preparation Image 7 – Edit the Copying Line Capture the Occlusion Image 8 – Virtual Restoration Select Next Icon to create restoration Capture the Antagonist Image 9 – Evaluate the Virtual Restoration Contours – Edit, Scale, Shape Icons 3 – Preparation Virtual Model Select Next Icon to create Virtual Model Contacts – Proximal (Contact Icon) and Occlusal (Antagonist Icon) 4 – Trim Preparation Virtual Model Trim the adjacent teeth for direct visual access to proximal margins. 10 – Mill Preview Select

Next Icon to choose milling mode and sprue location 5 – Margin Line Trace the cavosurface margin, start with cervical segment, 2-click for transition 11 – Mill the Restoration points between wall and cervical Select material and block size; insert segments block in milling chamber and mill. 119 CEREC 3D Manual 12.0 Parameters A series of parameters can be set for the CEREC 3D software program. (Figure 12-1) Figure 12-1. Parameters Window found under Setting Menu on the Menu Bar. Proximal Contacts Strength is a parameter that influences the degree of adjacent tooth contact when the Proximal Contact Line is proposed for inlays and onlays. The Proximal Contact Line must be adjusted manually for full crown restorations. The contact can be adjusted between -200 µm and +200 µm in 25 µm increments. If the line is edited, this setting has no influence on the restoration design. If the adjacent tooth is more than 1 mm from the cavity preparation, no contact is proposed by the

Proximal Contact Line. Spacer is a parameter that influences the degree of space available for cement under all restorations. It can be adjusted between -100 µm and +100 µm in 10 µm increments. A setting of “0” will allow for 40-50 µm of space for cementation. Occlusal Offset is a parameter that can alter the amount of material at the occlusal surface of the final restoration. Additional material can be arbitrarily added or removed from the occlusal surface. This may be problematic for inlays or onlay designs with occlusal cavosurface margins. It can be adjusted between -500 µm and +500 µm in increments of 25 µm. This parameter only affects the milled restoration and the affects are not visible during the design process. Emergence Profile is a parameter that influences the contour of the Virtual Restoration between the Margin Line and the Proximal Contact Line. It can be adjusted between 0 and 10 in increments of 1. The larger the setting, 120 CEREC 3D Manual the more

material added to the cervical of the Virtual Restoration. With a setting of 9 or 10, the cervical of the design may extend laterally beyond the Proximal Contact Line. Margin Thickness is a parameter that influences the amount of material at the margin of the restoration. It can be set between 0 µm and 200 µm in 25 µm increments. If the parameter is set greater than 0, additional material will be added to the margin of the restoration prior to milling. This parameter does not affect the fit of the margin. Display Thickness Threshold is a parameter that can indicate areas of the restoration that are thinner than the parameter setting. It can be set between 0 µm and 2000 µm (0 – 2 mm) in 25 µm increments. Any area of the designed restoration with a thickness less than the desired setting will be displayed in red in the Milling Preview Window as previously reviewed in Section 8.7 Scan Step Width is a parameter that applies to the laser scanning option in for the CEREC InLab

application. It can be set between 3 and 155 in increments of 1. The lower the scan step width, the greater the accuracy of the scanned data and the greater the time required to scan the preparation. 13.0 Drop-down Menus: Restoration, Design, Settings, Window, ? Restoration Menu New = open a window for a new restoration Load = load a restoration design from the hard drive Delete = delete a restoration design from hard drive Save = save an open restoration design Save as = save restoration design with a new name Export = copy open design to external drive Import = open design from an external drive Administer patient data = edit patient record Send to = transmit design data via e-mail 1 - 4 = last four opened restoration designs Exit = exit and close the program 121 CEREC 3D Manual Design Menu Next = proceed to the next design step Undo = delete the previous design step Change = change the design mode Center = define the tooth to be the center of the design; useful for quadrant

models Insertion axis = reset the insertion axis of the Preparation Virtual model Correct Optical impressions = options for trimming artifacts as well as remove limited inaccurate data areas from Virtual Models Settings Menu Parameter = default settings for the program Instruments = to select and change diamonds in the milling chamber (see below) Configuration = (see below) Calibration = (see below) Instruments Menu Cylindrical diamond, right = use for changing the cylindrical diamond Tapered diamond, left = use for changing the tapered diamond Configuration Menu Communication = settings for wireless connection to milling unit Acquisition system = select camera or scanner for image capture Save = options to save files by compression or .tiff format Odontogram = select USA or International Patient administration laboratory = options for patient data with scanner use 122 CEREC 3D Manual Calibration Menu 3D Camera = calibrate camera Scanner = calibrate scanner Milling Unit =

calibrate milling unit Window Menu Reset = rearranges the windows in the Design Window to default placement on the right side of the window Display Options = select visible virtual models; opaque or transparent mode Image Catalogue = optical impressions captured for a design Cursor = location of cursor in design window with 0,0 represented by the upper left corner of the window Distance = measures distance between two cursor points as well as relative height difference View = visualizes or hides View Window (see below) Design = opens or hides Design Window (see below) Cut = opens or hides Cut Icon for displaying serial crosssections Icon bar = opens or hides tool bar icons Status Bar = opens or hides information bar at bottom of design screen (thickness, fissure height, height) ? Menu Help = access the software help manual Info Options = shows information about the restoration design displayed in the Design Window Softguad info = display information on the softguard plug Info on CEREC

= display information on the current CEREC program 123 CEREC 3D Manual 14.0 Window References: View Options On column = activates the model indicated to be viewed in an opaque mode (preparation, occlusion, antagonist, restoration) Transp column = causes the model indicated to be viewed in a transparent mode (preparation, occlusion, antagonist, restoration) Lines = displays the restoration design lines View Window Can select the colored arrows which correspond to specific views of the Virtual Model and restoration design Trim = hides the adjacent teeth from view; select a second time to display the adjacent teeth Contact = activates colors to indicate area and degree of proximal contact with adjacent teeth Occlusion = displays the Occlusal Virtual Model for Correlation designs Antagonist = displays the Antagonist Virtual Model for both Dental Database and Correlation designs Text that is dimmed in the window indicates functions that are not available for the design 124 CEREC

3D Manual Design Window Edit = activates design lines Drop = add (or remove by smoothing) discreet amounts of material to the Virtual Restoration Scale = activates design lines to select areas of the Virtual Restoration to edit Shape = outline areas of the Virtual Restoration to add or remove material Position = only applies to crowns; slides the crown laterally or vertically along the buccal-lingual, mesial-distal, or occlusal-cervical axes Rotate = only applies to crowns; rotates the crown around the buccal-lingual, mesial-distal, or occlusal-cervical axes Text that is dimmed in the window indicates functions that are not available for the design Antagonist Window Interocclusal Clearance = indicates area and degree of occlusal contact with opposing Antagonist Virtual Model Antagonist = visualizes entire Antagonist Virtual Model Antagonist Surface = visualizes the occlusal surface of the Antagonist Virtual Model Move Antagonist = use of the up and down arrows raise or lower the

Antagonist Virtual Model relative to the Virtual Restoration 125