CEREC remains the key restorative dental technology

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Prof. Werner H. Mörmann (left) developed the CEREC system in the early 1980s together with electrical engineer and close friend, Dr Marco Brandestini. (Image: Dentsply Sirona)

CEREC was launched in 1985 as the first complete CAD/CAM system for the fabrication of dental restorations. Astoundingly, nearly four decades later, CEREC remains the sole solution of its kind and is used by dentists the world over, including by the youngest professionals, who would be hard pressed to swap their iPads for Macintosh Xls. CEREC founders, Prof. Werner H. Mörmann and electrical engineer Dr Marco Brandestini, unveiled the system to a bewildered profession, and many dentists insisted that digital technology had no place in oral healthcare. Dentsply Sirona, however, quickly recognised its potential, partnered with the inventors and became instrumental in the system’s development. Dental Tribune International had the honour of speaking with Prof. Mörmann, who recently celebrated his 80th birthday, and with Dr Cord F. Stähler, chief technology officer at Dentsply Sirona, about the history and future of the one-and-only CEREC.

Thank you for speaking with us, Prof. Mörmann. Could you tell us how you came up with the idea for CEREC?
Prof. Mörmann: In 1979, a very intense discussion in dentistry arose about a possible health risk from the mercury component of amalgam, the then standard material for treating carious defects in molar teeth. Dentists began to systematically replace amalgam fillings with composites, and patients liked the more aesthetic tooth-coloured fillings. However, these caused new problems: the large resin-based posterior fillings leaked from the beginning because of polymerisation shrinkage, causing pain and secondary caries. As a lecturer and researcher, I felt compelled to seek a solution.

The solution was to have the filling fabricated quickly outside the mouth and to bond it to the tooth as an inlay. However, conventional inlay procedures using ceramic or metal were laborious and time-consuming, and it was clear that new technology would be needed to solve the problem. Around this time, the accessibility of computers was increasing, and their potential fascinated me. That was when the idea came to me that dentists could produce inlays by themselves using digital technology: 3D-scanning the tooth, for example, and designing the inlay and having it formed quickly from a block of aesthetic material directly in the practice. This brought ceramics to the forefront of interest because the material was very similar to tooth structure physically, biologically and aesthetically. Using ceramics, however, required a completely new manufacturing technique as well as a new clinical concept. The rest is history!

CEREC pioneer Prof. Werner H. Mörmann. (Image: Dentsply Sirona)

The development of the CEREC system was not quite straightforward. What setbacks did you experience and how were they overcome?
Prof. Mörmann: I had a technical solution in mind that would integrate data acquisition, design and form grinding into a small mobile unit. The solution needed a monitor and had to be a practical device that could be used chairside by the dentist. Dr Marco Brandestini, an electrical engineer and a good friend of mine, was also enthusiastic about the idea and saw it as a technical challenge for himself. Our first functional model of a form grinding machine actually self-destructed when the grinder sank into the ceramic!

The solution was to use cylindrical plunge grinding along the mesiodistal inlay axis with a diamond-coated grinding wheel and a water turbine as the drive. This worked quickly at the chairside, but the occlusal surface was flat and dentists had to shape the fissures and cusps manually by themselves after bonding. I am extremely pleased that inlays made in this way still work after 25 years or more. This solution—together with many clinical studies—confirmed that the clinical concept was viable. The full story of the technical and clinical emergence of the CEREC method is rather long, but those who are interested can download it free of charge from moermanncerecstory.com, in English or German.

Dr Stähler, as CTO at Dentsply Sirona you are well versed in all matters relating to CEREC. How important has the system become for the company?
Dr Stähler: Dentsply Sirona and CEREC have been inseparably linked for many years. In 1985, when CEREC was launched, digitalisation in dentistry was still in its infancy, and scepticism and reservations about it were prevalent.

As a company, however, Dentsply Sirona always believed in this idea and demonstrated its perseverance from the very beginning. Engineers from our company were in constant exchange with Prof. Mörmann and Dr Brandestini, and with CEREC users. Together, the parties continued to develop the system and to set new standards in digital dentistry.

Today, the system is mature, and the quality of the clinical results are unquestionable. CEREC has had a huge impact on us as a company and continues to do so. Digital is now part of our DNA: we think, we act, and we live digitally.

How would you describe the current significance of CEREC in dentistry?
Dr Stähler: CEREC, as a system, is a fixed force in the market. The all-new CEREC includes Primescan and the CEREC Primemill, and it is now easier for an even wider circle of practitioners to decide how this modern digital technology can be used quickly and economically in individual dental practices.

The individual components of CEREC, including the scan, the software, the milling and grinding machine and the material block, are optimally coordinated to provide a seamless workflow. Digital chairside dentistry is now faster, easier and more reliable than ever before. It has reached a new level of quality, and this provides for a noticeably more comfortable treatment experience for the patient.

The use of 3D scanners is increasing dramatically. Where does the Primescan fit into the CEREC system?
Dr Stähler: We developed intra-oral scanning in the context of CEREC and, by doing so, established a market for the technology. Today, we see the use of intra-oral scanning and digital impressions growing beyond chairside and encompassing all areas of dental treatment; first and foremost with clear aligners, but also in the daily interaction with laboratories. Here, we see our market-leading and patient-benefiting precision and speed as key advantages. We will continue to drive single-visit dentistry, but we will also use our experience of dozens of years in chairside for all other applications, especially in the cooperation with dental laboratories.

“Anyone who is involved with digital technology knows: never say never” – Prof. Werner H. Mörmann, CEREC founder

Prof. Mörmann, are you surprised that new applications for CEREC are still being discovered?
Prof. Mörmann: Not at all! I said a few years ago that the intra-oral scanner has the potential to scan the complete oral situation for diagnosis during practically any dental examination. To name just one example, scans can also be done by dental assistants. In any case, as a treatment method, CEREC still offers plenty of scope for further developments. These could relate to any of the steps, including data acquisition, form grinding, milling technology and materials.

While we are on the topic of new developments, Dr Stähler, what can you tell us about the latest upgrades of the Connect and CEREC software?
Dr Stähler: The latest upgrade of the Connect and CEREC software is upgrade 5.2, and it has provided users with new functionalities and even better performance. Patient communication has also been improved through a new visualisation step in the model phase. It is now possible to view the model directly without restoration selection. Primescan users also benefit from these updates, and new firmware makes the intra-oral scanner faster and extremely stable while giving users access to new workflows and even better usability.

How do these developments benefit dentists?
Dr Stähler: Owing to its improved firmware, Primescan can now generate more 3D data points per second than ever before. With software generation 5.2, the scanning speed and scan stability have doubled. For clinicians working with Primescan in their practices, these improvements in firm- and software result in more efficient workflows and even greater reliability and they also provide a more comfortable patient experience.

Dr Cord F. Stähler is chief technology officer at Dentsply Sirona. (Image: Dentsply Sirona)

CEREC is the best example of Dentsply Sirona’s pioneering of digital dentistry. Using CEREC, we are building a digital platform that brings together all stakeholders and devices and the intention is that new technologies and existing equipment can be seamlessly integrated into the workflow. By doing that, we can help dentists to focus on providing patient care and we can give patients a much better and smoother experience.

What drives upgrades to CEREC? Is it advancements in technology or changes in dental treatment and patient preferences?
Prof. Mörmann: Foremost are the expectations of the patient. Whether he or she needs the perfectly aesthetic blending in of a single anterior tooth or a full rehabilitation of the dentition, the patient wants to have the treatment done with efficiency and the results of the restoration need to be pleasing and clinically and aesthetically durable. Upgrades have led to the perfection and expansion of the application of the CEREC method, and the system itself has also benefited from advancements in technology. These developments go hand in hand. For example, I expect that the large number of digital CEREC restoration designs worldwide could be analysed using artificial intelligence in order to develop assistance systems that would further improve restorative work.

Dr Stähler: I agree, and I would add that the driving force behind innovation is the sum of many factors. Dentists and dental technicians wish to treat and care for patients in the best possible way, and our goal is to support them. Our focus on digital technologies has made dental treatment more accurate and more pleasant for patients, and it has resulted in workflows in laboratories being safer, more cost-efficient and more predictable.

Our success in developing solutions that meet the needs of dentists worldwide is the result of a competitive spirit and talented employees who are committed to product innovation and high-quality service and training. Improving clinical outcomes, workflows and patient satisfaction is a driving force in our daily efforts, and we are continually investigating ways in which we can redefine the limits of what is possible. As you see, it is not just about technology; it is also about attitudes and emotions.

What do you think the future holds for digital dentistry and how will CEREC compete with other advancements, such as 3D printing?
Dr Stähler: Digital technologies will always offer benefits. Diagnostics and planning can be implemented in a time-saving manner, and the patient can find out very quickly which treatment options are available and what the results will be. The treatment itself is also faster. The keyword here is single-visit dentistry and, ultimately, this will lead to even greater cost-efficiency for dental practices. The CEREC procedure, which includes digital impressions and chairside manufacturing of restorations, plays an important role in this.

A 3D printer could be a useful addition to the portfolio for use in applications in which milling and grinding machines do not always provide an optimum result—such as in the use of composites. I believe that 3D printing is ready to take centre stage; it is ready to become a part of the daily workflow for clinics and laboratories alike. So, watch this space!

However, CEREC and 3D-printing technology are not mutually exclusive. They complement each other perfectly in digital practices and laboratories. I am certain that 3D printing will be used alongside CEREC for a long time to come and that both technologies will have their specific use cases.

Prof. Mörmann: Anyone who is involved with digital technology knows: never say never. Forty years ago, we would never have dreamed of all the things that are now possible with CEREC. In this respect, as we consider the future, all dental professionals can look forward to being part of a very exciting process of development.

“[Innovation] is not just about technology; it is also about attitudes and emotions” – Dr Cord F. Stähler, Dentsply Sirona

Finally, Prof. Mörmann, what gives you the most satisfaction as the inventor of CEREC?
Prof. Mörmann: For me, it is the fact that the method, as it is today, is more fascinating than ever. It has increased the enjoyment of restoring teeth, be it with single inlays, onlays, overlays of any form and size, half and full crowns, endocrowns, veneers, anterior and posterior crowns, tabletops, implant crowns, quadrant treatments, three- and four-unit bridges or complex full-mouth rehabilitations. Restorations are automatically generated with individual biogeneric occlusal morphology using habitual bite or virtual functional registration. Drilling templates can be fabricated. To sum up, CEREC provides dentists with a vast choice of high-tech, highly aesthetic ceramic, hybrid ceramic and composite restorative block materials with suitable strength.

Everything runs smoothly, quickly, easily and with high precision: the scanning, the restoration design and the machining. And the result is first fit, at the margins as well as at proximal and occlusal contacts. We are talking about a system that was launched in 1985. To me, this represents an awesome and truly fantastic success, and for this, I would like to thank the developers at Dentsply Sirona! It is wonderful to realise how many colleagues around the world are successfully using CEREC in their practices and providing patients with excellent clinical care. Without a doubt, at age 37, CEREC advances the restorative capabilities of dentists as never before.

Editorial note:

The name CEREC is derived from Chairside Economical Restoration of Esthetic Ceramics and also from the initial letters of ceramic reconstruction.

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