The massive/immense growing technology brings a lot of innovation in each and every field and this is not exceptional for the medical field where new innovations and methods are being proposed to make comfort and ensure better treatment for the people.

Rehabilitation is a vast field that restores the condition of good health and help people lead a better life after a trauma/injury. Various technologies have been proposed in rehabilitation and out of these this blog contains CAD/CAM application.

In our context, CAD refers to Computer Aided Design and CAM is Computer Aided Manufacturing. CAD is the use of computers to help in the creation, modification and analysis of the design/ model. CAM is nothing but the use of software programs to automate the manufacturing process.

APPLICATIONS OF CAD/CAM IN REHAB

CAD/CAM is the fastest growing technology in the field of modern restorative dentistry. The prosthetic management of the patients is taken by CAD/CAM. Fabrication of various restoration can be done with the help of virtual environment. This virtual environment along with onscreen designing and computer assisted production with rapid prototyping allows for fabrication without help of any physical models.

Let us consider a case study where 25 year old man was dissatisfied with his smile and visited prosthodontics department. He complained about the shape of the teeth, missing of some teeth and also about his unaesthetic smile. So, he was carefully observed by his orthodontist for 3 years and has been provided with orthodontic treatment. His score of oral quality of life was very poor (38/60). It was revealed that he was suffered from agenesis(absence of seven teeth).

Orthopantomogram of the patient’s initial dental condition in February 2021.
PCTURE COURETESY: https://www.mdpi.com/2227-9032/10/2/382/htm

The implant treatment was not possible due to the lack of space. The patient does not want to proceed with the orthodontic treatment. So, a decision was made to place a full-mouth prosthodontic rehabilitation (monolithic lithium disilicate glass-ceramic, IPS E-max CAD).

A software was used for modelling. It was possible to maintain the enamel necessary for bonding. Teeth was prepared and temporary resin were added to protect them. This digital cast is obtained by intraoral scanning and the quality was evaluated.

Veenerlays and crowns were designed by using the Dental Designer software program.

Design process

The design was sent to the machine and once when it was completed, glaze layer was applied & it was crystallized in an oven according to the manufacturer’s recommendation. Then the teeth was thoroughly cleaned and were tried on. The obtained result was satisfactory and successful. The treatment lasted for 7 weeks. The choice of material for full-mouth restoration in this case was lithium disilicate glass-ceramic (e-MAX, Ivoclar Vivadent). The use of CAD/CAM systems has allowed time saving, tissue saving, better communication and aesthetic management with the patient during a complex prosthetic treatment. After a month, the score of the oral quality of life was improved (54/60). This proves that CAD/CAM is a promising technology.

Orthopantomogram of the patient at 8 months after the end of the dental treatment.
PICTURE COURTESY:https://www.mdpi.com/2227-9032/10/2/382/htm

CAD/CAM IN ORTHOTIC AND PROSTHETIC DEVICES:

The problems faced in prosthetic and orthotic devices is the fitting procedure. CAD/CAM brings a solution to this as it can be modified and evaluated until a proper structure is provided.

This system includes digitizer, workstation and the carver. The digitizer traces the shape and converts it into digital information. The workstation consists of TracerCad software that modifies the three dimensional shape. A high speed cutter is used to carve the shape. The CAD/CAM system speeds the process of casting and modifying the devices. The design and manufacturing procedure is also efficient and requires very short span of time.

After a development of product in CAD system, standard softwares are used for finite element analysis. Prior to the cutting of metal, tool paths for CAM can be previewed.

In manual procedure, the body mold would be given to the technicians who would close and fill it with the plaster. But now the process can be digitized using CAD/CAM to create the shape from the measurements and these files are electronically sent to the manufacturing sites.

The mold taken, digitized and electronically modified and then sent to the carver. The carver cuts the socket design. After carving, fabrication is done by a technician.

Modification of the 3-D shape using the CAD/CAM system is done with the click of a mouse versus the manual procedure of mixing and applying of plaster and waiting for a long time for the plaster to set. Thus CAD/CAM technology allows the clinicians to address patients needs with a greater degree of precision. The rehabilitation equipment industry needs flexible design and manufacturing techniques and this is enormously supported by CAD/CAM system.

BENEFITS OF CAD:

  • Higher quality designs
  • Saves time
  • Increase productivity
  • Can easily change the designs

BENEFITS OF CAM:

  • Greater speed in producing components
  • Greater accuracy and consistency
  • Greater efficiency

Know more about role of robotics and VR in rehabilitation

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