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Scientific Research Report

TagedH1The Utilisation of CAD/CAM Technology Amongst

Austrian Dentists: A Pilot StudyTagedEn

TagedPTihomir Krastev a, Michael Payer b, Zhivko Krastev c,

Juan Francisco Pena Cardelles c,d,e, Adam Vegh f, Dorottya Banyai g,
Zoltan Geczi h, Daniel Vegh a,h*TagedEn
a
TagedP Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine and Oral Health, Medical University
of Graz, Graz, Austria
b
Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Graz, Austria
c
Department of Health Sciences, Rey Juan Carlos University, Madrid, Spain
d
Oral and Maxillofacial Surgery Department, School of Dental Medicine, University of Connecticut Health, Farmington,
CT, USA
e
Department of Prosthodontics, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA
f
Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, Budapest, Hungary
g
Department of Pedodontics and Orthodontics, Semmelweis University, Budapest, Hungary
h
Department of Prosthodontics, Semmelweis University, Budapest, Hungary
TagedEn
TAGEDPA R T I C L E I N F O TAGEDPA B S T R A C T

Article history: Objective: Computer-aided design (CAD) and computer-aided manufacturing (CAM) technology in
Received 8 September 2022 dentistry has become noticeably more significant in recent years. The further development of CAD/
Received in revised form CAM systems has led to a broader range of applications, more user-friendly operation, and improved
16 September 2022 accessibility. The present online survey aimed to investigate CAD/CAM technology utilisation
Accepted 22 September 2022 amongst Austrian dentists as the first social media pilot study from Europe on this specific topic.
Available online 21 October 2022TagedEn Materials and methods: For this purpose, an online survey consisting of 27 questions was created
using Google Forms. The questions were divided into 3 sections: general inquiries, questions for
TagedEnTagedPKey words: CAD/CAM users, and questions for nonusers. The questionnaire was randomly distributed to
Social media Austrian dentists via email and social media. A total of 115 responses were submitted.
Digital dentistry Results: The vast majority of respondents, 52.6% (n = 60), practised as general dentists. Further-
CAD-CAM more, a significant proportion of participants specialised in oral surgery, 17.5% (n = 20), and
Survey orthodontics, 12.3% (n = 14). Approximately half of the respondents, 51.8% (n = 59), reported
Intraoral scanner TagedEn having a CAD/CAM device at their current workplace. Amongst the CAD/CAM users, 70.7%
(n = 58) believed that CAD/CAM is important in increasing the number of patients visiting the
dental practice. In total, 54.2% (n = 26) of nonusers indicated the high initial cost of purchasing
a CAD/CAM device as the main reason for not utilising this technology.
Conclusions: CAD/CAM technology appears to have infiltrated the workflow of Austrian den-
tists with predictions of growing implementation amongst dental practices in the future.
Ó 2022 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)TagedEn

TagedH1IntroductionTagedEn products in a fully digital way compared with the old conven-
tional method. The virtual data can be manipulated as
TagedPComputer-aided design (CAD) and computer-aided required before being converted into a physical form using
manufacturing (CAM) are digital processes which provide the the dimensions and materials defined during the digital
opportunity to create prosthodontics and other dental design phase.1 This sequence of steps is referred to as a
“digital workflow”.2 The initial stage in a digital workflow is
TagedEn
* Corresponding author. Department of Prosthodontics, Sem- data capture. Data capture varies greatly amongst commer-
melweis University, Szentkira
ly utca 47, 1088 Budapest, Hungary.
cially available dental CAD/CAM systems. For example, the
E-mail address: [email protected] CEREC system includes an intraoral digital 3-dimensional
(D. Vegh).
https://doi.org/10.1016/j.identj.2022.09.004
0020-6539/Ó 2022 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
 tagednt h e u t i l i s a t i o n o f c a d / c a m t e c h n o l o g y a m o n g s t 431

(3D) scanning device which converts tooth geometry into dig- speciality area. A survey consisting of 27 questions was
ital data that a computer can process. In most situations, the prepared and sent to Austrian dentists via email and
scanner used to capture data is an inherent element of the social media. The survey was in German and was available
CAD/CAM system and can only be utilised in conjunction from February 9, 2022, to March 19, 2022. A total of 115
with customised software.3 The second stage of the digital responses were received.TagedEn
workflow is data processing/planning. Processing/planning TagedPThe questionnaire was divided into the following 3 sec-
software is mainly used for analysis and diagnostics, treat- tions: general questions, questions for CAD/CAM users, and
ment planning, or CAD. Before proceeding to the final stage of questions for nonusers. TagedEn
the digital workflow, the software is used to design the TagedPThe first part of the survey was designed to collect demo-
intended object (eg, crown, bridge, surgical guide). This pro- graphic data and information regarding the country and year
cess, referred to as CAD, is regarded as the last component of of graduation, and speciality of the participating dentists. The
this stage.4 The last stage of the digital workflow is the fabri- second section presented questions about dentists’ practice
cation of the desired restoration, referred to as CAM. There and experience with CAD/CAM systems.TagedEn
are 2 types of manufacturing technologies: subtractive and TagedPThe last section of the study included 2 questions designed
additive. Furthermore, the subtractive technologies are to assess why CAD/CAM technology may not have been
divided into 2 categories: milling and grinding.4 A “subtractive adopted in their daily dental practices.TagedEn
procedure” means removing material from a prefabricated
block to obtain the required end product.5 The basic process TagedH2Data collectionTagedEn
of additive manufacturing is the layer-by-layer merging of
materials based on 3D data models.6TagedEn TagedPThe survey was created using Google Forms and distributed
TagedPCurrently, CAD/CAM technology is increasingly being uti- as an electronic link on social media and email. The obtained
lised in all health care fields, including dentistry.7,8 CAD/CAM is information’s confidentiality and anonymity were main-
changing how products are designed, created, and serviced.9 tained. The collected data were stored using Google Forms
Based on the manufacturing technique, CAD/CAM systems are and Microsoft Excel.TagedEn
classified into 3 types10 as chairside, laboratory, and centralised
production. With the chairside system, all 3 phases needed in TagedH2Statistical analysis and visualisationTagedEn
the automated fabrication of restorations may be completed in
a dentist’s office. The dentist can prepare a tooth, create the TagedPData analysis was performed using SPSS, and data are
restoration, and seat it using appropriate materials within a reported as means § standard deviations (SDs) and range or
single session. The dental laboratory model is comparable to absolute numbers with percentages. Fisher exact test and
the one used to create conventional restorations. The dental chi-square test were used for statistical analysis. Differences
office transmits to the laboratory a virtual impression or model below the 5% limit (P < .05) were significant. For visualisation,
of the prepared teeth, and the laboratory fabricates the restora- we used Microsoft Excel.TagedEn
tion. In the centralised production model, the practitioner cap-
tures data using a scanning device and then sends it to the
laboratory via the internet.11 The dental laboratory is equipped TagedH1ResultsTagedEn
with data collecting and design software.12 The completed res-
toration design is sent from the laboratory to a production cen- TagedPThe online survey had a total of 115 participants: 72.6%
tre, where it is transformed into suitable commands to operate (n = 82) of the respondents received their dental degree in
the CAM component of a CAD/CAM system.TagedEn Austria, 8% (n = 9) of the participants completed their studies
TagedPCAD/CAM is used in every field of dentistry, including in Germany, and another 7.1% (n = 8) studied in Hungary.TagedEn
prosthodontics, orthodontics, implantology, and maxillofa- TagedPThe duration of the clinical experience of the dentists sur-
cial surgery.13−22TagedEn veyed varied from 1 to 46 years. The mean value of the clini-
TagedPThe rapid development of CAD/CAM technology in recent cal experience was 18.8 (§11.5). General dentists represented
years has resulted in easier handling, lower acquisition costs, the most significant proportion of participants at 52.6%
and increased quality of the requisite end porducts. In the (n = 60). The rest of the respondents specialised in various
absence of any data, we evaluated, in the current on-line, fields of dentistry, with a substantial proportion practising in
pilot questionnaire survey, the extent to which the new CAD/ the area of oral surgery (17.5%) and orthodontics (12.3%). The
CAM technology is used in Austrian dental practices. In addi- results are presented in Figure 1.TagedEn
tion we assessed the dentists’ attitudes towards the costs, TagedPThe majority of respondents (71.3%) reported that they
advantages, and disadvantages of CAD/CAM and the quality had already operated a CAD/CAM system, whereas 51.8%
of the produced restorations. TagedEn (n = 59) were using a CAD/CAM device at their current work-
place. Interestingly, most dentists who did not currently have
a CAD/CAM device had no intention of acquiring any.TagedEn
TagedH1Materials and methodsTagedEn TagedPMore than half (52.6%) of the CAD/CAM users became
aware of CAD/CAM technology online. The vast majority
TagedH2Survey characteristicsTagedEn (84.4%) of the participating users have integrated CAD/CAM
into their workflow within the last 10 years. The most fre-
TagedPThe target group of this online survey included all dentists quently cited reason for purchasing CAD/CAM devices was
currently practising in Austria, regardless of their the desire to be technologically up to date (58.8%), followed
TagedEn432 krastev et al.
TagedEn TagedFiur TagedEn TagedFiur

Fig. 1 – Specialty of participating dentists.TagedEn

by the demand for increased productivity (38.8%) and

improved quality (36.3%). About half of the users surveyed Fig. 2 – Distribution of the computer-aided design (CAD) and
stated that they had undergone CAD/CAM training (54.3%). computer-aided manufacturing (CAM) aspects.TagedEn
Intraoral scanners (78,8%) were the most-used aspect of the
digital workflow. Slightly less than half of the CAD/CAM users
(42.5%) stated that they had a full chairside device at their
current workplace. The implementation percentage of each
aspect is presented in Figure 2.TagedEn (86.3%). Furthermore, many respondents used CAD/CAM to
TagedPSixty-one percent of respondents believed that the avail- fabricate dental bridges and inlays (67.5% and 65%, respec-
ability of a CAD/CAM device impacted their clinical decisions. tively). To assess the overall satisfaction with the CAD/CAM
The most commonly used materials were zirconia, lithium restorations, the participating dentists were asked to rate
disilicate, and plastics, followed by hybrid ceramics, resins, them on a scale from 1 (very satisfied) to 10 (not at all satis-
and zirconia-reinforced glass-ceramics.TagedEn fied). The evaluation was based on 4 questions that consid-
TagedPIn terms of clinical application, a large percentage of the ered quality, marginal fit, and patient satisfaction. The
results are shown in Figure 3.TagedEn
TagedEn TagedFiur
dentists surveyed used CAD/CAM to fabricate dental crowns

Fig. 3 – Overall satisfaction with computer-aided design (CAD) and computer-aided manufacturing (CAM).TagedEn
 tagednt h e u t i l i s a t i o n o f c a d / c a m t e c h n o l o g y a m o n g s t 433

TagedEnTable 1 – Statistical correlations. some extent, already experienced individuals. In total, 71.3%
No. (%) P value (n = 82) of the respondents reported having operated a CAD/
CAD/CAM training No CAD/CAM training
CAM system before. Approximately half of the respondents
CAD/CAM users 43 (57.3) 32 (42.7) .102 (51.8%) had a CAD/CAM device at their current workplace.
CAD/CAM training No CAD/CAM training
Graduation before 2010 26 (61.9) 23 (62.2) The majority of the respondents (58.7%) who did not own a
Graduation after 2010 16 (38.1) 14 (37.8) .981 CAD/CAM device were not interested in acquiring one. Vari-
General dentists Specialists
Chairside device 16 (44.4) 18 (40.9) ous reasons were offered for this decision by the latter group
No chairside device 20 (55.6) 26 (59.1) .463
Austria Hungary and included lack of conviction regarding the quality of the
CAD/CAM users 52 (63.4) 8 (100) CAD/CAM restorations over conventional fabrication meth-
Nonusers 30 (36.6) 0 (0) .033
CAD/CAM users Nonusers ods, and the high acquisition costs of CAD/CAM equipment.TagedEn
Oral surgeons 17 (32.7) 3 (10.7)
General dentists 35 (67.3) 25 (89.3) .03 TagedPMost users (84.4%) have integrated CAD/CAM technology
CAD/CAM users Nonusers into their workflow within the last 10 years, possibly due to
Graduation before 2010 35 (61.4) 39 (71.9)
Graduation after 2010 22 (38.6) 16 (29.1) .288 the rapid development of digital dentistry in recent years.
Intraoral scanner Other aspects
General dentistry 11 (31.4%) 24 (68.6%)
The progress in CAD/CAM technology has resulted in easier
Orthodontics 10 (90.9%) 1 (9.1%) .001 handling, lower acquisition costs, as well as improved quality
of restorations in terms of features such as occlusal contacts
CAD, computer-aided design; CAM, computer-aided manufacturing.
and proximal fit of restorations. Another reason for the
increased digitisation of Austrian dental practices is probably
TagedPIt was noted that 96.2% of users would recommend CAD/ the increased affinity for technology amongst the new gener-
CAM to a friend or colleague. Furthermore, 72.7% of respond- ation of dentists. Although no apparent significance between
ents believed that CAD/CAM could lead to an increased vol- the year of graduation and CAD/CAM use could be deter-
ume of patients in the dental practice. The majority of users mined the users were slightly younger than the nonusers.TagedEn
(73%) prefer CAD/CAM technology instead of conventional TagedPThe most widely used aspect of the digital workflow was
manufacturing methods for fabricating prosthetic restora- the intraoral scanner (78.8%), and 42.2% of clinicians reported
tions.TagedEn having a complete chairside device. In a 2016 UK survey, a
TagedPAmongst nonusers, the high cost of purchasing a device correlation was found between the level of specialisation of
(54.3%) and the perceived lack of benefits compared to con- the participating dentists and the use of CAD/CAM technol-
ventional manufacturing methods (31.4%) were the most ogy.25 General dentists were more likely to use a complete
cited reasons for nonuse.TagedEn chairside device. In our survey, a similar correlation was not
TagedPA considerably higher proportion of oral surgeons than gen- observed. A possible reason for this is the lower number of
eral dental practitioners used at least one component of the digi- participants.TagedEn
tal workflow (P = .030). A statistically significant correlation TagedPThe survey revealed a positive perception of CAD/CAM
between graduation year and use of CAD/CAM was not observed technology amongst the respondents, comparable to other
(P = .288). Nevertheless, the CAD/CAM users were slightly youn- surveys conducted in the UK and Saudi Arabia.25,26 Future
ger than the nonusers. In addition, a correlation between the studies can be influenced by learning curve studies as well.27
country of graduation and CAD/CAM utilisation was noted. One drawback of our study is the relatively small number of
Overall, Hungarian dentists were more likely to use CAD/CAM respondents. In addition, it is likely that the majority of the
than their Austrian counterparts (P = .033). No significant corre- respondents were users with perhaps past experience with
lation was found between completed CAD/CAM training and a CAD/CAM technology, and most of the non-users may not
dentist’s clinical experience (P = .981; Table 1).TagedEn have responded. This inherent bias may have impacted the
final outcome of the survey. Hence further comprehensive
studies are needed to follow up the results of the current pilot
TagedH1DiscussionTagedEn study.TagedEn

TagedPThe present survey aimed to provide an overview of CAD/

CAM use in Austrian dental practices. To date, there are no TagedH1ConclusionsTagedEn
similar studies dealing with this subject. Questionnaires are
undoubtedly one of the most important data sources in any TagedPThe findings of this pilot study show a high level of satisfac-
research project.23,24 It is considered that adopting multiple tion and a favourable attitude amongst the questioned Aus-
sorts of processes for collecting data and receiving that infor- trian dentists on the use of CAD/CAM technology in clinical
mation from diverse sources can improve the validity and dental practice. CAD/CAM technology appears to have infil-
reliability of the data and their interpretation.23 In this regard, trated the workflow of Austrian dental offices, while further
the survey was sent by email and posted on social platforms increase in application could be anticipated going forwards.TagedEn
such as Facebook and Instagram to reach a broader range of TagedPThe number of dentists contacted was about 1100 and
participants.TagedEn therefore comprised one-fifth of the Austrian dentists. As a
TagedPThe majority of the dentists involved have completed their total of 115 responses were received, the response rate was
dental studies in Austria and have worked in general den- approximately 10%.TagedEn
tistry. The participants’ clinical experience averaged 18.8 TagedPThis survey demonstrated the challenge of collecting an
(§11.5) years. Consequently, we can assume that the majority acceptable respondent sample size for an online survey. The
of the clinicians who completed the questionnaire were, to disadvantages of such data-gathering approaches were
TagedEn434 krastev et al.

identified. Finally, multicentric studies are needed from TagedP10. Mo € rmann W, Krejci I. Computer-designed inlays after 5 years
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