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A pioneer in digital dentistry is convinced by the material and method

Read more about a success story with CEREC and VITABLOCS. 


Hardly any other development has shaped restorative dentistry as much as CEREC.
And not many other methods were initially as controversial as the CEREC method. The revolution in digital dentistry was significantly supported by the VITABLOCS feldspar ceramic. PD Dr. Andreas Bindl has been part of the development almost from the beginning. Read how he experienced the development of digital dentistry and find out why he is still enthusiastic about VITABLOCS after 25 years.

In September 1985, the first CEREC inlay was integrated.

The blocks, which were experimental at that time, were based on a feldspar ceramic. It would take some time before series production began, and after intensive testing, before the first-generation VITABLOCS were ready for the market. It was the very first material specifically developed for CAD/CAM application for the CEREC method. Since then, VITABLOCS have been intricately linked to the success of CEREC. 

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Digital dentistry: The first step to any success is courage

Andreas Bindl manages a dentistry practice in Zurich. He runs a patient-oriented dentistry practice on the Zürichberg, overlooking Lake Zurich. “If possible, then in one session” – this is how Andreas Bindl treats his patients. Andreas Bindl was a member of Prof. Dr. Werner Mörmann’s team (inventor of CEREC together with Dr. Marco Brandestini) from 1994 to 2007, and shares his enthusiasm. As one who has been actively involved in many developments, Andreas Bindl knows a great deal about the history of digital dentistry. “It's hard to believe that more than 25 years have passed since I first worked with CEREC.”

Information on Dr. Andreas Bindl

Name and place: Andreas Bindl, Zurich


Activity:

  • Owner of the Practice on the Zürichberg
  • Assistant Medical Director (20%) for computer-assisted restorative dentistry
  • Clinic for Tooth Preservation and Preventive Dentistry
  • Center for Dentistry at the University of Zurich


Specialization:

  • Restorative, computer-assisted dentistry
  • Minimally-invasive dentistry
  • Chairside production / full ceramic
  • Digital implantology


Ceramic CEREC materials:

  • Feldspar ceramics / hybrid ceramics
  • Glass ceramics
  • Zirconia ceramics
  • CAD/CAM composite

How it all began

During his studies, Andreas Bindl had hardly any contact with digital dentistry. “I had heard of CEREC, but we worked in analog,” he recalls. No direct feedback on the quality of the impression, hurdles with temporary restoration, long waiting times to the final restoration, etc. – he did not want to accept these limitations. And so CEREC came in very handy for him. “When I first heard about CEREC, I was naive. I thought, put the camera into the mouth and then somehow the finished workpiece comes out,” laughs Andreas Bindl. He really came into close contact with the technology at the University of Zurich when he joined the team led by Prof. Dr. Mörmann. When he started working there in 1994, he learned the correct way to use the technology. The two-dimensional software at that time required a complete paradigm shift. In addition, it was not the finished workpiece that came out of the machine, but a blank that required a lot of reworking. Since there was no three-dimensional CAD preview of the designed restoration at the time, the result was only visible after the milling process and was sometimes associated with disappointment.

The intuitive operation of the CEREC software no longer reveals anything about these initial difficulties.

However, as is typical for visionaries, there was further development, research and testing ….

Those who want to, will find a way. Those who don’t, will find excuses.

“We had a vision and pursued it ambitiously.” Inspired by the idea to establish the computer-assisted fabrication of dentures, they developed, researched, tested … “Dentures must be possible in one session. The conviction of Prof. Mörmann’s inspired me,” admits Andreas Bindl. This special spirit prevailed in the early pioneering years, “... everything was in motion.” The response from the dental profession was split. On the one hand, there were critics, and on the other, visionaries. “When I told my grandfather, also a dentist, about CEREC, he was quite reserved with his opinion,” smiles Andreas Bindl. The idea of CEREC shook established principles of dentistry. Comments about a marginal gap that is much too large or the “ceramic block in a lake of composite cement” … – it took fortitude to continue working with the technology. Despite the tough feedback from the professional world, the Zurich team continued to work undeterred.

Computer-assisted as well as time-saving – that was the vision of CEREC.

The first restoration material for CEREC – VITABLOCS ceramic – and the further development of the adhesive technique contributed significantly to its success. With the second generation, VITABLOCS Mark II in 1991, it was possible to develop a fine-structure ceramic with enamel-like properties. “That was the breakthrough. The material, with its fine, evenly distributed particles and good milling properties, convinced the users.” With VITABLOCS Mark II, highly esthetic restorations could then be fabricated. 

The success of CEREC and VITABLOCS is inseparable. Because in the beginning, this was the only material.

In the mid-1990s, CEREC 2 came on the market. “The software and hardware were more mature. Soon, full crowns could be milled.” Also, on the material side, there was continuous development, and the VITABLOCS portfolio expanded. The polychromatic VITABLOCS blanks differ in their shade gradient. While the VITABLOCS TriLuxe blocks have a horizontal shade gradient, the VITABLOCS RealLife impresses with a double-spherical and chromatic dentine core surrounded by a coat of enamel. “The structure inside the block allows the dentine core to be imitated. This results in a soft, diffused play of light,” explains Andreas Bindl.

History of VITABLOCS feldspar ceramic

  • 1985 VITABLOCS (first CEREC restoration)
  • 1991 VITABLOCS Mark II (monochrome)
  • 1998 VITABLOCS Mark II in VITA SYSTEM 3D-MASTER shades
  • 2003 VITABLOCS TriLuxe (polychrome with horizontal shade gradient)
  • 2007 VITABLOCS TriLuxe forte (polychrome with horizontal shade gradient)
  • 2010 VITABLOCS RealLife (polychrome with chromatic dentine core surrounded by enamel)


Additional milestones: Additional block sizes and a wider variety of shades

The restorations milled from VITABLOCS only have to be polished because the light-optical properties of the material ensure wonderful esthetics. Characterization with VITA AKZENT Plus stains is also possible for working out fine characteristics.

CEREC and VITABLOCS: Innovation became standard

When positive success reports regarding CEREC came in from all around the world, it was a great motivation and confirmation of the path Andreas Bindl was on. International studies relating to CEREC and VITABLOCS were carried out very early on. “Usually these studies were intended to show that CEREC didn’t work,” notes Andreas Bindl. But the opposite was true. The long-term studies on VITABLOCS ceramics are of great importance today and offer sound scientific proof.

The CEREC method is one of the most researched dental therapy protocols. There are a great number of scientific works and successful long-term results, especially for VITABLOCS.

In Andreas Bindl’s practice, the former “Clinic for Tooth-Colored and Computer Restauration” at the University of Zurich, patients from the early years of CEREC are still treated today. “This is how I see a lot of CEREC restorations that I made as a young dentist.” Confirmed evidence, because the majority are still in situ. 

All things are difficult before they become easy

Important milestones in the establishment of CEREC

  • Introduction of powder-free intra-oral scanners
  • User-friendly 3D-CEREC software
  • Further development of the VITABLOCS ceramic

If you ask Andreas Bindl about the hurdles that limited the spread of CEREC in the beginning, he answers without hesitation. A limiting factor, for example, was the need to powder the preparation and the neighboring teeth before scanning. There were no scanners that worked without powder until 2012. The two-dimensionality of the software also made the work more difficult, until the 3D-CEREC software came to market in 2003. “With this, the largest hurdles were eliminated.”

Reliability: The pioneering technology is still cutting edge today

Dentsply Sirona and VITA Zahnfabrik performed pioneer work in digital dentistry. “If I’m being honest, without these companies I would be missing something,” affirmed Andreas Bindl. He has been working closely with VITA Zahnfabrik for two decades now, and in his experience, the company is very safety conscious. “VITA places a high value on reliability and reliable products,” he adds.

The success of VITABLOCS is a beautiful confirmation of the consistently good and careful work of VITA Zahnfabrik.

The choice of the right CEREC materials

In the early days, there was no alternative to VITABLOCS as a CEREC material. At the end of the 1990s, a glass ceramic for CEREC appeared on the market, followed by additional materials. Today VITABLOCS scores among the multitude of CEREC materials with reliable durability. “I like a material that can be milled well and causes as little chipping as possible,” explains Andreas Bindl, regarding his continued trust in VITABLOCS. The beautiful esthetics and the easy polishability still inspire him in everyday practice. “Just today, I made another veneer from VITABLOCS TriLuxe forte. Thanks to the shade gradients, no reworking at all was necessary, except for polishing.”


You can rely 100% on the system (CEREC) and material (VITABLOCS) - a statement that confirms the clinical success. “We've really had very few failures here over the years.” And what negative experiences can dentists learn from today? “Never, ever go thinner than the specified layer thickness.”

The decision for the restoration material is primarily a matter of the necessary layer thickness and the possibilities of the adhesive technique.

For which indications does Andreas Bindl work with VITABLOCS ceramics?

  • Inlays
  • Partial crowns
  • Overlays
  • Crowns in the anterior and posterior area
  • Veneers

Five tips from Dr. Andreas Bindl for the successful use of VITABLOCS

  1. Indication according to the manufacturer’s instructions
  2. Adherence to the indicated minimum wall thickness
  3. Observance of the protocol for adhesive bonding
  4. Indication-related selection of the respective VITABLOCS materials
  5. Trust in the chameleon effect of the VITABLOCS ceramic

For Andreas Bindl, VITABLOCS as a CEREC material are state of the art today. His conclusion from decades of digital chairside treatment: “With VITABLOCS, dentists have a reliable material that has been used successfully for more than three decades, and has been scientifically proven through numerous studies. It is convenient to work with and offers a high degree of esthetics.”