Dr. Diogo Viegas
- Dr. Diogo Viegas is a prosthodontist based in Lisbon, Portugal, and an Assistant Professor in the Fixed Prosthodontics Department at Lisbon Dental School.
- He is also a certified dental technician and currently serves as Digital City Committee Coordinator for Lisbon Dental School.
- Dr. Viegas is an active member of multiple professional organizations, including the Portuguese Dental Association, the International Team of Implantology (ITI), the European
Association for Osseointegration (EAO), the European Prosthodontic Association (EPA), the Digital Dental Society (DDS), and the International College of Prosthodontists (ICP). - He lectures nationally and internationally and is the author of several books and articles.
introduction
introduction
Since its introduction, computer-aided design and manufacturing (CAD/CAM) technology has held promise for achieving same-day restorative dental care. Yet for many years, chairside workflows have remained out of reach for routine clinical use, and adoption has often been hesitant. Early CAD systems were designed primarily for dental technicians, requiring specialized skills and confident use of complex software. While these tools were clinically effective, their complexity and time demands made them difficult to integrate into busy practice schedules. [1]
In the early stages of digital dentistry, scanning, design, and manufacturing often relied on separate, non-integrated systems (Fig. 1).
Workflows required multiple handoffs, including exporting files, converting formats, and re-importing data across different platforms and access points. [2] This fragmentation added complexity, slowed turnaround times, and eroded staff confidence in the process. In other words, while the workflow was “digital,” it was not truly interconnected. These illustrations (Fig. 2) therefore contrast an older, fragmented digital workflow with a modern integrated equivalent, highlighting the automated data transfer and reduction of hand-offs that define today’s connected ecosystem.
INTRODUCTION
INTRODUCTION
Modern CAD platforms, such as the iTero™ Design Suite (Fig. 3), have transformed the chairside restorative environment. These platforms consolidate the full workflow—from intraoral scanning to design and fabrication—within a single, unified ecosystem. [3] Rather than operating as isolated tools, they function as connected applications that exchange data directly with scanners, milling units, and 3D printers, enabling an integrated digital workflow. [4] By reducing friction and delays between stages, clinicians can more reliably complete restorative procedures in a single visit.
Recent advances in artificial intelligence (AI) have further accelerated this shift, adding both technical capability and a new level of usability to chairside systems. Digital systems reach their full potential when operational performance is paired with intuitive interfaces. Guided workflows and restorative libraries help clinicians who lack laboratory training confidently adopt digital design tools. [5] AI-enabled features—such as automated margin detection, occlusal mapping, and tooth anatomy proposals—reduce manual steps and ease the learning curve. [6] These capabilities allow dentists to design and refine restorations in-office, decreasing reliance on external laboratory support.
Evaluating an upcoming AI crown design feature integrated into the iTero™ Design Suite—which automatically generates an initial design proposal (Fig. 4)—I found that it produced consistent, predictable outputs while significantly reducing design time. In my view, this type of automation can meaningfully lower adoption barriers for clinicians who are new to chairside workflows.
Such an integrated workflow also increases the overall value of existing equipment. Many clinics already have intraoral scanners and 3D printers, but they are often used as separate, loosely connected devices. When these tools share a common CAD platform, however, they function as a single system (Fig. 5). [7] By eliminating manual file exports and format conversions, the chances for data loss are reduced, supporting accurate translation from digital design to manufactured restoration. [8]
CASE 1: OCCLUSAL SPLINT
CASE 1: OCCLUSAL SPLINT
The first case demonstrates the chairside fabrication of an occlusal splint for a patient with parafunctional habits and morning muscle tension. Intraoral scans (Fig. 6) were captured with the iTero Lumina™ intraoral scanner in maximum intercuspation, and the splint was digitally articulated and designed (Fig. 7). The connected workflow enabled same-day manufacturing and delivery, providing immediate symptom relief and improved functional comfort.
CASE 2: PROVISIONAL CROWN ON A RETAINED PRIMARY TOOTH
CASE 2: PROVISIONAL CROWN ON A RETAINED PRIMARY TOOTH
The second case involved an orthodontic patient with a retained primary maxillary lateral incisor (FDI 6.3), requiring a provisional esthetic solution during active treatment. Following conservative tooth preparation, the tooth was scanned, and a provisional crown was designed and fabricated chairside during the same visit (Figs. 8, 9). This approach improved esthetics while preserving the soft-tissue architecture and maintaining flexibility for future implant planning.
“This orthodontic approach improved esthetics while preserving soft-tissue architecture and maintaining flexibility for future implant planning.”
CASE 3: ENDOCROWN FOR A MOLAR WITH EXTENSIVE CORONAL LOSS
CASE 3: ENDOCROWN FOR A MOLAR WITH EXTENSIVE CORONAL LOSS
A third clinical scenario involved a molar with extensive coronal loss requiring an endocrown restoration. After endodontic retreatment, the tooth was prepared under rubber dam isolation to ensure moisture control. Digital scanning under isolation enabled precise margin capture, after which the endocrown was designed, milled, and delivered in a single visit (Figs. 10–14). In my clinical experience, such a single-unit restoration previously required two visits and a 7–10 day laboratory turnaround; it can now be completed in approximately 60–90 minutes. This can improve patient convenience and satisfaction and reduce chair time spent on temporization and follow-up visits. Overall, it illustrates the practical value of a fully connected workflow.
A note on scanning under rubber dam isolation: Digital workflows provide an underappreciated benefit through intraoral scanning protocols, which show better results between rubber dam and non-rubber dam impression scans. The process of scanning under rubber dam isolation improves both marginal definition and moisture control, resulting in better visualization of preparation boundaries and eliminating soft tissue interference. [11] Modern scanners can achieve both of these benefits through real-time AI-based color rendering systems and adaptive stitching technology; these produce exact results for complex margins and subgingival areas while preserving accuracy. [12]
CASE 4: DIGITALLY GUIDED ESTHETIC MOCK-UP
CASE 4: DIGITALLY GUIDED ESTHETIC MOCK-UP
Finally, a patient seeking esthetic improvement of the upper anterior teeth underwent digitally guided smile design. Facial reference lines were established, and a virtual wax-up was created to evaluate shape and proportion. A chairside mock-up was then designed (Figs. 15, 16) and fabricated, allowing the patient to visualize and functionally test the planned esthetic outcome prior to definitive treatment.
“A chairside mock-up was then designed and fabricated, allowing the patient to visualize and functionally test the planned esthetic outcome prior to definitive treatment.”
DISCUSSION
DISCUSSION
From a manufacturing perspective, 3D printing offers advantages in material efficiency, speed, and the ability to produce complex geometries, making it well-suited for applications such as occlusal splints. In contrast, milling typically provides higher precision, mechanical strength, and immediate readiness for definitive restorative indications. When both manufacturing modalities are available (Figs. 17-20) within the same connected workflow, clinicians can select the most appropriate approach for each indication. This expands clinical flexibility while maintaining efficiency and quality in chairside care.
Nevertheless, limitations remain. Chairside CAD/CAM workflows are generally most predictable for single-unit restorations, small bridges, occlusal appliances, and esthetic prototypes; extensive rehabilitations and complex implant frameworks often still require laboratory support. [13] Material selection also requires careful consideration, as not all printable or millable resins are approved or appropriate for long-term definitive restorations. [14] Long-term success depends on an understanding of the performance of available materials in terms of mechanical properties and optical characteristics, including wear resistance, translucency, and fluorescence.
Implementation challenges also persist in digital communication and connected workflows, most notably around interoperability and training requirements. [15] Although many platforms are described as “open,” real-world interoperability between systems can remain limited due to proprietary formats, restricted integrations, or workflow constraints. [16] Successful integration therefore depends not only on the technology, but also on ongoing education, standardized communication protocols, and strong collaboration with industry partners across scanning, design, manufacturing, and materials. In parallel, as cloud-based platforms (Fig. 21) become increasingly central to clinical communication and data exchange, organizations must prioritize data protection and cybersecurity as foundational requirements rather than optional add-ons. [17]
CONCLUSIONS
CONCLUSIONS
Looking ahead, the direction is clear: The next phase of digital dentistry is likely to be shaped by three converging developments: AI, real-time cloud collaboration, and hybrid manufacturing workflows that combine additive and subtractive techniques. [18] Together, these advances have the potential to accelerate restorative workflows, improve predictability, and support the more sustainable use of materials, while expanding the range of chairside indications.
Ultimately, for chairside dentistry to scale, technology must align with clinical objectives through true simplification and integration. When digital tools function as integrated diagnostic and therapeutic extensions of the clinician—rather than as isolated devices—workflows become faster, more predictable, and easier to adopt with confidence (Figs. 24–27). [19] The clinical applications described in this article—occlusal splints, esthetic mock-ups, and definitive restorations—are grounded in the same underlying principle: when scanning, design, and manufacturing operate as one coherent system, chairside dentistry becomes more efficient, reliable, and clinically practical. [20]
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