35 years of CEREC and VITABLOCS: A story of pioneers

A legendary success story about courage, enthusiasm and the unshakeable belief in an idea: They shaped the course of digital dentistry!
Find out more about four pioneers who played their part in the remarkable history of CEREC and in the successful story of VITABLOCS. What drove them? What impact did their pioneering spirit have on the development? How did CEREC become the standard workflow that it is today? And why are VITABLOCS still state of the art today? We decided to take a closer look.

CEREC – At the beginning of the 1980s, a vision was born in Zurich that would revolutionize the world of dentistry. The journey that followed was shaped by passionate enthusiasm, unflappable courage, steadfast fearlessness and an unshakeable belief that digital workflows could contribute to improved patient treatment.

The pioneering quartet

Prof. Werner H. Mörmann – Dentist and inventor of CEREC – designed the CEREC system with his team.
Dr. Norbert Thiel – Chemist and materials scientist – played a crucial role in the development of VITABLOCS.
Dr. Joachim Pfeiffer – Physicist and Head of the CAD/CAM Division – led the continued development of CEREC at Siemens Dental (later Sirona, then Dentsply Sirona).
Dr. Bernd Reiss – Dentist and pioneering user – was the first practitioner in the world to use the CEREC system in his dental practice.

The birth of an idea – from the vision to the mission

It all began with the search for an alternative to amalgam; at the end of the 1970s, amalgam fell into disrepute as a material for fillings. "I recognized the urgency and felt that it was my duty to find a solution", writes Prof. Werner H. Mörmann in his book [1]. It seemed to him that ceramic was a suitable material for fillings because it was similar to tooth substance in terms of shape, shade, and physical properties. "The traditional technique of firing inlays or crowns in layers from feldspar ceramic powder was not suitable for treating a tooth in a single session." A workflow needed to be developed for shaping fillings from sintered ceramic and to make ceramic a material that could be processed by dental practices. This was around the time that the first computers for home use were launched by Apple and the first personal computer was launched by IBM. "The advent of computer technology for personal use was what made rapid, computer-aided fabrication of ceramic tooth fillings possible", says Prof. Mörmann. The idea of a machine for ceramic restorations was born and the age of digital dentistry had arrived.

We called it CEREC, an acronym for CERamic REConstruction.

In 1980, Prof. Mörmann convinced his friend and colleague Dr Marco Brandestini to join forces on the topic. Image capture, software, milling techniques – together they developed a system that measures the tooth cavity optically, constructs a virtual inlay and mills it from ceramic. "We called it CEREC, an acronym for CERamic REConstruction, and founded a company called Brains to manufacture the devices and launch them on the market." The first ceramic inlay was fabricated in 1985 (material: VITABLOCS). However, before this method could become established among dental specialists, Professor Mörmann first had to combat a great deal of skepticism. With his unshakeable belief in the idea, he eventually managed to have the CEREC method recognized by the Faculty of Medicine at the University of Zurich, and at the Academy for Dental Training in Karlsruhe, as well as worldwide.

Prof. Dr. Mörmann (r.) and Dr. Brandestini (l.) at the CEREC Symposium 2009

<p>Prof. Dr. Mörmann (l.) and Dr. Brandestini (r.) present the CEREC 1. The milling test with self-made block ceramics made of VITAdur alpha was still made on a prototype.</p>

Prof. Dr. Mörmann (l.) and Dr. Brandestini (r.) present the CEREC 1. The milling test with self-made block ceramics made of VITAdur alpha was still made on a prototype.

The technical concept of the Cerec system from the patent specification of 1980

CEREC: The power of an idea

"The time had come for digitalization of dentistry," says Dr. Joachim Pfeiffer, remembering when he first heard of CEREC. The physicist, who specializes in optics and laser physics, was working for Siemens Dental (later Sirona, then Dentsply Sirona). "We were following the activities of Prof. Mörmann and other pioneers with interest." Siemens was impressed with CEREC as a concept, and a groundbreaking decision followed. Siemens bought the licenses for CEREC and was ready to invest heavily in its development. The crucial factor was the clear vision behind the machine. "We knew that with enough development effort, the performance capacity of the system could be increased enormously, step by step. This was a task that fascinated me," says Dr. Pfeiffer. When he started with the technology, a CEREC prototype was available. Prof. Mörmann also remained closely involved with the development steps and marketing activities that followed. "His perseverance, vision and political savvy were admirable."

Dr. Joachim Pfeiffer

Physicist and Head of the CAD/CAM Division – led the continued development of CEREC at Siemens Dental (later Sirona, then Dentsply Sirona).

Hurdles and milestones

Given the intuitive handling of today's CERECs, it's hard to imagine the numerous hurdles that had to be dealt with during the development journey. Sticking with it was probably the biggest challenge that the team had to face together – inventor, technology partner, and material partner. "We motivated each other and believed in what we were doing." One small anecdote that the pioneers still remember: "Dentsply also developed a milling ceramic block for CEREC at the time (Dicor MGC, Machinable Glass Ceramics). However, the company quickly discontinued their efforts with the technology due to low sales." VITA Zahnfabrik persevered, and with VITABLOCS, offers a high-quality material that remains established on the market to this day.

The time had come for digitalization of dentistry.

There were a lot of technical challenges that required exploration and research. To begin with, the CEREC camera created individual images. "The image capture chips had a resolution of 250 x 250 dpi." For comparison: The cameras in modern smartphones have between 10 to 40 megapixels; in other words, several million dpi. Milling was also subject to several iterations of development. "Initially, a relatively large grinding disc was used. We wanted to use small power files to create different shapes, while maintaining the same durability and performance in terms of material removal. That requires complex, intelligent control," explains Dr. Pfeiffer. The software was also very challenging. To begin with, affordable computing capacity could not display irregularly shaped surfaces in 3D. Two-dimensional cross-sections had to be used. The dentist really needed to understand technology to use the 2D software." In the early 2000s it was finally possible to switch from 2D to 3D modeling. This was a milestone; Now the technology finally found widespread application. There were a number of technological breakthroughs. Other manufacturers entered the market. Important CEREC milestones included an improved acquisition unit. "After the need to use scanning powder for a long time, the powder-free Omnicam was the next big step." And the transition was made from a flawless camera for individual images to video mode.

So, what does the future have in store? According to Dr. Pfeiffer: "CEREC is already at over 90% on the development trajectory. The system is well established and meets the needs of its users. Of course, 3D cameras could always be faster, smaller and easier to use, and the potential of the CAD software is also considerable. Fully-automated fabrication is realistic; here, AI technology will play an important role."

VITA Zahnfabrik showed foresight, remaining grounded but with a visionary approach.

Prof. Mörmann's brilliant invention was the engine behind digital dentistry. However, material development also played an important part, as Dr. Pfeiffer emphasizes. "The group of inventors were smart enough to look for the right material partners right from the start. And VITA Zahnfabrik showed foresight, remaining grounded but with a visionary approach."

VITABLOCS: The future's already begun

A chance meeting shaped the course of CEREC history. In 1984, Prof. Mörmann and Henry Rauter (Managing Director of VITA Zahnfabrik) met at a symposium. Prof. Mörmann was looking for a company that manufactured industrially-fabricated ceramic blocks. Henry Rauter was immediately taken by his pioneering spirit. At the time, VITA Zahnfabrikalready had experience with ceramics, so with extensive ceramic expertise, Dr. Heinz Claus developed the experimental CEREC block material. It corresponded to the VITABLOCS feldspar ceramic, in terms of its structure. In 1985, it was possible to fit the first CEREC inlay made from VITABLOCS intraorally in a patient. Just a short time later, the chemist Dr. Norbert Thiel began working at VITA Zahnfabrik. His focus was inorganic chemistry. "When I heard about CEREC, I was fascinated. The charisma and power of persuasion of Prof. Mörmann when presenting his vision was truly compelling. I could feel that this idea could change the world of dentistry," remembers Dr. Thiel. Today he says: "The opportunity to collaborate on such an impressive and historic development was incredibly motivating. I am thankful and proud to this day of my friendly relationship with Werner Mörmann – as far as I am concerned, he really is a visionary. And Dr. Pfeiffer from Sirona is also one of the bright minds who made CEREC what it is today."

Dr. Norbert Thiel

Chemist and materials scientist – played a crucial role in the development of VITABLOCS.

When I heard about CEREC, I was fascinated. The charisma and power of persuasion of Prof. Mörmann when presenting his vision was truly compelling. I could feel that this idea could change the world of dentistry.

Today, VITABLOCS are available in three versions. The first VITABLOCS range at the introduction of Cerec still looked different.

Development: a balancing act

Further development of the VITABLOCS ceramic presented significant challenges. "The requirements seemed to conflict with one another. The goal was a material that offered optics similar to dentition and that could be easily milled – strong enough for restorations, yet soft enough that it could be machine-processed in the dental practice," says Dr. Thiel. The material scientists found themselves performing a balancing act. There was close collaboration with researchers from MIT (Massachusetts Institute of Technology). They also tried to develop a ceramic block material. "We were thinking along the same lines." It was clear that the material had to be more finely granulated. The goal was to develop a ceramic block with the esthetic quality of the first generation of VITABLOCS (chameleon effect), but with a much finer structure. With consistent development work, VITABLOCS Mark II was brought to market maturity.

Finding the balance

The big innovation was the fine, integrated structure. This created an even balance between strength and good milling properties. "The finer structure also made it easier to process." In addition, abrasion of the antagonists was significantly reduced. What didn't change was the outstanding esthetics of the material. The secret of VITABLOCS Mark II is the fine structure. "But without the adhesive technique, it wouldn't have worked. It was a stroke of luck that the University of Zurich also conducted research on the adhesive technique," adds Dr. Thiel. Success came with clinical use and remains impressive to this day. "Complaints were incredibly rare, even though millions of units of VITABLOCS Mark II were sold."

Simply unparalleled

Has VITABLOCS achieved its goal? For Dr. Thiel, it's clear that VITABLOCS is the ideal material for single-tooth ceramic restorations. "I have often thought about whether and how we could still improve the product. But in the end, it would always be a poor compromise." As a finely-structured ceramic, VITABLOCS Mark II is ideally suited to single-tooth restorations and offers the right balance of esthetics, strength and easy processing. The basic formulation is still unchanged today, and the material remains state-of-the-art.

In the dental practice: CEREC and VITABLOCS make a perfect team

This is confirmed by Dr. Bernd Reiss. He has been working with CEREC and VITABLOCS for more than 35 years. "At the time, the world was completely different," says the dentist from Malsch in Baden-Württemberg, remembering when he met Prof. Mörmann in 1983. When dentists were being recruited as testers in 1987, he was immediately enthusiastic. And that's how the first private dental practice in the world to work with CEREC came to be in Malsch. Dr. Reiss wasn't so impressed by the computers, as by the choice of material and the indications. "It was always my goal to work in accordance with the defect," he explains. CEREC and VITABLOCS offered an alternative to conventional workflows – a ceramic filling that could be fabricated in the dental practice and adhesively bonded with the tooth. Suddenly the rules of the game had changed. "It was possible to fabricate a workpiece in a standardized way, in which properties similar to dentition were 'built in'.“ At the time, VITABLOCS was already offering opacity that was a mixture of enamel and dentin. And the patients were enthusiastic too: "… it feels like a real tooth."

Dr. Bernd Reiss

Dentist and pioneering user – was the first practitioner in the world to use the CEREC system in his dental practice.

Dr. Reiss actively contributed to further developments as an alpha tester and as a beta user. "I was the worst-case tester because when it came to computers, I was all thumbs," he laughs, looking back. His work was enriched enormously by CEREC. The adhesive technique was the basis for good, long-term success, because at the time, CNC techniques were not as precise as they are today. "Sometimes, macrofill in a composite bath was called a CEREC inlay." The large marginal gaps worried him initially. "… but the adhesive materials were so good that marginal gaps did not present a problem." Right from the start, VITA Zahnfabrik took the broader view beyond the restoration material. The focus wasn't just fabrication of a workpiece, but the actual clinical concept. Collaborations were established with regard to adhesive bonding materials. Preparation instruments, scan spray, grinding discs … – it was possible to offer tailored accessories for CEREC and VITABLOCS.

State of the art: "We've been working with CEREC and VITABLOCS for 34 years"

The impressively high success rates show that the right approach was taken. To this day, numerous studies, for example by Dr. Bernd Reiss [2], demonstrate a high success rate. Today, single-tooth restorations prepared in accordance with the defect are the "bread and butter business" in his dental practice. Feldspar ceramic is used in around 70 percent of cases. "If natural enamel covers the tooth, then VITABLOCS is my material of choice – inlays, onlays, table tops, etc." The chameleon effect is remarkable. "We can achieve wonderfully esthetic results with properties similar to enamel," says the dentist.

"Today we have blanks for many CAD/CAM systems."

One person who was involved in dental CAD/CAM technology at VITA Zahnfabrik, almost from the very beginning, is Hartmut Kimmich. This trained dental technician has been a product manager for CAD/CAM materials for over 30 years and says: "Looking back, the history behind the development is truly impressive. Despite numerous hurdles and challenges, we firmly believed in the CEREC technology, and the incredible success is a validation of that. At VITA today, we have a large range of blanks for different closed and open CAD/CAM systems."

Statement from Prof. Werner H. Mörmann in 2021

Prof. Werner H. Mörmann

Dentist and inventor of CEREC – designed the CEREC system with his team.

"Prefabricating ceramic as a block and then milling the restoration from that in a matter of minutes using computer-aided technology was the idea behind the CEREC patent. The first blocks that I fired in 1982 using VITADUR Alpha, proved that perfect restoration quality can only be achieved if factory-produced ceramic is used. VITA's achievements in terms of durability, abrasion properties and natural shade effects, have been exceptional for almost 35 years, particularly with VITABLOCS, ENAMIC and zirconia blocks. For this, I'd like to offer my warmest congratulations to the VITA CAD/CAM team and to VITA Zahnfabrik as a company."

Are you interested? Click here and find out more:

[1] Mörmann, W. "Werner Mörmann's CEREC Story". www.moermanncerecstory.com
[2] Reiss B. Clinical results of Cerec inlays in a dental practice over a period of 18 years. Int J Comput Dent 11-11, 3/2006