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 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 CAD/CAM (Computer-Aided Design and Manufacturing) fixed 

prosthesis : current situation in Madagascar 

Research article 

LALANIRINA Gaël Lauricia 1, ALIJAONA Diarivalisoa Faneva1, 

RAZANADRAISOA Albertine 1, ANDRIANASOLO Volahasina Valentina 1,  

RANAIVO Joachim Marco 1, RANDRIANARIVONY Jeannot 3 and 

RALAIARIMANANA Liantsoa Fanja Emmanuel 1 

1Department of Dental Prosthetics - Institute of Tropical Odonto-Stomatology of 
Madagascar – University of Mahajanga – Madagascar 

2 Director of the Institute of Tropical Odonto-Stomatology of Madagascar, 

Department of Dental Prosthetics 

Corresponding author : Lalanirina Gaël Lauricia 

Dentistry Department, PZaGa University Hospital Center, Mahajanga 

Department of dental prosthesis, Institute of Tropical Odonto-Stomatology of 

Madagascar (IOSTM) 

Abstract  

CAD/CAM or Computer Aided Design and Fabrication is a technique used 

in dentistry to design and fabricate crowns, bridges and veneers in fixed 

prosthetics. This approach enables good prosthetic results to be achieved, and is 

highly practical and comfortable for both odontostomatologists and patients. The 

aim of this study was to describe the knowledge and practice of CAD/CAM fixed 

prosthodontics in the cities of Fianarantsoa and Antananarivo. 

It was a descriptive cross-sectional study involving 81 registered 

odontostomatologists who agreed to take part in the survey, and those who passed 

through the study sites, did not fill in their forms correctly and had never heard of 

CAD/CAM were excluded. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

The results showed that 35.8% of odontostomatologists were familiar with 

CAD/CAM and 11.1% of them used it for the fabrication of fixed prostheses such 

as single crowns (100%), inlays, onlays and veneers (88.8%) and multi-unit 

restorations (55%). Indirect CAD/CAM was most widely used (100%), and its use 

was highly correlated with participation in specific CAD/CAM training courses 

(p=0.000) and knowledge of CAD/CAM (p=0.001). Practitioners stated that this 

system offered time savings and improved ergonomics. 

We therefore suggest that odontostomatologists attend regular training 

courses to keep abreast of technological advances. The installation of this system 

at the CHU and the dental school in Madagascar could improve this situation. 

Key words: CAD/CAM, fixed prosthesis 

Introduction  

CAD/CAM, which stands for computer-aided design and manufacture, 

encompasses all the equipment used in the field of dentistry by the digital chain, 

from modelling to the manufacture of dental prostheses [1]. In fixed prosthetics, 

CAD/CAM is used to produce inlays, onlays, veneers, crowns, inlay-cores and 

bridge frameworks, and to improve the precision of fit. According to a 2014 study, 

prostheses fabricated by machining have a more accurate and better marginal fit 

(48 ± 25μm) compared to conventionally fabricated prostheses (74 ± 47μm)[2].The 

improvement in the quality of conjoined prostheses comes from the 

reproducibility, reduction and simplification of shaping steps. 

Today, many dental practices and laboratories are equipped with this 

CAD/CAM system to produce dental prostheses. In France, only 3% of dentists 

have adopted a fully digital dental practice, according to JF Choura [3]. The rate 

of CAD/CAM use was 40%, of which more than half of these practitioners owned 

a machining centre in 2017[4]. 

In Switzerland, a survey of members of the Swiss Dental Association 

revealed that 23% of practices surveyed were equipped with a chairside 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

CAD/CAM system [5]. In addition, a survey of US Navy dental clinics and 

laboratories confirmed that, as of June 2017, more than a third of indirect 

restorations supplied (38.1%) were fabricated by a CAD/CAM system [6]. 

Clearly, many advances and innovations will flow from this technique. 

However, few studies have been conducted on CAD/CAM in Madagascar. We 

hypothesized that the transition to digital prosthodontics represents a delicate 

transition for odontostomatologists in Madagascar. The overall aim of this study 

was to describe awareness and practice of the CAD/CAM system for fixed 

prosthetics in the cities of Fianarantsoa and Antananarivo. 

Methodology  

Study location : this study was carried out in dental practices in the cities of 

Fianarantsoa and Antananarivo. 

Type of study : this is a cross-sectional prospective descriptive study.  

Study period : the survey was conducted over a 6-week period, from June 12 to 

July 21 -2023.  

Study population : the study population consisted of all odontostomatologists in 

the cities of Fianarantsoa and Antananarivo. 

Inclusion criteria : registered odontostomatologists who cooperated with the 

survey. 

Exclusion criteria : odontostomatologists passing through the study sites, who 

had not correctly filled in their forms and had never heard of 

CAD/CAM were excluded.  

Sample size : our sampling was exhaustive, with a sample size of 81 

odontostomatologists. 

Studied variables  

The following independent variables were taken into account in this study: 

- gender, 

- age group, 

- length of practice, 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

- practice area, 

- type of fixed prosthesis used 

- type of CAD/CAM. 

The dependent variables were as follows: 

- odontostomatologists' knowledge of the CAD/CAM system  

- odontostomatologists' use of the CAD/CAM system.  

Data collection 

In Fianarantsoa, data were collected using a questionnaire-interview survey 

of odontostomatologists. In Antananarivo, however, the distribution of the forms 

was entrusted to a trustworthy person, supported by a telephone call to introduce 

him/herself to the odontostomatologists; the survey was carried out by self-

administration, i.e. we collected the survey forms when the odontostomatologists 

had already filled them in. 

Data processing and analysis 

The data collected were entered on the computer using Microsoft Word and 

Excel. Statistical analysis was performed using SPSS 20.0 (statistical package for 

the social science) on Windows. Descriptive statistics presented the 

characteristics of participating odontostomatologists, and frequency tables were 

generated to illustrate responses to questions. The chi-square test was used for 

bi-variate analysis, and a p-value of less than 0.05 was considered significant. 

Ethical and deontological considerations 

Authorization to carry out the survey was granted by the Institut d'Odonto-

Stomatologie Tropicale de Madagascar and the Ordre National. 

Odontostomatologists who gave their consent were surveyed. The confidentiality 

of data and the anonymity of respondents were respected throughout the study. 

Conflict of interest : none 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

Results 

Table I : distribution of odontostomatologists by socio-professional profile 

Socio-professional profile Effective 

(n) 

Proportion 

(%) 

Gender   

Male 42 51.9 

Feminine 39 48.1 

Age range   

Under 34 29 35.8 

35 and over 52 64.2 

Sector of practice   

Public 23 28.4 

Private 56 69.1 

Military 2 2.5 

Length of service   

Less than 10 years 32 39.5 

11 to 20 years 27 33.3 

21 years and over 22 27.2 

Place of service   

Fianarantsoa 15 18.5 

Antananarivo 66 81.5 

 

Table II : distribution of odontostomatologists according to place of training and 

completion of specific CAD/CAM training courses 

Training Effective 

(n) 

proportion 

(%) 

Training location   

Madagascar 69 85.2 

Abroad 3 3.7 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

Madagascar and abroad 9 11.1 

Total 81 100 

Follow-up to specific CAD/CAM training courses 

Yes 29 35.8 

No 52 64.2 

Total 81 100 

 

Table III : distribution of odontostomatologists according to knowledge and 

practice of the CAD/CAM system 

 Yes 

n(%) 

No 

n(%) 

Total 

n(%) 

 

Knowledge of the CAD/CAM 

system (exact answer on 

types and steps to follow) 

29(35.8) 52(64.2) 81(100)  

     

Practice of the CAD/CAM 

system 

9(11.1) 72(88.9) 81(100)  

If yes, types of CAD/CAM 

practiced 

    

Direct CAD/CAM 2 (22.2) 7 (77.8) 9 (100)  

Semi-direct CAD/CAM 4 (44.4) 5(55.6) 9 (100)  

Indirect CAD/CAM 9 (100) 0(0) 9 (100)  

types of fixed prosthesis         

performed 

    

Full-coverage crown 9 (100) 0(0) 9 (100)  

Partial veneer crown 8 (88.8) 1 (11.2) 9 (100)  

Substitute crown 6 (66.6) 3 (33.4) 9 (100)  

Bridge 5 (55.5) 4 (44.5) 9 (100)  

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

Table I: distribution of odontostomatologists (n=72) who do not use the 

CAD/CAM system, by reason for practice 

Reasons for not using CAD/CAM Effective 

n=72 

Proportion 

(%) 

Lack of training   

Yes 53 73.6 

No 19 26.4 

Financial reason   

Yes 59 81.9 

No 13 18.1 

Profitability problem   

Yes 40 55.6 

No 32 44.4 

Dependency   

Yes 2 2.8 

No 70 97.2 

 

Table V : distribution of odontostomatologists according to the change felt since 

the introduction of CAD/CAM fixed prosthetics (n=9) 

 Yes 

n (%) 

No 

n(%) 

Total 

n (%) 

Time saving 
9 (100) 0 (0) 9 (100) 

Better ergonomics 
9 (100) 0 (0) 9 (100) 

Greater patient comfort 
7 (77.8) 2 (22.2) 9 (100) 

Longer prosthesis life 
7 (77.8) 2 (22.2) 9 (100) 

Greater precision 
9 (100) 00 9 (100) 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                 Lalanirina Gaël Lauricia ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

Better aesthetics 
9 (100) 00 9 (100) 

 

Table II: distribution of OS according to the relationship between fixed prosthetic 

practice and knowledge of the CAD/CAM system 

 

 

CAD/CAM knowledge 

 

Practice of fixed prosthetics with 

CAD/CAM systems 

Yes 

n(%) 

No 

n(%) 

Total 

n(%) 

p 

Yes 

8 (27.6) 21 (72.4) 29 (100) 0.001 

No 1 (1.9) 51 (98.1) 52 (100)  

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Table VII : distribution of odontostomatologists according to knowledge and practice of the CAD/CAM system and training 

 Knowledge of the CAD/CAM 

system 

 CAD/CAM system practice 

 Yes 

n(%) 

No 

n(%) 

Total 

n(%) 

p Yes 

n(%) 

No 

n(%) 

Total p 

Training location         

Madagascar 18 (26.1) 51 (73.9) 69 (100) 0.000 7 (10.1) 62 (89.9) 69 (100) 0.457 

Abroad 3 (100) 0 (0.0) 3(100)  1 (33.3) 2 (66.7) 3(100)  

Madagascar and abroad 8 (88.9) 1 (11.1) 9 (100)  1 (11.1) 8 (88.9) 9 (100)  

 

Specific training in CAD/CAM 

    

Yes 6 (100) 0 (0.0) 6(100) 0.001 9 (64.3) 5 (35.7) 14(100) 0.000 

No 23 (30.7) 52 (64.2) 75 (100)  0 (0) 67 (100) 67 (100)  

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Discussion  

In this scientific study, we surveyed 91 odontostomatologists, including 15 

(18.5%) in Fianarantsoa and 66 (81.5%) in Antananarivo, to describe their 

knowledge and practice of CAD/CAM in fixed prosthetics.  

 Socio-professional profile of odontostomatologists   

    The study reported a higher proportion of males (51.9%), with a sex ratio 

of 1.07. This is in line with the study by Guinan JC et al, who found a value of 

56.7% in 2022 in Côte d'Ivoire[7]. We can say that even if all 

odontostomatologists had access to the same CAD/CAM tools and software, men 

were more likely to use new technologies to design and manufacture fixed dental 

prostheses. 

     Sixty-four point two percent (64.2%) of respondents were over 35, with an 

average age of 44.5. This result is similar to that of Hélène N in 2022, where the 

over 33 age group was predominant, with a rate of 62.5%[8].  

     Sixty-nine point one percent (69.1%) of respondents worked in private dental 

practices and 28.4% in public dental practices. This is justified by the fact that 

experienced graduates tend to promote the opening of their own private dental 

practices. These results are similar to those of Amrani Alaoui et al in Morocco in 

2022, who reported that 56% of respondents worked in private dental practices 

and 30% in public dental practices[9]. 

    Most Odontostomatologists (39.5%) had been practicing for less than 10 years.

 Similar assertion, a study conducted by Mbede Net al, in 2022, in Yaoundé 

showed that 63% of OSs had been practicing for less than five years [10]. 

    Nearly all participants (85.2%) received their initial training in Madagascar, 

and only 14.8% obtained their diploma abroad. Not only for financial reasons 

(tuition fees, cost of living), but also because of geographical distance, 

odontostomatologists may be discouraged from pursuing their studies abroad. 

Whereas in Romania, according to a study published in September 2017, a third 

of OSs graduated abroad [11]. 

 

 

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 Knowledge of the CAD/CAM system for fixed prosthetics 

Of those surveyed, only 35.8% knew exactly what the CAD/CAM system was 

(type of CAD/CAM and the steps involved in producing fixed prostheses using 

this system) (Table III). This could be explained by the fact that knowledge of 

new technologies depends on the availability of such training and awareness in 

the country. In addition, some odontostomatologists wanted to use more 

traditional methods in their practice. This rate of knowledge remains very low 

compared to that of Janani in 2018,who revealed that in France, all practitioners, 

declared 100% knowledge of CAD/CAM regardless of their geographical 

location[12]. 

Knowledge of the CAD/CAM system is very significantly linked to 

participation in specific CAD/CAM system training ( p=0.001) and highly 

significant with training location with a p=0.000 (table 8). Training enables staff 

to acquire new knowledge in order to improve their practice. This result 

corroborates with the study carried out in 2017 in France, where one practitioner 

in two had undergone specific CAD/CAM training [13]. 

 Use of the CAD/CAM system in fixed prosthetics 

In this study, 11% of dental surgeons used the CAD/CAM system in fixed 

prosthetics, while 89% of dental surgeons surveyed said they did not. This rate of 

non-use of the CAD/CAM system in this study is very high compared with a 

study carried out in the UK, where only 55.6% did not use CAD/CAM [14].  

According to practitioners who were not CAD/CAM users, the main obstacles 

to CAD/CAM were high costs (81.9%), lack of training for 73.6% of OS; 

profitability problems (55.6%) and dependency (2.8%) (Table IV). The adoption of 

new technologies could take time and depend on various factors such as access to 

training, resources and individual preferences. This result corroborates with that 

of Petridis in 2016, who argued that in the UK, various reasons explain why 

some practitioners did not use CAD/CAM, but the majority reason was the cost of 

CAD/CAM machines and lack or absence of training for 55.6% of participants 

[14]. 

For dental surgeons using the CAD/CAM system, the indirect technique was 

the most widely used for the design and manufacture of their fixed prosthesis 

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(100%) (TableIII). This means that ownership of CAD/CAM equipment in the 

dental practice is low. These results are at odds with that of Jananien 2018, 

where 25% of practitioners produced their prosthesis by CAD/CAM indirectly[12]. 

However, the indirect technique only concerns the laboratory part, and does not 

change the daily practice of odontostomatologists. Indeed, many 

odontostomatologists who are not CAD/CAM users may have practised indirect 

CAD/CAM without being aware of it. This bias may have distorted the survey 

results. 

The total (100%) and partial (88.8%) veneering crown, the substitution crown 

(66.6%) and the bridge (55.5%) were fabricated using the CAD/CAM system 

(Table III). These results are in line with those of ElkriefM in 2017, where 88% of 

practitioners used it for fixed unit prosthetics, 59% for fixed plural prosthetics 

and 56% for restorative dentistry such as inlays, onlays and veneers[4]. Another 

study conducted by Fabry J in 2018 reported that, in terms of clinical application, 

98% of the Odontostomatologists surveyed used chairside CAD/CAM for the 

fabrication of single-unit prosthetic crowns and for inlay and onlay 

restorations[15]. 

All practitioners confirmed that using the CAD/CAM system in fixed 

prosthetics offers time savings, improved ergonomics, prosthetic precision and 

also better aesthetics. Seventy-seven point eight percent (77.8%) of 

odontostomatologists added that CAD/CAM improved patient comfort and 

prosthetic longevity. These advantages were also reported by Janani et al. in 

their study, albeit to a lesser extent[12]. 

The use of CAD/CAM in fixed prosthetics was strongly correlated with 

participation in a specific training course (p=0.000) and knowledge (p=0.001) of 

this system (table 6).This could be explained by the fact that it is continuing 

education that enables odontostomatologists to keep up to date with technological 

advances and to understand the best practices and protocols recommended for 

achieving optimal aesthetic and functional results with dental CAD/CAM. The 

lack of willingness to train in new dental technologies may partly explain the 

reduced presence of CAD/CAM in dental practices [16]. 

 

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Conclusion  

CAD/CAM is a technology that combines the use of intra-oral scanners, 

computer-aided design software and a machine to produce dental prostheses. It is 

an undeniable advance in the daily practice of odontostomatologists, and this 

study has examined the case of Madagascar in relation to this technology.  

The majority of odontostomatologists in Fianarantsoa and Antananarivo are 

still less familiar with and practise CAD/CAM. However, working with this 

system is simpler, faster and more efficient. The odontostomatologists who used 

them produced all kinds of fixed prostheses, in the same way as elsewhere.  

In Madagascar, the major obstacle to the use of CAD/CAM is the investment 

required to set it up, not to mention the training time needed to master the 

technique. This obstacle is not irreversible, however, as the price of the machines 

will evolve in the same direction as any IT system, and prices will become 

attractive.  

The future of CAD/CAM in dentistry is promising, as this technique offers 

many advantages to odontostomatologists. The integration of CAD/CAM 

equipment into public health establishments and dental schools in Madagascar 

will facilitate access to digital technology for practitioners and students, ensuring 

better patient care in fixed prosthetics. 

 

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3. Celo D. Dental CAD/CAM: a global vision [Internet]. 2018 [Accessed 

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