Posted on Leave a comment

Tips About Filling Out Rx Form for CAD Program From Meditlink

For advanced users of meditlink software, you can skip filling out the Rx form and go straight into scanning.  But make sure to properly fill out the CAD Rx form so that all the necessary models are imported into the design software.  If you don’t designate the opposing or the Pre-op / Wax-Up in the form, they will not be part of the design equation.  Also, this video shows how to select multiple restorations at once.

video
Filing Out Rx Form for CAD
Posted on Leave a comment

How Medit’s AI Killed The Tibase Scanbody Star!

here is a list of why the Medit Artificial Intelligent Implant Suprastructure Identification System is significantly more advantageous over all other cadcam systems.

  1.  It s technically a crown and bridge case and the implant location or timing does not matter
  2. You can find margins outside the mouth!  See the first video to appreciate the significance of this
  3. You don’t have to deal with retraction or hemostatis at all
  4.  You don’t have to worry about sprue position. Many other systems force the placement of the sprue to a specific location often making the case more difficult to manage than necessary
  5.  you are not limited to just a few implant lines
  6.  you don’t have to worry about location of anti rotational notch
  7.  you can digitally alter the prep and get a virtual reduction coping in cad
  8.  Use any restorative block you want.  There is no need to order special blocks with pre-fabricated access channels and keep a large inventory of many colors. Your regular block inventory will suffice.  Just make sure the top of the tibase is wider than the diameter of the drill used to mill out the intaglio.  Also, the CAM and the milling machine determine the exact product and different settings maybe utilized to give you relief off the walls.  Some will even remove the antirotational notch because the adaptation is so tight, the restoration will not rotate due to the tall walls of the tibase
  9.  You can check the fit outside the mouth on the same tibase or a one you keep chairside for every case to let you know that if you are not seating, it is clearly a contact or contour issue as opposed to an intaglio issue.

 

video
Digital Tibase - Medit's AI Feature

video
Fit of Tibase to Milled Restoration

With Medit’s Crown Fit function, you can see exactly how much cement is required to seat the restoration and how well it is adapted to the tibase.

video
Medit Crown Fit
Posted on Leave a comment

Chairside Milling of Lithium Disilicate with Meditlink 2.3 and Medit Scan

This article features the new Meditlink 2.3 software which has some advanced functionality.  One of the greatest achievements is he ability to tell the scanner to avoid imaging certain colors like green and blue.  This greatly facilitates the imaging of full arches as you can let your gloves / fingers guide the camera and displace all the soft tissue that impedes image capturing.  We also feature how easy it is to launch CAD software to design the restoration and mill it out of lithium disilicate material

Case set up:  here we enter the patients name and a simple tab appears where we chose the material and restoration tab. Once you image, you can place an order to the lab or you can advance to the CAD tab:

video
Setting up a case in Meditlink 2.3

After the Rx has been filled out, you can launch the Medit Scan and image the upper and lower arches. Please note how we tell the camera to avoid the color blue and it ignores the clinicians fingers during imaging. The upper jaw and lower jaw were captured, then the bite registration even before the preparation was finished.  This allows the verification of proper reduction and space for the ceramic material

Lower Arch Scan

The lower arch is the most difficult area to scan as you frequently have to battle the tongue, saliva, and the lips. The optragate can be of great help but notice how we use the color filter to hide the blue gloves while we advance the camera.  It is a great aid in facilitating the capture of the lower arch

video
Scan of Lower Arch

Upper Arch Scan

The same principle is applied to the upper arch. Notice that the software does not care if you start with the upper or lower arch. Here, you can visualize how the blue glove was used to displace the cheek and capture the pre-op condition of the upper second molar. The rest of the arch was easily imaged. It is not necessary to capture full arch impressions and this was done just for demonstration purposes. For a single unit case, generally imaging distal from the canine is adequate.

video
scan of upper jaw (pre-op) in just a minute

 

Checkingthe reduction and aquiiring the bite registration

We recommend that you capture the bite before you finish imaging the preparation. This gives you one last chance to verify that you have reduced enough to accommodate material thickness.  You can see how we just take regular photos to document the lack of clearance and we continue to adjust the height of the preparation until we achieve the required space. We then activate the imaging process and capture the occlusal relationship between the upper jaw and the lower jaw

video
Always check reduction before taking final bite

 

Image the preparation and place margin in native MeditScan Software that transfers to CAD Software

The preop condition is then transferred to the arch model and the tooth in question is cropped out. The rest of the arch is protected so no extra data is added unnecessarily to the equation.  This protect feature is used for demonstration purposes and is subsequently removed. The prep in question is then highlighted and the local area is processed and the margins are placed.  This margin line can be sent to the lab or it can be automatically carried to the design software

video
image prep and place margin

Launch CAD Software

The Meditlink software allow you to launch a variety of CAD programs that include 3shape, exocad, cerec, etc… Here we launch exocad which automatically imports and aligns the models and marks the margins. The restoration is then designed to completion.

video
Easy launch to CAD software

Design of restoration

The CAD software allows you or the lab  to alter the marked margins if necessary. The restoration is aligned in the arch for and the contacts are adapted to the adjacents and the oppising

video
Quick launch of CAD software and Design

You can take the designed restoration to ANY milling machine or printer

video
Print it if you want

Milling of Lithium Disilicate with Imes Icore Coritec One

The final restoration design can be exported as an stl and taken to a variety of mills or printers.  Here we designed it millbox and milled with the coritec One.  The material used was Amber Mill and it was crystalized and seated

video
Amber Mill Size 12 block for molar crown mill

Post-op X-ray

Final X-ray was taken to verify the fit and to make sure no excess resin was left behind

video
Checking for Excess Resing Cement
Posted on Leave a comment

Prep Sequence for Easy Access

The following pictures depict the sequence of burs we recommend that you use to finish a preparation quickly. While patient is getting numb, take a quick look at the clearance you will need to reach proper material thickness. Once the quadrant is isolated with isolite and optragate, take an occlusal router bur and create a trough to gain the proper depth. Follow that with a flat disk, and you can quickly reduce the occlusal height.

A shoulder bur of .8 mm thickness can help you reduce the interproximal areas as well as the buccal and lingual margin lines. Before finishing the prep, place hemostatic agent like expasyl in the sulcus and place retraction cord. while it is setting, check your reduction. If you need more space, now is the time to reduce some more.

Once you have adequate clearance, retraction, and hemostatis, you can readily image and find your margins in the CAD software

 

video
Prep Sequence for Easy Access
Posted on Leave a comment

Full Arch Prosthesis – Current “Real World” Information


I am not one to place much faith in published articles from academicians. I usually draw my information from trusted colleagues and also a very reliable source, Mr. Andrew Sedler, from Advanced Technology Centers in Burbank California. He is in charge of manufacturing thousands of full arch restorations for clinicians and many other labs that outsource their manufacturing.

One of the things I always get a kick out of is whenever they do purchase technology or implement a process, they always have to do it with redundancy. What that means is that their machines can never go down for whatever reason, so they always purchase printers and mills by multiple sets. Interestingly, I was witness to them incorporating printers into the lab about 6-7 years ago and now they have a large wing dedicated to printing with over 20 machines for many different purposes.

I trust his judgement and always follow his recommendation and tested methods. When he says “do not bypass verification jigs, no matter what scanner was used”, I don’t even question it. He sees all the cases many entities can’t manage and he can manufacture any screw, prosthetic, abutment, etc… with their high end milling machines. In fact, it was on his word alone we decided to distribute the ICam4d by imetric.

I thought it would be a good idea to revisit full arch implant restorations with him and see what the state of the industry is like today and what he would recommend for the end users and patients. A very good perspective for a clinician to keep is how a simple mistake or misunderstanding can wipe away all the profit margins for a lab and even for the clinician. A simple example is if you have to correct an angulation issue on an abutment which can dramatically impact the costs of the lab work.

Here is the Q/A session:

“Hi Andrew, I am writing an article on full arches and would appreciate some info”

  • what % of the full arches that docs order from you are zirconia on tibases only at implant sites?
  • what % are on titanium bars?
  • what % are hybrids with acrylic?
  • what % are MUA vs Implant level?
  • what is the most prescribed full arch prosthesis now compared to 5 -10 years ago?
  • what % are soft tissue level vs bone level / mua level?
  • what would you do for yourself?
  • which one has the most failure rate?
  • how often does zirc framework break?
  • how much damage do you think people do to zirconia frameworks while trying to mill it to sharp corners of tibases?

Answers:

  1. MUA vs IMPLANT LEVEL : over 90% of upper arches will have MUA and 60 to 70 % of the lower arches will have MUA
  2. BONE LEVEL vs TISSUE: majority of implants (90% and up) bone level that requires MUA .
  3. The most failure rate in order is (all of these in respect to the material limitations ):
    • the traditional acrylic hybrid
    • composite hybrid next
    • zirconia monolithic
    • and the least breakage will be zirconia hybrid supported by metal frame
  4. Zirconia failure is around 4 to 5 %  (adding the internal lab remakes – i would say another 3 to 4 %)

The damage caused by adjusting the zirconia could be very considerable, especially around the access hole since those areas are thinner than the full teeth .  For myself i would restore zirconia over metal frame if my choice is hybrid, while removable bar overdenture will be a more predictable and more hygienic choice .

Posted on Leave a comment

Single Click Launches Shining3D CAD Program

Shining3d has a projector and a single camera that takes photos of the surfaces it is scanning. at first, you may think this is a shortcoming, but in many ways, it dramatically reduces errors a new user can introduce.

in the early days of cerec, all you needed to do was capture the margins and the area above the height of contours of the adjacent teeth. This made the try-in and the contacts really easy as the design software just dropped straight a straight wall down to make contacts to. same concept here!

also, after you image and place margins, A SINGLE CLICK takes you to design software where you can finish the case and mill it right away.

video
shining3d single click launch into CAD software
Posted on Leave a comment

Coritec One Mill Times with Icam (Millbox) Update Spring 2020

video
shape of first molar crown

This molar’s suggested mill times with the MCXL are for either Size 12 or 14 blocks:
Sprue on distal in normal speed mode is 14:05 minutes, fast speed at 7:54
Sprue on buccal in normal speed is 13:48 minutes, fast speed at 7:46

This molar would only fit in a size 14 block of Amber Mill in Imes Icore Coritec
Sprue on distal in normal speed mode is 14:15 minutes, sprue on buccal in normal speed is 14:42 and speed crown is proosed at 13:23

 

 

Posted on Leave a comment

Two distal extension molar crowns and one milling machine for single visit dentistry

For our advanced users who mill in house or what to speed up their digital impressions we advocate taking advantage of digital dentistry’s unique features that allow you to take impressions over a period of time and segments, building larger models over different sequences and time. In this particular case we have two molars in the lower left quadrant that warranted replacement.  The traditional method would be to prep both, isolate both, retract both, and take your final impression, but we will approach this as if there are two separate patients involved

video
Case Presentation on how to manage two crowns with a single milling machine

For the second molar, we will take advantage of the anesthesia time and capture the first bite, the opposing, the pre-existing situation and then crop out the preparation area digitally.  Once the tooth is prepared, we will check for proper reduction.  We will then take the second bite to verify the vertical dimension has not changed.

video
Second molar crown preparation with two bites

While the second molar is being designed and milled in the first case, we will launch a second window by cloning the first case.  All the data remains the same and this time we crop out the first molar digitally and protect the rest of the arch.  Once the first molar is isolated, it is digitally captured and then designed and milled.

 

video
image first molar while second molar is being milled

To manage the contact between the two crowns, there are many advanced applications.  Here is a simple explanation of how we use the prep model from case 1 as the pre-op model for case two.  Since the second molar in case 1 made contact with the distal wall of the first molar, when we design the crown for the first molar in case 2, all we have to do is make sure the distal wall is flush to the pre-op.  This guarantees us a contact between the two.  There are lots of shortcuts to this puzzle once you get the basics of digital impressions under your belt.

video
distal contact of first molar

We quickly printed these same models and crowns just for demonstration purposes

 

Posted on Leave a comment

Milling Tibase Crowns to CEREC MCXL with a Medit Scan and exocad design software

One of the big limitations of CEREC (a registered trademark of denstply sirona) with tibases and implant crowns is that it is limited to very few implant lines and the antirotational notch can just ruin your day as it needs to go into a specific location. You also have to deal with making sure the tibase is seated all the way and the scanbody is properly indexed.   The one benefit is that you are dealing with just crown and bridge and you do not need to know implant position or timing at all when doing the design.

In this case, we demonstrate how we utilize the Medit i500 to capture a Tibase from Blueskybio, Biomax NP Conical Connection.  Once the tibase is seated, we simply start scanning and then use the artificial intelligent implant suprastructure identification system to identify the location of the tibase.  This in essence allows you to capture your margins OUTSIDE the mouth and you don’t have to bother with imaging the tibase, which is highly reflective in the patient’s mouth.

Once processed, you can then modify the tissue digitally and gain access to the tibase margins.  You can print the model if you want and manufacture the restoration. In this particular case, we took the design to the CEREC mcxl inlab cam, nested it, and milled it out to demonstrate how we can image with one device from one manufacturer and fabricate a restoration by another company’s manufacturing machine.  But the single greatest benefit is that you can place the sprue wherever you want.

IMPORTANT NOTE: The Tibase that you use MUST be wider than the drill milling the intaglio and the sprue must be thick enough to handle the milling process.

video
image tibase in medit i500 and mill with mcxl

 

Once you understand how the digital workflow goes, you can image with one device, design in another, and then either print or manufacture with yet another device. Here we mill a sectional stent with the cerec that was designed in Blueskybio plan, although printing makes more sense because it is less wear and tear on your drills

PRODUCTS USED IN THIS CASE:

Posted on Leave a comment

How To Offer Digital Clear Aligner Therapy

Do you want to straighten your teeth but don’t want to pay $5000?
This is how most patients think today.
“I want straighter teeth but I don’t want to go through the pains of an uncomfortable/inconvenient experience or ridiculous price tag.”
Of course you as the clinician first needs to first decide if the case presented is a candidate for clear aligners instead of brackets.
Either way, using technology allows dentists and orthodontists to offer the ultimate customer experience and drive costs down.
This also allows freedom of choice for clear aligner brands you want to work with. You can even offer aligners in-house using a 3D printer for ultimate control and cost savings.
If you’re interested in offering clear aligners in-house and branding them as your own, you will need a full CAD/CAM set up. This involves intraoral scanners, orthodontic planning softwares, 3D printers (with wash & cure stations), and suckdown machines.

 

Posted on Leave a comment

How To Mark Margins in CAD

Marking margins on your model can occur in the native imaging software or the CAD software.

Visualizing your margin accomplishes 2 things.

  1. magnify 3D image 50x to identify any margin
  2. digitally control tooth morphology and customization according to the margin of your choice

In this video we use Exocad design software to quickly mark the perfect margin. We use the computer to manipulate models for best viewing purposes.

Posted on Leave a comment

Intraoral Scanning: The Basics & How It Works

Demonstrating the clinic to lab connection using technology. So much faster, so much easier.
You can replicate this workflow in your practice for anything from basic crown and bridge to full arch rehabs and clear aligner therapy.
Posted on Leave a comment

How To Keep Production Lean With Digital Workflows

Today, clinicians and lab technicians are leveraging technologies to produce better results and run a better business now more than ever.

So how does this work? Why should you care?

First we need to define the differences. What is a digital workflow?

A digital workflow is the process of using advanced technology and 3D precision without analog materials or human error to deliver patient care.

The reason clinicians or technicians should commit to mastering digital workflows is because it will lean out their production helping them avoid slow and costly processes.

Take for example a basic full coverage crown procedure. During the conventional process the clinician will start by taking an impression of the patient using polyvinyl materials. After the materials set and it’s determined there are no errors chairside, they will ship the impression to the lab which can take a few days depending on location. When the impression finally reaches the lab, a technician will pour up the impression in stone to produce a model and determine accuracy. After this time consuming process is completed, the technicians enter the manufacturing phase.

For comparison, if the clinician and lab practiced with a digital workflow, they would have the ability to cut out each of these steps therefore delivering superior accuracy. The clinician could use a device such as an intraoral scanner to digitally capture a 3D model of the patient and instantly deliver the model to the lab using electronic file exchange. The lab would download the file and immediately begin digitally designing the proposal before milling or 3D printing final prosthesis. Practicing with this process eliminates the costs and headaches of analog materials that can introduce errors and delays.

Digital workflows are very simple to learn. They make life so much easier once you understand.

In summary, any practice owner or lab owner can keep their production lean by introducing digital workflows to eliminate costs, time, and errors.

Posted on Leave a comment

Upper Left Premolar with Shining 3D

Proper isolation and retraction is key for all intra-oral scanners.  In this video, you can appreciate how the upper and lower arches were isolated, the margins were exposed with retraction cord and imaged with the shining 3d aoralscan

video
Isolation with isolite and optragate for imaging with Shining 3D

Download the obj file

 

Posted on

Proper Retraction and Isolation Leads to Great Marginal Fit

In this clinical presentation, we demonstrate the removal of a crown that has recurrent decay.  The bleeding tissue was managed with a double cord technique and expasyl and the margin […]
To access this page and view the premium content and support, you must either be a customer of CAD-Ray or purchase CAD-Ray Membership.
Posted on Leave a comment

A Premolar Crown With the Medit i500, exocad, and Coritec ONE

In this video we demonstrate a simple premolar case that is prepared and imaged with the Medit i500, designed in the cad software named exocad and then milled with the imes icor coritec one machine. Pay attention to the order and sequence of events and how we leverage anesthesia time with scanning time.

We have a large library of instructional videos on our site that can be found on our support page that can help you learn everything there is to know about the Medit i500

video
a simple chairside premolar crown with the Medit i500
Posted on Leave a comment

Implants and Digital Impressions

“Yes it can

I would however do separate abutments and crowns just in case you bind somewhere you can adjust crowns separate from abutments

You would have struggle with analog impressions

This is THE indication for digital dentistry over analog impressions!

I’m stealing this photo for my presentations 😉”


 

 

Posted on Leave a comment

One Mill Does It All

We are very pleased with millbox and the imes icore coritec one for a chairside milling solution. We’ve been testing it for a long time and its CAM (millbox) is very intuitive and the results are always predictable. It can mill titanium abutments, emax, and zirconia blocks.

The following videos illustrate how you can image a scanbody intra-orally and then design it in cad software. Here we used exocad to identify the biomax RP implant and designed both the custom titanium abutment and the suprastructure, both of which were milled with the CORiTEC ONE

video
video
video

There are so many implant and component libraries in cad/cam dentistry which can lead to a lot of confusion. What we highly recommend is that you visually compare the part numbers that you will be using with the part numbers displayed on the millbox software. One letter or number difference and the mistakes will have a profound impact on the bottom line of a dental practice

video