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Clear Water Lines to Your Milling Machine

A good maintenances practice for any milling machine is to check that the tip of the drill is getting adequate water, otherwise you may see sparks flying as you are essentially dry milling material that is not supposed to be dry milled leading to drill and block breakage.  We recommend that you run the water for a minute or two at the start of the day and check and make sure the spray is right on the tip of the  drill.  A simple ortho wire can help unclog the ports and redirect the water spray to where it belongs.

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Water to Tip of Drill

 

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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:

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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

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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.

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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

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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

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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.

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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

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Quick launch of CAD software and Design

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

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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

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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

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Checking for Excess Resing Cement
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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

 

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Prep Sequence for Easy Access
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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.

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shining3d single click launch into CAD software
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Coritec One Mill Times with Icam (Millbox) Update Spring 2020

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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

 

 

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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

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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.

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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.

 

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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.

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distal contact of first molar

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

 

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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.

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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:

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Adding Materials to Millbox Milling Options

For our coritec users: new users often mislabel restorations in the Rx form that leads to a lot of trouble. like calling a crown and onlay or vice versa. this can lead to all kinds of trouble

first sign of trouble is if the two purple lines don’t define the borders of the the restoration. sometimes it is missing, other times it is off the restoration. so always double check this step and usually the missed nomenclature is what causes the trouble.

the next problem people have is that the default setting for the sprue design is poor. it makes the sprue thicker at the mandrel than the restoration. this creates a crevice that the drill can’t get to. this leads to quick drill breakage as it tries to drill into that space (red circle). it is easy to set change these settings so the drill “flows” with the design of the sprue and you get a lot of use out of it. it’s annoying to do this manually so a subsequent video shows you how to change this by default.

another problem is the offset. the last video shows the distance from the restoration to the mandrel as 2mm. the drill is 2.5 in diameter. if you set it at 2, the calculation doesn’t allow enough space for the drill that also breaks it off. set it at 2.7 or 3 and it will last you a long time.

two subsequent videos will show you how to create your own blocks and change their orientation, so you can fit a taller design into a smaller size block

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sprue setting
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rotating a block in millbox to fit a restoration
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adding zircad to millbox menu
IPS+e-max+ZirCAD+Chairside
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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.

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A Pair of Amber Mill Restorations

case 1 first molar

 

virtual seat of first restoration

case 2 second molar

 

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amber mill try in
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Premolar Crown with Medit i500, Meditlink, exocad, Amber Mill Block, Coritec One by Imes Icore, and Millbox CAM Software

In this clinical case a patient lost a pre-existing crown. The remaining tooth structure had recurrent decay and a new crown was warranted.
After anesthesia was administered, the clearance from opposing dentition was assessed. The preparation was reduced to accommodate the necessary thickness of the material.
Once adequate clearance was achieved an Optragate was placed and an isolite was used to isolate the area. The preparation was scanned and then the lower arch was captured. The buccal bite was then taken to along the arches together

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case set up for a simple premolar

With Meditlink software, you have the option of designing the case yourself or sending it off to your partnered lab. The following video shows what happens to your case once the lab downloads the case

In this particular case, we designed our own crown and milled it with the coritec one milling machine

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premolar design in cad software

Once the amber lithium disilicate material was milled, its for was verified clinically. The crown was then crystallized and seated with NX3 resin cement

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fit of amber lithium disilicate
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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 […]
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Amber Mill HASS Some Serious Potential

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preop condition warranting cuspal coverage and class 2 restoration on second molar
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Amber Mill Try-In and Margin Comparisson of Desgined and Milled Margins

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Comparing Milled and Designed Crown Margins

Have you ever compared the milled product with the designed restoration?

We scanned with the medit i500, designed with exocad and milled with coritec. after try-in, we scanned the restoration in the bluephase and then merged it with the design in exocad to see how well our material, or design, and our margins measured up against the proposal. we also documented the fit clinically and with radiographs. you can download the 3d models of the case and compared them yourself

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comparing milled to designed margins

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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

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a simple chairside premolar crown with the Medit i500
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Distal Extension Second Molar Crown Replacement in Copy Mode and With Two Bites

Every distal extension case I have to accomplish the following:

  • take two bites to make sure my vertical dimension does not change with pre-op and prep images
  • make sure I have proper clearance
  • We usually take the bites and all other images BEFORE I have even imaged the prep- I usually grab the prep images last
  • most of this you can delegate to your team and just take the prep images and make it simple for yourself

this video shows the clinical steps. to see what the lab does with your case, click in the link to see the subsequent steps. you can also choose to design and mill it, which is what I did

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Distal extension copy case with two bites
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design of second molar case with two bites
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emax try in

 

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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

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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

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Premolar Crown Replacement with Medit i500 and CORiTEC ONE

In this case presentation, we utilize the medit i500 to image the pre-existing crown and to fabricate a restoration that is a replica of the pre-existing condition. The patient was advised that the recurrent decay was in close proximity to the canal space and that endodontic treatment may be a possibility. The CBCT showed no evidence of any peri-apical radiolucency and the premolar tested vital prior to treatment

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CT used to evaluate apex of premolar for crown replacement

Case set up involved imaging the pre-existing condition in the pre-op catalog box.  Excess information was cropped to reduce file size.  The data was then copied to the maxillary arch catalog box and the area to prepared was edited out in preparation for final optical impressions.

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crown removal, prep refinement, and tissue displacement for imaging

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optical impression of preparation

Immediate Post Op
The remaining decay and previous build up material was removed just prior to bonding the restoration with NX3 dual cure resin cement so the dentin was exposed for the least amount of time possible.

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Second Molar Crown Replacement in Copy Mode

crown replacement using medit i500 to mark margins

In this case presentation, we feature a crown that needs to be replaced due to open margins and recurrent decay.

With the Medit i500, after the patient is anesthetized and the area is isolated, the pre-existing crown is imaged in the pre-op catalog box. The area to be prepared is cropped out in anticipation of the imaging the modified preparation.

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Once the crown is removed, expasyl is packed into the sulcus with a Number 2 cord. With the pre-op bitewings X-ray it was readily apparent that the tissue should be positively displaced in order to capture the margins. It took two layers of cord to achieve hemostasis for imaging with the Medit i500.

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While placing the margin in the native imaging software, it was noted that some tissue was obscuring the margin on the lingual side. The area was isolated both clinically and in the software. It was cropped out and filled in with ‘good data’ after proper protection of the adjacent teeth and margins so that we did not obscure their geometry.

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Once the margins are identified and the case is processed it is automatically imported into exocad for design and then sent to the Imes Icore CORiTEC Once for manufacturing. The emax restoration was tried in and then delivered after crystalization.

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Immediate Post-Op X-Ray taken to verify seat and no excess resin cement

Click Image to Download the OBJ Files And design Along