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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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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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Keystone Splint Material for Nightguard with Medit i500 Scan

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imaging upper and lower jaws for a beginner
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lower arch scan
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capture occlusal relationship
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clinical bite scan

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splint design to print
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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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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