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Upper Right First Molar Scanned with the Shining 3D Intra-Oral Scanner for Beginners

In this case presentation, we introduce the Shining Aoralscan for beginner doctors who want to get into digital impressions.  Proper isolation and retraction is a key element of scanning. In this demonstration we showcase how a new user can easily control the operating field to deliver high quality restorations

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imaging with shining 3D AOralscan
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Replacing a PFM With Reccurent Decay with Medit i500 Version 2.2

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Imaging contact areas of adjacent teeth
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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

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Isolation with isolite and optragate for imaging with Shining 3D
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Download the obj file

 

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Mixing Photogrammetry and Intra-Orals Scanner by Medit i500

To date, the literature and research clearly points out that full arch scans with edentulous arches are prone to inaccuracies.  That’s because we have never had a way to measure and verify models while scanning. There are two features unique to the Medit i500, namely the reliability map and the artificial intelligent implant suprastructure identification system.  Individually, they do not provide much information with regards to accuracy, but if you understand how they work, you can utilize them to assess accuracy while you are scanning edentulous arches.

We proved the validity of this concept by utilizing these two features by incorporating a scan from the imetric Icam4D scanner and merging its data with the IOS to render a perfect match.  Details are posted for our users in the Imaging Implants Section of our tutorial liabrary

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Single Implant Scanbody Digital Impression with the Medit i500 Intra-Oral Scanner

This is a preview of a single unit case that was scanned using the Artificial Implant Suprastructure Identification System of the Medit Software.  To see the full case follow this link

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case example of implant scanning
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Hydroflouric Acid Etch Surface Treated Scanbody for Intra-Oral Scanning

Hydroflouric Acid Etched Treated Scanbody Surface makes Intra-Oral Scanning much easier for all dental scanners. Apply a coat of HF for a mere 10 seconds and rinse off.

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HF Surface Treated Scanbody for Intra-Oral Scanning
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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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The Digital Pour Up- Creating a Base Model From a Digital Denture Duplication Scan

In this video we show how to you can digitally pour up the intaglio of a denture scan with the medit software where you scan in the impression mode, “reverse normal”, process the case and the add a base to it.  You can then immediately send it to a printer

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imaging the intaglio of a denture to create a model base
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Implant Margins Impressions Performed Extra-Orally With The Medit i500

Taking impressions, digital or analog way, was one of the greatest hassles in implant dentistry. we can now image the margins of the implant suprastrucure OUTSIDE the mouth, merge it with the intra-oral condition, and mark the margins on the digital file as opposed to getting hemostasis and tissue retraction in difficult situations..

medit i500 takes one of the most complex and error prone situations and simplifies it, whether you send the case to the lab or do in office restorations.

 

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Proper Implant Placement and Digital Impressions with Scanbodies and Medit i500 Lead to Predictable Results

In this video, we show a recall of an implant restored with a scanbody. When the implant was initially placed, a scanbody was seated and an X-ray was taken to verify that it was seated. The titanium scanbody allows for visualization of seat. A peek scanbody does have a metal carrier but it is confusing to some users to verify that it is engaged with the fixture.

The proper placement of this biomax implant, followed by ideal contouring of tissue and bone around the head of the fixture, allowed for enough “running room” to create the desired emergence profile

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emergence prodile of crown imaged by medit i500
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Tissue Displacement Flash for Analog Impressions vs FLUSH for Digital Impression

With analog dental impressions, it is imparative to separate the gum tissue from tooth structure and to create a trough for flash for dye work. This is not the case with the intra-oral scanner by Medit.  All you need to do is displace the tissue so you have a clear line of site to the margins, and you just need to be flush. You don’t need flash like you do with stone work

replacing a crown with medit i500

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tissue and/or cord flush to margin for digital impressions
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emax try in

 

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What Is An Implant Scanbody, Why Should You Use it, And Why You Need The Medit i500’s AI !

dental implant scanbody used by the medit i500

Dental implant surgery and restorations were the most risky procedures just 10 years ago. They were also the most profitable, but also carried the largest liability and the most significant surgical and restorative lab costs. A simple error introduced in the restorative process could easily eliminate the profit margin and a more significant mishap can create an undesirable outcome

We have seen dramatic changes in implant surgery where both the cost of the surgical stent and the fixture placement have reduced to the point where fully guided surgery is now the norm as they speed up the surgery and normalize the accuracy of placement across a broad range of practitioners with varying levels of experience. We are now seeing the same type of effect on the restorative side of the implant treatment, where digital dentistry is greatly reducing costs and errors.

With permission from blueskybio.com, we captured some key elements with analog impressions to highlight potential errors that can be introduced. The full video can be seen here:

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analog impression of an implant fixture

The common sources of errors that someone can introduce are:

  • The inherent nature of impression material that can distort during the impression step
  • The angulation of the impression abutment may prevent it from seating all the way or may bind on the adjacent teeth making it difficult to capture an accurate impression
  • The size of the impression abutment can usually block access to the contours of the adjacent teeth where the pvs material does not capture the detail needed to generate good contacts and emergence profiles
  • Not securing the implant analog with the abutment in the impression material so that it does not distort or vibrate out of its position while pouring stone into the PVS material
  • With multiple implant, the problems can compound exponentially if the implants do not draw well together with complications ranging from locking the tray in the patient’s mouth accidentally or distorting the impression material enough when removing it where you decrease the accuracy.  Some practitioners prefer to do this in multiple steps, correcting angulation and collisions with custom abutments and several impressions

Fortunately, in this impression of 3 implants that were placed with a guided, the impression abutments are parallel to each other but just a few degrees in either direction, you can have multiple collisions of the abutments with the adjacent teeth or in between the abutment themselves. What a scanbody does is it allows for the optical scan of a geometric shape that helps CAD software identify the exact location of an implant fixture, its timing, and its relationship to the arch form.

It has significant advantages as there is no distortion of the impression material.  Moreover, you can capture all the detail of the adjacent teeth before you place the scanbody in the mouth.  This dramatically reduces the errors and adjustments you will need to make during the seat appointment.

This video shows you the contour or the shape of a specific scanbdoy. There are many manufacturers that produce the scanbodies for a variety of fixtures with different geometries.  Ideally, you use a titanium based one so that you can take an x-ray to make sure it is seated all the way.  A frequent cause for error with digital impression is that you bind on tissue of bone which block you form seating all the way.

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sample scanbody

Once you have scanned the pertinent information, you can then take the digital models to CAD software where the location of the fixture is identified digitally and you can design the restoration of your choice.  This can be titanium abutment or a tibase that retrofits ceramic material like emax or zirconia.  The following video demonstrates how you identify the scanbody in exocad and proceed with a sample design.

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purpose of a scanbody

Once the design is completed, you can outsource the fabrication of the abutment and/or the crown.  There are many machines that you can use to fabricate the titanium abutment.  Please note that the milling machines do not mill the connection. The connection to the implant comes pre-manufactured.  The cylindrical block is milled to shape.  The cad software also maintains the relationship of the abutment to the crown so that they retrofit to each other.

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Now imagine if you had multiple implants that did not draw together?  What’s great about digital dentistry and how we use the Medit i500 here is how we utilize a single scanbody to capture the location of 3 fixtures.  One thing we emphasize at CAD-Ray is how digital impression allow you to create models over time and out of sequence. They are also editable and additive.  In the subsequent video we demonstrate how you can capture segments at a time, which can greatly help when you have implant abutments colliding into each other.

You can place the scanbdoy in one location, scan it, digitally protect the area, remove the scanbody, place it into another location and image it at the new location, dramatically overcoming all the obstacles described above

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3 implant fixtures captured with one scanbody

Now for the greatest news and the largest advancement in digital dentistry in a decade!  Medit i500 has launched the Artificial Intelligent Implant Identification System where the software automatically recognizes these scanbody and lets you skip dozens of steps to get to the immediate design steps of the restoration.  The algorithm utilized to match the digital scanbody to the physical one is proprietary to Medit and is unparalleled in its accuracy.  A lot of the guess work and inherent errors in the digital platforms are reduced with this software which is a contrasting as the difference between analog and digital impressions.

 

 

Posted by Armen Mirzayan on Monday, September 23, 2019

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You Need Enough Redundant Data Between The Pre-op and Prep Models To Activate Image Aquisition

When you have preops that you are trying to stitch to preps in medit, and this could also include relating scanbodies to arches as well, you need enough data that is redundant in both catalog boxes

if you watch this video carefully, you can see how i over trimmed the mesial part of the equation and even though the camera is active, it is not acquiring images. you can see the red box.
once i move the camera to the distal molar, the acquisition starts because the molar has more data points than the premolar and the software / camera recognized the area and started to acquire images.
understanding this will unlock a lot of complicated cases and make the easier for you

case set up for medit copy case
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case set up for medit copy case

DOWNLOAD CASE FILE

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Shining 3D AoralScan Margins

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preview of margins captured by Shining 3D Aoralscan
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case set up and imaging of upper and lower arches and buccal bite
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labeling tooth and marking margins

Click to Download the Lower Arch Model OBJ file

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Medit i500’s Artificial Intelligence Custom Implant Identification Using The Analog Impression Abutment As A Scanbody

Medit has launched a software that is the greatest advancements in digital dentistry in more than a decade! With artificial intelligence, you can identify the scanbody during intra-oral digital scans. This has many implications for accurate scan captures and skipping multiple steps in the design process in CAD software like exocad.

But there is more! This will knock your socks off. You can build your own custom library for scanbodies or you can use geometries of abutment libraries from your favorite implant line. In this article we show how to import the stl file for a physical impression abutment (Closed Tray- Blueskybio Part #MIJH) and use it as a scanbody. Just watch the following videos

A lot of implant manufacturers will readily distribute their libraries of abutments and scanbodies. Here, we just chose the MIJH impression abutment and previewed it in one of the many free 3D viewer programs included in windows 10.

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stl of closed tray biomax impression abutment

Once the data is imported into the library, you can preview it and incorporated into your own library of abutment. Please note that the abutment libraries are stored in the arch catalog boxes while the scanbody libraries are stored in the scanbdoy library, which means the abutment itself may be taken into consideration when capturing the buccal bite.

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load digital abutment and identify physical abutment

Once the abutment is identified in Medit it is directly transferred into cad software like exocad to proceed with design. Note in this footage how little of the physical abutment impression was brought into cad software. This greatly reduces errors and your imaging time intra-orally. You can also place a stock abutment and scan it in the same manner and be able to find margins with great ease without having to reach hemostasis or good tissue retraction

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desing in exocad

CLICK TO OWNLOAD THE MUA LIBRARY

 

DOWNLOAD THE BIOMAX NP LIBRARY

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Our First Shining 3D Aoralscan Case- A Preview

At CAD-Ray, we are big proponents of open architecture and the doctors control the flow of their patients’ digital data, whether it is a CT scan or an digital impression system.  We have put the Aoralscan through a battery of tests. For single unit, it delivers on quality that equals any other scanner on the market.  We were particularly impressed with this deep margin and how well the graphics could differentiate tissue from tooth structure on the distal of the prep

image upper and lower arch with shining 3d aoralscan
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click to download the OBJ file of this case (note: we only scanned to pick up data for the margins)

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check out how well the shining 3d aoralscan picks up deep margins
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Instant Designs In Copy Mode and Cement Spacer Settings

In this particular case, we are restoring a lower left molar with a full coverage crown. The pre-existing condition has multiple fracture lines and the patient currently wears a retainer. The pre-op optical impression is taken while the patient is reaching anesthesia. Once enough reduction has been achieved, the preparation is captured and an immediate proposal is rendered that replicates the pre-op condition perfectly.

Note how the settings for the start of the adhesive gap influence the cement line that you see on the post-op bitewing after immediate delivery, even though it was milled with the CEREC MCXL.

copy mode- instant proposal
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copy mode- instant proposal

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Full Coverage Crown on a Fractured Second Molar and Two Bites

capturing two bites for fractured second molar

Same visit crowns can be a practice builder. We had a patient referred for in house fabrication of a restoration because she did not want to go through the procedure twice. A family member made the referral for a broken tooth.

After the tooth tested vital and the patient consented to treatment, she was anesthetized. While waiting for the onsite of anesthesia, the upper arch was imaged along with the lower arch and the bite in the occlusal one window box. The case was set up for just imaging the preparation. Most of this can be delegated to team members.

fractured DL susp of lower second molar
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We highly recommend that you capture the final bite after you have finished preparing the most distal tooth. You can use your camera to visualize your clearance. You can keep reducing the occlusal surface until you have enough clearance.

In this particular case, when we took the second occlusion images, the models would not turn green. When this happens, you should immediately ascertain if you have captured the first or second bite correctly. Double check to see if the jaw settled or if the patient moved their jaw during this acquisition step.

You can watch how we troubleshoot the bite and manually choose the second bite to relate the arches together.

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Correcting the occlusal relationship with second bite

Once the bite is captured, the isolite is re-inserted and the tissue is displaced and isolation is achieved. Then the predation is captured.

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imaging the prep after enough clearance has been established

After the crown is seated a final bitewing is taken to verify seat and if any excess resin is left behind.

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post op bitewing to verify seat and resin clean up