Posted on Leave a comment

Conelog (CAMLOG) Hybrid / Tibase Abutment Testing

conelog hybrid and tibase abutment testing

At CAD-Ray we are constantly testing milling machines that can render ceramic or metal abutment restorations. In this particular case, we are testing the conelog line of tibases and utilizing the automated identification of the scanbody with the new Medit i500 V2.1 Artificial Intelligence program. Not only does the software identify the scanbody and locate the fixture but it also imports the whole complex into the cad software where the fixture and digital tibase are already identified and aligned.

We scanned the tibase as well on the model and merged it to the digital proposal to see how closely the digital proposals matched the physical model.


It is very important to properly identify the scanbodies and to label them accordingly. A single mis-step can result in ill fitting restorations and cause disappointment. If the nomenclature or the math doesn’t add up, it is always a good idea to contact the manufacturer of the scanbody to verify your findings.

In the first set of videos, we demonstrate how the scanbody is imaged with the Medit i500.  For this particular demonstration, we placed a tibase on a conelog 4.3 mm diameter fixture and then a peek scanbody on top of it. Indexing and making sure it is seated is of paramount importance. Once the software identifies the complex it can automatically import it into exocad software so you can proceed with the design.

articial intellegence identification of tibase and scanbdoy
play-rounded-fill

This test case is milled for record keeping and FDA compliance as we are distributors of multiple scanners and milling machines.  We are only concerned about the fit of the restoration.  After the design was completed it was then imported into milbox CAM software, nested, and the sprue was configured for the mill.

autoimport and design hybrid abutment crown
play-rounded-fill

The first produced restoration did not seat completely and the internal was relieved in an analog manner.  It did finally seat but by then, it lost its anti-rotation mechanism.  The case was then reloaded in millbox and the internal relief was increased by – 0.05 mm.  That simple adjustment allowed for proper seating without any analog adjustments.  You can also appreciate some residual material that may keep you from seating.  Both the software and the carbon marks left on the intaglio of the restoration can be clear indications of what needs to be adjusted.

provide relief
play-rounded-fill
Posted on Leave a comment

Tired of Nuclear or Atomic Mushroom Bomb Cloud Shaped Abutment Crowns?

using exocad to design restorations

A very common source of frustration for most dentists or those who are new to designing implant crowns is the emergence profile of the abutment or crown.  Most of the time, the shape of the tissue dictates the digital design and this article showcases how we used the medit i500 for the intra-oral scan of the patient and then used exocad to design the restorations.  Our advanced users can appreciate how we bring the arch model in twice- once as the maxillary model and once as the gingiva model.  We then digital sculpt the tissue to create the proper profile yet we still have the original model to reflect back to asses the changes.

Download to ImplantCrownShaping.ZIP to design along

Medit i500 Beta Testing of Artificial Intelligence that Identifies Scanbody location
play-rounded-fill

DESS Library Information for Nobe Active Compatible Components

NobelActiveCompatibleComponents-DESSUSA2019-2

 

NobelActiveCompatibleComponents-DESSUSA2019-2
Posted on Leave a comment

Managing Second Molars And Clearance

protocol to reduce surprises and post op adjustmenst second molar restoration

Few things in dentistry that can be as frustrating as seating a second molar restoration, whether you are doing same day dentistry or having a lab made prosthesis delivered.  Here is a protocol we recommend that you follow to dramatically reduce surprises and post op adjustments.  In this particular clinical case a zirconia crown debonded and we elected to fabricate an in-office emax restoration.  The sequence is as follows:

  • While the patient is anesthetized and you are waiting for the onset of anesthesia, capture the opposing impression and the arch models.  Trim away the prep digitally and then proceed to the buccal bite capture
  • Do NOT capture the bite until you verify clearance.  In the sequences of videos that follow, watch how we use the Medit i500 to capture digital pictures of the clearance
  • Once we verify clearance, we image the bite.   You have the option at this point to see how well your occlusal stamps match the digital stamps if you want to.  A large deviation may mean the jaw settled or the patient moved during the bite capture.  Note that unlike conventional dentistry, you capture the bite here BEFORE the prep is finalized
  • Once you achieve isolation you can finalize the prep and retract the tissue and capture the prep.  We elected to capture the preparation in HD mode
  • The case is then immediately imported into the CAD software for design and fabrication
video
play-rounded-fill
second molar case set up in medit link
video
play-rounded-fill
Emax at Delivery

Immediate post op x-rays were taken to verify seat and aid in resin cement removal.  The excess cement was removed after the x-rays were taken

Posted on Leave a comment

How To Create A Flat Base That Is Parallel To The Occlusal Plane With The Medit i500

flat base that matches the occlusal plane of the arches

A common request when processing models is to create a plan that matches the occlusal plane of the arches. To keep it simple the algorithms of the Medit iScan will create a plane from the lowest data point on one side of the model to the highest point on the model on the contralateral side. You can control this plane by using the edit tool in the arches and crop out data so that you help the software to find this plane more easily.  The more discrepancy there is between these data points will render drastically different planes than the occlusal scheme as seen in the attached photo.  Besides, the less data you have to process, the faster the models will be rendered.

video
play-rounded-fill
How To Create A Flat Base In The Model That Is Parallel To The Occlusal Plane
Posted on Leave a comment

Problems Milling to a Tibase From a Scanbody Digital Impression ?

milling to a tibase from a scanbody impression

We got a bat signal from a group of doctors who were having trouble with ill fitting restorations to tibases.  This can suck up a lot of time and energy to pinpoint the exact source of the issue, and you basically have to go through a pilot’s checklist before take off.  Here’s a list you can use for yourself to determine what the cause of the issue, after you understand what the issue really is.

  • Take a picture of the scanbody and a picture of the tibase and then pictures of their packaging material and verify you ordered the right parts
  • Do not mix scanbody from company A to image implant fixture from company B and then mill a restoration to a tibase manufactured by company C even though they all say they are compatible with company D.
  • Verify that you have the latest library of scanbodies
  • Verify that you correctly chose the right scanbody from the large list of implant possibilities on the market
  • Verify that you have the correct height as a lot of companies have the multiple height scanbodies for same diameter fixture
  • When starting a case, you select either Custom Abutment for the implant restoration if there is no screw access hole and Screw Retained Abutment if you do have a screw access channel
  • Understand that the decision for custom titanium abutment is made when you identify the scanbody in the design step, not in the job definition step
  • You will not be able to verify seat / index until you fire and shrink material like zirconia
  • The smallest drill in your milling machine will determine if you can carve out that much detail
Retrofit Designs to Tibase
play-rounded-fill
Milling Internal for Tibases

We took the case file from our users and directly imported their design case into a few of the CAM systems we have at CAD-Ray. We used Celtra Duo burner blocks to verify the fit. The screw-mentable restorations were binding on the walls of the tibase so it took a few adjustments to seat it completely. The good part is that the carbon on the titanium abutment leaves metal marks on the internal intaglio, so it is easy to know where to adjust

 

 

 

video
play-rounded-fill

The restoration still needed some adjustments so we played around with some of the spacer settings, screw access holes, and other parameters to get it to seat all the way.

Could Screw Access Space Provide Relief?
play-rounded-fill
Changing Manufacturing Parameters to Aid in Seating

Even with these adjustments of the parameters a little analog milling helped get the restoration seated. The CAM software can give you plenty of hints on where it will bind. We recommend that you don’t change your spacer settings and understand that you will likely bind on the walls of the tibase and/or restorations as it is difficult for any machine to mill out all the detail you need to have NO adjustments. The good news is that the indexing and anti-rotation mechanism work properly.

Minor Adjustment at Seat
play-rounded-fill
Minor Adjustment at Seat

In conclusion, it is physically impossible to mill the intaglio of a ceramic restoration to perfectly retrofit most tibases as they have too much detail that even 5 axis milling machines cannot reach. The choices are to increase the space between the walls of the tibase and the restoration providing enough relief to allow you to seat the restoration, but that comes at the risk of losing your antirotation mechanism. Alternatively you can mill them out knowing full well that they will bind and using the sophisticated CAM to pinpoint the areas that need adjustment.

Posted on Leave a comment

Custom Abutment And Crown Designs Milled With Multiple Milling Machines

medit link to CAD to CAM

With the Meditlink software you can design a case and then export the designs and take them to any milling machine of your choice.  In this demonstration, we use the CORiTEC ONE to mill out the metal abutment in 45 minutes. This procedure is not intended to be a single appointment visit so timing is not critical and you don’t place undue wear and tear on the milling machine.

The crowns were milled with two different milling machines.  A Celtra Duo block was used and milled with the CEREC MCXL and retrofitted to the abutment to verify the fit and accuracy.  The same crown stl was milled out of Vita material in the imes icore machine.  The whole point of the demonstration is that you can take scans from any intra-oral scan, take it to CAD software (in this case exocad) and then export the case and take it to any printer or milling machine of your choice.  You must make sure critical information is accurately transferred from your CAD software to your CAM software, which is generally the construction / project file that accompanies the STL files of the prosthetic components

Crown Nested and Milled with CEREC MCXL
play-rounded-fill
Design Custom Abutment And Crown

The same crown was milled out of Vita’s Suprinity material in 20 minutes with the imes-icore CORiTEC ONE.  Take note of the internal adaptation of the metal abutment and the restoration and how when it is flipped upside down, the restoration does not fall out easily!

play-rounded-fill
Posted on Leave a comment

Image With Medit, Design in exocad, Mill to CEREC MCXL

cerec mcxl margin design

When imaging and designing a restoration in exocad, with models captured by the Medit i500 intra-oral scanner, you will produce an stl file of the restoration along with the construction file.

The stl file alone carries enough information for most CAM software to instantly mill the restoration.  The CEREC cam software gives you the ability to either import the project file or the stl file.

In this demonstration we showcase how you have to redraw the margins in the CEREC inlab software so you can mill the restoration when you only import the stl file.

Alternatively, if you imported the construction file, you could have skipped the margination step.

Image in Medit, Design in exocad, Mill with CEREC
play-rounded-fill
Imaging A Second Molar With The Medit i500

Our advanced users can appreciate “the lip” at the margin of the restoration. This is a function of the minimum parameter thickness in exocad.

Most people set this setting to 0.4 mm or less which adds material to the margins so they are protected during the milling process.  This thickness is invisible to the naked eye and produce desirable results with lithium dissilicate

Posted on Leave a comment

Delivery Of Occlusal Guard Without Any Adjsutments

two buccal bites imaging no adjustments on occlusal guard

This is the occlusal appliance that was milled and delivered from this patient’s scan approximately 7 days ago.  The appliance did not need a single adjustment neither on the occlusal surface, nor in the intaglio.

Digitally Desgined and Milled Occlusal Guard
play-rounded-fill
No Adjustments At Delivery
Posted on Leave a comment

Gauging the Accuracy of the Vertical Dimension Across Full Arch Impression

digital impressions capture open bite using own mouth as articulator

One of the biggest challenges of capturing a bite for an occlusal appliance is to properly tripod the upper arch to the lower arch. With PVS impressions we just send the impressions along with the patient’s bite registration in maximum intercuspation.

A unique advantage we have with digital impressions is that we can capture someone with an open bite while using their own mouth as the articulator. Moreover, with the following technique, you can rest assured you have little adjustments to make to the occlusal guard after it has been fabricated.

video
play-rounded-fill

Now as we continue to image in the same catalog box, we can gauge if we are on track as the bite model turns green. Notice how when we move from the upper arch to the lower arch, across an open bite, and we maintain a green active box and green model formation, we can rest assured that our case is mounted correctly.

video
play-rounded-fill
Posted on Leave a comment

Marking Margins in Medit i500 Before Sending a Case to a Lab or CAD Software Like exocad

marking margins in medit i500 iscan software

The new Medit i500 software will feature the ability to mark margins in the imaging step before you import the case into a CAD software or send it to the lab. In this article we showcase a case where a 12 year old implant crown needed replacement. The pre-op images were captured, along with the opposing and the bite.

play-rounded-fill

After the area was anesthetized and the crown was removed, expasyl was used to achieve hemostasis and tissue retraction. The margins of the abutment were imaged. Note how we used a feature in the Medit scanner to change the scan light from blue to white, which allows you to pick up red (blood and tissue) that is normally difficult to capture.

play-rounded-fill

Once the margins were captured, we activated the margination tool. You highlight the area you want to address and the meshwork is calculated and processed locally, where you can then designate your margins that are exported to CAD software along with the jaw model, the opposing, the pre-op and the bite.

play-rounded-fill

This is a preview of the models that you can export and send to a lab or take directly to design software for chairside milling.

play-rounded-fill

Alternatively, the traditional way would be to not place the margins in the native Medit software and to place it in the CAD software itself. As you can see both options are very viable and you do not lose any resolution of the scanned data between the imaging program or the design software.

play-rounded-fill
Posted on Leave a comment

Deleting The Raw Files in Medit v 2.1

syncing data in the cloud

A lot of our users are migrating to SSD Drives which greatly speeds up processing and graphics rendering in intense software applications. When you are capturing scans with the Medit i500 you can quickly fill up your hard drive with law videos (which is technically a series of thousands of images) and when you process the case, the data is converted into small 30-50 MB size digital models

In previous versions of the software that data was only stored on your local machine, which meant you could not log into another computer to add or edit your live video images. You now can sync the data through the cloud so you can access it anywhere, or you can delete the raw footage from the preview screen. In previous versions you would have to search hidden folders to find this data, but now it is readily available and you can dump the data with one click. You do not delete your models in this situation.

play-rounded-fill
Posted on Leave a comment

Titanium Abutment Screw Access Channel Design For Easy Sprue Removal

Titanium blanks are the hottest topic in digital dentistry in 2019. A lot of new milling machines can mill emax, zirconia, and custom metal abutments.

One of the parameters to keep in mind when milling them is the diameter of the screw access channel. Most CAM will carve them out but leave a lot of finishing processes remaining.

We’ve tested quite a lot of mills with the imes icore coritec one and the milbox cam software. If you set the settings to 2.5 mm’s , you can pee off the excess sprue material with just finger pressure, dramatically reducing the free hand work that you would have to do.

The pin diameter at object and at material under 2.5 mm’s will give you inconsistent results.

Posted on Leave a comment

Combine Individual Meshworks for Scanbodies in Medit Version 2.1

play-rounded-fill

Most scanners will export the jaw model and the scanbody model separately but a new feature on the Medit upcoming software will let you export them as individual models or as a single merged model.

There are design advantages to both scenarios based on the practitioners skill level!

There are numerous ways to quickly check a model before taking it to a design software. Windows comes with at least 3 such free software. Another one to have handy is called 3dviewer.net to let you verify models really quickly

Posted on Leave a comment

Full Arch Imaging With Medit i500 For Clear Aligner Therapy

intraoral medit i500 scanner full arch imagery
play-rounded-fill
play-rounded-fill
Posted on Leave a comment

Medit i500 Used For Implant Planning in BlueSkyBio Software

medit i500 used for implant planning in blueskybio software

In this case presentation, we scan a patient with the medit i500 for implant planning and restorations in the upper left quadrant. At first, you will notice how the camera was slow to capture the arch due to water spots on the mirror of the camera tip. Once these water spots were removed, the imaging was rapid and the whole upper arch was imaged in just a minute.

play-rounded-fill

Once the upper arch was digitize it was automatically merged with the dicom data from a ct scan in the blueskybio software. This automated step saves quite a lot of time and is rapidly becoming a reliable solution. It is imperative that you do NOT form a base or close holes in your intra-oral scans so that the software has an easier time to stitch the models together.

The implant case was designed and a surgical stent was fabricated for fully guided surgery. The lip line and the tooth position will be a challenge and the angulation will have to be corrected with an angled abutment

play-rounded-fill
play-rounded-fill
Posted on Leave a comment

Digital Implant Scanbody Finding Tool by Medit i500 Paves The Way For Accurate Implant Impressions

medit i500 digital implant scanbody feature

The Medit i500 software can now identify a scanbody and digitally place a virtual one in its location. This has a lot of ramifications. For starters, this great opportunity affords a dentist the ability to image multiple implants in long span edentulous areas, where you would have a clear indication of distortion or artifact introduced during challenging scans.

In this single unit case in the video below, we preview this feature. Once the patient is anesthetized, the isolite was placed to protect the airway and the edentulous area was scanned.

play-rounded-fill
play-rounded-fill

After uncovery of the fixture, the type of scanbody was identified in the menu and the location of the scanbody was identified on the digital model.

Once scanning was resumed, the digital scanbody was placed on top of the intra-oral one. As more data was captured you can appreciate how steadily the software tries to adapt the physical fixture to the digital one.

play-rounded-fill
Posted on Leave a comment

CORiTEC ONE For The Win! Under 15 Minutes to Mill an EMAX Molar Crown in a Size 14 Block (In Non-Detail Mode)

play-rounded-fill
play-rounded-fill
play-rounded-fill
play-rounded-fill

Here is the same crown milled in detail in 30 minutes with the additional 0.6 mm drill finishing the intaglio and the occlusal anatomy

Posted on Leave a comment

Occlusal Splint – Imaging With Medit i500 and Designed in exocad and Milled in Doowon Milling Machine

In this particular case, we designed an occlusal splint for a patient that is a heavy bruxer. We captured the bite by having the patient gently bite down on cotton rolls on both sides. The first purpose of this is to block out the tongue and the orophayrynx when imaging the buccal bite. But it can also help you find the proper vertical dimension and dramatically reduces the time it takes to deliver an appliance.

Ideally, you place the cotton rolls in such a manner so that you don’t obstruct your view of the second molars. This allows you to see and verify the proper clearance in the most critical area! If you take it one step further and design the guard to the opposing, your seat appointments are just a few minutes long.

play-rounded-fill

Once the upper jaw and the lower jaw are related to each other in the medit scan, and the clearance is verified, the models are brought into exocad’s Bite Splint Module. The case is designed in the CAD software and then milled with a 5 axis milling machine. This step should ideally be delegated to a lab as it is not practical to fabricate these in the office.

play-rounded-fill
play-rounded-fill

The delivery of the appliance is very predictable when you capture the bite with digital impression and you don’t have to grind away to get the jaws to close in the anterior, as the distance was taken into consideration during the design process.

play-rounded-fill