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Errors Introduced with Long Span Imaging and how to Correct Them

This case shows a full arch imaging where the model starts to go “off track”. To keep the explanation simple, the further away you get from multiple planes / heights of immobile structures, and the more you image in flat areas, you can inadvertently introduce errors in your models. You can see a sample case here in the video.

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There is a very simple solution, as you can see in this video. It entails consistently moving back to reliable landmarks to stitch new information to exisitng correctly. If you notice how we start imaging on the occlusal of the premolars and the molars, then we roll to the facial of the molars and the back around to the palatal of the molars. Then we sweep over soft tissue on the palate. But we don’t continue in that direction. We immediately return to the molar area so the software has landmarks it can recognize.

We then move the camera forward, image the palatal of the premolars, and then sweep back across the palatal midline. We repeat this back and forth movement to maintain a proper path for the software to recognize landmarks that do not move, in the equation. With this technique, you can scan a whole upper arch in just a couple of minutes and capture great details of the dentition and the soft tissue on the palate

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Here, you can see how the software rendered a perfectly accurate and detailed upper arch with the palatal vault captured without any errors.

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Duplicating an Existing Denture with Medit i500 Intra-Oral Scanner

A common question we get at CAD-Ray is if we can duplicate a denture with the Medit i500. It works, and takes about 5 minutes. You can then instantly export the STL, OBJ, or PLY file and take it to any software you want and design cases, print denture duplicates, or use it to set the vertical dimension of a case you are working on. If you capture the lower arch in occlusion with the upper arch wit the buccal bite, you an very accurate articulate edentulous arches to each other, get the right vertical dimension, and start your case planning. This denture dupe can also aid you with setting the teeth and their incisal edges in the correct position

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You have to be aware of the fact that you may introduce errors in the process so you have to image properly to reduce those errors. Here is some footage on imaging the denture. We do think scanning this with the desktop scanner, the Medit T500 is a more practical approach.

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CASE FILES
Download the OBJ
Download the STL

Here’s a good reason why you would want to dupe a denture chairside; so you can digitally design and fabricate a surgical stent for guided surgery!

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Cloning a Intra-Oral Scan with the Medit i500

Once an case is captured and processed, it is stored in the MeditLink Box of the software. You can open the same case file and apply different functions to it. You can clone the case, so that nothing is altered from the last step. You can delete it and rescan, or you can add new data to the equation.

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Second Molar Emax with Medit i500

This simple second molar restoration was imaged with the Medit i500.  There was no retraction used  and the lab worked with the OBJ file to render an eMax restoration.  The fit to the margins was perfect and the occlusion and contacts were not adjusted.  The benefit of digital impressions is the dramatic reduction in redos!

 

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Restorations fabricate by:

 

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Yes, It Can Scan Edentulous Arches

A frequent question we receive at CAD-Ray is if the Medit i500 can scan edentulous arches. You can certainly introduce errors in the process, but if you follow proper guidelines, you can easily render accurate models. The trouble starts with long span areas that are flat and edentulous and the mesh from one image to the next doesn’t quite line up properly and you veer off track. There are a lot of remedies for this and we detail it in our hands-on courses.

Here is a quick video on how to manage these large cases.

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Setting Up a Case for a Digital Impression

Most Intra-Oral Scanners take time to process the models after you capture them.  We highly recommend that you take advantage of the time it takes the patient to get numb.  In the first video, you will see how the upper arch, the lower arch, and the buccal bite are taken in real time.  There is no editing done and you can see the scan time in the upper left corner.  Once you hit save, the software will “clean up” the data and remove artifact and render clean models.  As it is saving, you can start your preparation after proper isolation and retraction.  Here, the optragate was used in conjunction with the Isolite.

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Once the preparation is finished and the tissue is retracted, you can bring the model back to the appropriate scan stage, edit out the area that was modified and the rescan just the area that has been altered. In this video, you can see how just the prepared tooth fills the cropped model. Once finished, when you hit save, there is little processing left for the software to do.
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The Deepest Scan – The Medit i500 Outperforms all other IOS Systems in the Market

Another example of how well the i500 from Medit can scan with a deep focal length. This is impossible to do with any other IOS system on the market. Don’t misunderstand, this is not an easy impression to capture, but if you are well trained and know what you are doing, it’s very accurate and simple.

In this video you will see how the upper arch is captured in under a minute. Then the lower arch is capture with the healing abutment removed. Watch carefully how there is a lot of effort made to capture the distal wall / contact area of the bicuspid. You can also see the effort made to capture information below the height of contour of the distal molar. The mesial information is critical for designing the emergence profile of the abutment and restoration

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After both arches are captured, the software leads you to the step where you capture the peek impression post. It is seated completely and an X-ray was taken to verify the accuracy. The edentulous area where the abutment would be positioned is cropped on the Meditlink software, and the impression post is scanned. It is imperative to make sure the adjacent teeth are imaged so the software can properly line up the landmark of this scan with the previous scan of the edentulous mandible.

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After the Peek Scan Body for a Narrow Platform is imaged, it is removed, and the patient bites down into maximum intercuspation. The camera then captures the data so that it can articulated the models together. The buccal bite scan turns green once a positive adaptation is made.

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Once the relationship of the upper arch and the lower arch are confirmed, the case can be submitted to a lab for the manufacturing of a custom abutment. You also have the choice of fabricating chairside abutments with a milling machine, if you choose to.

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Medit Version 1.1.1. build 23

Medit Link v1.1.1

  • Fixed crashing problem which has occurred when clicking ‘Save’ or ‘Scan’ button multiple times in Work Box.

Medit iScan v1.1.1.1

  • Enhanced scanning algorithm was applied to allow acquisition of more data with less scan images, leading to reduction in overall scan time.
  • Enhanced Occlusion alignment algorithm now provides more precise result of occlusion alignment.
  • Scanning depth has extended by 30%, making it easier to scan objects from various angles.
  • The software will automatically set the best option of Nvidia Graphics Card for using Medit iScan.
  • Provides smoother rendering performance even for those with UHD(4k) resolution display.
  • Changed default sound effect during scanning.
  • Non-adjusting auto brightness issue for HD Camera was fixed.
  • Issue of abnormal display of scan data after performing specific commands was fixed.
  • Issue of software crash occurring when “Swap Maxilla And Mandible” function was fixed.

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Full Arch Scan and Clear Orthodontic Retainer for Minor Tooth Movement

This is a case that demonstrates how a full arch scan is taken with the Medit i500. We generally recommend that you establish a good “purchase point” where you can always come back to if you get “lost during scanning”. It is very easy to start with the second premolar / first molar area by scanning the occlusal area. Migrate towards the last molar and then image both the buccal and lingual of the last molar.

These landmarks will help you get re-oriented if the patient moves or you need to stop for whatever reason. You will notice how fast the camera scans once it has these solid landmarks to recognize, and you can see it image from the palatal of the second molar from one side of the arch to the next.

After the upper arch is imaged, scans of the lower arch are taken, and then the buccal bite is captured.  You will notice areas where some data is missing on both arches.  It is really easy to go back in the process and fill in those areas.  You can see that at the tail end of the video.

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Once the case is captured, you can export the file and take it to third party software like BlueSkyBio Ortho Plan and start your clear retainer designs.

Download the BSB file to design along
Download the OBJ
Download the STL

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Full Arch Scans and Clear Aligners from Medit i500 Scans

In this particular clinical case, the patient has opted to utilize clear aligners to straighten some anterior crowding. The Medit i500 was used to capture both the upper and lower jaws, and articulating paper was used to marked the clinical contact points.
The data was then taken to BlueSkyBio’s Orthoplan for design

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In this video, you can see how we verify the accuracy of the occlusal contacts. In the software, you can open the articulated arches and look for contact points made digitally and you can compare those to the clinical marks left with articulating paper.

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Once you are satisfied with the models and the correct occlusal scheme, you can export those models in STL, OBJ, or PLY formats and import them into a third party software. Here, we have them imported into BlueSKyBio Ortho Planning software. Download the case files and design along

Download the STL files
Download the OBJ files

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Onlay Restoration Imaged with the Medit i500 Intra-Oral Scanner

This is a case presentation of a onlay preparation on an upper first molar. The area was isolated with the optragate and the isolite after anesthesia. After a little refinement, a green colored retraction cord was placed to displace the tissue from the gingival margin.

The attached video is unedited to show you exactly how long it takes to image a quadrant with the Medit i500 intra-oral scanner. You see an image counter and a clock in the upper left corner. First the prepared arch was captured. Notice how the camera is angled to capture all of the contact area on the second molar, below the height of contour. There are some areas that are not clinically relevant and less time was spent imaging those landmarks (palatal and lingual areas that will not have an impact on the restoration design).

After the upper arch was captured, the lower arch setting was selected and the camera was activate to image the mandible.  The isolite allows you to image both arches with great ease.  Once the lower arch was imaged, the isolite was removed and the buccal bite was captured and the case was processed

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Download the OBJ File
Dowbload the STL File

CASE DESIGN IN EXOCAD

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Premolar Crown Restoration from a Triple Tray and a Desktop Scanner

Another case delivered with the triple tray technique and the MeditT500 desktop scanner. The H&H technique was used to capture the margins and bite and there were no adjustments made to the contacts or the occlusion after delivery of the crown.

The scan, design, and fabrication was done by Burbank Dental Lab

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Articulated Models with STL Export / Import into BlueSkyBio Software

When you scan an upper arch and a lower arch with an intra-oral scanner and then export that case, usually the software places coordinates on the upper and lower models, so when you import them into another software, they properly articulate.

In this video, you can see how the upper arch is stitched to the CT image of the maxilla, an then how one can easily related the mandible stl file to articulate to the upper arch. This comes in handy in software like BlueSkyBio where you could add teeth to the equation and design implants so that they are prosthetically driven during the design phase.

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In this video, you can see how a quadrant of the lower arch and the upper arch can be imported into a third party software for design. Note that in this particular demonstration, there is not edentulous area and this video just demonstrates how you can place a digital tooth in your case and design the digital wax up to your liking. Advanced users generally just use the sleeve of the surgical stent to aid them in visualizing the occlusal table of the final prosthesis. A complete design lets you know where the contacts are and how much space you need to create the proper emergence profile.

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Different Model Trimming Methods with the Medit i500

There are multiple ways to adjust a model with refined tools like the Polyline Trimming, the Brush Trimming, and the Quick Trim feature. You can see all of them in action in the video.

PolyLine Trimming allow you to circumscribe an area that you want to remove. You start with a left click, delineate the area you want removed, and then right click to get rid of the data you don’t want included in your models.

Brush Trimming has three separate settings and it is a very effective way of removing data in incremental steps. it allows for real fine adjustments.

Quick Trimming removes data that is not part of the model, like an island of floating data. This usually happens when the tongue gets in the way of imaging, and if it happens enough times, the software starts to thing it is part of the equation. if you click on data points that are indeed attached to the rest of the model, you will delete the whole model. You can see that happening in the video attached.

It’s not a big deal if you inadvertently trim areas away as you can undo each step and get back to your point of origin

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Full Arch Scan Strategy for Medit i500

If you are new to Medit i500, or any introral scanner, and you are trying to scan full arches, there are some important concepts to keep in mind to make your life easier.  The scanners do not like parts that move (lips and tongue) and love landmarks that keep their position. They also dislike air or dark areas, but not as much as moving tissue.  Some times, if you image the lips or tongue enough, the software and camera can interpret that to be hard tissue and introduce errors.  So lip and tongue retraction certainly help.

Humidity of the mouth can cause fogging of the lens, but that is not a big deal with the Medit i500 because the fan on the camera lens prevents that from happening.  While keeping this in mind, and if you are new to full arch scanning, here’s a recommendation that works real well.  It’s the concept of establishing a “Home Base”, a purchase point, or an anchor abutment.  Not only does the camera like immobile parts, it likes these objects to cover large surface areas and also to cross multiple planes.

To build this home base, we recommend that you place the camera on top of the posterior and then turn on the scanning.  Note, there is a setting in the software that starts to autoscan the surfaces.  As a newcomer, you may inadvertently scan areas that you don’t want to.  So start in the manual mode, place the camera on the first molar, and start scanning that occlusal surface, Then move the camera to the distal to capture the second molar and come back to the premolar area.  Once you have the occlusal surfaces captured, we recommend you roll to the buccal and lingual of this quadrant.

Once you have the foundation of your scan established, you can proceed to capture the rest of the arch. If you get lost in the process, or your camera can no longer continue capturing because you moved to fast or you lost your orientation, you an always go back to your home-base and start from there again. The software will quickly orient itself to that landmark.  If you watch the video, you can see how we get back on track on a few occasions by applying this concept.

The first sequence shows how the camera is looking at the opposing arch, and just by moving the camera back to the original landmark, the software quickly recognizes where it is.  The second sequence shows how we scan a blue glove and then move the camera to that position.  It takes little time for the system to recognize where it is and what it needs to do next.

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Powderless, Full Color Intraoral Scanning (IOS) Price and Specs Comparison Chart

The prices and specifications cited in these charts are best estimates from published data readily available on the internet. We suggest you verify the numbers for accuracy and fluctuations over time.

 Medit i500Sirona Omnicam 3Shape Wired Carestream iTeroPlanscan Emerald
Retail Price$18,000$29,995$39,000$37,000$29,995~$36,000
Yearly Fee$0$2400$1800 after first year$0$2280
Required Training$2500
5 Year Total~$18,000~ $43,000~$49,500~$37,000~$41,000~$36,000

Medit i500 Facts and Comparison to other intraoral scanners

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24 Karat Magic in the Scan

Imaging reflective surfaces like gold is often difficult with intra-oral scanners. In this video, you can see how the whole occlusal surface of the gold crown is captured with the Medit i500 and the contact area as well. It is certainly not flawless, but it works great. No powder or dusting was used here and no animals were harmed in the process either. Take a look at how nicely visible the margin is on the mesial of the second molar!

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Restorations fabricate by:

 

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Desktop Scanner and Triple Tray

This is the triple tray technique used to image the prep, the opposing, and the bite with the Medit Desktop Scanner by Burbank Dental Lab. Not a single contact was adjusted and crown fit perfectly!

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Fit perfectly. Not a single adjustment to the contact area or the occlusion

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First Molar Crown Scan with Medit i500 with Opposing and Buccal Bite

Here’s a straight forward scan of a molar crown prep. You can see how angling the camera helps you capture the contact areas of adjacent teeth. You can spend a little more time capturing more data below the height of contour, but that is not necessary as you won’t be making contact to that area (otherwise you won’t be able to seat the crown).

You can see the rest of the process of imaging the opposing and capturing the buccal bite and articulating the models together in the video. With the color capture, more often than not, it is not necessary to retract the tissue to visualize the margins.

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