Category: Digital Impressions

Digital Dental Impressions with Intra-Oral and Desktop Scanners

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Denture Duplication with the Medit i500 for Guided Implant Planning and Surgery

When planning for guided surgery in edentulous patients, it is important to have the final vertical dimension and tooth position determined. Ideally, a denture duplicate should be used with proper radiographic markers.

The traditional way was to embed radio-opaque material in the denture dupe, CT scan the patient with the denture dupes, and then CT scan the denture dupes themselves. Alternatively, you can scan the denture duplicates with a digital impression system. Here we used flowable composite and spread them through the wax set up and take a 3D X-ray of the patient. We then use those landmarks to merge the data sets between the digitize denture and the markers on the CT Scan

 

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Once the dentures are digitized and merged with the CT data, the cases is analyzed to make sure there are no gaps in between the intaglio of the denture and the soft tissue of the palate and the lower / mandibular ridge

An important concept to keep in mind for these edentulous cases is that you actually need 2 models for each arch. One model is used for tooth positioning and implant design, and the other model is used for stent design. Essentially, you design the stent on the ridge, not the denture dupe

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Virtual Extraction for Implant Planning

One of the biggest hassles in most software is to plan a guided surgery case when the tooth is still present in the arch. Some software will force you to part-take in pylon course handling, gymnastics maneuvers, musical chairs, and multiple imports and exports. The issue revolves around the placement of the sleeve / ring in the design step. Usually you are forced to manipulate the data in 3rd party software and then bring it back with the tooth virtually extracted.

This article is about how you can scan the arches and export the STL, OBJ, or PLY data from the Medit i500 scanner. You can then clone the same case and alter it- namely, you can crop out the tooth that will be extracted in the future. This video shows you how the virtual extraction is performed.

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The multiple data sets are then imported in BlueSkyBio software where there are no limits to the number of models you can bring in. In the following video, you can see how the complete upper arch, the virtually extracted lateral arch model, and the opposing are brought in an merged with the CT Data.

The implant is planned for fully guided procedure and a surgical stent is manufactured on the model that has the virtual extraction. You cannot design a stent correctly with the tooth present in the equation. Open architecture and speedy results are the name of the game now with CAD/CAM dentistry. As you can see, these steps are super fast and easy with the open licensed Medit Scanner

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Download the STL
Download the OBJ
Download the PLY
Download the BSB file and design along

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Digital Impressions for Obstructive Sleep Apnea Appliance

This article documents how to capture upper and lower scans for an oral appliance to treat obstructive sleep apnea. The patient was recently diagnosed with mild sleep apnea with a Home Study Test which revealed quite a lot about his sleeping habits and patterns.

The patient decided to pursue treatment with an oral appliance in lieu of CPAP therapy. Upper and lower impressions were taken, and the occlusal relationship was captured in protrusive and with the vertical dimension set a a tolerable distance. Cotton rolls were used to block out the movement of the tongue which usually interferes with capturing the bite.

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Once the bite is captured, we recommend that you move back to the maxilla and mandible catalog box and take additional images to complete and remaining voids in the model. At the end of the article, you can download in multiple formats to see the meshwork and the data that is rendered from the Medit i500 scanner.

Once the patient adapts to the appliance, a titration study will be conducted to measure the effectiveness of the oral appliance

Download the STL
Download the OBJ
Download the PLY

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Occlusal Guard with Digital Impressions by Medit i500

This is a case imaged for an occlusal guard, wehre the upper arch took only 43 seconds to capture. Afterwads, the lower arch is captured, and then ultimately we move to the dual buccal bite. To get enough clearance, we just have the patient bite down on two cotton rolls and hold that position.

One thing to keep in mind is that when you move from one image catalog to another, some processing is done. What we recommend you do is to actually go back to your upper and lower models and fill in any missing data or correct any artifact you may have captured inadvertently. You can see in the footage how the second molars are corrected and filled in with good information.

Note how

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Download STL of this Case
Download OBJ of this Case
Download PLY of this Case

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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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