In the following three videos we walk you through the steps of how the digital “scanbody drop” works to identify the location of an implant fixture. In the demonstration videos, we highlight this upcoming feature and how you an integrate the CAD software for implant designs and restorations. In the final video, we demonstrate how you can take the construction files to the milling machine of your choice and mill out the abutment and/or suprastructure.
When you start a case in exocad or in Meditlink, you have to define a project or define the job by entering a prescription. A dentalproject file is created that has all the pertinent data, like the type of restoration, the shade, the material, parameter settings,etc..
After the case is designed a dental cad project file is formed, along with the stl file of the restoration, accompanied by the construction information. Once the construction file is formed, the case can be import it into CAM software like cerec inlab. It carries a lot of information like the margin line.
Some CAM software can process simple redirections without the need for any other pertinent information from the construction file, while others require it. Some are so specific that a simple typo or wrong character will lead to mis-production.
In the case of cerec inlab, it’s best to have the construction file accompany the stl of the restorations, although there are numerous work-arounds in case you don’t. Once processed, the restoration is taken to the Mcxl milling machine.
Why are we so focused on teaching this concept ? Because it is critical for milling metal abutment where you have to keep track of an object that is cylindrical and symmetric in shape. The code in these files will dictate the indexing of the connections and how these abutments are milled.
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.
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.
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.
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.
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.
The Medit i500 intra-oral scanner has two different software programs to operate, one is of which is geared towards clinical dentistry and the other is geared towards laboratories. Our advanced users are encouraged to use the lab version as it has a lot more functionality. One of them is to directly link to exocad software.
In this particular preview we show you the interface where you can launch the iScan program and define the work order and set all the parameters for your restorations.
Once all the settings are chosen, you launch the Medit scanner and image the case. Here, we defined the custom abutment for the crown and the opposing, which activated the catalog box for the antagonist, the arch, the scanbody, and the buccal bite. All respective images were captured.
The models were then processed and exocad was launched for the design of the custom abutment and crown.
Once the implant type is identified then you can design the abutment and crown with great control, where you can contour the underbelly of the abutment to help provide tissue support.
The design and the construction file is taken to the milling machine. Here, we used the CORiTEC ONE to mill the titanium abutment and then the Lithium Disilicate crown. You can see the great internal adaptation when the crown and the abutment are flipped around completely and the abutment does not fall out.
This case shows the amount of control one can have over the fit of a restoration. The upper right first molar was imaged with the Medit i500 and then imported into exocad design software. Once the margins are marked, the user can then define parameters that affect the fit of the restoration.
The diameter of the drill can be taken into consideration; in the design, 1.0 mm was chosen, but ultimately, we used the 0.6 mm bur to mill the intaglio of the emax restoration. The cement gap can be controlled as can the distance from the margin where it takes effect. The minimum thickness parameter also reinforces the material at the margins which will reduce the chances of chipping and ditching at deep chamfer margins. All of this translates into well fitting restorations with little space needed for the resin. That ultimately translates to easier clean up.
The case was milled using a few different materials and at varying speeds to see how thin the margins could be handled and how much detail the 0.6 mm burr can carve into emax and the glass ceramic material
At any given time, we are milling restorations with 3 or 4 milling machines. Recently, we designed a restoration with the Medit i500 scanner, designed in exocad, and milled with a chairside mcxl cerec milling machine. Here are the steps we took to do this:
- Purchased Inlab CAM for 3000 euros and this dongle
- Installed the dvd for inlab 18.0 CAM. This was the hardest part because we couldn’t find any machines that still had DVD drives.
- Went to this page and download the service patch for inlab 18.2
- You may have to install some .net framework files from Microsoft. It’s generally an automated installation
- Once installed, make sure to have your milling machine turned on and connected. A lot of the functionality is closed if your machine is not on and connected to the PC with the software.
- We had to follow certain steps in sequence to get this to work. We had to activate the license in a pre-installed CEREC software and then move that thumbdrive to the machine where the inlab CAM was going to be installed
You can contact Mr. Milos Gedosev who runs DentalCADCAM in Germany and has earned a great reputation over two decades if you have any questions.
If you are new to digital dentistry, this introductory video will show you how to judge if digital models are related to each other. As a simple exercise, we opened one digital model and then imported the exact same model as a pre-op scan into the equation.
Once the models are in the design software, they are manually related to each other with at least 3 common points. After the merge, we performed “best fit matching” and then demonstrate how the color histogram in exocad has the both models painted completely blue.
We then slightly altered one model by adding material to one cusp tip, reduce the adjacent cusp tip, and then smoothing the third cusp tip. We then re-aligned both models to each other again and you can see how the software lets you know the range of discrepancy in those areas. Notice that all three areas have the same histogram color but all three have distinct meshwork areas from the original.
Once you understand this concept, it opens up many avenues for you that you can never achieve with traditional impressions.
Posted by Armen Mirzayan on Sunday, May 5, 2019
Some of the features:
Custom abutment and tibase design / fabrication
Temporary Shell / Provisional fabrication
Fast copy case designs
Direct launch of desktop and intra-oral scanners
Auto import into CAD software from multiple sources
CT data manipulation and surface meshwork fabrication
Coming Soon: Mixing Desktop Scanning and Intra-Oral Scanning
There are may advanced ways that you can articulate the maxilla with the mandible if you happen to have models that are not accompanied by a bite registration or the arches were scanned intra-orally in separate folders as files
Generally, when you scan intra-oral and complete the case with both arches and the buccal bite, the models maintain their relationship to each other when exported to CAD software. But if you do not include the buccal bite scan, or if you scan the arches in separate files or cases, there is no way for a software to know how they are supposed to align with each other.
This simple video tutorial shows beginners how they can hand articulate the arches together with digital software. There are two steps you should take to make this an easier process to visualize, once you become comfortable with the moving models around as a system or as independent units. Crop the model at its base so that you can see through it and then turn on the feature “show distances” in exocad that will give you a color map and help you with alignment.
Obviously a bite alignment scan will come in hand, whether you use a desktop scan or an intraoral buccal bites scan
Once in a while, our users get themselves in a bind and you have to rely on manual alignment of jaws to each other. Sometimes, it feels like you are doing gymnastics to get the process to work. The sequence of how you import the models and how you set up the case is important in exocad.
Here we have 3 models; one of the upper, one for the lower, and one for the bite. Don’t ask how we ended up here:) The “direction of travel” is important to keep in mind, and as you can see in this video that is sped up, how the case was managed. if you bring in the upper and lower models in together, and then the bite, as soon as you align the bite to one jaw, you end up dislodging it when you tack it to the opposing jaw.
Reversing the sequence of import helps. We first bring in the upper jaw and the bite alignment and stitch those together. Then we bring the lower jaw into the equation and then merge that to the whole complex. Once that is done, the arches now know their relationships to each other and when you save each arch individually and import them into other programs, they will know exactly how to line up.
At the end of this video demonstration you can see how we re-import the two models in stl format just to verify that they do align properly
In this particular case, we demonstrate an emax restoration fabricated with the Z4 milling machine by VHF. In the first video, you can see how the case was set up initially within the software. You will notice how we image the preop, image the opposing and can even image the bite out of sequence, all while the patient is being anesthetized.
Once the preparation is captured, we place the margins and design a crown in exocad. The emax is milled, tried in, and them placed in the oven for crystallization. It is then delivered to the patient. Note how the decay at the contacts of the adjacent teeth was drilled out and restored, while the crown was milling / crystalizing. An immediate post op x-ray was taken to make sure there was no resin left behin
When imaging a preparation, all you really need for a restoration to “fit’ is the contact area of the adjacent teeth (above the height of contour) and the opposing occlusal surface.
But the more you feed the computer aided design software the less work you have to do in the design of the restoration. For example, in the video below, you can see how the software automatically recognizes the adjacent teeth and a great initial proposal is rendered.
However, if you don’t capture all the data in the adjacent teeth, you will have to manually plot the adjacent teeth and spend more time in the design steps.
Download the OBJ files and import them into smile design software and do a virtual wax up for a real case
This is a first molar crown that was replaced with an in-office milled eMax restoration. The adjacent second molar had recurrent decay under the existing class 2 restoration. That was removed and replaced and pre-existing crown was also removed.
The preparation was refined and the recurrent decay was removed. Once hemostasis was achieved and the tissue was retracted the area was scanned with the medit i500. The crown was designed to full contour and milled chairside. After it was chrystalized, it was bonded into place with Nx3 resin cement. The excess was removed and an immediate post-op bitewing was taken to verify that no excess cement was left behind.
This video shows the design of a crown after the impression was taken where vivid colors of the retraction cord, the sulcus, the preparation, and the details of the adjacent tooth can be visualized.
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Download the case files in OBJ Format
There are so many incredible and robust features to exocad and it is precisely why there are over 35,000 users around the world. There are many distributors to the software, including us, at CAD-Ray.com
We focus mostly on our clients who are generally dentists, and our main goal is to streamline your workflow and make this easy and not intimidating. During our two day hands-on course for new medit i500 owners, we install the software and design four cases in exocad.
Here are some of the top highlights for you to understand. The software is installed and self contained within a folder that you can place anywhere on a computer’s directory. What’s great about this is that your software operates completely independent of the windows operating system. So whenever there is an automatic windoes update, it does not mess with your configurations or settings and you don’t have to deal with firewalls and other technical terms we don’t even comprehend.
Another benefit to this is that you can place this folder on the cloud like dropbox and then you can go to ANY machine- at home, in another operatory, at another office and launch the program there, instead of carrying a laptop around. Since the data can only be accessed by a real license / dongle, there are no concerns about HIPAA violations as it is encrypted and only accessible by the active license. Moreover, one machine can be running Windows 7 and another could be runnng Windows 10, and you wouldn’t know the difference or have to worry about configurations
Also, multiple doctors in multiple locations could be working off the same program on the cloud, as long as they have an active dongle. This really allows for a lot of flexibility in a practice or a group setting.
You can see the basic elements in the folder, which are broken down into a case data storage folder, the CADApp and the DentalDB folders. We’ll explain what these other two folders do below.
As a distributor, we can custom make our own private label version of exocad. Since we are focused on chairside dentistry, or on dentists, generally, we strip the software down to the essentials. Namely, we’ve programmed it for inlays, onlays, crowns, and veneers. We also include bridges that can fit in 40mm blocks. You can choose to add on other modules like implant planning, implant designs, dentures, etc.. if you choose to.
It is important for you to understand that we provide a fully functional version of this software, and if you want to add more features as your confidence grows, all you have to do is swap out these files called WorkParamsDB.xml
Watch the video that shows you how we have multiple versions of the file. We provide you with many versions of this file that you always have access to and they are all configured differently. In seconds, you can change the look and the feel of the software to your liking, and turn on multiple modules that we hide from the version that we provide. Please note that we only provide support and tutorials for the what we call the Dentist Version of exocad, as opposed to the lab version. If you grow to the point where you want to add the other components, it is very to transition, just recognize that we don’t support the heavy duty version. We certainly can refer you to the right people to learn how to use those extended functions.
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One more thing for you to get excited about is the WorkParamConfigTool.exe
Now, if you are scared of the mouse and can’t press the “Any Key” button on keyboard, stop reading any further.
In this file, you can add, edit, remove material profiles, parameters and configurations to your delight. Let’s just leave it at that for now
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SAMPLE VIDEO OF EXOCAD DENTAL CAD
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SAMPLE VIDEO OF IMPLANT DESIGN MODULE
One of the greatest advantages of digital impressions is the ability to copy a pre-existing condition. This has a lot of benefits, one of which is that the patient will not notice a difference in the new restoration vs. the old one. For this to happen with the medit i500, you need an extra image catalog box. Rumor is that this will be available in the near future. Since we only have the upper and lower jaws, and the buccal bite to imagine into (and scanbody catalog boxes), what you can simply do is treat the case as if they are two separate patients.
Create a new patient, and scan the preop condition and save the case. Once processed, you can export the case file in OBJ, PLY, or STL format.
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You can then launch a second case, where you take the opposing, the prepared arch, and the buccal bite images. You can download the Korolation OBJ case files and design along. Just remember, in exocad, the upper and lower arches from “patient #2″ will automatically articulate with each other, but you will have to manual import the preop scan and merge the prepped model and the pre-op models.
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Once you import in the pre-op condition, you can manually relate the models to each other by identifying common landmarks between the two models. After you perform alignment, you can then click on “Best fit matching”. The color scheme in exocad is a great guide in letting you know how well you have articulated the models together.
The more blue you see in the Korolated models, the more reliable your stitch is and you can be assured of greater accuracy in your final restoration.
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