With Medit i500, there is an incredible feature where you can import a 3D model from source, even another scanner and be able to add live scans to that model. This is a first in the dental industry and has great impact for advanced users who utilize multiple models.
One of the most important lessons a digital dentist has to learn quickly is how to not introduce errors when scanning dentition. The most likely area when s/he can introduce errors is in the anterior area where the incisor are not only narrower than molars but can also have translucent enamel. Add just a little spacing between teeth with diastemas and you can quickly distort the accuracy of the model. This is true of ALL intra-oral scanners in the market
There are a few ways you can overcome these issues and the second video highlights some of our preferred methods. The concept is easy- block the light from travelling through the tooth structure and you are set! Watch the videos to learn how to do it
Here are some examples of how light shinning through the enamel and /or ceramic instead of bouncing back resulting in errors in model accuracy. Lesson #1 for every ios user is to know when and where they are likely to introduce error. in dentate cases, it usually is right that the transition from premolar to canine to lateral. The surface area decreases dramatically and if you have translucent enamel and / or material and / or highly reflective surfaces you can “derail” the model building. Here is an exaggerated demonstration
Translucent enamel can also play a role in distorting the cavosurface margins of a inlay or onlay restoration. When imaging from the occlusal, the gingiva below the margins acts as a barrier to block light transmission through the enamel, but as soon as you start to roll the camera to the buccal or lingual, and you have enamel with no substrate behind it to block light transmission, you can introduce errors in the equation with any scanner.
There are many ways to combat this which include powdering the tooth structure, using a rubber dam, or in Medit’s case, you can use the color subtraction filter. You selectively tell the scanner to ignore certain colors and you use that exact color (here, it is the color of the glove) to block light transmission through the enamel. So the software just ignores the blue, but the light is prevented from shining through reducing the errors you would introduce.
For advanced users of meditlink software, you can skip filling out the Rx form and go straight into scanning. But make sure to properly fill out the CAD Rx form so that all the necessary models are imported into the design software. If you don’t designate the opposing or the Pre-op / Wax-Up in the form, they will not be part of the design equation. Also, this video shows how to select multiple restorations at once.
Setting the occlusal plane in the native medit software will allow for much nicer initial proposals in the CAD software
in this case we import multiple models, videos, CT scans, and Face Scans so that our users can utilize all of these features. Click here to enter the member’s section to download the whole case and design along
here is a list of why the Medit Artificial Intelligent Implant Suprastructure Identification System is significantly more advantageous over all other cadcam systems.
- It s technically a crown and bridge case and the implant location or timing does not matter
- You can find margins outside the mouth! See the first video to appreciate the significance of this
- You don’t have to deal with retraction or hemostatis at all
- You don’t have to worry about sprue position. Many other systems force the placement of the sprue to a specific location often making the case more difficult to manage than necessary
- you are not limited to just a few implant lines
- you don’t have to worry about location of anti rotational notch
- you can digitally alter the prep and get a virtual reduction coping in cad
- Use any restorative block you want. There is no need to order special blocks with pre-fabricated access channels and keep a large inventory of many colors. Your regular block inventory will suffice. Just make sure the top of the tibase is wider than the diameter of the drill used to mill out the intaglio. Also, the CAM and the milling machine determine the exact product and different settings maybe utilized to give you relief off the walls. Some will even remove the antirotational notch because the adaptation is so tight, the restoration will not rotate due to the tall walls of the tibase
- You can check the fit outside the mouth on the same tibase or a one you keep chairside for every case to let you know that if you are not seating, it is clearly a contact or contour issue as opposed to an intaglio issue.
With Medit’s Crown Fit function, you can see exactly how much cement is required to seat the restoration and how well it is adapted to the tibase.
This article features the new Meditlink 2.3 software which has some advanced functionality. One of the greatest achievements is he ability to tell the scanner to avoid imaging certain colors like green and blue. This greatly facilitates the imaging of full arches as you can let your gloves / fingers guide the camera and displace all the soft tissue that impedes image capturing. We also feature how easy it is to launch CAD software to design the restoration and mill it out of lithium disilicate material
Case set up: here we enter the patients name and a simple tab appears where we chose the material and restoration tab. Once you image, you can place an order to the lab or you can advance to the CAD tab:
After the Rx has been filled out, you can launch the Medit Scan and image the upper and lower arches. Please note how we tell the camera to avoid the color blue and it ignores the clinicians fingers during imaging. The upper jaw and lower jaw were captured, then the bite registration even before the preparation was finished. This allows the verification of proper reduction and space for the ceramic material
Lower Arch Scan
The lower arch is the most difficult area to scan as you frequently have to battle the tongue, saliva, and the lips. The optragate can be of great help but notice how we use the color filter to hide the blue gloves while we advance the camera. It is a great aid in facilitating the capture of the lower arch
Upper Arch Scan
The same principle is applied to the upper arch. Notice that the software does not care if you start with the upper or lower arch. Here, you can visualize how the blue glove was used to displace the cheek and capture the pre-op condition of the upper second molar. The rest of the arch was easily imaged. It is not necessary to capture full arch impressions and this was done just for demonstration purposes. For a single unit case, generally imaging distal from the canine is adequate.
Checkingthe reduction and aquiiring the bite registration
We recommend that you capture the bite before you finish imaging the preparation. This gives you one last chance to verify that you have reduced enough to accommodate material thickness. You can see how we just take regular photos to document the lack of clearance and we continue to adjust the height of the preparation until we achieve the required space. We then activate the imaging process and capture the occlusal relationship between the upper jaw and the lower jaw
Image the preparation and place margin in native MeditScan Software that transfers to CAD Software
The preop condition is then transferred to the arch model and the tooth in question is cropped out. The rest of the arch is protected so no extra data is added unnecessarily to the equation. This protect feature is used for demonstration purposes and is subsequently removed. The prep in question is then highlighted and the local area is processed and the margins are placed. This margin line can be sent to the lab or it can be automatically carried to the design software
Launch CAD Software
The Meditlink software allow you to launch a variety of CAD programs that include 3shape, exocad, cerec, etc… Here we launch exocad which automatically imports and aligns the models and marks the margins. The restoration is then designed to completion.
Design of restoration
The CAD software allows you or the lab to alter the marked margins if necessary. The restoration is aligned in the arch for and the contacts are adapted to the adjacents and the oppising
You can take the designed restoration to ANY milling machine or printer
Milling of Lithium Disilicate with Imes Icore Coritec One
The final restoration design can be exported as an stl and taken to a variety of mills or printers. Here we designed it millbox and milled with the coritec One. The material used was Amber Mill and it was crystalized and seated
Final X-ray was taken to verify the fit and to make sure no excess resin was left behind
The following pictures depict the sequence of burs we recommend that you use to finish a preparation quickly. While patient is getting numb, take a quick look at the clearance you will need to reach proper material thickness. Once the quadrant is isolated with isolite and optragate, take an occlusal router bur and create a trough to gain the proper depth. Follow that with a flat disk, and you can quickly reduce the occlusal height.
A shoulder bur of .8 mm thickness can help you reduce the interproximal areas as well as the buccal and lingual margin lines. Before finishing the prep, place hemostatic agent like expasyl in the sulcus and place retraction cord. while it is setting, check your reduction. If you need more space, now is the time to reduce some more.
Once you have adequate clearance, retraction, and hemostatis, you can readily image and find your margins in the CAD software
A Medit i500 scan was taken and merged with a CT scan and the distance to bone was measured (5.5 mm’s) giving enough space for soft tissue contouring with a diode laser. The 3D X-ray must be captured with cotton rolls placed in the vestibule so that you can differentiate between the gingiva and the lip. Ideally you should not close the base of the digital model by the intra-oral scanner as it can make the merge of the data sets more difficult than it needs to be.
Comparison of Pre-Op Scan and Post Gingivectomy Scan with Medit i500
For our advanced users who mill in house or what to speed up their digital impressions we advocate taking advantage of digital dentistry’s unique features that allow you to take impressions over a period of time and segments, building larger models over different sequences and time. In this particular case we have two molars in the lower left quadrant that warranted replacement. The traditional method would be to prep both, isolate both, retract both, and take your final impression, but we will approach this as if there are two separate patients involved
For the second molar, we will take advantage of the anesthesia time and capture the first bite, the opposing, the pre-existing situation and then crop out the preparation area digitally. Once the tooth is prepared, we will check for proper reduction. We will then take the second bite to verify the vertical dimension has not changed.
While the second molar is being designed and milled in the first case, we will launch a second window by cloning the first case. All the data remains the same and this time we crop out the first molar digitally and protect the rest of the arch. Once the first molar is isolated, it is digitally captured and then designed and milled.
To manage the contact between the two crowns, there are many advanced applications. Here is a simple explanation of how we use the prep model from case 1 as the pre-op model for case two. Since the second molar in case 1 made contact with the distal wall of the first molar, when we design the crown for the first molar in case 2, all we have to do is make sure the distal wall is flush to the pre-op. This guarantees us a contact between the two. There are lots of shortcuts to this puzzle once you get the basics of digital impressions under your belt.
We quickly printed these same models and crowns just for demonstration purposes
One of the big limitations of CEREC (a registered trademark of denstply sirona) with tibases and implant crowns is that it is limited to very few implant lines and the antirotational notch can just ruin your day as it needs to go into a specific location. You also have to deal with making sure the tibase is seated all the way and the scanbody is properly indexed. The one benefit is that you are dealing with just crown and bridge and you do not need to know implant position or timing at all when doing the design.
In this case, we demonstrate how we utilize the Medit i500 to capture a Tibase from Blueskybio, Biomax NP Conical Connection. Once the tibase is seated, we simply start scanning and then use the artificial intelligent implant suprastructure identification system to identify the location of the tibase. This in essence allows you to capture your margins OUTSIDE the mouth and you don’t have to bother with imaging the tibase, which is highly reflective in the patient’s mouth.
Once processed, you can then modify the tissue digitally and gain access to the tibase margins. You can print the model if you want and manufacture the restoration. In this particular case, we took the design to the CEREC mcxl inlab cam, nested it, and milled it out to demonstrate how we can image with one device from one manufacturer and fabricate a restoration by another company’s manufacturing machine. But the single greatest benefit is that you can place the sprue wherever you want.
IMPORTANT NOTE: The Tibase that you use MUST be wider than the drill milling the intaglio and the sprue must be thick enough to handle the milling process.
Once you understand how the digital workflow goes, you can image with one device, design in another, and then either print or manufacture with yet another device. Here we mill a sectional stent with the cerec that was designed in Blueskybio plan, although printing makes more sense because it is less wear and tear on your drills
PRODUCTS USED IN THIS CASE:
In Digital Dentistry, once you acquire your models accurately, the CAD software doesn’t care where and how you capture them. Once you are done with the design, the cam and the milling machine have no clue what scanner you used.
here we take an intra-oral scan with the medit i500 and design in exocad and send it to 2 different milling machines. One is the CEREC MCXL and the other is the imes icore coritec one.
we even milled the bridge with the z4 milling machine by vhf just to show the concept works
Please Note: This page is from dentalcadcamshop.com: 13.03.2020
When it comes to single visit dentistry (procedures in under 90 minutes), CEREC is tough to beat. From the integrated camera, CAD software and mill, CEREC is the most streamlined technology to serve patients in one visit.
Nevertheless, increasingly doctors are expanding their range of indications with CAD/CAM technologies and sometimes we simply want to combine CEREC with other equipment and software manufacturers. But wait, isn’t CEREC a closed system? Yes and no. While nobody would accuse CEREC of being a completely open system, it is possible to export .STL files of CEREC scans which gives us some flexibility to bring CEREC scans into other programs.
But today we are not focusing on exporting CEREC scans, but rather:
1) How can we bring scans from other cameras into CEREC?
Example: I own a 3rd Party Camera and I want to import those scans into CEREC for making crowns, etc.
2) How can we use CEREC to mill CAD objects made from 3rd Party Software?
Example: I own a 3rd Party CAD Software and want to import those into CEREC for milling.
But wait, I thought no 3rd Party files (scans or CAD designs) may be imported into CEREC. How, then, can we unlock the system? The missing piece to the puzzle is the inLab Software! With inLab Software, the CEREC system can be opened up for all kinds of interesting workflows. Here are two workflows CEREC owners constantly ask us about:
1) I own a 3rd Party Camera – How do I mill from my MC XL?
2) I own a 3rd Party CAD Software (e.g. exocad) and I want to mill (e.g. crowns) designed with 3rd Party software and mill them with my MC XL
Please note carefully the Requirements listed above!
– If you want to import a Scan .STL… You will need the inLab SW Interfaces Module, inLab CAD Software (18.0 and above) andthe inLab CAM Software (18.0 and above).
– If you want to import CAD .STL designs for milling… You only need inLab CAM Software (18.0 and above).
– In case you never owned any inLab Software before, or your copy of inLab Software is below 4.X, you will additionally need to order the License Stick (SKU: 6364785) and install the License Stick on the PC or workstation on which you are using the inLab Software (CAD or CAM). Please note this is NOT the same License Stick as you have on your CEREC AC unit!
– In no case can the inLab Software mill on the CEREC MC!
Still have questions? No problem, we are here with answers: Contact us
Good luck everyone and Happy Milling!
Import Scan .STL
Import CAD .STL