Imaging highly reflective surfaces can be challenging. In this particular situation, every tooth had either a pfm or a gold crown restoration. The video playback feature of the medit software allows you to see exactly how these areas are managed and captured. in the live preview box in the lower right corner, you can see the purple silhouette which shows areas that cannot be seen. Just angle the camera and moving its focal length and angulation allows all the areas to be captured. Not retraction besides a mirror was used. No isolation, air, or suction was used. Both arches were captured for an obstructive sleep apnea device with the Medit i500

Scanning highly reflective surfaces can be a challenge with every intra-oral scanner. Here’s a pointer that can help: don’t start by trying to scan the metal or highly reflective surface. Get your purchase point on material that is easy to scan, like gum tissue or tooth structure. Once the model starts to form, you can then build on your desired material.

In this example, we are scanning a metal framework for a hybrid. Notice how the scanner does not recognize the metal at first, until it starts to image the thumb holding it. Once you start building the metal model and then remove the thumb and image over that area, the fingers are removed from the equation

One of the most popular design techniques in digital dentistry is copying the pre-existing morphology of a restoration. When it is in occlusion and has desirable contours, you can image the pre-op condition before removing the crown.

Once the crown is removed, the preparation can be modified and new images can be taken. Placing margins is immediately followed by a great proposal that takes very little effort to finalize.

Our CAD-Ray software, powered by exocad and exoplan (pending 510k clearance) allows you to import your intra-oral scans and merge them with dcm files from ANY CT machine.

All CBCT machines can export the 3D x-rays into our software where you can merge the data with your intra-oral scans, design implants, and fabricate surgical stents for fully guided surgery. Here’s a preview of what’s coming up soon.

The Medit I500 is powered by a software called Meditlink. Within the program, you have workboxes where you can scan, design, nest, and mill a restoration, when you utilize the software as a laboratory, instead of a clinic. The feature is not available when you log in as a dentist, but all you have to do is register as a lab, and you have access to all these features.

You can can manage a case all within the meditlink software in a
seamless workflow. More importantly, you can utilize whatever CAD
software you want, nest and mill with your CAM software of choice, or
just export the case to someone else to collaborate with

In this video, you can see how you can launch the scanner and capture the data, then you can choose to utilize exocad, 3shape, Maestro design software. You can even export the data to another platform or launch your CAD of choice. Here, we utilize the CAD-Ray software which is a private label program powered by exocad.

The following pdf files document all the changes and updates to the Medit i500 intra-oral scanner. Some of the new features include taking pre-operative images, localized high definition scanning, a variable and custom scan depth field, scanning of impressions and much more

 

A well fitting surgical stent makes guided surgery very easy. You can CT scan a stone model or an impression to get a digital model to design the surgical stent

Download the DCM Files
Download the STL Files

Design Along by download the stl and dcm files

This failing three unit fixed partial denture was replaced with the Medit i500 and the CAD-Ray Design Software. While the patient was getting numb, a physical quadrant impression was made to fabricate a temporary after the removal of the existing bridge

With distal extension case, we advocate that you take a the pre-op scans, the maxillan and mandibular scans, and the first of the buccal bites. After the preparations are done and imaged, we advocate that you take the second bite IN THE SAME area so that you can judge if the jaw has settled once your distal stops were prepared.

This preview shows how the two bites can aid with aligning the arches accurately and to determine if the jaw settled after the lateral pterygoid muscles releases.

For the sequence of events, you can see how the pre-op scan of the bridge was taken. The same model was then trimmed in the maxillar folder, the lower arch was scanned and the first buccal bite was taken.

After the bridge was removed, the premolar preparation was modified and the margins were exposed with expasyl and cord retraction. The premolar prep was imaged with the medit i500 and the pontic area was also captured

Proper isolation and retraction greatly contribute to ease of access and imaging. Here you can see how the isolite and the optragate are used in conjunction to control the clinical environment

Notice how the red soft tissue is harder to pick up in the scan and the camera mode was changed to white light, as opposed to blue light scanning. Blue light is great at picking up tooth structure, white light is great at picking up red- blood and soft tissue.

Once the premolar area was captured, the imaging was stopped and then the molar crown prep was modified and the model was extended to include the new prepration. The difficult access was address by breaking up the model into sections that are much easier to maintain. The protect mode was used to not “ruin a good impression” elsewhere on the preparation

After the case was processed, the margins were marked and the rough design was proposed and then shared with the lab through the dentalshare network

Download the Case File and Design Along

A common question we get about the Medit i500 is about its cross arch accuracy. There are dozens of ways one can introduce errors with digital impressions and the user must be able to recognize the potential pitfalls. Once you adhere to strict scanning protocols, you can achieve very accurate scans.

To demonstrate the accuracy of intra-oral scanning vs physical impressions, we place 6 DESS Desktop Scanning Scanbodies (REF: 5041) on a stone model that contained six implant analogs.

The original impressions were taken using traditional impression abutments on BioMax Implants from BlueSkyBio Narrow Platform Fixtures. The surgical stent was used to capture the impression duralay pattern resin was used to secure the relationship of the impression abutments to each other and the tray.

The model was poured and a stone cast with analogs were fabricated. The stone models were desktop scanned with the Medit T500 and the rendered models were exported to exocad software to analyze the precision of the intra-oral scan with the traditional method.

Download the case files

At CAD-Ray, we have a tough job balancing the interests of patients, dentists, and labs. The hand-off or delegation from dentist to the lab in a digital workflow is difficult to identify because of various habits all parties are accustomed to.

We think the sweet spot is for the dentist to mark the margins, verify that the case is mounted corrected for the proper vertical dimension, and then submit the case to the lab. A great tool is the DentalShare feature from exocad that allows collaboration between dentists and labs.

This eliminates so many obstacles, reduces cost for labs dramatically, and expedites the fabrication of the restorations. There are no phone calls that need to be made and it allows collaboration at the highest level where you can pass files and images back and forth to your technician at your and their convenience.

With the products we distribute and the number of clients we have managed over the years, we identify this segment of digital dentistry as the largest growth potential in our profession.

Click here to download the DESS library for exocad. It gets tricky making sure you have the right parts for both the scanbody identification and the tibases that would go with the zirconia substructures you will be ordering and/or manufacturing.

DESS-Library-Installation-INS-12-MUL-02-2

DESS_Library_Guide_INS-08-ENG-08

There are some great new features coming to Version 2.0 by the Medit i500. We now have the option to image the pre-operative condition, the upper and lower jaws, and the buccal bite, along with the catalog boxes for scan bodies.

In this particular case, we are restoring a left Central Incisor that has been temporized for approximately 4 months

To set up the case, the pre-op arch was imaged, then the mandible was scanned, and the buccal bite was taken. After the occlusal relationship was registered, we moved back to the maxillary catalog box.

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The screw retained temporary was removed and the contact areas and the gingiva was captured with the Medit i500. Then we moved to the scanbody catalog box, inserted a NT-Trading scan body, made sure it was completely seated and imaged that as well.

Once the case is processed, the relationship of the upper jaw to the lower jaw is preserved, as is the relationship of the pre-op condition to the maxilla as well as the scanbody relationship to the same arch. This is critical when you bring it into design software as the steps to relate the jaws to each other is dramatically reduced

A new feature coming soon to Medit I500 is localized High Definition Scanning. There are two modes you can scan and save the models in; Normal and High Definition. In previous versions, either the whole arch model was process in regular or HD mode. Although of little clinical significance, if any, the visual properties provided by the High Definition mode resonate with all clinicians.

The processing times for HD mode was 4-5 times longer than regular mode. Now, you an just scan local areas in High Definition, greatly reducing processing time and provided you sharp details of the preparation.

In this video you can see clinically how the upper arch was imaged in regular mode. The whole lower arch was then imaged while expasyl was applied as a hemostatic agent. Once bleeding stopped, the area was irrigated and dried. In the software, the molar area was trimmed away and the local HD feature was turned on. The topography of the preparation was captured in the new Local HD mode.

As a clinician, you will appreciate the depth of the margin and the quality of the scan when designing the restoration in exocad

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Here, you can see the design process in our software powered by exocad.

A very common issue for a new user of Intra-Oral Scanners is to appreciate that, generally, the cameras nor the software, can tell the difference between tooth structure and soft tissue.

Furthermore, once soft or hard tissue is captured by a scanner, it assumes that the data is part of the model and part of the “equation”. What this means for automation is that this data, if you don’t take it into consideration, can actually hinder the automatic stitching of arches to each other via the buccal bite.

In the attached video, you can see how some excess data in the lower arch, namely the cheek, prevented the automatic stitching of the buccal bite with the upper and lower arches. Simply trimming away data sets that are in the line of sight for your camera can greatly speed up the process.

In the original version 1.0 of Medit Software, you would capture the upper jaw and lower jaw, then the buccal bite on either one side or both sides. Once you capture the arches and their occlusal relationships, you then process the case.

In the preview box, you will then find two models that you can export. The mandibular and maxillary files are readily visible, but the buccal bite, or the occlusion models are not present. This can be confusing to some new users or people used to other programs / software. Rest assured that when you import the case into another software, the relationship of the upper arch is maintained with the lower arch.

The above case is imported into another software and you can see how it automatically relates the arches to each other as there embedded coordinates in the two arches and they know their positions on the X,Y,Z planes

Now imagine if you actually wanted or needed the buccal bite models too. Once thing you could do is to start a new case, and take the right side buccal bite in one of the catalogs, and the left side buccal bite in the opposing arch catalog box.

You could then export both of those models to third party software to utilize them for their intended uses. In this video, you can see how this is managed- all you have to do is label them properly when exporting them because the software will label them as maxillary and mandibular files.

In the new software version 2.0, the buccal bite models can be exported along with the upper and lower arches. So can the preop models or wax ups if you wanted to utilize them in a particular design

Advanced users will like this feature as they can manipulate the models with the two bite models. For example, in the video attached, there are 4 models being utilized to establish the current bite. You can bring multiple other models to set the arches at differing vertical dimensions and tooth positions for more complex cases.