I bought my Medit I-500 from them. Everything has been been first class, from the training to the customer support. I highly recommend buying through CAD RAY. - 6/16/2020
William Daily
Excellent support and price on our medit IOS! Bought a second one a year later. Can always count on Armen and Frank for help when we need it. - 6/16/2020
Tara Ericson
Very pleased with the EXCELLENT support we have received from Frank DeLuca! Loving our new Medit so far, definitely more user friendly than our previous one. - 6/02/2022
JCarlos Mendoza
Had a good experience when purchasing my scanner, it was very easy, and to date after three months of using the scanner no support is a plus, anytime I call me I will answer and troubleshoot - 7/10/2022
Dr. Steven E. Hollister
Had a training session for use of my Medit scanner this afternoon, and Heather G. was simply the best.....knowledgeable, patient and a great trainer. She had a wealth of knowledge regarding my scanner and she was so very patient with my computer glit...read moreHad a training session for use of my Medit scanner this afternoon, and Heather G. was simply the best.....knowledgeable, patient and a great trainer. She had a wealth of knowledge regarding my scanner and she was so very patient with my computer glitches! CAD-Ray is number one in my book! Thanks Heather, your time was much appreciated! Dr. Steve Hollisterread less - 5/14/2025
Delicate Dentistry
Cad-Ray's support is truly exceptional. While the equipment represents a significant investment, the peace of mind that comes from knowing they stand firmly behind their products is invaluable. Their support team is efficient, professional, and remar...read moreCad-Ray's support is truly exceptional. While the equipment represents a significant investment, the peace of mind that comes from knowing they stand firmly behind their products is invaluable. Their support team is efficient, professional, and remarkably persistent in ensuring everything runs smoothly. I'm especially grateful to Destaney and Laura for their ongoing assistance- their dedication and expertise have made a world of a difference!read less - 5/15/2025
Jared Gustafson
One of the best companies to work with for dental tech needs. They have a vast video training library that makes the transition easy to digital dentistry. I’ve recommended a few of my colleagues purchase the medit through them. It’s been a great year...read moreOne of the best companies to work with for dental tech needs. They have a vast video training library that makes the transition easy to digital dentistry. I’ve recommended a few of my colleagues purchase the medit through them. It’s been a great year!read less - 6/16/2020
A C
Kaila and Laura were amazing to work with. I would not hesitate to buy again from them. Super helpful/available and one of the best experiences I’ve had making such a big investment in equipment like I had to make for my practice. Way to go Cad Ray f...read moreKaila and Laura were amazing to work with. I would not hesitate to buy again from them. Super helpful/available and one of the best experiences I’ve had making such a big investment in equipment like I had to make for my practice. Way to go Cad Ray for running a solid business!read less - 11/15/2024
Suzanne Stock
Excellent experience, customer service has been stupendous! - 11/20/2023
Penelope Lee
Frank and his team have always been ready and able to help us with any issue we’ve come across in the last 2 years since we purchased our mill and equipment from them. Today, Griffen went above and beyond to find a solution to our software issue. I w...read moreFrank and his team have always been ready and able to help us with any issue we’ve come across in the last 2 years since we purchased our mill and equipment from them. Today, Griffen went above and beyond to find a solution to our software issue. I was able to finish a project on time for a patient in pain because of his dedication. “We’ve never had a more helpful team for any of our equipment” was a quote from our head Doctor today. Excellent job Griffen and team!read less - 5/14/2025
Milton Ruiz
Best customer service I have ever experienced from any company I have worked with! They alway answer the phone and are ready to help with whatever question you may have. Love that I do not have to press 500 buttons to get to a live person. Bought my...read moreBest customer service I have ever experienced from any company I have worked with! They alway answer the phone and are ready to help with whatever question you may have. Love that I do not have to press 500 buttons to get to a live person. Bought my Medit from them and could not be happier with decision!read less - 12/20/2022
Jeff Johnston
Very Helpful, good company to work with. Always been there for me - 3/10/2017
Aaron - Cooleysmiles
fantastic experience with this company for over 7 years! Top customer service and support! Its great having them as part of our team! Highly recommend! - 3/22/2022
Matt v
Matt Newman was excellent solving a cable problem.! Quick response and good follow up! - 9/11/2024
Blake Ferando
I purchased my medit in April of 2019 from Cad-Ray. The support offered is second to none, and the training videos are some of the best out there. Add to that a great support team that is fast to answer questions and issues, its hard to beat Cad-Ray. - 6/19/2020
Jansen Bean
Heather with CADRay provided wonderful assistance with setting up our new scanner, and was able to work around a minor scheduling issue on my part. Top notch service! - 6/28/2024
Thanh Huynh
I am beyond impressed with Destaney and Cad-Ray! Despite accidentally throwing away my old scanner, which I was supposed to return, their team went above and beyond to advocate for me. Their exceptional support and understanding turned a stressful si...read moreI am beyond impressed with Destaney and Cad-Ray! Despite accidentally throwing away my old scanner, which I was supposed to return, their team went above and beyond to advocate for me. Their exceptional support and understanding turned a stressful situation into a seamless experience. Highly recommend!read less - 8/02/2024
Kristine Keshishyan
My Intraoral scanner was not working. It wouldn’t scan, during the scan the screen was completely blue. I contacted Laura and she logged in remotely and took care of the problem. She was extremely helpful and knowledgeable. Thank you Laura for your o...read moreMy Intraoral scanner was not working. It wouldn’t scan, during the scan the screen was completely blue. I contacted Laura and she logged in remotely and took care of the problem. She was extremely helpful and knowledgeable. Thank you Laura for your outstanding service. Thank you.read less - 12/07/2021
Andrew Cole
The D.I.Y. Medit i500 package was right for me. I bought a nice gaming PC for my 2 operative rooms, downloaded the software, watched some videos, and started scanning. It's really easy to use, my crowns fit better with fewer adjustments, and they cos...read moreThe D.I.Y. Medit i500 package was right for me. I bought a nice gaming PC for my 2 operative rooms, downloaded the software, watched some videos, and started scanning. It's really easy to use, my crowns fit better with fewer adjustments, and they cost less because they are made model-less and without impression materials. I will start to see a return on investment in less than 2 years and it makes my work more fun, and I can deliver better results. Armen puts on a 2 day course which is very helpful to refine your technique. Start with watching the videos, scan your employees, and then use it on patients. I considered buying an iTero Element 2 and I'm so glad I didn't. The Medit is smaller, as good or better, and it costs ~$25,000 less over the course of 5 years. Ongoing fees for other scanners are a joke. Medit keeps providing updates that make the software even better and there are no additional charges.read less - 3/29/2020
Great scanner at a good price...Excellent customer service . I never want to take a conventional impression again! Best upgrade to my office in years. - 11/16/2021
Varghese George
The customer service has been top notch, every single time. I have only good things to say about them. - 4/05/2022
Brenden Rogers
This company is excellent. Their knowledge, support, and sincerity is unmatched.Thank you, Frank, Damien, and Jonathan. You guys rock! - 5/08/2025
Jonathan Acker
Awesome people who care about their clients. - 7/09/2021
Esther Quintana
Se ve muy bien, aunque yo le tengo, pánico, a los Dentistas, Sorry, pero tengo que ir, Ni modo - 2/25/2015
Christopher Godla
I have had my Medit i700 scanner for about 2 months now and have completed 67 restorative cases with it. Scans have generally been pretty quick, and the accuracy seems to be superior to the iTero I used. My first scanner ended up dying after a few ...read moreI have had my Medit i700 scanner for about 2 months now and have completed 67 restorative cases with it. Scans have generally been pretty quick, and the accuracy seems to be superior to the iTero I used. My first scanner ended up dying after a few weeks. Medit and cad-ray were great- they sent a new scanner within the week and haven't had any problems since. Customer service has been spot on. Overall I have been very satisfied.read less - 6/30/2021
Digital dentistry has changed my work flow for the better and could not imagine going back. So important that I have the support when things don't work as expected. CAD-Ray has been there every step and trust their expertise and knowledge! - 4/20/2022
Bio Solution
Very great company, especially Frank. He is very helpful and has saved us a lot of money on resin for our 3D printers. We've recently bought a new scanner and Exocad software. He has been very gracious and quick to respond with the many questions I h...read moreVery great company, especially Frank. He is very helpful and has saved us a lot of money on resin for our 3D printers. We've recently bought a new scanner and Exocad software. He has been very gracious and quick to respond with the many questions I have had. Highly recommend Cad-Rayread less - 1/25/2023
Alec Keon
I was on the fence on getting a scanner for years and finally pulled the trigger. CAD-Ray's support and knowledge has made this one of the best investments in my practice to date. When I spoke with Damien on the phone about my options he literally sa...read moreI was on the fence on getting a scanner for years and finally pulled the trigger. CAD-Ray's support and knowledge has made this one of the best investments in my practice to date. When I spoke with Damien on the phone about my options he literally saved me thousands after figuring out what my exact needs were. I went with the Medit i600, MSI laptop and 3D dental systems cart. The final product looks and feels as premium as it gets.read less - 2/21/2024
Jorge Gonzalez
Armen is a dentist and knows what a dentist need, on other words cad ray sells technology that works for dentists! - 6/16/2020
Erica Zolnierczyk
Purchased the Medit right before the COVID shut down, which gave us time to train on it by watching all the awesome videos CAD-Ray provides. If I couldn’t figure something out, our questions were answered quickly. Now we’re back and using it like cra...read morePurchased the Medit right before the COVID shut down, which gave us time to train on it by watching all the awesome videos CAD-Ray provides. If I couldn’t figure something out, our questions were answered quickly. Now we’re back and using it like crazy. It’s quick, my assistant picked it up quickly and my cases have been coming back perfect. Super happy with the Medit!read less - 6/16/2020
Jennifer Ebner
After using the medit i500 scanner at an office as an employee, I purchased it from Cad-ray,com specifically because of their good reviews and their large, concise training library of videos. I've used CEREC as an instructor at a dental school and bo...read moreAfter using the medit i500 scanner at an office as an employee, I purchased it from Cad-ray,com specifically because of their good reviews and their large, concise training library of videos. I've used CEREC as an instructor at a dental school and bought a used Planscan, Planmill for my private office. Both were hard to learn and the fees and cost associated with training were a bitter pill to swallow after the costs to purchase. The ease of seating restoration was instant. The scanning learning curve is quick. I have easily added occlusal guard scanning, and implant scanning and will be trying a digital denture soon.
The purchase was easy, the product came quickly and the set-up videos guided me through very necessary adjustments to my Laptop I never knew I needed. Learning the new features with each FREE update is a treat. The DIY option was an extra bonus as the $2000 rebate came without having to ask for it. Cad-ray has delivered more than I expected with the purchase of the fantastic Mediti500 scanner.
I've included my cart set up. purchased from Amazon for $68. Its stable, has room for the necessities. I've taken it home and back to the office half a dozen times and it transports the scanner safely. It also keeps the cords from being run over. I haven't taken the included 2 day course but look forward too it after Social Distancing mandates are lifted.read less - 4/25/2020
Frank DeLuca was very helpful even though i didn't buy Medit from Cad ray ! Had an issue and my original dealer was not helpful and i contacted Cad ray thinking it was direct Medit. Frank was extremely nice to log in and do what ever he could until ...read moreFrank DeLuca was very helpful even though i didn't buy Medit from Cad ray ! Had an issue and my original dealer was not helpful and i contacted Cad ray thinking it was direct Medit. Frank was extremely nice to log in and do what ever he could until Medit could take over. would give 7 stars if available.read less - 8/10/2022
Micah Bickel
Great products, training and support - 11/01/2021
Nisarg Parikh
Absolutely a phenomenal company. Everyone you engage with is extremely knowledgeable and helpful.I’m sure they get the same questions day in, day out but they are happy to help you without being condescending. The entire team has been helpful through...read moreAbsolutely a phenomenal company. Everyone you engage with is extremely knowledgeable and helpful.I’m sure they get the same questions day in, day out but they are happy to help you without being condescending. The entire team has been helpful through phone calls, the Cad-Ray FB group, and recorded webinars. Jonathan helped me get a great deal, Laura was awesome on the webinar, Damien is always answering questions on FB, and Armen had a great in-person presentation in Dallas. 100% recommend.read less - 4/22/2022
I'm a dentist in NJ, and I purchased the Medit i700 from CAD-Ray. Hands down they have the best support team. Laura is awesome with helping us using the Medit and with providing any support we may need. One of my best decisions so far was working wit...read moreI'm a dentist in NJ, and I purchased the Medit i700 from CAD-Ray. Hands down they have the best support team. Laura is awesome with helping us using the Medit and with providing any support we may need. One of my best decisions so far was working with CAD-Ray.read less - 4/15/2022
LoAn Huynh
Erika is one of a kind! She truly is patient with me. She has gone above and beyond to help me every time I call her. We have a few locations and she is always prompt in her responses and always manages to find a solution for me. I wish every rep was...read moreErika is one of a kind! She truly is patient with me. She has gone above and beyond to help me every time I call her. We have a few locations and she is always prompt in her responses and always manages to find a solution for me. I wish every rep was reachable ALL THE TIME and helpful! Thank you Erika! ❤️read less - 6/04/2025
Thomas Lim
5 stars for a great product and great service. After much research I knew I was set on the Medit 500. I considered some of my local equipment reps, as well as cad-ray. Cad-ray won out due to their efficiency, speed of service, and knowledge. Their on...read more5 stars for a great product and great service. After much research I knew I was set on the Medit 500. I considered some of my local equipment reps, as well as cad-ray. Cad-ray won out due to their efficiency, speed of service, and knowledge. Their online presence makes it easy to get help via messaging, social media, or phone. The fact that one of the employees of Medit (an engineer?) posts on the cad-Ray Facebook group speaks volumes of the vendor-mfg relations.
The scanner itself works great, but make sure to contact them to get the minimum specs required for a laptop — it will make a difference in how the scanner performs. I had some slow scans at first but upgraded from 8gb to 32gb ram and also got some coaching from customer service (Frank) to get me up to speed.
To make the scanner mobile, I purchased this cart from Staples: https://www.staples.com/Oklahoma-Sound-Premium-Audio-Visual-Presentation-Cart-40-1-2-H-x-18-W-x-30-D-Black-Ivory-Wood/product_932437.
Lastly, I purchased “3M Dual Lock Fastener” to keep the power module attached to the wand from falling off the cart. I carry the scanner between two offices, so I wanted something sturdy, but removable. (see in photos). The hockey puck shaped holder (comes with the scanner) is heavy and sticks to the countertop without needing any adhesive.read less - 10/12/2019
I live in Puerto Rico and Cad-Ray made my decision easy when it comes to purchasing Dental equipment. I decided to call after having connection issues with my i700 and Andy responded immediately. He was very pleasant to work with and within 2 days, r...read moreI live in Puerto Rico and Cad-Ray made my decision easy when it comes to purchasing Dental equipment. I decided to call after having connection issues with my i700 and Andy responded immediately. He was very pleasant to work with and within 2 days, received my brand new cord. I can always always rely on Cad-Ray for their incredible support and highly recommend this company to anyone looking to explore digital dentistry.read less - 12/30/2021
Sonrisas Dental
Support was our main concern, and we chose very carefully. Frank is 100% every step of the way - 1/25/2023
arthur lyford
I cannot say enough about the support I have received from the beginning. I chose CadRay ultimately because of the support reviews...I can attest first hand...they are all right on...though I have been practicing for more than 35 years, this old dog ...read moreI cannot say enough about the support I have received from the beginning. I chose CadRay ultimately because of the support reviews...I can attest first hand...they are all right on...though I have been practicing for more than 35 years, this old dog has been taught a lot of new tricks from the support staff at Cad Ray...Truly impressed with every interaction so far! Thanks 10/4/2023 And they did it again today with ten minutes before the pt came in 3Shpe server would not connect with the computer and Andy got to 3Shape directly and had us up and running...thankfully I didn't have to call anyone but CadRay...thanks again....read less - 10/05/2023
Ray Voller
There’s nothing like a company with top notch support like Cadray! Frank DeLuca is one of THE most helpful, non- condescending people I’ve ever dealt with! He ALWAYS strives to make us the BEST we can be and almost immediately helps us with any quest...read moreThere’s nothing like a company with top notch support like Cadray! Frank DeLuca is one of THE most helpful, non- condescending people I’ve ever dealt with! He ALWAYS strives to make us the BEST we can be and almost immediately helps us with any questions or problems ( which are minimal with the i700!) HIGHLY recommend this company and their scanner!!read less - 10/06/2022
Jacob Masters
Best dental equipment company I have ever worked with! Great response and super helpful for any issues even years later. - 8/03/2023
Stuart Adam
Amazing team!
Andy was amazing with explaining everything needed to be successful with the medit i700 and encouraged me to give CADRAY a call if I have any questions in the future. I have some colleagues that have regarded CADRAY as the gold stand...read moreAmazing team!
Andy was amazing with explaining everything needed to be successful with the medit i700 and encouraged me to give CADRAY a call if I have any questions in the future. I have some colleagues that have regarded CADRAY as the gold standard for service and I can now say that I completely agree. Thank you!read less - 12/27/2021
Nothing but good things to say about CAD-Ray. All of the education, recommendations, and products they provide are truly the best in digital dentistry at the time. - 6/20/2020
Scott Chong
The i500 has been a game-changer for our orthodontic practice. Patients love not having to do alginate impressions. Records appointments and debands take much less time plus there's significantly less clean-up. And it's fast/easy enough to use tha...read moreThe i500 has been a game-changer for our orthodontic practice. Patients love not having to do alginate impressions. Records appointments and debands take much less time plus there's significantly less clean-up. And it's fast/easy enough to use that we've even been able to train summer interns to scans with zero prior dental experience. Our retainers, nightguards, and sleep apnea appliances all showed improved fit with less chair-side delivery time due to accuracy of the scans. Customer support is top-notch. Whenever we've had issues, we get someone immediately and they either talk us through a fix or login via screenshare to help us directly. They have a great loyalty program which gives significant discounts to upgrade to newer units. We recently took advantage and are excited to try out the new i700, especially since they're now Mac-compatible. Simple version: Great intra-oral scanner, easy to use/operate, intuitive software interface, fantastic support.read less - 8/16/2023
Mark Evans
I’d like to tell you a story about CAD-Ray.com.
I ordered a VHF N4+ from CadRay. About two weeks after the order was placed, they called me up and said, “VHF just got an exclusive with “The Big Boys” so they are cutting ties with all the little ind...read moreI’d like to tell you a story about CAD-Ray.com.
I ordered a VHF N4+ from CadRay. About two weeks after the order was placed, they called me up and said, “VHF just got an exclusive with “The Big Boys” so they are cutting ties with all the little independent distributors. They just called us, and we just found out. What this means is that we won’t be able to provide you service after purchasing the VHF mill that you just bought.”
Now, they could have just left it at that. They could have said, “Sorry, it’s out of our hands.” They could have said, “We appreciate your business, but it’s not our fault.” They could have said, “That’s the way the cookie crumbles.”
But they didn’t.
Frank Weinstein calls me up and tells me that they want to make this right, so they are going to hook me up with a brand new Imes Coritec One+ for the same price as the VHF. The Coritec One+ is like the Mercedes of mills for in-office. This is the new model that just barely came out. It is a 5 axis mill. It does wet and dry milling. It does blocks and pucks. It mills all materials know to man, including Vibranium. It can also fly the space shuttle, and make all your wishes and dreams come true. It’s that good. It came with the laptop, Exocad, all the tools, and all the bells and whistles. It came fully loaded. It came white glove delivered to my office. It came with in office training. It came with the extra bur package. It came with everything and the kitchen sink.
So, I paid 36k for a mill, and because of something that was not Cad-Rays fault, they ended up giving me a 60k mill for the same price.
In the words of the great Tony Stark: “That’s how Dad did it. That’s how Cad-Ray does it. And it’s worked out pretty well so far.”
Thank you Frank Weinstein and Armen Mirzayan for having outstanding customer service and going the extra mile every time.read less - 4/02/2021
Suresh Patel
Kaila Larson is absolutely the best support person I have ever used. She knows her stuff and is a pleasure to work with. Medit is only as good as the support and SHE MAKES CadRay and Medit an amazing experience! - 1/05/2023
Steve Blank
I bought the Medit i500 and self installed to save $$$. The web site provided great step by step instructions. The Facebook group filled in the gaps. The software has been continuously upgraded and works great for scanning and tracking cases sent and...read moreI bought the Medit i500 and self installed to save $$$. The web site provided great step by step instructions. The Facebook group filled in the gaps. The software has been continuously upgraded and works great for scanning and tracking cases sent and received. My tip for scanning single crowns: While waiting for anesthesia, Scan the upper and lower quadrants and record the bite. Then i delete the tooth to be scanned. That saves time later after tooth preparation. At that time, switch to HD and scan the prep, done!read less - 6/16/2020
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.
One of the greatest advantages of digital impressions and oral appliances is how there is very little post op adjustments to be made when you capture the vertical dimension correctly. Here, we deliver a Panthera OSA device with just an exam kit.
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
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
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.
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
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
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.
I am not one to place much faith in published articles from academicians. I usually draw my information from trusted colleagues and also a very reliable source, Mr. Andrew Sedler, from Advanced Technology Centers in Burbank California. He is in charge of manufacturing thousands of full arch restorations for clinicians and many other labs that outsource their manufacturing.
One of the things I always get a kick out of is whenever they do purchase technology or implement a process, they always have to do it with redundancy. What that means is that their machines can never go down for whatever reason, so they always purchase printers and mills by multiple sets. Interestingly, I was witness to them incorporating printers into the lab about 6-7 years ago and now they have a large wing dedicated to printing with over 20 machines for many different purposes.
I trust his judgement and always follow his recommendation and tested methods. When he says “do not bypass verification jigs, no matter what scanner was used”, I don’t even question it. He sees all the cases many entities can’t manage and he can manufacture any screw, prosthetic, abutment, etc… with their high end milling machines. In fact, it was on his word alone we decided to distribute the ICam4d by imetric.
I thought it would be a good idea to revisit full arch implant restorations with him and see what the state of the industry is like today and what he would recommend for the end users and patients. A very good perspective for a clinician to keep is how a simple mistake or misunderstanding can wipe away all the profit margins for a lab and even for the clinician. A simple example is if you have to correct an angulation issue on an abutment which can dramatically impact the costs of the lab work.
Here is the Q/A session:
“Hi Andrew, I am writing an article on full arches and would appreciate some info”
what % of the full arches that docs order from you are zirconia on tibases only at implant sites?
what % are on titanium bars?
what % are hybrids with acrylic?
what % are MUA vs Implant level?
what is the most prescribed full arch prosthesis now compared to 5 -10 years ago?
what % are soft tissue level vs bone level / mua level?
what would you do for yourself?
which one has the most failure rate?
how often does zirc framework break?
how much damage do you think people do to zirconia frameworks while trying to mill it to sharp corners of tibases?
Answers:
MUA vs IMPLANT LEVEL : over 90% of upper arches will have MUA and 60 to 70 % of the lower arches will have MUA
BONE LEVEL vs TISSUE: majority of implants (90% and up) bone level that requires MUA .
The most failure rate in order is (all of these in respect to the material limitations ):
the traditional acrylic hybrid
composite hybrid next
zirconia monolithic
and the least breakage will be zirconia hybrid supported by metal frame
Zirconia failure is around 4 to 5 % (adding the internal lab remakes – i would say another 3 to 4 %)
The damage caused by adjusting the zirconia could be very considerable, especially around the access hole since those areas are thinner than the full teeth . For myself i would restore zirconia over metal frame if my choice is hybrid, while removable bar overdenture will be a more predictable and more hygienic choice .
Shining3d has a projector and a single camera that takes photos of the surfaces it is scanning. at first, you may think this is a shortcoming, but in many ways, it dramatically reduces errors a new user can introduce.
in the early days of cerec, all you needed to do was capture the margins and the area above the height of contours of the adjacent teeth. This made the try-in and the contacts really easy as the design software just dropped straight a straight wall down to make contacts to. same concept here!
also, after you image and place margins, A SINGLE CLICK takes you to design software where you can finish the case and mill it right away.
it’s here! well technically it is crossing the atlantic. the icam4d’s are on their way.
separate from that, after i think a year long search, we have decided to carry the dess line of abutments because it is the one of the only lines that i can confidently say is well thought out and verified from start to finish. so you will be able to get a MUA to pretty much any implant line. some like bicons, if you choose to go that route will still have to be custom made and we can help you with that. But the vast majority of the implant lines and connections will be covered by this approach. Keith Goldstein is a tremendous resource and has agreed to provide us with a some important files and libraries. here is the significance of all this:
if you want a fixture level impression vs MUA in those rare situations, you can still place a MUA and image that. The dess library can easily convert that information to the location of the fixture. you just need to make sure that you make note of the exact mua and collar height you used. the timing won’t matter as these are RP non-indexed abutments. that solves the number 1 request you folks make when looking at this.
we will have all the libraries of the abutment from the margin and up available to you so you can pop them into the medit scan and easily identify the MUA in the mouth.
for the process to work in the traditional way, you would have had to place the mua’s, place the scnflags, image with icam. take off scanflags, place cylinders, scan with ios. then take off cylinders and then place healing caps. NOW, you can place the MUA’s, place scanflags, image with icam. export the stl and import it into medit. take off scan flags, BYPASS the cylinders, and just start scanning MUA’s in the mouth. With the AI feature, you will readily identify the multi unit abutments no matter how bloody the field is and if parts of the margins are buried under tissue. Of course, in the situation where the implant is super deep and the mua can’t stick its neck out, you will still have the option of popping the cylinders on. you will know which route to go as soon as you seat the MUA after surgery or uncovery
Thanks to Justin Shafer who created a script for us that allows you to export an stl file to a specific directory, where you create a subfolder for each program you want to run. Once the file lands in a subfolder the program is launched and the models are important.
Justin did this at no cost. The more you donate to his work, the more programs he can add to the installer. Some programs like Rayware allow you to import multiple files into one program whereas others launch a single program for each file, like BlueSkyBio. Contact the software designers to easily add commands line to accommodate your needs
This molar’s suggested mill times with the MCXL are for either Size 12 or 14 blocks:
Sprue on distal in normal speed mode is 14:05 minutes, fast speed at 7:54
Sprue on buccal in normal speed is 13:48 minutes, fast speed at 7:46
This molar would only fit in a size 14 block of Amber Mill in Imes Icore Coritec
Sprue on distal in normal speed mode is 14:15 minutes, sprue on buccal in normal speed is 14:42 and speed crown is proosed at 13:23
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
Case Presentation on how to manage two crowns with a single milling machine
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.
image first molar while second molar is being 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.
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
For our coritec users: new users often mislabel restorations in the Rx form that leads to a lot of trouble. like calling a crown and onlay or vice versa. this can lead to all kinds of trouble
first sign of trouble is if the two purple lines don’t define the borders of the the restoration. sometimes it is missing, other times it is off the restoration. so always double check this step and usually the missed nomenclature is what causes the trouble.
the next problem people have is that the default setting for the sprue design is poor. it makes the sprue thicker at the mandrel than the restoration. this creates a crevice that the drill can’t get to. this leads to quick drill breakage as it tries to drill into that space (red circle). it is easy to set change these settings so the drill “flows” with the design of the sprue and you get a lot of use out of it. it’s annoying to do this manually so a subsequent video shows you how to change this by default.
another problem is the offset. the last video shows the distance from the restoration to the mandrel as 2mm. the drill is 2.5 in diameter. if you set it at 2, the calculation doesn’t allow enough space for the drill that also breaks it off. set it at 2.7 or 3 and it will last you a long time.
two subsequent videos will show you how to create your own blocks and change their orientation, so you can fit a taller design into a smaller size block
Last Thursday, we announced RayWare 2.5 – the software update that makes your SprintRay 3D printer new again. Watch the announcement here to learn about Pixel Toning, Parallel Slicing, Ludicrous Speed, and much more. Full-Length Video: https://youtu.be/Cix1DNNQdYY Download RayWare: https://sprintray.com/software/ Request a Dental Model Sample: https://store.sprintray.com/samples
If you place enough implants, you may find yourself in need of a prosthetic part that just isn’t manufactured by anyone. For example, you may have a hybrid case on Bicons and for some reason you wanted to restored them with Multi Unit Abutments (MUA) and photogrammetry, yet there are no parts manufactured for such an endeavor. The problem is complex because a manufacturer needs to mass produce these parts and get them past regulatory matters.
Some have found a simple solution, which is to have the parts custom made specifically for the implant. If they need the MUA part before the procedure, they just send a digital or physical model into a lab that can custom make the part. The lab itself needs a prescription form on the lab analog. Since it is custom made, you have direct input on how tall you want the height of the margin, how much you want to displace the tissue, how much would want the restorative head angled, etc..
Most people will order a variety of them to address any situation on the same model and keep it in stock. What’s important to realize is that from the restorative standpoint, all your CAD software needs to know is the location of your abutment margins. It doesn’t care where fixture is and how the timing is lined up in the arch form. As long as it knows where the margins are, you can proceed with the design of the prosthesis.
Contact Andrew Seddler to send a digital or physical model and an Rx to get your custom made MUA’s
Are you interested in an office build out or incorporating technology into your practice? feel free to visit us when we are conducting courses or sign up to take a...
There is a concept in digital dentistry that is called “mixing good and bad data”. What you have to appreciate is that two different objects can’t occupy the same space...
In this presentation we detail the implant suprastructure identification system where an existing abutment is removed and scanned extra-orally to capture the margins readily after the abutment is anodized...
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