Perfectly Placed Implant course in San Diego was very good. Armen and Brian are excellent lecturers and educators. A lot of practical tips and pearls of wisdom for those getting into cone beam and guided surgery. Would recommend this course highly. ...read morePerfectly Placed Implant course in San Diego was very good. Armen and Brian are excellent lecturers and educators. A lot of practical tips and pearls of wisdom for those getting into cone beam and guided surgery. Would recommend this course highly. Looking forward to other courses that they offerread less - 2/18/2017
Matt v
Matt Newman was excellent solving a cable problem.! Quick response and good follow up! - 9/11/2024
Jaspreet Ghuman
Shout out to Nick, Frank and Armen ! Cheers . Great customer service by Nick and Frank. Too early to make a comment about the scanner but these guys are awesome. - 9/19/2020
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
jeff-J65
You guys are great! I have been a Cerec user for about a decade and wanted to expand my horizons. I bought the I700 and have just loved it. We don't do impressions any more, only scanning, even for the full arch. The customer service has been excelle...read moreYou guys are great! I have been a Cerec user for about a decade and wanted to expand my horizons. I bought the I700 and have just loved it. We don't do impressions any more, only scanning, even for the full arch. The customer service has been excellent, even though I haven't had any problems with the scanner. I really like the online learning modules, they have been awesome getting me up to speed with the scanner quickly. I am looking forward to some of the in person courses to maximize the usefulness of this scanner. -- Jeff Allred, DDS FAGD DABOI FAAIDread less - 9/28/2021
I have owned this scanner for six months now. I have experience with other scanners including Trios and Carestream. The Medit scanner can stand with the big names. The scanned images are good. The ease of communication through the software with the l...read moreI have owned this scanner for six months now. I have experience with other scanners including Trios and Carestream. The Medit scanner can stand with the big names. The scanned images are good. The ease of communication through the software with the lab is probably my favorite part. Another thing I like is that the company is very open to improvements and listens to what its customers are wanting.
Cad Ray has a great team working alongside this product and continually updates all of the users on new features or new ways to use existing features. They are extremely responsive to questions and provide fast and competent support to the product that they sell.
I would recommend both the scanner and the company to anyone looking to get into the digital scanning world.read less - 10/09/2019
I have enjoyed using the Medit i500 scanner. Previously I had two 3Shape scanners, however, the yearly fees were adding up and there are no ongoing fees with the Medit. Quality is great, and support has also been solid. Overall very happy with thi...read moreI have enjoyed using the Medit i500 scanner. Previously I had two 3Shape scanners, however, the yearly fees were adding up and there are no ongoing fees with the Medit. Quality is great, and support has also been solid. Overall very happy with this purchase.read less - 2/16/2020
Absolutely the best customer service I have ever seen. I couldn't be happier with the service received. I won't be going anywhere else!! Thank you again. - 2/01/2022
Roopam Garg
I purchased Medit scanner few weeks ago . Frank and Nick have been really excellent answering my questions promptly. The scanner itself is wonderful with no back fees , customer service is top notch. The entire team works fast and helps you out. I st...read moreI purchased Medit scanner few weeks ago . Frank and Nick have been really excellent answering my questions promptly. The scanner itself is wonderful with no back fees , customer service is top notch. The entire team works fast and helps you out. I strongly recommend this scanner!read less - 6/17/2020
best customer service on the planet. very easy to use. and always fine tuning to make the user experience better. - 6/16/2020
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
jeremiah choi
Never had customer care like Cad-Ray, you can't go wrong purchasing through them. Trios is a great scanner. All the reps at Cad-Ray are very knowledgeable and helpful and will make sure you are up and running smoothly. Above and beyond customer serv...read moreNever had customer care like Cad-Ray, you can't go wrong purchasing through them. Trios is a great scanner. All the reps at Cad-Ray are very knowledgeable and helpful and will make sure you are up and running smoothly. Above and beyond customer service.read less - 8/27/2022
The support is even better then the camera itself. I used many other scanners and this is by far the best one. Recommended to many people. Looking to purchase a second one for my practice. The use and results are amazing. No adjustments to the p...read moreThe support is even better then the camera itself. I used many other scanners and this is by far the best one. Recommended to many people. Looking to purchase a second one for my practice. The use and results are amazing. No adjustments to the prosthetics at all.read less - 7/15/2020
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 indepe...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 - 4/09/2021
Lauri Ann
I am about the worst person when it comes to technology. I decided to get a scanner and chose the Medit due to all the positive comments users had. I haven't used it much-the pandemic started right as I received it, however, the customer service has ...read moreI am about the worst person when it comes to technology. I decided to get a scanner and chose the Medit due to all the positive comments users had. I haven't used it much-the pandemic started right as I received it, however, the customer service has truly been amazing! I had an online training and a rep checked in with me several times to see if I needed help. I am going to do another online training soon as a refresher. I wouldn't hesitate to recommend this company and scanner to anyone!read less - 6/16/2020
Daniel Hwang
Fantastic scanner and best company to buy from. They make sure you are happy with your product. Armen, Frank, and team are the best. High recommendations for CADRAY and the i500. - 7/18/2020
CAD-Ray is amazing! Prompt replies, quick delivery, knowledgeable team! I had some cracks on my scanner that I read on their FB group may be a manufacturer's defect. My scanner was still covered under warranty. They overnighted a brand new one to me ...read moreCAD-Ray is amazing! Prompt replies, quick delivery, knowledgeable team! I had some cracks on my scanner that I read on their FB group may be a manufacturer's defect. My scanner was still covered under warranty. They overnighted a brand new one to me before I even knew they were going to replace it! That's how quick they are! Highly recommend them!!!read less - 12/23/2021
William Huszti
Nicely done Cad-Ray- Thanks for helping me get back to work! The new i700 is our tech fav! - 3/03/2022
AMISH DESAI
Awesome! Great support. If you are planning on getting a scanner, make sure you have Cad-Ray on your side ! - 4/20/2022
Francis Shin
Amazing customer service. Wayne Glassoff helped me with purchase decision, taking the time to find out my needs, and then my order was delivered quickly! Easily the best "dental" purchase experience that I have ever had. - 9/07/2022
David Wheeler
I have had excellent , prompt , customer service and support from the entire team . Especially from Frank DeLuca as I move along the learning curve. His patients and expertise is much appreciated - 1/24/2023
Aaron Olson
This product is the best out there. Do the math and your ROI makes more sense than most products we purchase as dentists. Get on the digital train or you’ll be left behind. This is the best product to make the jump with. - 6/16/2020
Still beginner to use IO scanner. best customer service. Live training was very useful. Andy Nova was great in improving my skill for scanning and showing me all features. Thank you. - 5/19/2022
These guys are 1st in class service every time! - 7/08/2022
Shahnam Shifteh
I just ordered my i700 and am
Very excited to get into the digital world of dentistry and Nick was extremely helpful with answering any questions and helping to put the order together. - 12/09/2021
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
Aaron S
Great ongoing support and customer assistance. Been working with Frank for years, even before cad ray. Always there for any help i ever need. Cad ray support is like no other. - 1/26/2023
Dado Dado
Frank DeLuca has been great since we bought the scanner! Always there for you and returns his calls asap. Thank you Frank! - 1/25/2023
Brian Wilkinson
This company is genuinely amazing. Amazingly good products, but the thing that sets them apart is the support. Frank and Sean have answered any questions I have unbelievably fast. And I LOVE the DOF Craft 5x milling unit. Learning the flow of same da...read moreThis company is genuinely amazing. Amazingly good products, but the thing that sets them apart is the support. Frank and Sean have answered any questions I have unbelievably fast. And I LOVE the DOF Craft 5x milling unit. Learning the flow of same day milling was tricky for me, but they held my hand the whole way. Can’t go wrong here.read less - 1/06/2024
Rosemary Toczydlowski
I had a phone call with Frank from support today, and he was awesome! Very helpful and knowledgeable. He sorted out all our issues no problem. Thank you Frank!! - 6/09/2021
Collin Kwasnik
will never buy any product they offer from any other company regardless of price. this team is the best and incredible. - 6/05/2022
David Blanco
Cad-Ray is great! Great customer service and they are consistent with their followthrough . Always helpful when you need questions answered and helping to lower the learning curve with newly purchased equipment. I’m very satisfied with my medit i-...read moreCad-Ray is great! Great customer service and they are consistent with their followthrough . Always helpful when you need questions answered and helping to lower the learning curve with newly purchased equipment. I’m very satisfied with my medit i-500 intraoral scanner. Armen and Frank are solid!read less - 6/16/2020
Laura
Very helpful and attentive when setting up my new Medit scanner. Seamless process from start to finish - 10/28/2024
Jared Gustafson
We started our journey with CAD-Ray 3 years ago them helping us find a digital scanner that fits our practice needs and have relied on them for our 3D printing needs. They are an excellent company and I highly recommend them for their knowledge and s...read moreWe started our journey with CAD-Ray 3 years ago them helping us find a digital scanner that fits our practice needs and have relied on them for our 3D printing needs. They are an excellent company and I highly recommend them for their knowledge and service they provide. I would buy and dental tech needs from them!read less - 9/07/2022
Norman Knowles
I have had the original iTero, a Trios 3, and a Carestream CS3600. A staff member broke the lens on the Trios and while waiting 3 weeks for an RMA to send it to Poland for six weeks to get it repaired, Carestream was sniffing around and suggested tha...read moreI have had the original iTero, a Trios 3, and a Carestream CS3600. A staff member broke the lens on the Trios and while waiting 3 weeks for an RMA to send it to Poland for six weeks to get it repaired, Carestream was sniffing around and suggested that I trade in my Trios so I did which began a 4 month nightmare with their piece of junk scanner. Absolutely awful customer service from both 3Shape and Carestream. I needed a scanner and had heard great things about it the Medit i500 at the Florida Academy of Coesmetic Dentistry so I got one. It works really well and Medit keeps adding new and useful features and their architecture is completely open. Two weeks ago, my i500 died so I contacted Cad-Ray surrport and I had a new unit in my office 24 hours later! That's absolutely unheard of in the industry!!! Both Cad-Ray and Medit have positioned themselves to be industry giant killers and they're doing it. The i500 is a phenomenal scanner at a phenomenal price point and service and guidance at Cad-Ray is just plain excellent.If you are thinking about getting a scanner, do it! Just contact Cad-Ray and go for it. You will only be happy about your purchase! Highly recommended!read less - 3/09/2021
Jeff Johnston
Very Helpful, good company to work with. Always been there for me - 3/10/2017
jorge lube
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
Ravi Sawhney
Fantastic folks. I'm an orthodontist and opened an office in 2020. They helped me find the perfect intraoral scanner to suit my needs. Not too much or too little, and a great price. Every time we have a technical question, a sharp human answers the p...read moreFantastic folks. I'm an orthodontist and opened an office in 2020. They helped me find the perfect intraoral scanner to suit my needs. Not too much or too little, and a great price. Every time we have a technical question, a sharp human answers the phone, troubleshoots, and remotes in when needed-- navigating MS updates and graphics card issues. My i500 died this week. They overnighted me a trade-in at a totally reasonable price, and even shipped me a laptop to drive the i600 while I got a new one (they knew my 2020 laptop wouldn't keep up!). CAD-Ray has consistently hit it out of the park.read less - 4/14/2025
Brent Hale
Been using my i700 for a month now and it's been great. The tutorials that Cad-ray provides have been very helpful. This scanner with a fast computer turns out great results. - 11/01/2021
This company has the best customer support I have ever experienced. I purchased the I700 Intraoral scanner and the transition from impression material to io scanner has been so easy because of Cad-Ray. I highly recommend them. The response to questi...read moreThis company has the best customer support I have ever experienced. I purchased the I700 Intraoral scanner and the transition from impression material to io scanner has been so easy because of Cad-Ray. I highly recommend them. The response to questions/issues is instantaneous even with a patient in the chair they have the capability to go online and help. Absolutely first rate.read less - 4/13/2022
Johnny Vredenburg III
Before working with cad-ray, I was hesitant to dive into digital dentistry due to the complexity of it. Working with Laura at cad-ray made all of my concerns go away. She was there to help me with my Exocad software installation, even outside of norm...read moreBefore working with cad-ray, I was hesitant to dive into digital dentistry due to the complexity of it. Working with Laura at cad-ray made all of my concerns go away. She was there to help me with my Exocad software installation, even outside of normal business hours - really hard to come by! I also purchased a Medit i500 and getting that setup and working in my clinic was seamless. I could not have asked for better support while navigating digital dentistry. My next purchase will be a 3D printer, and i know exactly where i will buy it from! Highly recommend these guys.read less - 11/20/2020
Diego Humberto Marquez Rodriguez
I am a very happy customer, the team behind cad ray, is amazing. Ive had small issues, and tech support is always available. I always call for them to help me use new apps, or updates and they stay on the phone with me all thru out, until fixing the ...read moreI am a very happy customer, the team behind cad ray, is amazing. Ive had small issues, and tech support is always available. I always call for them to help me use new apps, or updates and they stay on the phone with me all thru out, until fixing the issue. Andy has helped me several times, and he's a really nice guy too, great attitude, doesn't make me feel dumb when I don't understand. Sometimes it feels like he's part of my office team! Thank you Cad Ray, thank you Andy!read less - 2/01/2023
Shefali Pilar
Our office has been using the Medit scanner for a few months now and are loving it! CAD-Ray was super easy to work with in purchasing the scanner and providing support as needed. Their Facebook forum with the updates and video tutorials are incredibl...read moreOur office has been using the Medit scanner for a few months now and are loving it! CAD-Ray was super easy to work with in purchasing the scanner and providing support as needed. Their Facebook forum with the updates and video tutorials are incredibly helpful.read less - 6/16/2020
Barton Davis
Every time I need support for my scanner, the Cad-Ray team is there to help. I recently had a question on how to manipulate a scan and export it back to Medit Scan. Damien logged in and helped me out. Problem solved in under five minutes. Awesome ser...read moreEvery time I need support for my scanner, the Cad-Ray team is there to help. I recently had a question on how to manipulate a scan and export it back to Medit Scan. Damien logged in and helped me out. Problem solved in under five minutes. Awesome service. Thanks Cad-Ray support team!read less - 3/04/2022
Greg Stepka
Highly Recommend working with Cad-Ray. Just purchased a MeditI700. So easy to work with. Training with Destaney was awesome. - 3/19/2024
Matt St George
I had 3 Cerec machines and switched to medit. It’s awesome and do not regret the switch one bit. This is the place to buy it bc Armen and Frank are a wealth of knowledge and Frank is awesome with support. He’s always there whenever I need him! - 10/10/2019
Overall great company to work with. They sell wondeful products and give stellar service for a much lower price than any of the supply houses. I can't recommend them enough. - 8/19/2022
David Christensen
I purchased the Medit i500 from Cad-Ray December 2018. I couldn’t be happier with the scanner. The improvements Medit has made over the last 10 months are nothing short of astounding! I can’t imaging what they’ll come up with next.
As for Cad-Ray...read moreI purchased the Medit i500 from Cad-Ray December 2018. I couldn’t be happier with the scanner. The improvements Medit has made over the last 10 months are nothing short of astounding! I can’t imaging what they’ll come up with next.
As for Cad-Ray, their support has been second to none. Never have I experienced the kind of attention and help from any other company. Wether it’s with help installing, computer hardware issues or technical help they respond IMMEDIATELY!
Armen is also a huge reason why I chose Cad-Ray. No one selling a product has helped me more evolve my scanning technique. He’s quick to respond to questions and issues I feel his service is a huge reason why to buy from CAD-RAY.read less - 10/09/2019
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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