I got the Medit scanner last fall and I have been nothing but impressed by it and the support by CAD-Ray. The level of support, training videos, and continuously upgraded software is really impressive. If you are on the fence, you should feel confide...read moreI got the Medit scanner last fall and I have been nothing but impressed by it and the support by CAD-Ray. The level of support, training videos, and continuously upgraded software is really impressive. If you are on the fence, you should feel confident in moving forward with CAD-Ray.read less - 6/16/2020
Madhavi Chavda
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
I had an issue that was due to the Medit settings. Damien logged on remotely to my laptop, and resolved the issue in a couple of minutes. Fantastic service. Thank you. - 8/27/2021
Krupal Chhotu
Finally going digital and Cad-Ray was the place to start. Got the Medit i500 and began scanning right away. Now I am doing digital dentures, making my own surgical stents, etc. The support available is the best. "Frank" is always available! :) - 10/09/2019
The i700 provides amazing ease of use and versatility for any digital restorative application. It’s been game changing for our practice. CAD-Ray’s amazing support and Medit’s constant improvement of the software are revolutionary. I’ve been taking di...read moreThe i700 provides amazing ease of use and versatility for any digital restorative application. It’s been game changing for our practice. CAD-Ray’s amazing support and Medit’s constant improvement of the software are revolutionary. I’ve been taking digital impressions for over 15 years with other systems and nothing comes close to the Medit.read less - 8/27/2021
Great company. Pioneer in digital dentistry. Armen knows his stuff. Hands down the go to scanner reseller in the US. Support and training courses are incredible. - 10/02/2022
Rafael Dimayuga
Have been chatting with the CADRAY group for at least a year now even though I did not buy anything from them. They are very receptive, prompt and helpful. Finally bit the bullet and received my Medit yesterday! Now my Bluecam has a new buddy!! - 7/17/2020
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
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
Micah Bickel
Great products, training and support - 11/01/2021
Jared H
Purchasing my medit i700 from Cad-Ray was a great decision. I did my first training with Kaila and she was fantastic! Super knowledgeable, patient and truly helpful in making sure I was ready to hit the ground running with patient care. I put a call ...read morePurchasing my medit i700 from Cad-Ray was a great decision. I did my first training with Kaila and she was fantastic! Super knowledgeable, patient and truly helpful in making sure I was ready to hit the ground running with patient care. I put a call into cad-ray support in the middle of a case and sure enough Kaila was also the one to answer and handle the situation. She jumped right on my computer and had things fixed in a matter of a few minutes. Awesome support, great staff and overall super positive experience with Cad-ray thus far!read less - 5/06/2022
Anthony Vu
If you are looking to buy a Medit, you shouldn't look anywhere else to buy it. My Medit i700 was having issues on a Friday and I was able to get Heather from Cad-Ray to troubleshoot the issue. She remoted into my computer to try and troubleshoot the ...read moreIf you are looking to buy a Medit, you shouldn't look anywhere else to buy it. My Medit i700 was having issues on a Friday and I was able to get Heather from Cad-Ray to troubleshoot the issue. She remoted into my computer to try and troubleshoot the issue and helped with getting Medit on board as well. Once it was confirmed it was a hardware issue, I got sent a BRAND NEW Medit i700 OVERNIGHT.Can you believe that? Service and warranty that Cad-Ray offers is really TOP NOTCH.Highly Recommend Cad-Ray for all things MEDIT. Thank you Heather from Cad-Ray for all your help!!!read less - 2/02/2022
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
Brian Jaques
After weeks of research I purchased the i700 through Nick at cad-ray. My office has never used a scanner before and despite the great pricing, this was still a major purchase for me. Nick was incredibly helpful guiding me through the process while an...read moreAfter weeks of research I purchased the i700 through Nick at cad-ray. My office has never used a scanner before and despite the great pricing, this was still a major purchase for me. Nick was incredibly helpful guiding me through the process while answering my many questions. The customer service was very responsive and my friends who have purchased medit scanner were correct that this is the way to go. 5 Stars!read less - 5/08/2021
John Pobanz
We had an outstanding experience purchasing two Medit scanners. The delivery was timely . The onboarding clean. Laura was dazzling with her acumen and quick solutions . We highly recommend the investment in Cad Ray .Pobanz Orthodontics , Ogden Utah :...read moreWe had an outstanding experience purchasing two Medit scanners. The delivery was timely . The onboarding clean. Laura was dazzling with her acumen and quick solutions . We highly recommend the investment in Cad Ray .Pobanz Orthodontics , Ogden Utah :)read less - 12/10/2021
Chris Kleist
Cad-Ray is the absolute best if you're in the market for digital dental tools. I have purchased two Medit scanners through them. There will be hiccups with any complex piece of machinery, but every time I have needed Cad-Ray, they have been there. I ...read moreCad-Ray is the absolute best if you're in the market for digital dental tools. I have purchased two Medit scanners through them. There will be hiccups with any complex piece of machinery, but every time I have needed Cad-Ray, they have been there. I recently had a scanner go down. I called Cad-Ray tech support and they got me on the phone with Medit immediately. Within a day, a replacement scanner was sitting on my desk. It doesn't get much better than that.read less - 10/03/2024
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
David Stall
These guys are great. Always available and helpful. My scanning issues were dealt with quickly and courteously. - 10/01/2021
Alvin Aquino
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
Evan Bedell
Laura has always been so helpful with the medit when we needed assistance or resources. The training she provided the office was invaluable! She is quick to respond whenever we reach out. 13/10 - would recommend her to anyone looking to get a medit ...read moreLaura has always been so helpful with the medit when we needed assistance or resources. The training she provided the office was invaluable! She is quick to respond whenever we reach out. 13/10 - would recommend her to anyone looking to get a medit scanner.read less - 12/16/2021
Richard Wu
Great customer service! Had an issue with our dongle and Cad-Ray got it squared away and a new dongle sent right away. - 1/25/2023
Matt McReynolds
Great scanner (medit i500) and mill (coritec one). They were great for an open system that allows me to do just about anything. - 6/16/2020
Matt Stratman
only dental company that I have no complaints about - 11/03/2022
Jason Ehtessabian
Fantastic! Scanner went down after a few years, and they had a new one in my office the next morning. Highly recommended. - 8/26/2021
Preston Poole
Great company with even better customer service. Premier dental business with digital dentistry and scanners! - 11/03/2022
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
Varghese George
The customer service has been top notch, every single time. I have only good things to say about them. - 4/05/2022
Mark Gerome
When I bought my first scanner a few years ago I was blown away by CAD-RAY’s support! They do a great job of getting you and your team ready to go with it. Frank D. has been a huge help with getting us confident with our scanners and making sure we a...read moreWhen I bought my first scanner a few years ago I was blown away by CAD-RAY’s support! They do a great job of getting you and your team ready to go with it. Frank D. has been a huge help with getting us confident with our scanners and making sure we are taken care of. He and his colleagues at CAD-RAY are always a responsive to our calls. Thank you!read less - 2/21/2023
ed borio
I was dragging my feet before purchasing my first scanner because I was apprehensive of the effort required to change to a digital workflow. Laura assured me my fears were overblown and because of her patience and exceptional training abilities it h...read moreI was dragging my feet before purchasing my first scanner because I was apprehensive of the effort required to change to a digital workflow. Laura assured me my fears were overblown and because of her patience and exceptional training abilities it has been a rewarding and relatively seamless transition to the world of scanning. I never dreamed implementation would have been this easy and its attributed to Laura's skillful training ability. The scanner is wonderful and powerful, but we would have never been able to unlock its potential without her assistance.read less - 8/31/2021
Heather Gramely provided excellent costumer support today. She went above and beyond the reason I even called to update our computer and software and aid in warranty information/repairs. - 2/08/2022
Tim Mininger II
Great product and company. all the help and support you need on their website and Facebook group. recommended them to many of my colleagues and bragged to other reps about how good my deal was compared to what they were offering. - 6/16/2020
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
Scot Bruce
We found the digital training very informative - 8/20/2021
Yoav Taub
I purchased my Medit from Cad-Ray just prior to Covid and they have been fantastic in getting me the proper training on the machine, both through there 2 day class as well as the many video's they post on the website. I recently purchased some acce...read moreI purchased my Medit from Cad-Ray just prior to Covid and they have been fantastic in getting me the proper training on the machine, both through there 2 day class as well as the many video's they post on the website. I recently purchased some accessories for a different office and they accidently sent it somewhere else. After a quick email they had my stuff at my door within 24 hrs and they threw in a box of tips which I was not expecting (around $300). It is a pleasure to deal with them!read less - 7/19/2021
Andrea Sleep
Thank you guys so much. You guys have the absolute best customer service! - 5/05/2025
Evelyn Chan
Going with CAD-RAY and Laura is one of best investment I've made year 2020 ( I have MEDIT 500). Jumping into scanning is something that intimidated me since I am not a techie person and taking PVS impression is something second nature to me. Laur...read moreGoing with CAD-RAY and Laura is one of best investment I've made year 2020 ( I have MEDIT 500). Jumping into scanning is something that intimidated me since I am not a techie person and taking PVS impression is something second nature to me. Laura made everything a breeze, she is very accomodating and most importantly responds so fast, I never felt left out. Attending the level 1 course of Armen M. was awesome , learned the basics and it was taught in a way so easy to apply. Since my first scan, I never looked back, thinking to myself , I should have done this earlier. The crowns comes back with little to no adjustements which saves a lot of chair time. Cannot get better than this. Big shout out to CAD-RAY, Laura and Armenread less - 10/19/2021
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
Jeff Muszynski
Fantastic customer service - 6/19/2020
Laveen Smiles
CAD-Ray has the best customer service and support that you will ever receive from any dental company anywhere. I had an issue with a sintering oven I purchased from them. I needed immediate assistance, because I was in the middle of a case. The perso...read moreCAD-Ray has the best customer service and support that you will ever receive from any dental company anywhere. I had an issue with a sintering oven I purchased from them. I needed immediate assistance, because I was in the middle of a case. The person at CAD-RAY who had the knowledge to help me had just gotten into a car accident and was at the ER. Now most companies and people would have said “Sorry, we can’t help right now due to extenuating circumstances.” Not CAD-RAY! That person called me from the ER, in the middle of his personal problems, and gave me the needed information to solve my problem. Exceptional customer service and support is what you will get from CAD-RAY, and it won’t be for a limited time after your purchase. You won’t go wrong with a purchase from CAD-RAY.read less - 1/29/2023
Jeff Johnston
Very Helpful, good company to work with. Always been there for me - 3/10/2017
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
Greg Camfield
CAD-Ray keeps knocking it out of the park. Upgraded from i500 to i700. Transition was seamless! Thanks again guys! - 11/15/2022
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
Wes Buchman
Used CAD-Ray for my Medit scanner purchase, training, and assistance and have had zero problems. They are so quick to respond to inquiries and helping with any minor issues (which have been very minimal). Highly recommend working with this company - 8/27/2021
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
Scot White
It's rare to find a company that actually has its customer's best interests in mind. They took all the intimidation out of the equation for me as I took the leap into the "digital dentistry." Frank Weinstein is the right person to know if you are try...read moreIt's rare to find a company that actually has its customer's best interests in mind. They took all the intimidation out of the equation for me as I took the leap into the "digital dentistry." Frank Weinstein is the right person to know if you are trying to learn about and buy and use digital tools in your office. It's so mush easier when you have knowledgeable people who are really on your side.read less - 7/07/2021
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
Chirag Vaid
I ordered my Medit scanner from them in Feb 2020, so far no issues with support or the product. They are a great company with great support. Disclosure: they did promise me a scanner tip for this review, but in all honestly I was meaning to give it t...read moreI ordered my Medit scanner from them in Feb 2020, so far no issues with support or the product. They are a great company with great support. Disclosure: they did promise me a scanner tip for this review, but in all honestly I was meaning to give it to them anyway.... if you are looking to buy, this is a great way to go about it.read less - 7/19/2020
Mary Oliverie
Last year when I started looking into the Medit i500 I had my front desk call 3 sellers to get preliminary information. She told me hands down call CAD-RAY and don’t bother with the others. Boy was she right! Frank got us going with all our hardware ...read moreLast year when I started looking into the Medit i500 I had my front desk call 3 sellers to get preliminary information. She told me hands down call CAD-RAY and don’t bother with the others. Boy was she right! Frank got us going with all our hardware needs and trained us until all our questions were answered. Then Jonathon and Armen jumped in at our 2 day live training in Baltimore. I still review my notes to implement all the great ideas. When I get myself in a jam time to time CAD-RAY responds immediately and fixes my problem. Best decision I have made in the practice in a long time - Thank you everyone at CAD-RAY!read less - 10/09/2019
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
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