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Exposing and Correcting the Distal Margin Scan

In this video we demonstrate some of the most common problems associated with second molar impressions. Usually the distal margins can be blurred by the presence of hemorrhaging or soft tissue. In this particular case, we use the tip of the camera to displace the tissue and digitall correct an area for better accuracy. The isolite systemisolite systemisolite system does a great job controlling the tongue and the lips and with proper retraction you can image a quadrant in very little time

The second most commong problem is a change in the vertical dimension before and after we prepare the last vertical stop in the arch. We advocate that you take two bites; one before preparing the distal extension and one after you prepare it. Comparing the two buccal bites will let you know if you will have issue with your vertical dimension and allow you to reduce the post op adjustments

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correcting and capturing the distal margin of second molars
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A Premolar Crown With the Medit i500, exocad, and Coritec ONE

In this video we demonstrate a simple premolar case that is prepared and imaged with the Medit i500, designed in the cad software named exocad and then milled with the imes icor coritec one machine. Pay attention to the order and sequence of events and how we leverage anesthesia time with scanning time.

We have a large library of instructional videos on our site that can be found on our support page that can help you learn everything there is to know about the Medit i500

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a simple chairside premolar crown with the Medit i500
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Implant Margins Impressions Performed Extra-Orally With The Medit i500

Taking impressions, digital or analog way, was one of the greatest hassles in implant dentistry. we can now image the margins of the implant suprastrucure OUTSIDE the mouth, merge it with the intra-oral condition, and mark the margins on the digital file as opposed to getting hemostasis and tissue retraction in difficult situations..

medit i500 takes one of the most complex and error prone situations and simplifies it, whether you send the case to the lab or do in office restorations.

 

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Proper Implant Placement and Digital Impressions with Scanbodies and Medit i500 Lead to Predictable Results

In this video, we show a recall of an implant restored with a scanbody. When the implant was initially placed, a scanbody was seated and an X-ray was taken to verify that it was seated. The titanium scanbody allows for visualization of seat. A peek scanbody does have a metal carrier but it is confusing to some users to verify that it is engaged with the fixture.

The proper placement of this biomax implant, followed by ideal contouring of tissue and bone around the head of the fixture, allowed for enough “running room” to create the desired emergence profile

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emergence prodile of crown imaged by medit i500
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Flash and Flush For Digital Impressions

With digital dentistry and designing cases in color, you do not need flash like you do for analog impressions.  The purpose of flash is so that you can discern the separation of the margin from the tissue in stone.  You still need to displace the tissue to expose the line of sight to your margins, but you don’t necessarily need the flash. But if you get both, it certainly helps!  You can see an example of this with the margins scanned in HD mode with the Medit i500.

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flash and flush help expose the margins for the Medit i500 ios

In the following video we demonstrate how we set up the case and image the prep.  With digital dentistry, you can image the opposing, the arch, and the bite in any sequence you want. This has great implications clinically where team members can scan most of the data needed and the dentist can step, prepare the tooth, and just image the prep and the contacts of the neighboring teeth. Advanced users who are looking for speed can process the case even before the prep is imaged, and then just image the prep and only process that arch and merge them in the cad software, greatly speeding up the process

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case set up for medit preparation imaging

 

CLICK TO DOWNLOAD THE UPPER AND LOWER OBJ FILES TO LOOK AT IMAGE QUALITY FOR YOURSELF

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Distal Extension Second Molar Crown Replacement in Copy Mode and With Two Bites

Every distal extension case I have to accomplish the following:

  • take two bites to make sure my vertical dimension does not change with pre-op and prep images
  • make sure I have proper clearance
  • We usually take the bites and all other images BEFORE I have even imaged the prep- I usually grab the prep images last
  • most of this you can delegate to your team and just take the prep images and make it simple for yourself

this video shows the clinical steps. to see what the lab does with your case, click in the link to see the subsequent steps. you can also choose to design and mill it, which is what I did

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Distal extension copy case with two bites
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design of second molar case with two bites
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emax try in

 

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Tissue Displacement Flash for Analog Impressions vs FLUSH for Digital Impression

With analog dental impressions, it is imparative to separate the gum tissue from tooth structure and to create a trough for flash for dye work. This is not the case with the intra-oral scanner by Medit.  All you need to do is displace the tissue so you have a clear line of site to the margins, and you just need to be flush. You don’t need flash like you do with stone work

replacing a crown with medit i500

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tissue and/or cord flush to margin for digital impressions
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emax try in

 

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Implants and Digital Impressions

“Yes it can

I would however do separate abutments and crowns just in case you bind somewhere you can adjust crowns separate from abutments

You would have struggle with analog impressions

This is THE indication for digital dentistry over analog impressions!

I’m stealing this photo for my presentations 😉”

 

 

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Live Intra-Oral Scan Verification Jigs for Full Arch Scans and Global Accuracy

This is a detailed video demonstration that shows you how to capture full arch scans for multi unit implant cases in edentulous jaws and, more importantly, how to assess its accuracy.

this is a very controversial topic and most aspire to capture intra-oral scans without the need for a verification jig. to date, this has been impossible to measure during live intra-oral scans. you can only do so with trueness and precision studies on benchtops, with known reference frames.

All that changed this month with the launch of Medit’s AI (artifical intelligent implant suprastructure automatic identification) system. it is meant to primarily identify a scanbody and the location of the fixture. But we can use it to our advantage to give us a LIVE verification jig.

this is not comparing telegammetry to ios scans. it is showing how you can assess the accuracy of your live global scan, which was impossible a month ago. it should be readily apparent to you that every scanner on the market can produce accurate or inaccurate models, and the end result is completely up to the operator.

this invalidates most if not all studies to date that assess trueness and precision of intra-oral scanners because none of them can measure those values intra-orally. this is a new benchmark that all manufacturers should try to achieve now

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live full arch verification jig

A summary and review of the above video

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review of full arch imaging and accuracy verification

In this video we slowed the speed down so you can appreciate the subtle changes in the histogram

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Notice microns worth of changes while imaging across the arch

This video shows the relationship of the two models to each other and the location of the implant suprastructures

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matching models
  
Download the Case File

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What Is An Implant Scanbody, Why Should You Use it, And Why You Need The Medit i500’s AI !

dental implant scanbody used by the medit i500

Dental implant surgery and restorations were the most risky procedures just 10 years ago. They were also the most profitable, but also carried the largest liability and the most significant surgical and restorative lab costs. A simple error introduced in the restorative process could easily eliminate the profit margin and a more significant mishap can create an undesirable outcome

We have seen dramatic changes in implant surgery where both the cost of the surgical stent and the fixture placement have reduced to the point where fully guided surgery is now the norm as they speed up the surgery and normalize the accuracy of placement across a broad range of practitioners with varying levels of experience. We are now seeing the same type of effect on the restorative side of the implant treatment, where digital dentistry is greatly reducing costs and errors.

With permission from blueskybio.com, we captured some key elements with analog impressions to highlight potential errors that can be introduced. The full video can be seen here:

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analog impression of an implant fixture

The common sources of errors that someone can introduce are:

  • The inherent nature of impression material that can distort during the impression step
  • The angulation of the impression abutment may prevent it from seating all the way or may bind on the adjacent teeth making it difficult to capture an accurate impression
  • The size of the impression abutment can usually block access to the contours of the adjacent teeth where the pvs material does not capture the detail needed to generate good contacts and emergence profiles
  • Not securing the implant analog with the abutment in the impression material so that it does not distort or vibrate out of its position while pouring stone into the PVS material
  • With multiple implant, the problems can compound exponentially if the implants do not draw well together with complications ranging from locking the tray in the patient’s mouth accidentally or distorting the impression material enough when removing it where you decrease the accuracy.  Some practitioners prefer to do this in multiple steps, correcting angulation and collisions with custom abutments and several impressions

Fortunately, in this impression of 3 implants that were placed with a guided, the impression abutments are parallel to each other but just a few degrees in either direction, you can have multiple collisions of the abutments with the adjacent teeth or in between the abutment themselves. What a scanbody does is it allows for the optical scan of a geometric shape that helps CAD software identify the exact location of an implant fixture, its timing, and its relationship to the arch form.

It has significant advantages as there is no distortion of the impression material.  Moreover, you can capture all the detail of the adjacent teeth before you place the scanbody in the mouth.  This dramatically reduces the errors and adjustments you will need to make during the seat appointment.

This video shows you the contour or the shape of a specific scanbdoy. There are many manufacturers that produce the scanbodies for a variety of fixtures with different geometries.  Ideally, you use a titanium based one so that you can take an x-ray to make sure it is seated all the way.  A frequent cause for error with digital impression is that you bind on tissue of bone which block you form seating all the way.

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sample scanbody

Once you have scanned the pertinent information, you can then take the digital models to CAD software where the location of the fixture is identified digitally and you can design the restoration of your choice.  This can be titanium abutment or a tibase that retrofits ceramic material like emax or zirconia.  The following video demonstrates how you identify the scanbody in exocad and proceed with a sample design.

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purpose of a scanbody

Once the design is completed, you can outsource the fabrication of the abutment and/or the crown.  There are many machines that you can use to fabricate the titanium abutment.  Please note that the milling machines do not mill the connection. The connection to the implant comes pre-manufactured.  The cylindrical block is milled to shape.  The cad software also maintains the relationship of the abutment to the crown so that they retrofit to each other.

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Now imagine if you had multiple implants that did not draw together?  What’s great about digital dentistry and how we use the Medit i500 here is how we utilize a single scanbody to capture the location of 3 fixtures.  One thing we emphasize at CAD-Ray is how digital impression allow you to create models over time and out of sequence. They are also editable and additive.  In the subsequent video we demonstrate how you can capture segments at a time, which can greatly help when you have implant abutments colliding into each other.

You can place the scanbdoy in one location, scan it, digitally protect the area, remove the scanbody, place it into another location and image it at the new location, dramatically overcoming all the obstacles described above

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3 implant fixtures captured with one scanbody

Now for the greatest news and the largest advancement in digital dentistry in a decade!  Medit i500 has launched the Artificial Intelligent Implant Identification System where the software automatically recognizes these scanbody and lets you skip dozens of steps to get to the immediate design steps of the restoration.  The algorithm utilized to match the digital scanbody to the physical one is proprietary to Medit and is unparalleled in its accuracy.  A lot of the guess work and inherent errors in the digital platforms are reduced with this software which is a contrasting as the difference between analog and digital impressions.

 

 

Posted by Armen Mirzayan on Monday, September 23, 2019

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Using Medit’s Artificial Intelligent Implant Suprastructure Identification System to assess the accuracy of a cross arch digital impression!

medit i500 artificial intellegent implant identification system

 

Using Medit’s Artificial Intelligent Implant Suprastructure Identification System to assess the accuracy of a cross arch digital impression! long title but it had to be to do it justice. For a primer, we highly recommend that you watch all of our videos on imaging fundamentals

imaging fundamentals with the medit i500

 

here we put all the pieces of a puzzle together to answer how you can capture full arch impressions for implants accurately (or inaccurately). As the user, you are completely responsible for not introducing errors or capturing the data correctly

The Medit i500 has features that help you not only capture implant suprastructures, where you can bypass the scanbodies all together which impedes capturing the bite correctly for a lot of people, but you can identify their location and margins, even if they are hampered by bleeding. Most importantly you can use them as landmarks to accurately capture very accurate full arch impressions.

Medit’s reliability map, implant suprastructure identification system, and matching histogram colors can help you drastically reduce or eliminate steps and errors in full arch digital implantology

 

Using Medit’s Artificial Intelligent Implant Suprastructure Identification System to assess the accuracy of a cross arch digital impression! long title but it had to be to do it justice

here we put all the pieces of a puzzle together to answer how you can capture full arch impressions for implants accurately (or inaccurately). As the user, you are completely responsible for not introducing errors or capturing the data correctly

The Medit i500 has features that help you not only capture implant suprastructures, where you can bypass the scanbodies all together which impedes capturing the bite correctly for a lot of people, but you can identify their location and margins, even if they are hampered by bleeding. Most importantly you can use them as landmarks to accurately capture very accurate full arch impressions.

Medit’s reliability map, implant suprastructure identification system, and matching histogram colors can help you drastically reduce or eliminate steps and errors in full arch digital implantology

Posted by Armen Mirzayan on Wednesday, September 25, 2019

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Artifical Intelligence by Medit i500 Allows Automatic Implant Suprastructure Identfication

case set up for scanbody
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case set up for scanbody

uncover to digitally impress titanium scanbody
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uncover to digitally impress titanium scanbody

Just like that, the world of implants changed overnight!

Medit i500’s artificial intelligence implant identification…

Posted by Armen Mirzayan on Monday, September 23, 2019

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How To Transfer The Margin Line To The Lab From Your Medit i500

This first video details how you can mark your margins in meditlink with your medit iscan software.  The very first step that you must do is properly identify the job definition.  If you choose orthodontic modules or bite splints for example, you will not have the opportunity to transfer the marked margins because they are not part of the equation.  So the best practice is to always properly label the tooth and the prescription

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margin placement to transfer from dentist to lab with meditlink

Once you have processed the case and it is in the preview mode you have one last chance to review the order and submit it to your lab of choice.  In this next video we show what happens to your data once your lab receives it and particularly how your drawn margin line accompanies the upper and lower arches and the prepared upper right molar

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how the lab receives your margin line from medit i500
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You Need Enough Redundant Data Between The Pre-op and Prep Models To Activate Image Aquisition

When you have preops that you are trying to stitch to preps in medit, and this could also include relating scanbodies to arches as well, you need enough data that is redundant in both catalog boxes

if you watch this video carefully, you can see how i over trimmed the mesial part of the equation and even though the camera is active, it is not acquiring images. you can see the red box.
once i move the camera to the distal molar, the acquisition starts because the molar has more data points than the premolar and the software / camera recognized the area and started to acquire images.
understanding this will unlock a lot of complicated cases and make the easier for you

case set up for medit copy case
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case set up for medit copy case

case set up for medit copy case

enough data is required between your preop and prep condition to actively take images

quick design in exocad

DOWNLOAD CASE FILE

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Missing Order Form in Meditlink

A common question we get at cad-ray.com is how a case cannot be submitted to a lab.  Most of the time, it is because the job has not been created.  You must identify the teeth or the arches that you will be working on define the restorative material of choice or the type of appliance you will be submitting.  Once you have done so, the order box will appear for you to submit the case

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missing order form to submit a case to a lab

In this next video, you can see what happens when a lab gets your case and what they can do with it

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what the lab gets