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
“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 😉”
We are very pleased with millbox and the imes icore coritec one for a chairside milling solution. We’ve been testing it for a long time and its CAM (millbox) is very intuitive and the results are always predictable. It can mill titanium abutments, emax, and zirconia blocks.
The following videos illustrate how you can image a scanbody intra-orally and then design it in cad software. Here we used exocad to identify the biomax RP implant and designed both the custom titanium abutment and the suprastructure, both of which were milled with the CORiTEC ONE
There are so many implant and component libraries in cad/cam dentistry which can lead to a lot of confusion. What we highly recommend is that you visually compare the part numbers that you will be using with the part numbers displayed on the millbox software. One letter or number difference and the mistakes will have a profound impact on the bottom line of a dental practice
In this case presentation, we feature a crown that needs to be replaced due to open margins and recurrent decay.
With the Medit i500, after the patient is anesthetized and the area is isolated, the pre-existing crown is imaged in the pre-op catalog box. The area to be prepared is cropped out in anticipation of the imaging the modified preparation.
Once the crown is removed, expasyl is packed into the sulcus with a Number 2 cord. With the pre-op bitewings X-ray it was readily apparent that the tissue should be positively displaced in order to capture the margins. It took two layers of cord to achieve hemostasis for imaging with the Medit i500.
While placing the margin in the native imaging software, it was noted that some tissue was obscuring the margin on the lingual side. The area was isolated both clinically and in the software. It was cropped out and filled in with ‘good data’ after proper protection of the adjacent teeth and margins so that we did not obscure their geometry.
Once the margins are identified and the case is processed it is automatically imported into exocad for design and then sent to the Imes Icore CORiTEC Once for manufacturing. The emax restoration was tried in and then delivered after crystalization.
Immediate Post-Op X-Ray taken to verify seat and no excess resin cement
Click Image to Download the OBJ Files And design Along
In this article, we demonstrate how to manage a crown replacement on a second upper premolar with the Medit i500, exocad, and the imes icore CORiTEC ONE milling machine. The pre-existing crown was over 2 decades old and the recession revealed a supra-gingival margin. Furthermore, there was no room to improve the anatomy or its outline form as it was in occlusion with the opposing dentition.
A powerful design technique is the copy of the pre-existing crown. Images of the pre-op are taken while the patient is numb and its contours are copied onto the final design of the restoration. This process usually takes a minute or so, after which we milled a size 12 emax block restoration.
One of the most dreaded procedures in dentistry is to cut off a bonded lithium disilicate material. With zirconia, since the bond strength is weak, just “rattling” the crown helps it pop off. You could also debond the restoration with a laser pretty quickly. With emax, you must use copious amounts of water so you don’t fry the pulp. You must also refrain from splitting the crown with a crown remover because you can damage the remaining tooth structure catastrophically.
In this sequence of photos, you will see how we recommend the removal of the bonded restoration. You must first create a trough across the occlusal surface of the crown. Ideally, use a 1.6 mm disposable bur to reach the interface between tooth structure and restorative material. As soon as you reach this junction, take a flat ended diamond bur and start working that same location and remove all the ceramic on the occlusal surface. Staying right at the junction of the material and tooth is the critical part of the process.
After you have removed the occlusal surface, you can take any bur and work the junction one the axial wall. By this time enough work has been done where the walls of the restoration start to break and peel off on their own.
All milling machines have guidelines for proper cleaning and maintanance. The imes icore CORITEC ONE’s spray channels must be kept clean, otherwise they will spray off the target block materials. Essentially you will dry mill ceramic which will damage the material and break the drills very quickly.
You can see how little particles of ceramic and titanium dust can clog the lines.
Here we just used an ortho plier and orthowires to unclog the lines. It’s easiest to have the water spraying so you can identify the channels and see the immediate results.
When cleaned and clear make sure the water it sprayed on tip of the drill from all channels.
A new feature coming to Medit i500 is the automatic detection of scanbodies while you are imaging. In this clinical case, two implants are placed in the lower left quadrant in a fully guided fashion. Spacing limitations and proximity to vital anatomy did not allow for proper parallelism. This can create all kinds of headaches with analog dentistry where the trays can inadvertently lock in the mouth of distort upon poor up.
With the digital approach, you can scan the gingiva, the arch with easy access to adjacent contacts, and then the scanbodies themselves. What is great is that you do not disturb the primary stability you just achieved by placing physical forces on freshly placed implants.
Once the images are captured and the scanbodies are identified, we launch exocad and the data is not only automatically imported into the Computer Aided Design Software, it also plots the fixtures in the correct position and identifies their location and timing so you can proceed with the design of the custom abutment and / or tibase restoration.
This 4 unit case was imaged in Medit i500 and designed in exocad. The final restoration was taken to CEREC inlab cam. When the construction file is imported into cam, it contains data such as the margin line which is important for the milling machine to know for its tool path calculations.
In this particular situation, the construction file dictated the position of the restoration in the block which would have not allowed for proper milling. Instead of loading the construction file, we imported the stl design, redrew the margins really quickly and were able to mill the two separate (4 unit) case out of a single emax block.
The milled restorations were then separated and finished free-hand
try in and deliver of 3 unit bridge and single unit veneer after extraction of right central incisor
try in and delivery of a 3 unit bridge and a single unit veneer
A very common source of frustration for most dentists or those who are new to designing implant crowns is the emergence profile of the abutment or crown. Most of the time, the shape of the tissue dictates the digital design and this article showcases how we used the medit i500 for the intra-oral scan of the patient and then used exocad to design the restorations. Our advanced users can appreciate how we bring the arch model in twice- once as the maxillary model and once as the gingiva model. We then digital sculpt the tissue to create the proper profile yet we still have the original model to reflect back to asses the changes.
Download to ImplantCrownShaping.ZIP to design along
DESS Library Information for Nobe Active Compatible Components
NobelActiveCompatibleComponents-DESSUSA2019-2NobelActiveCompatibleComponents-DESSUSA2019-2
Few things in dentistry that can be as frustrating as seating a second molar restoration, whether you are doing same day dentistry or having a lab made prosthesis delivered. Here is a protocol we recommend that you follow to dramatically reduce surprises and post op adjustments. In this particular clinical case a zirconia crown debonded and we elected to fabricate an in-office emax restoration. The sequence is as follows:
Immediate post op x-rays were taken to verify seat and aid in resin cement removal. The excess cement was removed after the x-rays were taken
With the Meditlink software you can design a case and then export the designs and take them to any milling machine of your choice. In this demonstration, we use the CORiTEC ONE to mill out the metal abutment in 45 minutes. This procedure is not intended to be a single appointment visit so timing is not critical and you don’t place undue wear and tear on the milling machine.
The crowns were milled with two different milling machines. A Celtra Duo block was used and milled with the CEREC MCXL and retrofitted to the abutment to verify the fit and accuracy. The same crown stl was milled out of Vita material in the imes icore machine. The whole point of the demonstration is that you can take scans from any intra-oral scan, take it to CAD software (in this case exocad) and then export the case and take it to any printer or milling machine of your choice. You must make sure critical information is accurately transferred from your CAD software to your CAM software, which is generally the construction / project file that accompanies the STL files of the prosthetic components
The same crown was milled out of Vita’s Suprinity material in 20 minutes with the imes-icore CORiTEC ONE. Take note of the internal adaptation of the metal abutment and the restoration and how when it is flipped upside down, the restoration does not fall out easily!
When we 3D scan the surface of an object, we plot geometric figures (usually triangles) on the surface of that object which is usually round or has some other geometric shape. A satellite beam hitting the surface of the earth is a good way to visualize the scanning process as the photo illustrates.
As you span across long distances, a meshwork of triangles are plotted together to accurately represent the topography of the object. You can start “veering off track” and forming models that are inaccurate representations of that object if you don’t properly form this framework. There are many variables that can introduce these errors including simple matters like speed of scanning.
Now, with this dental artificial intelligence program, the software can digitally plot and drop known shapes on top of attachments or devices we place in the mouth. Color mapping can let us know if we are staying accurate, on path, or introducing errors and deviations!
Now imagine if you have 6 objects sticking out of a flat plane that this AI program readily recognizes. Identifying these landmarks is the first step, but the bigger significance is that we can scan from object 1 > 2 > 3 > 4 > 6, and when we continuously to image backwards from object 6 to object 1, and our color coding remains the same, we are guaranteed scan accuracy.
People go to 2 extra years of schooling to do accurate work in complex cases, most of which will be replaced with software algorithms like this. This is a serious and significant advancement in dentistry, particularly in implant dentistry. Here’s a video that detail how we use it to restore dental implants.
In the following three videos we walk you through the steps of how the digital “scanbody drop” works to identify the location of an implant fixture. In the demonstration videos, we highlight this upcoming feature and how you an integrate the CAD software for implant designs and restorations. In the final video, we demonstrate how you can take the construction files to the milling machine of your choice and mill out the abutment and/or suprastructure.
In this case demonstration, we show how you can image in the Medit i500 and follow the most logical steps and sequences to produce a restoration. You capture the preparation, the opposing and bite and once the models are rendered, you can launch the CAD software of your choice. The lower right molar was endontically retreated and the porcelain fused to ceramic crown needed to be replaced as it was overcontoured and impinging on the soft tissue. After the crown was removed, the preparation was refined and impressions were taken. The remaining cotton / cavit / gutta percha was removed right before placement, a NX3 by Kerr was used, which is both build up material and a resin cement. The space between the intaglio of the crown and the pulp chamber was retrofilled at seating time and a final x-ray was taken to make sure there was no excess resin left behind.
Here, we utilize exocad. Once we click on the CAD software button, the software is launched and the models are imported automatically.
Once the case is designed, meditlink walks you through the next step which is to nest the restoration and to mill it with whatever milling machine you choose to utilize. Here, we used the CEREC MCXL, the Z4 from VHF, and the imes icore CORiTEC one.
Nest and mill with CEREC MCXL
Nest and mill in Zed 4 from VHF
Nest and mill in imes icore CORiTEC One.
Here, you can watch how all three machines come to a grinding halt as we pushed the amps on the surge protector and power to the units.
Immediate post op x-rays to verify seat and to make sure all excess resin cement was removed.
We’re so stoked to hear this podcast from Dr Alan Mead of Dental Hacks fame on CAD-Ray.com and the Medit i500
Here’s the link
When you start a case in exocad or in Meditlink, you have to define a project or define the job by entering a prescription. A dentalproject file is created that has all the pertinent data, like the type of restoration, the shade, the material, parameter settings,etc..
After the case is designed a dental cad project file is formed, along with the stl file of the restoration, accompanied by the construction information. Once the construction file is formed, the case can be import it into CAM software like cerec inlab. It carries a lot of information like the margin line.
Some CAM software can process simple redirections without the need for any other pertinent information from the construction file, while others require it. Some are so specific that a simple typo or wrong character will lead to mis-production.
In the case of cerec inlab, it’s best to have the construction file accompany the stl of the restorations, although there are numerous work-arounds in case you don’t. Once processed, the restoration is taken to the Mcxl milling machine.
Why are we so focused on teaching this concept ? Because it is critical for milling metal abutment where you have to keep track of an object that is cylindrical and symmetric in shape. The code in these files will dictate the indexing of the connections and how these abutments are milled.
This is the occlusal appliance that was milled and delivered from this patient’s scan approximately 7 days ago. The appliance did not need a single adjustment neither on the occlusal surface, nor in the intaglio.
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