Category: CAD/CAM

One of the biggest challenges of capturing a bite for an occlusal appliance is to properly tripod the upper arch to the lower arch. With PVS impressions we just send the impressions along with the patient’s bite registration in maximum intercuspation.

A unique advantage we have with digital impressions is that we can capture someone with an open bite while using their own mouth as the articulator. Moreover, with the following technique, you can rest assured you have little adjustments to make to the occlusal guard after it has been fabricated.

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Now as we continue to image in the same catalog box, we can gauge if we are on track as the bite model turns green. Notice how when we move from the upper arch to the lower arch, across an open bite, and we maintain a green active box and green model formation, we can rest assured that our case is mounted correctly.

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This is an advanced case and won’t make any sense unless you have taken our course on digital dentistry. If you are an advanced user, watch how we break this complex case up into many small manageable segments to create full arch impressions of multiple prepared teeth.

Take note of the fact how the buccal bite is captured over a long course of time. This indicates that the arches are related to each other properly and we have not lost track of the bite. Pay attention to how we operate “independent of time and sequence.”

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pre-op condition scanned with Medit i500

Anterior preps scanned along with the opposing and the initial bite

segmental imaging to building a master model

upper and lower models related to each other for design

screenshot and margin placement in exocad

Immediate Post Op

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Post op intra-oral scan with Medit i500 to capture irritated and hemorrhaging tissue (for demonstration purposes only)

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One Month Post Op with Radiographs

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another week of improved hygiene for the laterals

Digital impressions have turned one of the most complicated and error prone procedures in dentistry into one of the most predictable treatments we can provide.

When taking a physical impression of an impression abutment, you need to secure it to the PVS material so it remains rigid during pour ups. Some choose open trays while others prefer closed trays. When you deal with multiple units, their divergence or convergence can inadvertently lock the tray in the patient’s mouth. Sometimes, the impression abutments impinge on each other and keep you from seating them all the way.

That was a short list of the many things that can go wrong. With a digital impression, you can capture the contacts or the adjacent teeth, the opposing, and the tissue profile very easily. You can then place a scan-body and take an impression of it’s position and identify the location of the fixture.

In the following videos you can see the steps involved and how easy it is to manage the impression and accurately capture the implant location.

In titanium blanks, there is only one place to put the sprue, which is on the occlusal. One might think that this is would be easier to manage, but the trouble is that the titanium blank is cylindrical in shape, and it makes it difficult to keep track of the implant hex position and proper indexing.

There is one important matter to keep in mind when digitally designing an implant abutment for milling from a pre-milled blank. Unlike regular restorations you can design a restoration in (CAD software) and position it in a block , place a sprue in a desired position, and mill (CAM software) the final product.

The solution is to provide data to the milling machine so that it can properly index the titanium blank. To keep it simple, a regular restoration can just be milled from a designed stl file. The titanium pre-milled blanks need accompanying files to the designed stl to properly mill the abutment for indexing purposes. In exocad software, there is a construction file that accompanies the design and the CAM software can read both files and produce a desired result.

In all of our courses, once every user gets comfortable with the software and the camera, we quickly ramp up to reveal the greatest advantage of digital impressions over analog ones. The premise is that digital impressions can create models of data (note the deliberate omission of words like teeth, tissue, etc.) that are independent of time and sequence, and moreover, you can edit or manipulate the captured information.

In this particular case, we demonstrate how the upper anterior eight were prepared and how the preps were captured over an extended period of time. You can appreciate how one case protect margins and preparations from introducing subsequent errors. You can also visualize how you can create models without following a certain pattern.

Once you understand this concept, you can apply multiple ways to tackle the most complex and comprehensive cases and treat them with ease. We would love to host you at one of our courses to teach these principles and how you can take ANY intra-oral scan from any device, take it to CAD software, and take it to ANY milling machine you want. Oh yeah, we can also teach you how to introduce CT data into the mix from any machine to handle an even bigger case.

Click on our courses and events to see future courses. We’ll be adding more dates very soon.

Separate from how we imaged the arches, we think the perfect place to “hand off” a case like this is when you have mounted your upper and lower jaws, the opposing, marked margins, and set the path of insertion. At this point, as a clinician you have provided all the information needs to proceed with the case.

In this simple first molar case, we scan the pre-op condition as there is no room to add any contours to the pre-existing crown. In the video below, you can see how it occludes with the opposing and how it contacts the adjacent teeth. A pre-op scan is taken and the crown is removed. Images of the recurrent decay are taken and the preparation was modified. Final impressions were taken after tissue retraction and hemostasis.

The pre-existing condition must be trimmed away and you want to keep only the areas you want to make contact with in the proposal. This simple method gives you instant proposals where you only modify the contact areas and proceed to production

In just under a decade, we have turned dental implants from the most risky and stress inducing procedures we can perform both surgically and restoratively into one of the most predictable procedures we can perform while drastically reducing the cost of care, whether you fabricate the prothesis yourself or outsource it to a lab.

With guided surgery, the benefits are immeasurable. One good argument is that clinicians can avoid certain surgeries while discovering physical limitations during the planning stage. Furthermore, if performed fully guided, once can generally place the implant exactly where it was digitally planned in 3D on a CT scan.

Restoratively, we also have some tremendous advantages; whether you are performing single units or multiples, digital impressions give you an advantage you never had with physical impressions. In this first video, we emphasize how you and your team should take picture of the scanbody that is being used during the digital impression. It is very easy for you or the lab to mistakenly label digital impression in the design software.

The great benefit of digital impressions is realized when you can capture all of the contact areas of neighboring teeth. Furthermore, you have the ability to digitally sculpt the soft tissue and create the emergence profile for your abutment. When you take the soft tissue profile, the position of the head of the implant, and the contacts of the adjacent teeth into consideration in your design, you stack the odds of a successful restoration into your favor

In this video we demonstrate how to capture implant impressions of scan bodies intra-orally with the medit i500 scanner and then design a screw retained crown with our customized CAD-Ray software.

The sequence of steps for a new user are critical. Although it doesn’t matter if you image the opposing arch first or after the arch that is being restored, the steps to capturing the scanbody must be followed in chronological order. You must capture the arch and then the scanbody impression. You should not return to the arch catalog box and add any more data. This can introduce a lot of error in the processing steps

In this video you can appreciate the distinct advantage you have tissue training on a digital model. You can contour to the soft tissue very easily. It is best to do so after you have identified the scanbody, which will pinpoint the location of the fixture. Once you have that in the equation, you can sculpt your tissue to your liking, making sure your abutment margins never drop apically below the head of the fixture