Digital Dental Impressions with Intra-Oral and Desktop Scanners
In this case presentation, we introduce the Shining Aoralscan for beginner doctors who want to get into digital impressions. Proper isolation and retraction is a key element of scanning. In this demonstration we showcase how a new user can easily control the operating field to deliver high quality restorations
Proper isolation and retraction is key for all intra-oral scanners. In this video, you can appreciate how the upper and lower arches were isolated, the margins were exposed with retraction cord and imaged with the shining 3d aoralscan
To date, the literature and research clearly points out that full arch scans with edentulous arches are prone to inaccuracies. That’s because we have never had a way to measure and verify models while scanning. There are two features unique to the Medit i500, namely the reliability map and the artificial intelligent implant suprastructure identification system. Individually, they do not provide much information with regards to accuracy, but if you understand how they work, you can utilize them to assess accuracy while you are scanning edentulous arches.
We proved the validity of this concept by utilizing these two features by incorporating a scan from the imetric Icam4D scanner and merging its data with the IOS to render a perfect match. Details are posted for our users in the Imaging Implants Section of our tutorial liabrary
This is a preview of a single unit case that was scanned using the Artificial Implant Suprastructure Identification System of the Medit Software. To see the full case follow this link
Hydroflouric Acid Etched Treated Scanbody Surface makes Intra-Oral Scanning much easier for all dental scanners. Apply a coat of HF for a mere 10 seconds and rinse off.
In this clinical case a patient lost a pre-existing crown. The remaining tooth structure had recurrent decay and a new crown was warranted.
After anesthesia was administered, the clearance from opposing dentition was assessed. The preparation was reduced to accommodate the necessary thickness of the material.
Once adequate clearance was achieved an Optragate was placed and an isolite was used to isolate the area. The preparation was scanned and then the lower arch was captured. The buccal bite was then taken to along the arches together
With Meditlink software, you have the option of designing the case yourself or sending it off to your partnered lab. The following video shows what happens to your case once the lab downloads the case
In this particular case, we designed our own crown and milled it with the coritec one milling machine
Once the amber lithium disilicate material was milled, its for was verified clinically. The crown was then crystallized and seated with NX3 resin cement
In this video we show how to you can digitally pour up the intaglio of a denture scan with the medit software where you scan in the impression mode, “reverse normal”, process the case and the add a base to it. You can then immediately send it to a printer
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.
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
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
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:
The common sources of errors that someone can introduce are:
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.
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.
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.
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
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
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
DOWNLOAD CASE FILE
Medit has launched a software that is the greatest advancements in digital dentistry in more than a decade! With artificial intelligence, you can identify the scanbody during intra-oral digital scans. This has many implications for accurate scan captures and skipping multiple steps in the design process in CAD software like exocad.
But there is more! This will knock your socks off. You can build your own custom library for scanbodies or you can use geometries of abutment libraries from your favorite implant line. In this article we show how to import the stl file for a physical impression abutment (Closed Tray- Blueskybio Part #MIJH) and use it as a scanbody. Just watch the following videos
A lot of implant manufacturers will readily distribute their libraries of abutments and scanbodies. Here, we just chose the MIJH impression abutment and previewed it in one of the many free 3D viewer programs included in windows 10.
Once the data is imported into the library, you can preview it and incorporated into your own library of abutment. Please note that the abutment libraries are stored in the arch catalog boxes while the scanbody libraries are stored in the scanbdoy library, which means the abutment itself may be taken into consideration when capturing the buccal bite.
Once the abutment is identified in Medit it is directly transferred into cad software like exocad to proceed with design. Note in this footage how little of the physical abutment impression was brought into cad software. This greatly reduces errors and your imaging time intra-orally. You can also place a stock abutment and scan it in the same manner and be able to find margins with great ease without having to reach hemostasis or good tissue retraction
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At CAD-Ray, we are big proponents of open architecture and the doctors control the flow of their patients’ digital data, whether it is a CT scan or an digital impression system. We have put the Aoralscan through a battery of tests. For single unit, it delivers on quality that equals any other scanner on the market. We were particularly impressed with this deep margin and how well the graphics could differentiate tissue from tooth structure on the distal of the prep
click to download the OBJ file of this case (note: we only scanned to pick up data for the margins)
In this particular case, we are restoring a lower left molar with a full coverage crown. The pre-existing condition has multiple fracture lines and the patient currently wears a retainer. The pre-op optical impression is taken while the patient is reaching anesthesia. Once enough reduction has been achieved, the preparation is captured and an immediate proposal is rendered that replicates the pre-op condition perfectly.
Note how the settings for the start of the adhesive gap influence the cement line that you see on the post-op bitewing after immediate delivery, even though it was milled with the CEREC MCXL.
copy mode- instant proposal
Same visit crowns can be a practice builder. We had a patient referred for in house fabrication of a restoration because she did not want to go through the procedure twice. A family member made the referral for a broken tooth.
After the tooth tested vital and the patient consented to treatment, she was anesthetized. While waiting for the onsite of anesthesia, the upper arch was imaged along with the lower arch and the bite in the occlusal one window box. The case was set up for just imaging the preparation. Most of this can be delegated to team members.
We highly recommend that you capture the final bite after you have finished preparing the most distal tooth. You can use your camera to visualize your clearance. You can keep reducing the occlusal surface until you have enough clearance.
In this particular case, when we took the second occlusion images, the models would not turn green. When this happens, you should immediately ascertain if you have captured the first or second bite correctly. Double check to see if the jaw settled or if the patient moved their jaw during this acquisition step.
You can watch how we troubleshoot the bite and manually choose the second bite to relate the arches together.
Once the bite is captured, the isolite is re-inserted and the tissue is displaced and isolation is achieved. Then the predation is captured.
After the crown is seated a final bitewing is taken to verify seat and if any excess resin is left behind.
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