Please, take a seat, you should not be standing while you watch this.
Artificial intelligence by Medit i500 now identifies the location of your scanbody but it also automatically launches all that proper information into CAD software for instant abutment designs. Make sure to watch both videos. Enjoy.
A custom titanium metal abutment is milled in such a manner where the drills DO NOT touch the connection. The type of connection is predetermined by the blank manufacturer and the cylindrical part of the abutment is milled out. This makes the symmetric geometry of the abutment a bit tricky for some to handle as indexing it properly to manage the timing of the connection is critical for easy delivery.
It is a good idea to know the exact dimension of the screw access hole. You want to set the diameter just outside the channel so that you don’t have to do a lot of post production adjustments. if it is made too thin however, you can have a mis-mill and have to repeat it. We’ve found 2.5 mm the perfect setting for the DESS titanium abutments.
Download this case to mill and see the results for yourself
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.
The Medit i500 intra-oral scanner has two different software programs to operate, one is of which is geared towards clinical dentistry and the other is geared towards laboratories. Our advanced users are encouraged to use the lab version as it has a lot more functionality. One of them is to directly link to exocad software.
In this particular preview we show you the interface where you can launch the iScan program and define the work order and set all the parameters for your restorations.
Once all the settings are chosen, you launch the Medit scanner and image the case. Here, we defined the custom abutment for the crown and the opposing, which activated the catalog box for the antagonist, the arch, the scanbody, and the buccal bite. All respective images were captured.
The models were then processed and exocad was launched for the design of the custom abutment and crown.
Once the implant type is identified then you can design the abutment and crown with great control, where you can contour the underbelly of the abutment to help provide tissue support.
The design and the construction file is taken to the milling machine. Here, we used the CORiTEC ONE to mill the titanium abutment and then the Lithium Disilicate crown. You can see the great internal adaptation when the crown and the abutment are flipped around completely and the abutment does not fall out.
In this case presentation, we scan a patient with the medit i500 for implant planning and restorations in the upper left quadrant. At first, you will notice how the camera was slow to capture the arch due to water spots on the mirror of the camera tip. Once these water spots were removed, the imaging was rapid and the whole upper arch was imaged in just a minute.
Once the upper arch was digitize it was automatically merged with the dicom data from a ct scan in the blueskybio software. This automated step saves quite a lot of time and is rapidly becoming a reliable solution. It is imperative that you do NOT form a base or close holes in your intra-oral scans so that the software has an easier time to stitch the models together.
The implant case was designed and a surgical stent was fabricated for fully guided surgery. The lip line and the tooth position will be a challenge and the angulation will have to be corrected with an angled abutment
The Medit i500 software can now identify a scanbody and digitally place a virtual one in its location. This has a lot of ramifications. For starters, this great opportunity affords a dentist the ability to image multiple implants in long span edentulous areas, where you would have a clear indication of distortion or artifact introduced during challenging scans.
In this single unit case in the video below, we preview this feature. Once the patient is anesthetized, the isolite was placed to protect the airway and the edentulous area was scanned.
After uncovery of the fixture, the type of scanbody was identified in the menu and the location of the scanbody was identified on the digital model.
Once scanning was resumed, the digital scanbody was placed on top of the intra-oral one. As more data was captured you can appreciate how steadily the software tries to adapt the physical fixture to the digital one.
The Z4 Milling Machine can drill emax, zirconia and metal abutments. You can use a scanbody, identify the location of the fixture, design the abutment and mill our either ceramic or metal as the abutment.
Metal abutments in the posterior molar areas, tibases in canine and premolar regions, and angled abutments in incisor area is the general consensus for restoration of choice
One of the greatest advantages of the Z4 is that it can start milling while it is doing the calculation for milling. Furthermore, you can load multiple designs in preparation of continuous milling. In the picture attached, the CAM software is shown which operates in the background. Most users don’t usually see this interface.
Here you can see how there are 5 drills for the machine. The top tier, consisting of 3 drills, labeled G240, G100, and G060 are all labeled as R. The G120-T and G060-T are used only for a screw access holes
Retail Cost
$450 – holder with 10 premills
$1200 – holder with 50 premills
All abutments include one final screw. Additional screws sold separately.
DESS-USA-Premilled-Blank-Catalog
SAMPLE VIDEO OF IMPLANT DESIGN MODULE
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When planning for guided surgery in edentulous patients, it is important to have the final vertical dimension and tooth position determined. Ideally, a denture duplicate should be used with proper radiographic markers.
The traditional way was to embed radio-opaque material in the denture dupe, CT scan the patient with the denture dupes, and then CT scan the denture dupes themselves. Alternatively, you can scan the denture duplicates with a digital impression system. Here we used flowable composite and spread them through the wax set up and take a 3D X-ray of the patient. We then use those landmarks to merge the data sets between the digitize denture and the markers on the CT Scan
An important concept to keep in mind for these edentulous cases is that you actually need 2 models for each arch. One model is used for tooth positioning and implant design, and the other model is used for stent design. Essentially, you design the stent on the ridge, not the denture dupe
One of the biggest hassles in most software is to plan a guided surgery case when the tooth is still present in the arch. Some software will force you to part-take in pylon course handling, gymnastics maneuvers, musical chairs, and multiple imports and exports. The issue revolves around the placement of the sleeve / ring in the design step. Usually you are forced to manipulate the data in 3rd party software and then bring it back with the tooth virtually extracted.
This article is about how you can scan the arches and export the STL, OBJ, or PLY data from the Medit i500 scanner. You can then clone the same case and alter it- namely, you can crop out the tooth that will be extracted in the future. This video shows you how the virtual extraction is performed.
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The multiple data sets are then imported in BlueSkyBio software where there are no limits to the number of models you can bring in. In the following video, you can see how the complete upper arch, the virtually extracted lateral arch model, and the opposing are brought in an merged with the CT Data.
The implant is planned for fully guided procedure and a surgical stent is manufactured on the model that has the virtual extraction. You cannot design a stent correctly with the tooth present in the equation. Open architecture and speedy results are the name of the game now with CAD/CAM dentistry. As you can see, these steps are super fast and easy with the open licensed Medit Scanner
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Download the STL
Download the OBJ
Download the PLY
Download the BSB file and design along
Another example of how well the i500 from Medit can scan with a deep focal length. This is impossible to do with any other IOS system on the market. Don’t misunderstand, this is not an easy impression to capture, but if you are well trained and know what you are doing, it’s very accurate and simple.
In this video you will see how the upper arch is captured in under a minute. Then the lower arch is capture with the healing abutment removed. Watch carefully how there is a lot of effort made to capture the distal wall / contact area of the bicuspid. You can also see the effort made to capture information below the height of contour of the distal molar. The mesial information is critical for designing the emergence profile of the abutment and restoration
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After both arches are captured, the software leads you to the step where you capture the peek impression post. It is seated completely and an X-ray was taken to verify the accuracy. The edentulous area where the abutment would be positioned is cropped on the Meditlink software, and the impression post is scanned. It is imperative to make sure the adjacent teeth are imaged so the software can properly line up the landmark of this scan with the previous scan of the edentulous mandible.
After the Peek Scan Body for a Narrow Platform is imaged, it is removed, and the patient bites down into maximum intercuspation. The camera then captures the data so that it can articulated the models together. The buccal bite scan turns green once a positive adaptation is made.
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Once the relationship of the upper arch and the lower arch are confirmed, the case can be submitted to a lab for the manufacturing of a custom abutment. You also have the choice of fabricating chairside abutments with a milling machine, if you choose to.
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When you scan an upper arch and a lower arch with an intra-oral scanner and then export that case, usually the software places coordinates on the upper and lower models, so when you import them into another software, they properly articulate.
In this video, you can see how the upper arch is stitched to the CT image of the maxilla, an then how one can easily related the mandible stl file to articulate to the upper arch. This comes in handy in software like BlueSkyBio where you could add teeth to the equation and design implants so that they are prosthetically driven during the design phase.
In this video, you can see how a quadrant of the lower arch and the upper arch can be imported into a third party software for design. Note that in this particular demonstration, there is not edentulous area and this video just demonstrates how you can place a digital tooth in your case and design the digital wax up to your liking. Advanced users generally just use the sleeve of the surgical stent to aid them in visualizing the occlusal table of the final prosthesis. A complete design lets you know where the contacts are and how much space you need to create the proper emergence profile.
