Category: CORiTECT ONE by Imes Icore

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Premolar Anatomic Copy Case with Medit i500, exocad, and imes icore eMax Milled Restoration

medit i500 manage crown replacement on second upper molar

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.

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imaging sequence of a second premolar wit medit i500

design of second premolar crown

make sure the water spray is directed to tip of grinding drill

immediate post op delivery of second pre-molar crown

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Keep The CORiTEC ONE Spray Channels Clean

ortho plier and orthowires to unclog lines

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.

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keep irrigation lines clear

When cleaned and clear make sure the water it sprayed on tip of the drill from all channels.

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Anterior Copy Crown With Medit i500 Direct Import Into CAD for Design and Mill with CEREC MCXL and CORiTEC ONE

medit i500 direc timport into cad for design and mill with cerec mcxl vs coritec one

In this article, we feature an upper left lateral crown that needed to be replaced due to recurrent decay.  While the patient was getting numb, we defined the job description in the Medit i500 software and imaged the pre-existing crown, the opposing and the bite.  We digitally cropped out the tooth to be prepared and proceeded with crown removal. Once the margins were refined and the tissue was displaced, we imaged the preparation in HD mode and processed the case.

Crown Replacement Due To Recurrent Decay with Medit i500
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Crown Replacement Due To Recurrent Decay with Medit i500

Image Pre-op, the opposing, the bite while the patient is getting numb

Image prep and process models

Once the digital models were rendered, we launched the integrated CAD software that automatically imported the pre-op, the opposing, the prep model, and the bite. Their relationship is preserved in the CAD software and no modifications were necessary.  You have two ways to copy the pre-op; one way is to program the CAD software so it replicates the pre-op perfectly while the other gives you a raw proposal that you can then choose to adapt to pre-existing situation.

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Direct Import of Models into CAD Software for Design and Mill

Once the case is designed in the CAD software, you can then take it to any CAM and Milling Machine to produce a restoration. Here we milled an emax restoration with the CEREC MCXL and the imes icore CORiTEC ONE at the same time so we can compare the final results.  The CEREC milling machine produced a restoration faster by about 90 seconds but the final results of the margins by the CORiTEC Machine was far superior.  Also, the CAM software, Millbox in this situation, allows us to choose a third drill that is 0.6 mm in diameter.  This increases milling time but results in less overmilling than the 1.2 mm burrs that milll the intaglio of the CEREC Machine.

 

Nesting to Mill To imes icore CORiTEC One
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Nesting to Mill To imes icore CORiTEC One

Lateral Incisor Milled with CEREC and CORiTEC One for Coparisson of Finished Restoration

Dueling Milling Machines

 

Hacked Margins by CEREC
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Hacked Margins by CEREC

Same Case Milled with CORiTEC ONE with 0.6 mm Internal Cavity Drilling

Ceramic Margins Scanned by Medit for Comparisson

Immediate post op 

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Artificial Intelligence in Medit i500 Automatically Identifies Implant Location into Imports into CAD Software

artificial intelligence medit i500 identifies location of your scanbody and automatically launches that information into CAD software

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.

Medit's i500 Artifical Intelligence Identifies Implant Fixture
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Medit's i500 Artifical Intelligence Identifies Implant Fixture

ALL of the Pertinent Information is Imported into exocad as One Complex
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Managing Second Molars And Clearance

protocol to reduce surprises and post op adjustmenst second molar restoration

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:

  • While the patient is anesthetized and you are waiting for the onset of anesthesia, capture the opposing impression and the arch models.  Trim away the prep digitally and then proceed to the buccal bite capture
  • Do NOT capture the bite until you verify clearance.  In the sequences of videos that follow, watch how we use the Medit i500 to capture digital pictures of the clearance
  • Once we verify clearance, we image the bite.   You have the option at this point to see how well your occlusal stamps match the digital stamps if you want to.  A large deviation may mean the jaw settled or the patient moved during the bite capture.  Note that unlike conventional dentistry, you capture the bite here BEFORE the prep is finalized
  • Once you achieve isolation you can finalize the prep and retract the tissue and capture the prep.  We elected to capture the preparation in HD mode
  • The case is then immediately imported into the CAD software for design and fabrication
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second molar case set up in medit link

capture opposing and arch and trim away prep

check clearnace and then take bite after rough prep

capture prep in hd

autoimport into cad and design
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Emax at Delivery

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

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Simulation of Custom Abutment Milling

simulation custom abutment milling

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.


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How A Custom Titanium Abutment is Milled

Download this case to mill and see the results for yourself

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Custom Abutment And Crown Designs Milled With Multiple Milling Machines

medit link to CAD to CAM

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

Crown Nested and Milled with CEREC MCXL
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Design Custom Abutment And Crown

Crown Nested and Milled with CEREC MCXL

Crown Nested in Millbox and Milled to CORiTEC ONE

Nest and Mill Implant Abutment Crown With CEREC MCXL

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!

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A Pair Of Molar Crowns With Medit i500, exocad Designs, And Milled With CEREC MCXL And CORiTEC ONE

two unit molar multiple charise restorations in single visit

For our advanced users, we demonstrate how to plan and manage a two unit molar case so they can deliver multiple chairside restorations in a single visit.  There are numerous short-cuts to this treatment protocol and we present them in great detail during our courses.  The limiting factor for most doctors is that they have a single milling machine and we show our users how to balance prep and mill time so that they can complete 2 units in less than 90 minutes.

In this case however, we present two restorations that were prepared and delivered at the same time.  The sequence of steps are:

  • Anesthetize the upper right first and second molar
  • While the patient is getting numb, image the arch to be prepped, image the opposing, and image the bite WITHOUT the teeth being prepared
  • Reduce the occlusal height of your preparation but do not image them
  • Check your reduction visually or with the camera function of the Medit i500
  • Reduce more tooth structure until you have the proper clearance for material strength
  • Finish refining your preparations, displace the tissue, reach hemostasis, and then crop out the area of the model that you have altered
  • Image the two preps into that equation.  Most people turn on the HD mode for capturing the margins
  • For distal extension cases, we recommend that you take the second bite.  While imaging the second bite (NOT the left vs right bite), if the occlusal model turns green, it is a clear Indication that the vertical has no changed from the pre-op to the prep situation and that you will have minimal post-op adjustments to make.  If the second buccal bite does not register in green, it should serve as a warning to you that the vertical dimension has changed
Managing a Pair of Molars
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Pre-Existing Condition

Managing a Pair of Molars

Case Set Up During Anesthesia

Check and Verify Clearance

Image Preps in HD Mode

Image SECOND Buccal Bite For Distal Extension Cases

As advanced users, you quickly recognize what areas in the model need to be closed either with imaging or with the “close hole” options during the processing step of the Meditlink software.  If you are familiar with exocad or other CAD software programs you can just ignore these areas as they do not have any clinical significance whatsoever.

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Once the case is designed you can mill them with your milling machine of choice. The testing of materials, fit, and milling machines are a constant at CAD-Ray.com so we milled the first molar with emax material and the MCXL and the second molar, a Celtra Duo material, was milled with the Imes Icore CORiTEC Once

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Mill Second Molar Celtra Duo With CORiTEC ONE and eMax First Molar With CEREC MCXL

CEREC MCXL Milling

CORiTEC ONE Milling Machine

An immediate post-op bitewing X-ray was taken to verify fit and to make sure that there was no excess resin cement left behind in the interproximal area.  The premolar mesial to the working field also needs to be replaced and will be in the near future

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Milling Simulation With Millbox And The CORiTEC ONE

crown milling simulation

At CAD-Ray, we are constantly looking for solutions that will satisfy a clinician’s needs in a dental practice.  For the better part of a full year, we have been developing milling strategies that can speed up the manufacturing process and increase the longevity of the drills and the instruments used in fabrication.

In this video, we demonstrate a sample crown milling simulation where we try and place the restoration in the block to render the fastest crown in the shortest amount of time possible, with little wear on the drills.

Milling Simulation
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Milling Simulation