Category: Implants

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

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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

 

Once the dentures are digitized and merged with the CT data, the cases is analyzed to make sure there are no gaps in between the intaglio of the denture and the soft tissue of the palate and the lower / mandibular ridge

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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