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Digital Copy Milling (Anatomic Wax Up) Vs. Scan Pre-Op Model

In CAD-Ray’s version of exocad, we have dramatically reduced the steps necessary to get a final proposal with copying a pre-op, mock up, or wax-up. We’ve configured the wizzard to walk you through the steps of defining your path of draw after margin placement, trimming away material you don’t want your proposal “to touch” and giving instant proposals.

There is one difference you need to be aware of in design modes; Anatomic Crown vs. Anatomic Wax up. When designing a crown, you can choose to include the pre-existing model in the equation. When you select “YES” to “Scan Pre-Op Model?” you tell the design software to incorporate that into the equation, but you will get a free form proposal and then you adapt it to the pre-op model. Alternatively you can choose Anantomic Wax Up and you will design an restoration in under a minute that is to your liking.

Digital Copy Milling Vs. Scan Pre-Op Model
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Tired of Nuclear or Atomic Mushroom Bomb Cloud Shaped Abutment Crowns?

using exocad to design restorations

A very common source of frustration for most dentists or those who are new to designing implant crowns is the emergence profile of the abutment or crown.  Most of the time, the shape of the tissue dictates the digital design and this article showcases how we used the medit i500 for the intra-oral scan of the patient and then used exocad to design the restorations.  Our advanced users can appreciate how we bring the arch model in twice- once as the maxillary model and once as the gingiva model.  We then digital sculpt the tissue to create the proper profile yet we still have the original model to reflect back to asses the changes.

Download to ImplantCrownShaping.ZIP to design along

Medit i500 Beta Testing of Artificial Intelligence that Identifies Scanbody location
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DESS Library Information for Nobe Active Compatible Components

NobelActiveCompatibleComponents-DESSUSA2019-2

 

NobelActiveCompatibleComponents-DESSUSA2019-2
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One Line of Code… (Line 3327 out 3620 lines)

making sure CAD software talking to CAM software correctly

Making sure that CAD software talks to the CAM software is critical for certain types of restorations. Simple crowns are fairly easy, but for crowns to fit to a milled abutment that needs to be indexed with the walls of an implant fixture, that is a much larger task. Here is an example of a simple error in code that resulted in lots of miss-mills and cost us hundreds of hours of trial and error to figure out. The incorrect nomenclature would prevent us from milling. Sometimes, it would actually make it to the milling machine but it would mill a completely different abutment than the one designed!

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Once the abutment was milled out after correcting the line of code, it perfectly retrofitted the crown that was milled by CEREC MCXL (Celtra Duo material) and by the Imes Icore CORiTEC ONE (Vita Suprinity)

 

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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

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

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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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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Digital Scanbody Drop By Medit i500

medit i500 scan body drop

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.

Video 1 - Setting Up the Medit i500 For The "Scanbody Drop"
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Introducing "Implant ScanBody Drop" by Medit
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What are the Dental Project Files in exocad and Medit i500 Lab Software?

cam to cad files

When you start a case in exocad or in Meditlink, you have to define a project or define the job by entering a prescription.  A dentalproject file is created that has all the pertinent data, like the type of restoration, the shade, the material, parameter settings,etc..

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exocad file types

After the case is designed a dental cad project file is formed, along with the stl file of the restoration, accompanied by the construction information.  Once the construction file is formed, the case can be import it into CAM software like cerec inlab.  It carries a lot of information like the margin line.

Some CAM software can process simple redirections without the need for any other pertinent information from the construction file, while others require it. Some are so specific that a simple typo or wrong character will lead to mis-production.

In the case of cerec inlab, it’s best to have the construction file accompany the stl of the restorations, although there are numerous work-arounds in case you don’t. Once processed, the restoration is taken to the Mcxl milling machine.

Why are we so focused on teaching this concept ? Because it is critical for milling metal abutment where you have to keep track of an object that is cylindrical and symmetric in shape.  The code in these files will dictate the indexing of the connections and how these abutments are milled.

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Marking Margins in Medit i500 Before Sending a Case to a Lab or CAD Software Like exocad

marking margins in medit i500 iscan software

The new Medit i500 software will feature the ability to mark margins in the imaging step before you import the case into a CAD software or send it to the lab. In this article we showcase a case where a 12 year old implant crown needed replacement. The pre-op images were captured, along with the opposing and the bite.

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After the area was anesthetized and the crown was removed, expasyl was used to achieve hemostasis and tissue retraction. The margins of the abutment were imaged. Note how we used a feature in the Medit scanner to change the scan light from blue to white, which allows you to pick up red (blood and tissue) that is normally difficult to capture.

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Once the margins were captured, we activated the margination tool. You highlight the area you want to address and the meshwork is calculated and processed locally, where you can then designate your margins that are exported to CAD software along with the jaw model, the opposing, the pre-op and the bite.

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This is a preview of the models that you can export and send to a lab or take directly to design software for chairside milling.

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Alternatively, the traditional way would be to not place the margins in the native Medit software and to place it in the CAD software itself. As you can see both options are very viable and you do not lose any resolution of the scanned data between the imaging program or the design software.

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Launch exocad Direct from Medit i500 for Custom Abutment Design from an NT-Trading And Mill With The CORiTEC ONE

digital design exocad direct from medit i500 for custom abutment design

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.

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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.

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The models were then processed and exocad was launched for the design of the custom abutment and crown.

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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.

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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.

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Control Over The Finest Detail With exocad And The 0.6 mm Drill of the CORiTEC One

control over restoration fit of first molar with cad-ray exocad and imes icore milling

This case shows the amount of control one can have over the fit of a restoration. The upper right first molar was imaged with the Medit i500 and then imported into exocad design software. Once the margins are marked, the user can then define parameters that affect the fit of the restoration.

The diameter of the drill can be taken into consideration; in the design, 1.0 mm was chosen, but ultimately, we used the 0.6 mm bur to mill the intaglio of the emax restoration. The cement gap can be controlled as can the distance from the margin where it takes effect. The minimum thickness parameter also reinforces the material at the margins which will reduce the chances of chipping and ditching at deep chamfer margins. All of this translates into well fitting restorations with little space needed for the resin. That ultimately translates to easier clean up.

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The case was milled using a few different materials and at varying speeds to see how thin the margins could be handled and how much detail the 0.6 mm burr can carve into emax and the glass ceramic material

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How We Milled With a MCXL After Designing in exocad

At any given time, we are milling restorations with 3 or 4 milling machines. Recently, we designed a restoration with the Medit i500 scanner, designed in exocad, and milled with a chairside mcxl cerec milling machine. Here are the steps we took to do this:

  1. Purchased Inlab CAM for 3000 euros and this dongle
  2. Installed the dvd for inlab 18.0 CAM. This was the hardest part because we couldn’t find any machines that still had DVD drives.
  3. Went to this page and download the service patch for inlab 18.2
  4. You may have to install some .net framework files from Microsoft. It’s generally an automated installation
  5. Once installed, make sure to have your milling machine turned on and connected. A lot of the functionality is closed if your machine is not on and connected to the PC with the software.
  6. We had to follow certain steps in sequence to get this to work. We had to activate the license in a pre-installed CEREC software and then move that thumbdrive to the machine where the inlab CAM was going to be installed

You can contact Mr. Milos Gedosev who runs DentalCADCAM in Germany and has earned a great reputation over two decades if you have any questions.

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An Introductory Lesson on Accurately Relating Digital Dental Models to Each Other

digital dental design

If you are new to digital dentistry, this introductory video will show you how to judge if digital models are related to each other. As a simple exercise, we opened one digital model and then imported the exact same model as a pre-op scan into the equation.

Once the models are in the design software, they are manually related to each other with at least 3 common points. After the merge, we performed “best fit matching” and then demonstrate how the color histogram in exocad has the both models painted completely blue.

We then slightly altered one model by adding material to one cusp tip, reduce the adjacent cusp tip, and then smoothing the third cusp tip. We then re-aligned both models to each other again and you can see how the software lets you know the range of discrepancy in those areas. Notice that all three areas have the same histogram color but all three have distinct meshwork areas from the original.

Once you understand this concept, it opens up many avenues for you that you can never achieve with traditional impressions.

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Introducing CAD-Ray Software Version 7.0

CAD-Ray Software 7.0 features and updates

Posted by Armen Mirzayan on Sunday, May 5, 2019

Some of the features:

Custom abutment and tibase design / fabrication

Temporary Shell / Provisional fabrication

Fast copy case designs

Direct launch of desktop and intra-oral scanners

Auto import into CAD software from multiple sources

CT data manipulation and surface meshwork fabrication

Coming Soon: Mixing Desktop Scanning and Intra-Oral Scanning

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Hand Articulate Upper and Lower Jaw Models in Digital Manner with CAD-Ray Software Powered by exocad

There are may advanced ways that you can articulate the maxilla with the mandible if you happen to have models that are not accompanied by a bite registration or the arches were scanned intra-orally in separate folders as files

Generally, when you scan intra-oral and complete the case with both arches and the buccal bite, the models maintain their relationship to each other when exported to CAD software. But if you do not include the buccal bite scan, or if you scan the arches in separate files or cases, there is no way for a software to know how they are supposed to align with each other.

This simple video tutorial shows beginners how they can hand articulate the arches together with digital software. There are two steps you should take to make this an easier process to visualize, once you become comfortable with the moving models around as a system or as independent units. Crop the model at its base so that you can see through it and then turn on the feature “show distances” in exocad that will give you a color map and help you with alignment.

Obviously a bite alignment scan will come in hand, whether you use a desktop scan or an intraoral buccal bites scan

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Bite Alignment Scan to the Rescue in exocad

Once in a while, our users get themselves in a bind and you have to rely on manual alignment of jaws to each other. Sometimes, it feels like you are doing gymnastics to get the process to work. The sequence of how you import the models and how you set up the case is important in exocad.

Here we have 3 models; one of the upper, one for the lower, and one for the bite. Don’t ask how we ended up here:) The “direction of travel” is important to keep in mind, and as you can see in this video that is sped up, how the case was managed. if you bring in the upper and lower models in together, and then the bite, as soon as you align the bite to one jaw, you end up dislodging it when you tack it to the opposing jaw.

Reversing the sequence of import helps. We first bring in the upper jaw and the bite alignment and stitch those together. Then we bring the lower jaw into the equation and then merge that to the whole complex. Once that is done, the arches now know their relationships to each other and when you save each arch individually and import them into other programs, they will know exactly how to line up.

At the end of this video demonstration you can see how we re-import the two models in stl format just to verify that they do align properly

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Upper First Molar Restored with Medit i500, exocad, emax, and VHF Z4 Milling Machine

In this particular case, we demonstrate an emax restoration fabricated with the Z4 milling machine by VHF. In the first video, you can see how the case was set up initially within the software. You will notice how we image the preop, image the opposing and can even image the bite out of sequence, all while the patient is being anesthetized.

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Once the preparation is captured, we place the margins and design a crown in exocad. The emax is milled, tried in, and them placed in the oven for crystallization. It is then delivered to the patient. Note how the decay at the contacts of the adjacent teeth was drilled out and restored, while the crown was milling / crystalizing. An immediate post op x-ray was taken to make sure there was no resin left behin

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Good Initial Proposals in exocad Design Software

When imaging a preparation, all you really need for a restoration to “fit’ is the contact area of the adjacent teeth (above the height of contour) and the opposing occlusal surface.

But the more you feed the computer aided design software the less work you have to do in the design of the restoration. For example, in the video below, you can see how the software automatically recognizes the adjacent teeth and a great initial proposal is rendered.

However, if you don’t capture all the data in the adjacent teeth, you will have to manually plot the adjacent teeth and spend more time in the design steps.

With exocad, the first step is to align the orientation of the arch so that the occlusal surface is directly facing you. Once the prepped arch and the opposing models are imported, then you place the margins.
With the color OBJ files from the Medit i500 it is very easy to identify the margin based on color and geometry. Once the margins are placed, the next step in the wizard is to calculate the initial proposal.
This video demonstrates how the CAD software recognizes the adjacent teeth and renders a great initial proposal
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Smile Design and Makeover with Medit i500 and exocad

Download the OBJ files and import them into smile design software and do a virtual wax up for a real case

This patient has had crown lengthening procedure performed on all the teeth in her smile line, greatly increased the tooth structure visible in this video. Her chief complaint was a gummy smile and now she is ready to “fill in the buccal corridor”
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First Molar Crown Margins by Medit i500 and exocad

This is a first molar crown that was replaced with an in-office milled eMax restoration.  The adjacent second molar had recurrent decay under the existing class 2 restoration.  That was removed and replaced and pre-existing crown was also removed.

The preparation was refined and the recurrent decay was removed. Once hemostasis was achieved and the tissue was retracted the area was scanned with the medit i500.  The crown was designed to full contour and milled chairside.  After it was chrystalized, it was bonded into place with Nx3 resin cement.  The excess was removed and an immediate post-op bitewing was taken to verify that no excess cement was left behind.

Pre-Op

This video shows the design of a crown after the impression was taken where vivid colors of the retraction cord, the sulcus, the preparation, and the details of the adjacent tooth can be visualized.

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Immediate Post-Op

Download the case files in OBJ Format