what do u think of this workflow

[prestige.dental]

Trios/Intraoral scan body------------->printer projet3500 implant model-------->

Desktop scanner D900/scan body------> design------------>glue tibase onprinted model/add porcelain

 

[Sevan P]

What implant markers are you using? Certain libraries are able to print digital implant modles. NT trading & Nobel, Core 3D and soon MIS. Are you going to use metal DIM analogs?

I have a Dr on Trios and I gave him NT trading markers so I can have digital implant models printed from Argen, once I receive the models I drop in the DIM analog and off we go.

Workflow should go like this:

Trios Scan with tissue scan and marker scan, pre op scan optional
Accept scan into 3shape and design (Ti abut, Zr abut, Screw retained full or cutback crown or Splitfile abut and crown.frame) on the digital scan
Run file through model builder
Print on 3D printer.
While printing order Ti base
Fit Ti base to unit and build up.

One shot no need to scan.

When you design the abutment on the scan and slightly impinge the tissue, when you go to print it will print ti to where your design is and not the original scan. So no need to rescan the printed model with marker AGAIN, the dr did it for you. Now if you use one marker to make the models then use the OE marker to make a OE straumann then that's when you would have to scan the printed model. Example: my Dr does implant direct only, well ID doesn't have a digital model setup yet. So i gave him NT trading zimmer markers, he uses them to scan so we can have Argen print a DIM implant model. I then take the printed model with the metal DIM zimmer analog and place the ID marker and rescan if to make a ID Ti or Zr abutment using OE ID parts. Since ID doesn't have DIM analogs this is the work around i came up with. But he normally sends me pre fabs so I also have to rescan the printed model with the pre fab to make my crown.

 

[prestige.dental]

Sevan: I also work with NT trading scan bodies with trios scanner. But I have never done any printing yet. The reason I ask this question is out of desperation as things are not working that great for more than single units.

For eXample the case of 3 Unit 9-10-11 bridge to be cemented on two custom abutments 9 and 11. The doctor will put NT trading scan bodies in 9 and 11 implants ( 15N tight) and trios scan. The doctor will also give me closed tray pvs impression of the two implants that we pour in Fuji rock which is honestly of not much use because you can't verify the model with mouth.

We will mill two custom ti abutments and make full contour 3 unit bridge on multi fz CAP zirconium. And when the doctor fits the abutments and bridge in the mouth, the fit is no that great, open margins visible on X-ray and you just don't enjoy your work.


CAP says , you design abutments first and then seat them on the cast( but which cast, the closed tray impression cast is not accurate and then what good is it to have the trios scanner) then scan through D900 scanner like a crown and bridge case.

So the question is if we can print the implant model from trios scan and use it to screw our milled ti abutments and then design it like a 3 unit crown and bridge case.

 

[2thm8kr]

PM sent

 

[JohnWilson]

There are so many ways to check the clinical work to have more predictable workflow. Its not the scanner that is failing you its the operator and the error along the way.

If your client is going exclusively with IOS scans make sure he is taking X-ray of scan locator seated. This is often the first problem

When you do your abutment/bridge design you can make a simple temp bridge to verify the digital models accurac with a screw retained mock up. This can also be used to verify contour esthetics and occlusion. If for some odd reason its not correct section it and make an altered cast.

I will say my experience with IOS scans are much better and more predictable in SHORT SPANS. When its cross arch its much more technique demanding. We then automatically make a printed model of the scan and make a sectioned verification jig before we do any digital design.

We are just getting recently FULL arch Trios cases "have done 6 now" and the last 4 were spot on, the first two were off. The first two were 6 fixture cases and the most post fixtures were very distally inclined. There were some anomalies in the scan and I think we have a better understanding of what the software is doing to overcome holes.

In all the time we have been receiving Trios scans which by all accounts is rather small about a year now we have done MANY single unit implant cases and all have fit spot on. We also have done MANY 6 to 8 unit tooth borne bridge cases and all fit bang on perfect. I am sold on Trios and IOS and really am looking forward to what 3shape has up its sleeve for the new impression scanning so we can all but eliminate the gypsum model in the near future.

 

[JohnWilson]

PM sent

You should just post it here, I guarantee many others can use your wisdom on this topic

 

[2thm8kr]

You should just post it here, I guarantee many others can use your wisdom on this topic

Here is the PM.

I do not use 3Shape so I am not sure how well the matching algorithms are.

In exocad I take scans from Planscan with NT trading scan bodies. Design the abutments and have them milled. When they come back I finish them, but do not alter the Z height. Scan with desktop scanner and merge into the original scan data from Planscan as new dies. Then design the bridge and mill. Fit the bridge to the abutments. Now you can alter the Z height if needed. 3 units is as far as I have had success with regarding implants and IO scanners. Printing a model is introducing variables that you can not control.


I'll add here that I think split files are for labs that don't care about marginal fit. The margins on milled abutments if done on a mill rather than a Swiss type lathe will NOT be exact enough to get away with doing split files.
IO scan data in my experience is accurate enough to do small cement retained implant cases that are not in need of layering without models. On natural abutments you can get away with longer spans, but in my experience it is not predictable enough to roll the dice on every large case.

 

[prestige.dental]

There are so many ways to check the clinical work to have more predictable workflow. Its not the scanner that is failing you its the operator and the error along the way.

If your client is going exclusively with IOS scans make sure he is taking X-ray of scan locator seated. This is often the first problem

When you do your abutment/bridge design you can make a simple temp bridge to verify the digital models accurac with a screw retained mock up. This can also be used to verify contour esthetics and occlusion. If for some odd reason its not correct section it and make an altered cast.

I will say my experience with IOS scans are much better and more predictable in SHORT SPANS. When its cross arch its much more technique demanding. We then automatically make a printed model of the scan and make a sectioned verification jig before we do any digital design.

We are just getting recently FULL arch Trios cases "have done 6 now" and the last 4 were spot on, the first two were off. The first two were 6 fixture cases and the most post fixtures were very distally inclined. There were some anomalies in the scan and I think we have a better understanding of what the software is doing to overcome holes.

In all the time we have been receiving Trios scans which by all accounts is rather small about a year now we have done MANY single unit implant cases and all have fit spot on. We also have done MANY 6 to 8 unit tooth borne bridge cases and all fit bang on perfect. I am sold on Trios and IOS and really am looking forward to what 3shape has up its sleeve for the new impression scanning so we can all but eliminate the gypsum model in the near future.

Ok John:

Xrays always take to check seating of scanbody
Screwed to 15N to make sure
Cap found some NT trading scan bodies glued 5-10 degrees off to it metal interface


so when u are saying make a simple temp bridge screw retained mock up,

1) what would u make it on, hexed tibases, or non engaging tibases

2) how is it possible if the implants are 30 degree off from each other, unless u make it non engaging and if you make it non engaging, then you can not use your milled custom tit abutments.

could u kindly make this step clear.

 

[prestige.dental]

Here is the PM.

I do not use 3Shape so I am not sure how well the matching algorithms are.

In exocad I take scans from Planscan with NT trading scan bodies. Design the abutments and have them milled. When they come back I finish them, but do not alter the Z height. Scan with desktop scanner and merge into the original scan data from Planscan as new dies. Then design the bridge and mill. Fit the bridge to the abutments. Now you can alter the Z height if needed. 3 units is as far as I have had success with regarding implants and IO scanners. Printing a model is introducing variables that you can not control.


I'll add here that I think split files are for labs that don't care about marginal fit. The margins on milled abutments if done on a mill rather than a Swiss type lathe will NOT be exact enough to get away with doing split files.
IO scan data in my experience is accurate enough to do small cement retained implant cases that are not in need of layering without models. On natural abutments you can get away with longer spans, but in my experience it is not predictable enough to roll the dice on every large case.

So you never have any model during the entire process from IOS scan to delivery of the final prosthesis.

 

[prestige.dental]

" When its cross arch its much more technique demanding. We then automatically make a printed model of the scan and make a sectioned verification jig before we do any digital design."

so you are using the trios scan to make sectioned jig, which the doctor will glue in mouth and give you a stone model and then, you would proceed from the stone model via the desk top scanner.


and for the cases which are short span, you would make the prosthesis and the fit would be found out at delivery in the patient's mouth.

 

[2thm8kr]

So you never have any model during the entire process from IOS scan to delivery of the final prosthesis.

Correct, but I am not doing full arch anything from IO scan only singles and multiple singles in the same quadrant natural or implant borne. Cement retained single crowns or multiples in a row non-splinted.
If I need a model for layering I have the clinician take an impression after scanning. The cord is already in place for natural abutments. Open tray if implant borne.
IO scanners are awesome, just not the solution for every situation.

 

[zero_zero]

Cap found some NT trading scan bodies glued 5-10 degrees off to it metal interface

I find that hard to believe, NT advertises 2-3 microns tolerance...being off by 5-10 degrees should've been caught by their QC before shipping out...

 

[2thm8kr]

" When its cross arch its much more technique demanding. We then automatically make a printed model of the scan and make a sectioned verification jig before we do any digital design."

so you are using the trios scan to make sectioned jig, which the doctor will glue in mouth and give you a stone model and then, you would proceed from the stone model via the desk top scanner.


and for the cases which are short span, you would make the prosthesis and the fit would be found out at delivery in the patient's mouth.

Make the verification jig from the IO scans. When tried in, if it passes the Sheffield test you can count on the accuracy of the IO scan. If it doesn't pass, take an impression with the jig in place and pour a model.

 

[JohnWilson]

Ok John:

Xrays always take to check seating of scanbody
Screwed to 15N to make sure
Cap found some NT trading scan bodies glued 5-10 degrees off to it metal interface


so when u are saying make a simple temp bridge screw retained mock up,

1) what would u make it on, hexed tibases, or non engaging tibases

2) how is it possible if the implants are 30 degree off from each other, unless u make it non engaging and if you make it non engaging, then you can not use your milled custom tit abutments.

could u kindly make this step clear.

I have not received NT trading scan locators from IOS scans YET. I know a bunch of people do but my experience with IOS the majority are with ELOS. Perhaps they are of better quality???? What I can tell you I have never had an issue in the lab using the NT as I have the complete system.

As for Temp bridge if your bound an determined to do a cemented bridge due to angle and or divergence you can do the exact same verification after making your single abutments. Just mill a temp bridge from a split file and then section that if need be and join in the mouth if you have inaccuracy. Take a bite over the top of the bridge extending to natural teeth and then do an altered cast of the printed model. Simple

Now lets be clear here it NO DIFFERENT than what I have been doing for 15 years in traditional non digital path. It just allows a much cleaner quick more accurate way in my opinion.

 

[prestige.dental]

Make the verification jig from the IO scans. When tried in, if it passes the Sheffield test you can count on the accuracy of the IO scan. If it doesn't pass, take an impression with the jig in place and pour a model.

Is it not true that zigs is the concept for non engaging interfaces and not custom titanium abutment cemented bridges.

 

[JohnWilson]

Here is the PM.

I'll add here that I think split files are for labs that don't care about marginal fit. The margins on milled abutments if done on a mill rather than a Swiss type lathe will NOT be exact enough to get away with doing split files.

Interesting you say this I have been to MahWah NJ, Nobel Biocare facility, I have no idea how they do their TI or Zirc abutments but they did not show me any lathes. Plenty of big ass mills though

I can show you how good our split files are. Truthfully we have the temp crown milled and in the pan waiting for the abutment to come back. It always blows my mind have yet to have a gap that is detectible with naked eye. I would bet there are more triangles miss appropriated with the merge back in of sprayed Ti new dies

Just saying

 

[2thm8kr]

Interesting you say this I have been to MahWah NJ, Nobel Biocare facility, I have no idea how they do their TI or Zirc abutments but they did not show me any lathes. Plenty of big ass mills though

I can show you how good our split files are. Truthfully we have the temp crown milled and in the pan waiting for the abutment to come back. It always blows my mind have yet to have a gap that is detectible with naked eye. I would bet there are more triangles miss appropriated with the merge back in of sprayed Ti new dies

Just saying

Fair enough, but I have tons of x-rays showing closed margins with this technique. I do this for guys that scan single/multiple implants in a quadrant. I design the abutments and rescan, put back into the scan file and return to them to fabricate with a chair side mill before the abutment arrives. Nothing but compliments on fit for margins and proximal/occlusal. Not saying we don't ever have a stinker, but hey we are dealing with computers.
I first tried this with printed models and the results were all over the place. I had been doing model less single crowns on natural abutments for a few years, so I just said I am going to try this with implant scans.
When I eliminated the models I started getting the technique dialed in. After about 20 cases I had my settings dialed in. I did at least 300 units last year for a surgeon with an IO scanner. No models, but not cases larger than 4 in a row on a single quadrant.

Nobel has the budget to use mills that are far more accurate and sophisticated than the average dental milling center so I don't doubt your split file success. Plus I don't think you are a bull sh!tter unless you are in a poker game.

 

[2thm8kr]

Is it not true that zigs is the concept for non engaging interfaces and not custom titanium abutment cemented bridges.

I use non engaging temp abutments for the majority of my jigs. I will shorten the engaging part of temp abutments if I need the connection timing indexed on divergent implants for cement retained. I rarely get crazy angles anymore since everything is placed with guides. I almost never get closed tray impressions for any implant cases unless there is no other option.

 

[Sevan P]

Sevan: I also work with NT trading scan bodies with trios scanner. But I have never done any printing yet. The reason I ask this question is out of desperation as things are not working that great for more than single units.

For eXample the case of 3 Unit 9-10-11 bridge to be cemented on two custom abutments 9 and 11. The doctor will put NT trading scan bodies in 9 and 11 implants ( 15N tight) and trios scan. The doctor will also give me closed tray pvs impression of the two implants that we pour in Fuji rock which is honestly of not much use because you can't verify the model with mouth.

We will mill two custom ti abutments and make full contour 3 unit bridge on multi fz CAP zirconium. And when the doctor fits the abutments and bridge in the mouth, the fit is no that great, open margins visible on X-ray and you just don't enjoy your work.


CAP says , you design abutments first and then seat them on the cast( but which cast, the closed tray impression cast is not accurate and then what good is it to have the trios scanner) then scan through D900 scanner like a crown and bridge case.

I have done 4 unit bridges on a Trios scan and Argen printed model. Had a tight fit, then ended up finding out the abutment would rotate the DIM analog a bit when tighten and change the overall fit. So I called up Argen and asked if there was any way to tighten the fit a bit and they said now cause it was already set to zero. Did some digging and found that i selected the wrong model profile. i did a Argen quad model instead of Argen DIM quad which has the DIM analog to model space set to zero. Once i found that out never had loose analogs again and fit issues was fixed.

While in model builder go to File in upper left corner if you don't see it take model builder window out of full screen, go to file and then go to virtual settings, a pop up window will appear with in one of those setting is a analog to model or base that should be set to zero for optimal DIM analog fit.

I would trust the Digital scan more then a PVS impression in this case. Are you doing split file on the design, I have been doing these for a while now and get great fits on singles and bridges, sometimes having to just round off the tips and sharp edges on the abutments and they drop right down.

You can print them in house but it is such a hassle to maintain and clean I just have Argen print it for me. Let the big wigs do all the mess work for you at $8 a quad its not a bad deal and they have DME's set to their machines for perfect results, you do it then you have to play around with the settings until you get everything dialed in, not worth your time. Ad since Argen is NT trading your already set up, just need to order the DIM analogs as needed, then tell you docs to send them back once the case is seated and you can reuse them over again.

So the question is if we can print the implant model from trios scan and use it to screw our milled ti abutments and then design it like a 3 unit crown and bridge case.

Yes, this is part of the work flow I provided above. It will provide you to mode accurate cast in a digital workflow.

 

[prestige.dental]

Interesting you say this I have been to MahWah NJ, Nobel Biocare facility, I have no idea how they do their TI or Zirc abutments but they did not show me any lathes. Plenty of big ass mills though

I can show you how good our split files are. Truthfully we have the temp crown milled and in the pan waiting for the abutment to come back. It always blows my mind have yet to have a gap that is detectible with naked eye. I would bet there are more triangles miss appropriated with the merge back in of sprayed Ti new dies

Just saying

i don't know why CAP asks us to mill ti abutments first and then scan them on the cast. When we do split file case with trios /scanbodies for 3 unit bridge, and it does not fit, CAP says this option does not work well with 3 shape. Very glad to hear split files WORK.......we just need the right knowledge.