ALL on X work flow and scanning vs impression

[Brett Hansen CDT]

I've done a few of these cases. I have a doctor that wants to send a new one to me. The implants have been placed. Is scanning as good or better than impression taking at this point for these types of cases?

I would love some guidance on work flow. Here's how I think it will go:
-Dr scans in the restorative arch, antagonist arch and bite and sends to me.
-I will then print models and design a PMMA prototype on ti bases
-Patient wears the prototype while the doctor dials in the function and the patient determines if they would like any design changes
-Doctor scans prototype after the function and design changes have been recorded and sends back to me.
-I will have a custom bar fabricated by Atlantis and then design the zirconia to be cemented to the bar.

How does that sound?

 

[Pronto]

From the printed model, make a jig with non-engaging temp cylinders and send back for a test fit. We just went through this with a Pita Dr. that cost us time, money and frustration. If the jig fits passively then you know the model is good to go.

 

[sidesh0wb0b]

From the printed model, make a jig with non-engaging temp cylinders and send back for a test fit. We just went through this with a Pita Dr. that cost us time, money and frustration. If the jig fits passively then you know the model is good to go.

i second this.
always a jig, or the Dr eats all the costs involved.

 

[RileyS]

Meanwhile I still can't trust a printed model for a single posterior....seriously. I loath printing. Everyonce and a while I get the call that nothing fit. Well doc, I just have to hope all your scans are good, the printer is good cause I can't double check things back to the impression. Yesterday a doc called pissed cause no contacts were fitting on a full mouth. He had to grind the hell out of each one. Fit great on the model though. Cost of being up to date? The occasional PITA. I guess.
Sorry to go off topic. I only ever hear 100% good things about full digital and printing so you'll be just fine.

 

[Toothman19]

That workflow sounds like a pain in the a$$. My first question would be exocad or 3shape? What scanbodies is the doctor using? Scanning a full endentulous case is not accurate enough unless a very specific workflow is used. I'd recommend going the traditional route or look into Optisplint or InstaRisa for scanning

 

[LarryRDC]

Agree with Adam..Unless your doing photogrammetry, or the IOS user is REALLY good at scanning, then I mostly have them take a physical impression, then do the rest digital.
I mean REALLY good at scanning or your looking a "rabbit hole!"

 

[lumieredentalarts]

Meanwhile I still can't trust a printed model for a single posterior....seriously. I loath printing. Everyonce and a while I get the call that nothing fit. Well doc, I just have to hope all your scans are good, the printer is good cause I can't double check things back to the impression. Yesterday a doc called pissed cause no contacts were fitting on a full mouth. He had to grind the hell out of each one. Fit great on the model though. Cost of being up to date? The occasional PITA. I guess.
Sorry to go off topic. I only ever hear 100% good things about full digital and printing so you'll be just fine.

Im with you. While its getting better in the right hands, for me theres nothing better than PVS and Die stone. Especially when matching single anteriors as far as contour and suface anatomy.

 

[Brett Hansen CDT]

Agree with Adam..Unless your doing photogrammetry, or the IOS user is REALLY good at scanning, then I mostly have them take a physical impression, then do the rest digital.
I mean REALLY good at scanning or your looking a "rabbit hole!"

Thanks for your input. The doctor is going to want a custom tray. Would you recommend that she scan for that to be fabricated? I don't think I've made a custom tray before. I know there is a work flow on 3shape and we could print one here.

 

[lifelikedental]

Meanwhile I still can't trust a printed model for a single posterior....seriously. I loath printing. Everyonce and a while I get the call that nothing fit. Well doc, I just have to hope all your scans are good, the printer is good cause I can't double check things back to the impression. Yesterday a doc called pissed cause no contacts were fitting on a full mouth. He had to grind the hell out of each one. Fit great on the model though. Cost of being up to date? The occasional PITA. I guess.
Sorry to go off topic. I only ever hear 100% good things about full digital and printing so you'll be just fine.

Which printer do u use?
You’d be surprised how inaccurate these models can be.

 

[LarryRDC]

Thanks for your input. The doctor is going to want a custom tray. Would you recommend that she scan for that to be fabricated? I don't think I've made a custom tray before. I know there is a work flow on 3shape and we could print one here.

I don't make custom trays, A standard tray can work .. but I insist they modify it for an open tray technique.

 

[RileyS]

You’d be surprised how inaccurate these models can be.

Not me! I feel like the strangest person all the time because everywhere I look it's "Printing is the best thing ever! Everything scanned intraorally is 1 million times better and faster throughout the entire production process guarenteed!" I must be a freak of nature. My wife always tells me technology is alergic to me so it's probably is just me.

 

[tuyere]

Modern DLP/LCD printed parts should significantly exceed traditional impressions in terms of accuracy. When printed correctly. But in an industry where people tend not to really understand the processes involved in digital workflows, and where most people rely on a service call to address any issues, well, you're going to get a lot of variance in finished parts.

 

[RileyS]

So the resellers should tell me more than "Load the part here. Press print. Keep the firmware and materials up to date."
Interesting.

 

[Brett Hansen CDT]

Which printer do u use?
You’d be surprised how inaccurate these models can be.

Asiga 4K. We have zero issues with IOS implant case accuracy. I have never tried an All on X type case though.

 

[sidesh0wb0b]

Meanwhile I still can't trust a printed model for a single posterior....seriously. I loath printing. Everyonce and a while I get the call that nothing fit. Well doc, I just have to hope all your scans are good, the printer is good cause I can't double check things back to the impression. Yesterday a doc called pissed cause no contacts were fitting on a full mouth. He had to grind the hell out of each one. Fit great on the model though. Cost of being up to date? The occasional PITA. I guess.
Sorry to go off topic. I only ever hear 100% good things about full digital and printing so you'll be just fine.

totally agreed!
after tens of thousands and a list of printing solutions tried, none hold a candle to analog models. but everyone raves about each one like its the next best thing
that said, we finally get some sort of reasonable results. i dont trust them, but they work lol

 

[tuyere]

So the resellers should tell me more than "Load the part here. Press print. Keep the firmware and materials up to date."
Interesting.

One Touch Operation / "It Just Works!" claims have probably caused more frustration and bad experiences than any other single claim that gets made to push sales in this industry. At least with traditional techniques, the skill and craft required it self-evident, you can't even try without understanding what you're doing- but the digital stuff just seems like a black box that you feed material and information into and parts come out the other end, so yeah, when someone says your untrained techs can absolutely run a 5-axis mill, or this printer will never need calibrating, sure, that sounds plausible. But alas.

 

[TheLabGuy]

I do quite a few of these, which doesn't mean donkey spit, just means I made a shlt ton of mistakes. First off IOS is not accurate enough by itself, anyone who tells you different is blowing smoke up your six. If your Doctor insists on using IOS, that's fine, but they have to incorporate Nexus or Optisplint scanbodies into their workflow. It's the only way we will accept them anymore. Now if they use photogrammetry (i.e. icam, pic, many others out there),that is great for this workflow but the lab has to have access to the current libraries for those systems and that can be a pain as well - don't believe me?...go look. As for impression, pretty tough to screw up that way, takes longer but it works. Either way, first step in all this is a verification jig - whether you like stone or acrylic, doesn't matter - have to have a verification jig or nothing is warrantied. Nothing definitive gets decided (i.e. all on zir, bar, hybrid, etc.) until verification jig comes back and accurate bite is done/mounted. Have to see the interocclusal space we are working with before definitive gets decided is why...and restorative Doc doesn't make that decision on day one EVER in my lab.

 

[PRO ARTS DL]

An IO scan will not be accurate enough for this. There is too much "empty"(tissue) space in between the implants for it to be accurate enough.
That's why photogrammetry is the go to for these cases when doing them all digital.

Another option would be to look into the OPTISPLINT. It solves the issue of empty space between implants, but it has to be to MUA's.

 

[JonnyLathe]

Go all digital, tell the doc to get an optisplint.

Lute in the mouth, have doctor take IOS with optisplint healing caps.

Lab scan the optisplint, align it to the IOS scan of the tissue with optisplint healing caps to align, and design. Print monolithic straight to the multi-unit.

 

[Toothman19]

Asiga 4K. We have zero issues with IOS implant case accuracy. I have never tried an All on X type case though.

You will be able to print the arches on the asiga no problem. The most important thing you'll need to figure out is going to be the VDO. Since the patient has already had the surgery, it might be best to create a bite rim, then scan and align with healing caps