Milling/printing bite splints -thoughts?

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miltonic

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Hey all, used to be in a removables lab with my Dad but switched over to crown and bridge 4 years back to get a jump on the digital wave that had been causing us concern. Fast track forward, business is going good, my Dad is getting close to retirement, and there is a huge demand for quality removables in our area. I'm curious about anyones thoughts on milling, or even possibly printing bite splints. How do milling puck material compare to analog made bite splints such as the Clearsplint material? Any comments on their durability, comfort or presentation? Anyone happy with a materila they found and that their clients and patients like? As doctors get more used to using io scanners, they are looking for ever increasing ways to work in complete digital workflows, at least for their part.

Are there any recommended brands of milling pucks that are of decent quality for bite splints? We also have an Asiga Max printer and I'd consider printing as well as long as the resin quality was durable enough and met biocompatible requirements. Thanks for any shared thoughts, I'd be happy to reciprocate info that is working well for me if you have questions about Exocad/milling/printing. So jump in and lets share our experience!

-Matt
 
mightymouse

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Being you already have a printer your set for printing the splints. If you don’t have the module for splints then that would be the only draw back. The material of choice is from Keystone either hard or soft can’t go wrong. It’s a matter of preference from you/and or doctor.

Milling I can’t speak to as I have no experience in that realm. I do know you can’t beat the amount or efficiency with printing. Can easily get 5-6 splint printed in 2-3 hours as opposed to one puck milling 1-2 at a time.

Analog is wide open. We use to use Eclipse (hard soft) but Dentsply went cold turkey with all analog products and cut them out. Currently for Analog biteguards we use Erkodent-pro system from Glidewell. We made our money back within 4 months. Good luck.
 
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Hi, can you explain more about Erkodent pro sistem? What thickness you use for biteguards? By biteguards do you mean bruxoguards? Any difference in making them? Thanks
 
mammasan

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I really like milling the thermoplastic material from primotec.
 
Brett Hansen CDT

Brett Hansen CDT

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Printing has several advantages over milling. Here is a link to a webinar from Whipmix. There are a few others as well. These will give you a great understanding of designing and printing splints and will also help you understand the benefits of printing over milling.

 
LuthorCorp

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I vouch for printing, we have switched and are printing 16-20 splints a day without issue and the quality is compared to the clear splint we used to use for our conventional splints. The Keysplint soft is a nice thermal active material that replicates clear splint fairly closely. The only noticeable change is the color as their is a slight purplish tinge unless you print direct from a Carbon printer.

The overall cost is very comparable to conventional methodology, and the finishing time is nearly nonexistent. The splints come out nearly ready to ship if you iron out your design process. 5-10 min per to trim finish and polish.

Durability is also a non issue, we have gotten no complaints about these splints wearing out any faster when compared to Clearsplint.
 
bigj1972

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I vouch for printing, we have switched and are printing 16-20 splints a day without issue and the quality is compared to the clear splint we used to use for our conventional splints. The Keysplint soft is a nice thermal active material that replicates clear splint fairly closely. The only noticeable change is the color as their is a slight purplish tinge unless you print direct from a Carbon printer.

The overall cost is very comparable to conventional methodology, and the finishing time is nearly nonexistent. The splints come out nearly ready to ship if you iron out your design process. 5-10 min per to trim finish and polish.

Durability is also a non issue, we have gotten no complaints about these splints wearing out any faster when compared to Clearsplint.
wonder why the difference with carbon?
 
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ztech

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Another thing to consider when milling, PMMA is the toughest thing most mills will mill. You will come close to your spindle max at several point during the rough out stage. Because of this, I stopped doing this with my machine. I still mill PMMA but only for provisionals.
 
TheLabGuy

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I have the erkodent machine...it's like a really fancy suck down but allows you to keep vertical and use opposing. The material is soft inside, hard outside. Comes in clear, blue and pink color. Has different mm's of thickness, we use 5mm because by the time you occlude the opposing you will be left with 2mm of inter-occlusal thickness. We also offer the hard inside and hard outside, clearsplint milled puck, and @rc75 sold me some great clear stuff back in the day that we use too on rare occasions as well that is milled.
 
tehnik

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One more vote for keysplint soft. Wonderful material. Printing it with Asiga.
 
doug

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After a few months in the mouth with poor cleaning by the patient it will look just fine.
 
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miltonic

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Hey thanks so much everyone for sharing their thoughts. I agree, printing is a much better option than milling pmma, if the resin is quality. The time is much faster printing, and the wear on the mill is significant, and less accurate when compared to a fine resolution printer, particularly in areas where the burr would have a hard time milling, and also burr compensation over milling. Plus costs of pmma puck much higher per splint than printing. It sounds like Keystone is well received by a lot of technicians. That's great to hear, I did purchase the resin, I opted for the hard version since one of our clients is afraid the soft would make the patients want to chew on it and activate the masticators. I'm not a clinician, I'm sure it's just one concern/opinion, where as most clients would probably be happy with it.

LuthorCorp, what do you think about Keystone hard resin for fit/durability and patient preference? Also, I have Exocad's bitesplint module, I thought I saw one of your earlier posts that mentioned you initially weren't printing models with your splints, but then had to resort to printing them because they needed additional adjustments to get the fit and occlusion dialed in better. Are you still following that protocol to print out a model, mount it and dial in fit and excursions? Or have you optimized your design to have great fit right out of the print and accurate excursions? Thanks so much for sharing, I learn a lot from you guys.
 
LuthorCorp

LuthorCorp

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Hey thanks so much everyone for sharing their thoughts. I agree, printing is a much better option than milling pmma, if the resin is quality. The time is much faster printing, and the wear on the mill is significant, and less accurate when compared to a fine resolution printer, particularly in areas where the burr would have a hard time milling, and also burr compensation over milling. Plus costs of pmma puck much higher per splint than printing. It sounds like Keystone is well received by a lot of technicians. That's great to hear, I did purchase the resin, I opted for the hard version since one of our clients is afraid the soft would make the patients want to chew on it and activate the masticators. I'm not a clinician, I'm sure it's just one concern/opinion, where as most clients would probably be happy with it.

LuthorCorp, what do you think about Keystone hard resin for fit/durability and patient preference? Also, I have Exocad's bitesplint module, I thought I saw one of your earlier posts that mentioned you initially weren't printing models with your splints, but then had to resort to printing them because they needed additional adjustments to get the fit and occlusion dialed in better. Are you still following that protocol to print out a model, mount it and dial in fit and excursions? Or have you optimized your design to have great fit right out of the print and accurate excursions? Thanks so much for sharing, I learn a lot from you guys.
So for hard splints we use a completely different resin, and we do very few of these. The vast majority of our splints are the Keysplint Soft, because its so much similar to ClearSplint so all our customers prefer it. Hard printed splints need a very specific design as the inflexible nature really points out poorly blocked out designs.

As for models we take any intra oral scan and print models to articulate prior to designing the splint. We ran tests with the "Modeless" design, and it does work but to handle the more specific requests from clients, nothing beats the physical touch for final adjustments. So we print a set of models, articulate it on our calibrated articulator and then scan them back in for design.

This is basically only for functional ramp finalization, we have everything else dialed in to the point that it requires very little adjustment but we have limitations of the software that doesn't accommodate all requests so in some cases we need to adjust it manually anyways.
 

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