New to digital splints

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pRehm

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#1
Long time lurker, first time posting,
Our lab has been digital for 6+ years in the fixed department, we are now expanding more digital into the removables department (my department) , looking for suggestions for a software to make splints, it needs to be able to incorporate an anterior ramp for posterior disclusion in excursions, hoping to possibly go model-less in the future. We have 3-shape software and scanners, 3 rolland mills, and a new formlabs printer, but open to all suggestions. what has been working for you guys? printing? milling? which software?
 
JMN

JMN

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#2
Long time lurker, first time posting,
Our lab has been digital for 6+ years in the fixed department, we are now expanding more digital into the removables department (my department) , looking for suggestions for a software to make splints, it needs to be able to incorporate an anterior ramp for posterior disclusion in excursions, hoping to possibly go model-less in the future. We have 3-shape software and scanners, 3 rolland mills, and a new formlabs printer, but open to all suggestions. what has been working for you guys? printing? milling? which software?
Greetings Earthling! Welcome! Thanks for coming out of the shadows.
 
ND2020

ND2020

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#3
Long time lurker, first time posting,
Our lab has been digital for 6+ years in the fixed department, we are now expanding more digital into the removables department (my department) , looking for suggestions for a software to make splints, it needs to be able to incorporate an anterior ramp for posterior disclusion in excursions, hoping to possibly go model-less in the future. We have 3-shape software and scanners, 3 rolland mills, and a new formlabs printer, but open to all suggestions. what has been working for you guys? printing? milling? which software?
Curious to know as well. I’m in a similar situation.
 
Jason D

Jason D

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You need to look at the long term intraoral materials if you want to do splints, pmma with the Roland’s (or acetal resin but it is another animal with its own drawbacks and learning curves) last I checked form2 did not have an fda approved long term material, need. Cara from Kulzer (badass printer for the price) or go with the big boys ( stratasys, envisiontec, 3d systems, etc)
We have forms, Cara, bego, and stratasys eden 260 printers, and each had its own idiosyncrasies. If I was to do digital guards I would do them on the Cara or the stratasys.

Milling guides is just plain wasteful, mill one guide worth a hundred bucks using $30 worth of a puck in 2-4 hours - or - mill 8- 10 zirconia crowns in the same time with $50 worth of materials that sell for a thousand bucks....
 
Chalky

Chalky

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#5
I mill a lot of splints... up to 12 a day when they are in the lab! Its a pretty steep learning curve! I use AG Motion 2 mills, with their software (Exocad essentially) for design, they are all milled in a wet milling strategy. I don't print for a few reasons (please note my opinion is constantly changing as I see and learn more and more!)... I dont believe the materials are as good personally, they are much harder to repair than PMMA too! Those that I have seen and spoken to that print, still get inconsistent results - this seems to be across a few different printers (don't get me wrong, I am very interested in printing in the future, I am just waiting for things to be where I think they need to be before I go into that space). My advice... Learn and understand the parameters in the design software irrespective of what design software you look into using. there is no 'one size fits all' set of parameters that works in my opinion. Computer cant distinguish between desirable and undesirable undercuts, it will engage a set amount of all undercuts! Therefore, designs need to be adapted to each situation. Once you have an eye for it you'll be fine. As mentioned above though... work out the costs vs mill time etc too to see if it is cost effective for you! Milling crowns is soooo much more cost effective!! bear in mind the tool usage too, this was a vital number we initially overlooked. more time to mill = more tool abrasion! you will go through a lot of tools. I have found that a lot of people have issues with getting splints right. I get told in many places they are one of the hardest things to get right in cad/cam. I get lots of calls for help in this regard from other users. If you are coming from a removable background and understand what is required from a splint and how to engage undercuts, it will be easier I believe.
hope this helps a little
 
P

pRehm

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#6
You need to look at the long term intraoral materials if you want to do splints, pmma with the Roland’s (or acetal resin but it is another animal with its own drawbacks and learning curves) last I checked form2 did not have an fda approved long term material, need. Cara from Kulzer (badass printer for the price) or go with the big boys ( stratasys, envisiontec, 3d systems, etc)
We have forms, Cara, bego, and stratasys eden 260 printers, and each had its own idiosyncrasies. If I was to do digital guards I would do them on the Cara or the stratasys.

Milling guides is just plain wasteful, mill one guide worth a hundred bucks using $30 worth of a puck in 2-4 hours - or - mill 8- 10 zirconia crowns in the same time with $50 worth of materials that sell for a thousand bucks....
Thanks for the info, and yeah our three mills are running all day and night with C&B cases and its not worth it to use them for milling splint, I have looked into the Cara do you have any software suggestions?
 
P

pRehm

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#7
I mill a lot of splints... up to 12 a day when they are in the lab! Its a pretty steep learning curve! I use AG Motion 2 mills, with their software (Exocad essentially) for design, they are all milled in a wet milling strategy. I don't print for a few reasons (please note my opinion is constantly changing as I see and learn more and more!)... I dont believe the materials are as good personally, they are much harder to repair than PMMA too! Those that I have seen and spoken to that print, still get inconsistent results - this seems to be across a few different printers (don't get me wrong, I am very interested in printing in the future, I am just waiting for things to be where I think they need to be before I go into that space). My advice... Learn and understand the parameters in the design software irrespective of what design software you look into using. there is no 'one size fits all' set of parameters that works in my opinion. Computer cant distinguish between desirable and undesirable undercuts, it will engage a set amount of all undercuts! Therefore, designs need to be adapted to each situation. Once you have an eye for it you'll be fine. As mentioned above though... work out the costs vs mill time etc too to see if it is cost effective for you! Milling crowns is soooo much more cost effective!! bear in mind the tool usage too, this was a vital number we initially overlooked. more time to mill = more tool abrasion! you will go through a lot of tools. I have found that a lot of people have issues with getting splints right. I get told in many places they are one of the hardest things to get right in cad/cam. I get lots of calls for help in this regard from other users. If you are coming from a removable background and understand what is required from a splint and how to engage undercuts, it will be easier I believe.
hope this helps a little
12 a day is impressive! thats where we'd hopefully like to get to. The AG motion 2 has wet and dry milling right? And the software that you use with it, does it easily allow for the creation of an anterior ramp for excursions?
We are currently playing with the 3 shape software and printing with a formlabs , but the people working on it have never done removable cases only digital C&B and yeah they are struggling with the concepts of undercuts and where to blockout, the splints are either waaaay to tight, or waaaay to lose.....its a work in progress..
 
Bryce Hiller

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#8
Thanks for the info, and yeah our three mills are running all day and night with C&B cases and its not worth it to use them for milling splint, I have looked into the Cara do you have any software suggestions?
I highly recommend looking into Asiga printers from WhipMix.
 
Chalky

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#9
12 a day is impressive! thats where we'd hopefully like to get to. The AG motion 2 has wet and dry milling right? And the software that you use with it, does it easily allow for the creation of an anterior ramp for excursions?
We are currently playing with the 3 shape software and printing with a formlabs , but the people working on it have never done removable cases only digital C&B and yeah they are struggling with the concepts of undercuts and where to blockout, the splints are either waaaay to tight, or waaaay to lose.....its a work in progress..
yes the motion 2 is a wet/dry mill... all splints we use in a wet strategy. As for building ramps it is pretty straight forward, there is a few ways it can be done, either adding wax in free form mode or 'pulling' sections using one of the waxing features to create your ramp. its then just a matter of adding/smoothing and refining the design to how you want/need it to be. I commonly hear that getting the fit just right is very difficult! I frequently get call from all over the country asking me for help with these parameters. As I mentioned, there is no one size fits all - it requires understanding! you need to get a feel for what each parameter does and what it is changing in the final splint. I personally have done 1600 - 1700 splints in the last 18months, the only issues that we encounter are more to do with occlusion, not fit. Dentists need to understand that an articulator is not always a great representation of a patient - especially one with TMD, so occlusal adjustments are normal!
to be honest the first month or two for me was a really fast learning curve! we went from completely 'manually' making all splints to complete 'digital' manufacture over night... we simply had to get it right!
I agree with @Bryce Hiller Asiga for my money too! Ive been keen on the Asiga Max for a while, I'm waiting more for the materials to be where I want them to be. before taking the leap.
 
JMN

JMN

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#10
12 a day is impressive! thats where we'd hopefully like to get to. The AG motion 2 has wet and dry milling right? And the software that you use with it, does it easily allow for the creation of an anterior ramp for excursions?
We are currently playing with the 3 shape software and printing with a formlabs , but the people working on it have never done removable cases only digital C&B and yeah they are struggling with the concepts of undercuts and where to blockout, the splints are either waaaay to tight, or waaaay to lose.....its a work in progress..
Hand them a wax knife and a model. depth perception is difficult enough on a monitor. Let them see what is really happening and it will probably make a difference. But i'm old, so whatta I know.
 
Chalky

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#11
Hand them a wax knife and a model. depth perception is difficult enough on a monitor. Let them see what is really happening and it will probably make a difference. But i'm old, so whatta I know.
I honestly believe this is why I can do it well @JMN... 20+ years with a wax knife and models! if you don't know how to use undercuts then you are in trouble! the cad software actually presents more challenges in that a computer cant/wont determine the difference between desirable and undesirable undercuts. It will engage only the parameter measurement that is defined, irrespective of if it is deep or shallow. soooo much to get your head around to get it right!
 
CoolHandLuke

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#12
Dental Direkt makes a good hard clear acrylic for splints, i can mill one in about 55mins (think snapon smile type) to 1h 20min (for full splint) and it won't need touchups except to trim sprues. its not something we're ready to offer but its nice to know we can do it. depends on the arch but usually 2 per disc.

i don't even use that material for clear guides. so...

i could adapt the cutting strategy to be used in Rolands, but it would take a bit of help from some people in France, and you'd be buying at least 2 new tools. after all the work 1 hr 20 might turn into 3-4 hrs with roland's low feed. i'll talk with my french connections anyway, see if we can work something out.
 
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pRehm

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#14
This is great info, I have some researching to do. I have more questions about material, I'm assuming everyone milling or printing is only making "hard acrylic splints"? As of right now the majority of our analog splints are thermoflex, only a small percentage is hard acrylic, has anyone tried milling a thermo material? I see that protect is offering a "proflex" milled splint....anyone try them?
 
Chalky

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#15
@Chalky which materials are you waiting for, if I may ask?
At the moment from what I have seen and from those that we have outsourced... the resins that are being used fairly quickly go cloudy and opaque with use. if and when compared to acrylics or PMMA's they don't seem to be able to 'look' as good as they age. This has an impact on patient acceptance and affects use. I work alongside a bunch of Oral Medicine Specialists here in Australia and we deal with a lot of pain management, not simple bruxism cases, so there is also a need to adjust and sometimes add/remove as bites/joints stabilize and change... this is difficult with resin materials. When I have spoken to different company reps all seem to say the same thing - these materials aren't easily added to or repaired. all seem to say just go in and reprint! This isn't the most efficient way to go about it in my opinion. we have outsourced and looked at some printed splints and results are also a little inconsistent. I tell some sales people what it is I am doing and what it is I am wanting from the outcomes and a lot tend to agree with me and tell me to watch and see... which I am! It is simply my opinion for now, for me and my lab.
 
Chalky

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#16
This is great info, I have some researching to do. I have more questions about material, I'm assuming everyone milling or printing is only making "hard acrylic splints"? As of right now the majority of our analog splints are thermoflex, only a small percentage is hard acrylic, has anyone tried milling a thermo material? I see that protect is offering a "proflex" milled splint....anyone try them?
Experiment!!!! I have with success! problem is the availability of flexible materials in pucks and the cost of the ones that are available... if you cant buy it, why not make it! we are technicians, find a problem and solve it. :p
 
rlhhds

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#17
I have both exocad and 3shape. The splint design on exocad kills it, very easy to use compared to 3shape. If you understand splint design it goes real quickly in design once you are familiar with the software. We have been printing with Formlabs and getting good results. Do not know about the color stability of the material yet. Strength does not seem to be an issue. You can drop a splint on the floor and it will survive just fine. Throwing one on the floor not so much. I have been finishing my splints so I can better understand my designs and have made adjustments along the way. Also getting feedback from a Dr. who only treats TMJ.
 
Chalky

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#18
I have both exocad and 3shape. The splint design on exocad kills it, very easy to use compared to 3shape. If you understand splint design it goes real quickly in design once you are familiar with the software. We have been printing with Formlabs and getting good results. Do not know about the color stability of the material yet. Strength does not seem to be an issue. You can drop a splint on the floor and it will survive just fine. Throwing one on the floor not so much. I have been finishing my splints so I can better understand my designs and have made adjustments along the way. Also getting feedback from a Dr. who only treats TMJ.
This is also a concern for me... with time will the material get more brittle? if it does get brittle, how will it go under load of bruxing and clenching? splints that fracture cant then be repaired. But I also agree, exocad design is much more intuitive in the way it flows, when I compared to 3shape. I can go from scanning to finished nesting in under 25 minutes, that's a splint with disclusion ramps included.
 
2thm8kr

2thm8kr

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#19
Certainly it needs to last for a certain time, but splint material is porous like a lot of other dental materials. It has a finite life cycle. Like traditionally processed acrylic or even fired porcelain the materials harbor bacteria and should be replaced from time to time. Everything thing me make is temporary to some extent.
 
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