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Understanding Digital Dentistry: Cbct and Intra

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Understanding Digital Dentistry: Cbct and Intra UNDERSTANDINGDIGITAL DENTISTRY: CBCT AND INTRA-ORAL 30 SCANNING -=- & UNDERSTANDINGDIGITAL DENTISTRY: CBCT AND INTRA-ORAL 30 SCANNING ----CBCTi-------iTERO------­ NewTom VGi DIGITAL MODELS SYSTEM The iTero Experience *Vertical Patient Positioning *No More Goop, Gagging, or Discomfort *Medical Grade Tube Head *No tray and putty experience * Rotating Anode *Less mess more accuracy *.3mm Focal Spot *Faster more detailed digital models *Flat Panel *30 high quality imaging for better case *Safe Beam™ Technology (reduces planning radiation based on patient size) *Scan time: I 8sec Digital Models *X-Ray time: 5.2sec As iTero scans utilize I I-micron surface-tooth the leading 30 CBCT on the market, recognition software to create a highly NewTom is setting the industry standard accurate digital model of the patient's for patient experience and safety, image anatomical structure. quality, and 30 case diagnosis. Contact Points Choose the right implant software The iTero software allows doctors to examine the contact points of a patient's for your 30 case planning occlusion. Once a virtual wax-up is made contact points can be examined again to facilitate the fabrication of a provisional or a final crown. iTero Scan and Merge to CBCT iTero Scan CBCT Scan Doctors can perform implant placement using 30 imaging when the patient meets the specifications for an accurate merge of the iTero and CBCT scans. Your imaging center is responsible for all workflow leading up to treatment planning. Specifications for an Accurate Merge with CBCT: * At least 4 teeth on same arch *Pre-molar and molar on same side that each have an opposing tooth *Without these specifications an iTero scan will not work due to Jack of a virtual articulator and therefore vertical height cannot be established. Imaging Center Workflow iTero Scan l J iTero Scan performed on patient 2J CBCT Scan performed on patient 3J iTero file is sent to CyberMed or lab of your choosing On0emand30 /Lab CyberMed Workflow /L 4J OnDemand30 ab Virtual Ceramist receives iTero file SJ Virtual Ceramist constructs virtual wax-up Virtual Wax-Up 6J Virtual wax-up file is sent back to iTero derived wax- merged 1 imaging center with CBCT scan Imaging Center Workflow cont. t 7J Imaging center receives virtualwax-up file with and merges it CBCT 8J Case files and accurate merge is organized as and sent email to doctor Doctor's Workflow 9J Doctor plans implant surgery based on virtual wax-up and CBCT merge Merged scans imported I OJ Implant softwarec ase planning is completed ln2Guide implant placement into 30 treatment and surgical guide can be fabricated with abutment planning software -=- RADIOGRAPHIC & iTero Scan and Merge to CBCT CyberMed/LabWorkflow Patient with Provisional 7) OnDemand3D/Lab Virtual Ceramist If the provisional represents the final prosthesis it can be receives both iTero files 8) Virtual Ceramist constructs virtual used as a virtual wax up for planning. The cement on wax-up of patient and prosthesis the provisional will need to be removed so that the based on scan with provisional patient can be scanned with and without the provisional - Virtual wax-up includes accurate in place. prosthesis as illustrated on 29 + 30 Specifications for an Accurate Merge with CBCT: 9) Virtual wax-up file is sent back to imaging center *At least 4 teeth on same arch *Pre-molar and molar on same side that each have an Imaging Center Workflow cont. opposing tooth I OJ Imaging center receives virtual wax-up file *Without these specifications, an iTero scan will not work I 1) Virtual wax-up is merged to CBCT due to lack of a virtual articulator and therefore vertical 12) Accurate merge verified and case files height cannot be established. are emailed to doctor Doctor's Workflow Doctor's Workflow cont. I) Remove cement from provisional 13) Merged case files are imported into 2) Send patient to imaging center with 3D treatment planning software iTero CBCT removed provisional for scan 14) Doctor begins implant case planning Merged and - Patient must be able to remove I 5) Surgical Guide is fabricated and guided and replace provisional themselves surgery can begin! Imaging Center Workflow 3) iTero Scan of patient with provisional removed 4) iTero Scan of patient with provisional Surgical Guide in place 5) CBCT scan of patient with provisional removed Verification of Implant Placement 6) iTero files are sent to CyberMed OnDemand3D : iTero Scan of Model and Merge to CBCT Traditional impressions can be scanned by the iTero Imaging Center Workflow when the patient specifications for an intra-oral 4) Model complete with diagnostic wax-up iTero scan are not met. or prosthesis is scanned using the iTero Intra-Oral scanner. Specifications for an accurate merge to CBCT: - iTero scan provides 30 Stereolithographic - 4 teeth or more in entire mouth model (STL file) of plaster model - Polyvinyl siloxane (PVSJ impressions or alginate if necessary *plaster model must be poured SJ CBCT scan taken of patient without immediately with alginate impression anything in mouth - Diagnostic Wax-up fabricated 6) CBCT and STL file merged into 30 Doctor's Workflow treatment planning software and emailed to doctor I J Impression Specifications: - no drag - no pull - no bubbles - cover palette - deep into vestibule -cover retro molar pad Doctor's Workflow cont. =-....2) Diagnostic wax-up and Plaster model - Once plaster model is poured the 7) Doctor receives merged iTero and CBCT the diagnostic wax-up can be file and imports it into implant software fabricated by the doctor for 30 case planning - This wax-up must represent the final prosthesis (shape/size of teeth) 8) Implant case planning begins and - The upper/lower impressions must be surgical guide can be ordered and articulated with mounted hinge fabricated *articulator establishes vertical heights in mouth, proper teeth positioning, and how prosthetic teeth will inter­digitate 3) Diagnostic wax-up and Plaster mode/ sent to a3Dimage for iTero scan. ·a3Di1nage Moa1LE Co•• BstM C:I Partially Edentulous Patient Dual Scan *NOTE* Dual Scans can be used for most patients. a3Dimage recommends the Dual Scan for patients Doctor's Workflow with 3 teeth or less. 1 J Take preferred Polyvinyl siloxane *Fabricate Bite Support for use during (PVSJ impression or if necessary, CBCTscan alginate impression with a plaster - Ensure no overlap of incisal or posterior model poured immediately occlusion *Impression Specifications: - Use stiff, radiolucent bite support material - no drag - no pull - Cover Complete Arch - no bubbles - cover palette - If teeth are missing in opposing arch - deep into vestibule fill edentulous space with index -cover retro molar pad material to make contact with alveolar 2) Prepare Plaster Models ridge - Must accurately reproduce the buccal and lingual margins SJ Send patient with radiographic guide and - Vestibule must be clear and bite support to imaging center understated 3) Fabricate Radiographic Guide Imaging Center Workflow *The accuracy of this guide is very 6) CBCT scan performed on patient wearing important, as it will be the basis for radiographic guide utilizing bite support fabricating the surgical guide 7) CBCT scan performed on radiographic - Use clear orthodontic acrylic guide alone - Tooth position and size should 8) Scans are merged in implant software represent the final prosthesis 9) If the doctor's workflow protocol is - The crowns should be distinctively followed, the Dual Scan will show that the represented on the facialjbuccal surgical guide and radiographic guide and occlusal aspects of guide have an identical fit to the cast and patient. - Guide should cover occlusal surface of full arch 1 OJ Merged files are sent to doctor - Guide should extend over the gums on lingualjpalatal side Doctor's Workflow cont. note: gutta percha markers do not represent implant 4) Dri/16 gutta percha filled markers (GPM) I I J Import merged files into implant software sites. They facilitate the merge - Use #2 round bur to I mm depth for 3D case planning of the scanned guide to the -All lingual I 2) Order surgical guide CBCT scan - On varying horizontal planes 13) Verify Step.9 by placing surgical guide and ) _ 1.smm � ; - On flange, below gingival plane on radiographic guide on cast and patient prior PM the mandible - above on maxilla to surgery " 1 1 m m Dimensions ��- _ _ _ __� - Fill holes flush with gutta percha 14) Perform guided surgery! 'a3Di1nage ;•0••1.• Co•• a... < 1 Fully Edentulous Patient Dual Scan Imaging Center Workflow SJ CBCT scan performed on patient wearing Doctor's Workflow denture with bite support in place 1 J Ideal prototype denture fabricated 6) CBCT scan performed on denture alone - Teeth of proper size, shape, length with gutta percha markers - Established occlusion 7) Scans are merged in implant software - no metal components 8) ff the doctor's workffow protocol is - 2.5 - 3mm thickness followed the Dual Scan will show that - Buccal flanges w/ length for the intaglio surfaces of the surgical guide gutta percha markers and denture are ensured to have an - Hard refine only - no softrefine identical fit to the cast and patient. - Excellent fitto softtissue and 9) Treatment planning begins and the Fit of denture to cast patient cast radiographic surgical guide is fabricated - No radio-opaque components 2J Drill 6 gutta percha filled markers (GPM) Doctor's Workflow cont. Fit of denture/guide to cast - Use #2 round bur to 1 mm depth 1 OJ Doctor receives surgical guide and -All lingual duplicate denture with drilling sleeves - On varying horizontal planes for fixation pins -On flange, below gingivaf plane on 11 J Step 8 is verified by placing surgical the mandible - above on maxilla guide on original cast of patient - Fifi holes flush with gutta percha 12J Bite Support returns with patient note: gutta percha markers do not - Bite support used to articulate represent implant sites.
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