hey there welcome to chair side life I'm Megan strong and I'm will Schmidt register
dental assistant here at gladwell dental and in today's episode we're picking up where we
last left off with you and we're moving on with your case this is part two of your scan school
and now we'll move into the upper arch that's right we're moving onwards and upwards with a
full arch pretreatment scan a bite registration and we're gonna go through the steps to send this
case to the left well let's get started let's go welcome back to I Tarot school class is once
again in session let's continue here where we left off in the last episode with our patients
pretreatment scan as a quick recap I have already explained how to locate or add patients into the
system the proper seating position and then I initiated and completed the full lower arch scan
we are scanning this patient pretreatment this is for initial records or for diagnostic models and
this line treatments or even appliances such as sports cards and night guards even if you
already have I Tarot experience this is a great basic skills refresher course to help you develop
those skills just a little more I'm going to get started today with the maxillary arch scan when
we convened last episode I was briefly talking about the two different view modes that can be
used during the scan I mentioned that I prefer scanning in the grayscale mode but for this
maxillary arch I'm going to scan in the high resolution mode just to show the difference to
start I'm selecting the maxillary arch on the left side of the screen and it will save the
previous scan and clear the screen for this arch I'm seated once again at the 12 o'clock position
and I've got the scanner to my right at about 7 o'clock the scanning wand is in my dominant hand
with my palm and fingers facing upwards just like the lower arch scan my opposite hand is
at the ready but stabilizing as a fulcrum base in this case she has her third molar number one
present but not number 16 to make it easier on this patient I'm starting with the possibly more
difficult quadrant first this is the one with the third molar present so she doesn't have to open or
stretches she does now towards the end starting as distal to the most posterior tooth and the
arch as I can I start this scan by tapping one of the buttons found on each side of the wand on this
first pass I'm acquiring occlusal records only as I'm wrapping around to the anterior of this
arch I need to stay more lingually inclined - rather than looking straight down on the
incisal edges remember incisal edge detail on a full arch is always the last step a contrary
to the greyscale scan mode blue instead of red will indicate the data that has not yet been
captured I'm going to stop that scan and review what we have already captured up at this point
starting once again from the distal of the third molar on the upper-right quad I'm going to scan
the lingual next I can't mention enough times to make things easy on yourself and start on
the occlusal surface first scan for a few seconds until the old and new data meshes together once
that scan appears on screen I can turn the wand to the lingual and start to move around the arch I'm
most concerned here about scanning the embrasures and undercut areas of the lingual really pay
attention to the wand position I've turned it so it faces almost straight up to the ceiling and I
will twist it with both hands if needed as you can see here laterally left and right and move along
the arch bold and purpose-driven smooth movements are the key to success in this case the scan looks
clean so I continue to the buccal I'm just asking her to loosen the relax her lips a bit before
starting this buccal scan patients in general tend to keep their upper lip tighter against the teeth
more than the lower so I'll just create a little clarity and my expectation that their positioning
before I get started so beginning from the distal of the most posterior tooth in the arch I'll once
again scan the occlusal until the previous scan meshes together and then move towards the buccal
I'm still rocking the wand with a lifting motion from the tail end up and down for interproximal
areas and then I'll stop at the midline the distal of the adjacent quads molar is reached by asking
the patient to close down slightly to give it more room I'll wrap around to the midline and
then get the incisal scans to finalize all we need to do here is rock the wand buccal lingual over
the incisal edges again start more towards the bicuspids until the mesh happens and then rock
the wand buckle the lingual moving towards the midline I am reviewing the final scan now and I
notice a bit of untouched information mesial of tooth number three and that's designated here by
this blue spot I don't want to simply rescan back over this area this scanner is picking up images
at a rate of six thousand still frames a second we want the scans to include as little layered data
as possible while at the same time acquiring all the necessary elements in this case I'll use the
fill feature this allows only the missing areas to be scanned into place to avoid multiple layers by
pressing and holding on the screen this reveals a new menu with a few options this allows you to
delete an entire scan erase segments of scans as I'm doing here just painting my finger along areas
that I want to remove or as a last option fill in the missing data areas I'm pressing on the
fill button and the element will take a moment to search for possible missing data and then circle
them to be scanned now that the data search is complete its found a few areas that it suggests
may be voids that need to be filled this is simply a guideline and you determine which
areas do in fact need to be scanned over like I mentioned the beauty of using this feature is that
only the voided areas are being scanned into and multiple layers aren't being placed on top of the
existing completed scanned areas the reason why I've got to stress that this feature is simply a
tool to assist with missing data acquisition and you can see here in the screenshot is that the
data I wasn't able to acquire on the third molar wasn't auto marked to fill in in situations such
as these there are three options at your disposal the first option is to attempt to rescan of the
missing areas I found this reattempt to be in such a tight area that I even broke my rule about using
retracting devices and enlisted the help of a mouth mirror I was able to scan just a little
more but I don't fully have the molar anatomy like I would want it the second option and one
that isn't recommended under many circumstances is to let the program auto fill the missing area in
post-production in other words when we finish all required scans and the program prepares the data
to send to the lab it will fill in the missing data points with ideal Anatomy this option is
fine if it doesn't impede the outcome of the final product that you're requesting for example
if I'm scanning this patient for a diagnostic wax model from say 4 to 13 I'm confident that in this
case the auto filled information isn't going to interfere with the outcome however if this is
being sent for a form-fitting maxillary appliance I may want to rethink the auto fill option as you
can see by these still shots the ideal Anatomy that the auto filled shows really isn't the
smoothest transition and may just interfere with some removable appliances fit and function now I
wanted to show this patient specifically as a training tool I've that no matter how skilled
you may be at the scan process there are times of an anatomy and angulation simply prevent a
tooth service from being reached which leads me to option 3 and that is after all other methods
have been exhausted you are absolutely sure the data can't be acquired and the missing area will
definitely interfere with the final product and the only choice is to revert to taking a
manual impression the chances are substantially minimal that this is going to occur but it does
and in real-world dentistry we aren't going to learn anything when presented with the picture
perfect example every single time moving back to our pretreatment scanning steps I'm going
to assume that for this case the missing third molar data is not going to interfere with the
outcome and I'm going to get ready for the bite registration process I'm going to switch into bite
registration mode by clicking on the icon of the bite located between the arches on the left side
of the screen and you'll notice now that our upper and lower scans are staged opposing each other on
the screen the bite needs to be taken bilaterally and it is your preference as to where you'd like
to start I'll ask this patient to open wide and I'm going to place the wand in the vestibule and
then ask them to bite again and press together in their normal centric occlusion I'm going to
keep a close eye on the real-time view screen on the lower left the monitor and just to make sure
that they never deviate from this solid bite I can tell fairly quickly if any movement occurs
this scan only needs to recognize the arches and invite them together once the process
starts I'll press one of the start buttons on the wand and then begin the scan towards the
anterior in a large s or a zigzag pattern the moment the program bites the models together is
a perfect time to start the scan at this point it should merge pretty quickly I'll move over to the
opposite side and perform the same steps until the bites found with an image acquisition speed of six
thousand frames a second it is important here to end the scan right after the arches merge let's go
ahead and send all this data for post-production on the top of the screen I'll press on the post
scan case review button and it will send all the scans into post-production depending on how much
data was received during this entire process the length of time it will take the idea to complete
this step of very now that the processing is complete I got a smoother more readable view
of the final scans before sending them out I'll do one last review to make sure everything I want to
scan has been documented and then I'll click on the order authorisation button at the top of the
screen from here ask my doctor to sign the order this will give the doctor a chance to final review
the scan and approve it as well the option also exists to save the dentist signature and send it
on their behalf as long as they'd give them pre approval this stage also gives you a chance to go
back and review the completed prescription page if you'd like without losing any data when all
items are ready to go press the confirm and send button on the order authorization tab and let the
transfer complete the screen is going to switch right to the odours page and we can see here that
the order status is marked as sending just let the IT era continue to send the case either to
your in office design software or to the lab in the meantime if you do need to use the scanner
for another patient this is perfectly alright it will not affect the current project status once
the order has finished sending an ID number will be created this allows you to reference the case
if you need to contact the lab or for any other reasons otherwise this patient scan appointment
is complete thank you for that will not a problem and if you like those episodes there's more in
store I have plenty of content when it comes to digital scanning well I'm setting my alarm
marking my calendars due but for today that's it for this episode so on behalf of everyone here at
Glidewell dental thank you so much for watching we will meet you right back here next time
you