what we're going to do today is take you through a start to finish using a digital impression system
digital digital design and we'll mill out a restoration
and just show you what that workflow looks like
so even if you send in a traditional impression to us uh that impression gets poured up and
immediately digitized you can see the technician using a benchtop digital scanner scans it into
software where they then design creating the contours creating the contacts and from there
that design proposal gets transferred to a milling system so the initial design is the
cad portion a computer aided design and then now we're entering the computer aided manufacturing
the cam portion of that process you can see here the universal robotic arm reaching for one of the
blocks depending on which shade is required so here's the case i'll introduce you to the
preparation here it was a porcelain fuse and metal restoration on tooth number 30 with open margins
throughout so we're going to go ahead and first certainly remove the old restoration and that you
saw i was fitting in the iso dry it's a nice retraction and isolation tool and then here's
a screwdriver type instrument or christensen removal tool to separate that mechanical bond to
from the coping that metal coping to the prep here i'm using a flowable i like using flowable for a
lot of situations to adapt well to these different irregular surfaces particularly on these buildup
areas it adapts well and then now we're going to refine the preparations so i typically for gross
reduction use a coarse grit green stripe diamond burr again actually it's a round ended tapered
diamond burr occlusally it's a usually a football or a rounded diamond burr once everything's smooth
i do the probe check to make sure all the margins are connected as you can see here
so that wraps up the introduction to the case i'm going to move over into the operatory so if you
can hang tight for a couple minutes we're going to get the patient ready and i'll introduce you to
the clinical situation we're going to place a retraction cord and then we'll
get the digital impressions scanned and i'll show you some cool features with the itaro
we're going to place a single we're going to try a size three i know we go to the side three as
the largest boards i'm going to try that with just a little bit of hemostatic agent on there
so when we place the cord i like to try to first seat it in inner crosstalk first so on
the mesial or distal area usually that's you know it sounds like a really large size port
which it is and again visually visualizing from an occlusal aspect we want to try to be able to see
the margins and the axial surfaces together from that top down view all right so we're
going to jump over to the aitero now and i'll show you the setting up of the prescription
so the digital impression it's kind of like a digital triple tray you're going to
pick up the preparation you're going to pick up the quadrant that the preparation
is on in this case we're going to get prep 30 first the scanner with the iteral gets a
higher resolution scan of the preps just a little bit more detail and then we're going
to capture the rest of the adjacent teeth i like to go all the way up to the canine and
then the opposing and then from there we're going to bring those two models together
with a bite scan with the patient biting fully and centric all right so this first scan
will be of the preparation so with the iteral element you're going to rest the camera down on
the teeth and you can see the crosshairs there all right so we've transitioned to the itaro so you
can see the crosshairs i start off on the occlusal once i activate the camera with the button on the
body of the camera i then begin rotating to the lingual and it's almost a hard rotation to
90 degrees all right so now that we've completed the scans we're going to advance to the third
page on top and this is our post processing prep evaluation stage and we can take a look at our
impression we want to evaluate the margins we want to evaluate whether or not we have the adjacent
surfaces of the contacts so again just like with your digital pictures if you see right away that
your picture is blurry or you got the wrong angle or you didn't actually capture what you want it
same concept with this visual impression taking the image evaluating it it's so powerful to see
your work right away again a little bit humbling at first you some dentists shy away from wanting
to see their prep so magnified but i guarantee you promise you that it would make you better
when you can see your work right away so now that we have our digital impression we've got the prep
adjacent teeth opposing and the bite that digital triple tray now we're going to transfer that
digital impression to our digital design station which is in the lab right next to us so if you can
hang tight for a couple minutes i'll introduce you to how we would design a case using fast design
all right so we're in our lab we have our chair side workstation here our design station and our
milling unit i'm going to open the file that we just transferred over from the digital impression
system and now that we're in design so we have our design here i'm using the mouse to control so
we have our digital control of the rotation and zoom of our preparation i'm just going to start
off the margin placement there so i just give a single left click and you can see how the software
begins trying to identify so it's kind of an automated process and again the software has
no idea where the margins are that's why we need to tell it where to begin placing it so this is
designating that start point of our restoration it's so critical and it's just basically going
until we reach that starting point that original starting point of the margin placement so now now
that i made that click on the mesial lingual area the software completes the placement of the margin
and now you see we have a couple of figures some some arrows that appears over the prep
so now we have our initial proposal so the artificial intelligence it does expand and
using a library that's embedded within the software to create a proposal that
fits the space so let me show you here we have our lower model but i can bring the opposing out
so we can further evaluate how this articulation is for the patient and again for the purposes
of this presentation i'm going to mill out a camouflage material so this material camouflage
it's a resin hybrid material so it's 80 percent 80 percent ceramic 20 resin once it's locked in
i shut the lid down and press ok and now it's going to initiate the milling cycle for this
particular case it's a full coverage crown on 30. and this will probably take about eight minutes to
mill using this material and we'll talk more about the differences in the materials now
so we'll head back to the patient and then we'll come back and grab this crown once it's done
looks like right out of the mill so this is the metal mandrel and the restoration of course and
that connection piece is the sprue just to show you what it looks like from the milling box
i'm going to show you side by side what one of the blocks looks like pre-milled so again this
is a pre-centered zirconia so again that means it's already gone through that curing or centering
cycle processing of the material at the laboratory and so when it mills out it's already in that high
strength 1200 plus megapascal flexural strength so it's the same strength that you would get from
the laboratory all right so we're going to go ahead and seat this down
all right normally uh inner proximal contacts i do like to use a shim stock very thin piece
just to make sure it doesn't tear but here we're just going to check it with floss we certainly do
want to have contact this is probably the most universally used method to check contacts but
and compare the differences between these blocks that we have available
just really quick we have the camouflage that we milled out of course we have bruxer so the broxter
material that's the center zirconia that's meant for posterior full coverage cases and by request
of our existing users with the system they love having the ability to mill a centered zirconia
chair side we're they've requested an anterior block so an anterior block would be a taller block
to accommodate those longer teeth in the anterior so we're currently developing
a even more translucent and more aesthetic bruxer material for the anterior that's coming out soon
so that's going to be pretty exciting to have and you can see this is the only material that's in
this shape because of that centered nature and if you're curious about the strength of the material
it's just as strong as the material that you get from the lab and so right now the system
can be used on any single unit situation posterior anterior partial or full coverage the highlight
material certainly is bruxer getting to do a bruxer high strength material centered zirconia
chair side and that takes about 35 to 40 minutes to mill because of that high strength state
and but the thing is right out of the oven uh right out of the oven which here we have our
polished zirconia crown that we did earlier it's ready to cement so because of the high strength
nature of it you can use a conventional cement if you like using reliax looting plus like 3m's resin
modified glass ionumber it's a really easy to use cement or seromere you can just slap whatever
you normally like to use into the crown and it works very well but there is an option if you
want to bond that in as well the other materials obsidian depending on the size of the restoration
takes about 12 to 15 minutes to mill camouflage usually less than 10 minutes because of that resin
nature to it and the bio temps is not far off less than 10 minutes if you want to mill a quick
provisional for your patients are you enjoying this instructional video i hope so if you'd like
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so we have a couple minutes left i think we might have some questions and so we have dr manola here
that will be presenting later at one on guided surgery but i think she has some questions
yeah so we had some really great great questions come in over the last couple hours so thank you
guys unfortunately we don't have time to answer all of them but uh leading up to kind of what you
were just talking about the bruxer can you talk about maybe the differences between the mil the
boxer that comes out of the mill here versus the lab rocks are material so the difference between
bruxer from the lab and bruxer now that's milled in the fast mill chair side there's actually not
much difference in the strength the formulation is exactly what you would receive from the laboratory
so it's going to be upwards of that thousand plus mega pascal flexural strain so strength wise
there's no difference and i know there sometimes is a concern i do get questions
about micro fractures through that milling cycle but zirconia has this amazing property which is
transformational toughening so it actually doesn't receive a lot of micro fractures if for any reason
it did itself heals so it's actually we've done a lot of tests internally to determine the strength
to see that it is actually what we're getting through the lab and the strength is on par
if not actually some of the samples were even stronger than what we got through the laboratory