hello everyone and welcome to episode 160 of chairside live I'm your host
Megan strong today we'll visit dr. Chynn our thermoforming department
we're fabricating bite spoons through digital technology let's go take a look
hi for today's case our patients chief complaint is grinding and clenching at night with headaches
in the morning so we're gonna prescribe for her a Nastran lint and for this case we're gonna
take it through the digital workflow scanning it with a 3m true definition camera and without any
traditional impressions we can send it digitally and it just expedites the process and makes it a
lot more comfortable for the patient all right for this case with the digital scan since we
are going to scan the entire arch we're utilizing the avec la option which is helping to retract the
lips and cheek we're also utilizing a couple of dry angles to add additional isolation in
and retraction and before you start scanning you want to ensure that you remove any excess saliva
from the teeth surfaces so we're going to put a little bit of air to dry those off because any
saliva and bubbles can be captured during the scans once the teeth surfaces are dry the 3m
scanner requires a light dusting of a contrast powder which is titanium dioxide and that just
helps the system capture the data a lot more efficiently so once the light application of
the contrast spray is applied to the teeth I'm going to start off by capturing the
upper right quadrant I get most of the occlusal surfaces first I work my way toward the distal
and ensure I get the distal of number two in this case and what digital scans you do want
to ensure that you take rotations toward the buccal as I'm doing right now and fill in the
buccal data and capturing any areas underneath the height of contour once I've captured the
buccal I'll rotate toward the lingual and ensure that these areas are captured as well
the working distance for the 3m system is about 3 to 17 millimeters you can see in the center of the
screen the orange circle that is an indicator for whether or not I'm in the correct depth of field
so I now have the upper right quadrant scanned in and now I will transition on the N terior
teeth to the upper left side with the anteriors it can be a little bit more tricky if the system
ever loses its place you just returned back to an area that it has already scanned in that case
it's the upper right starting on number 5 here I'm working on the lingual x' what the anterior
is again can be a little bit more difficult because the incisal edges are pretty thin
and so here it was able to transition well to the upper left quadrant and I'll get all of the
occlusal areas and lay this foundation on the upper left teeth traditional impressions can be
a source of increased anxiety and discomfort for the patients so digital impressions are
very nice application in the office for patients like that that may have an increased gag reflex
or may have had bad experiences with traditional impressions before so we now have our completed
maxillary model want to evaluate and ensure that all of the critical areas for this case
or are captured in this case we have all of the occlusal areas buccal and lingual we'll go ahead
and accept the file the next step will be to repeat this process for the mandibular scans
alright so we now have our completed scans this is our maxillary arch and the mandibular arch to
establish the opposing and then we've captured the bite registration and how the two arches
relate to each other and so the next step is to complete the prescription on the 3m true def
software we're gonna first indicate the date that we would like the restoration or the prosthesis
back and then indicate the lab if I were doing it chair sighted chair site restoration I'd send to
iOS but in this case I will send directly to Glide well for the fabrication of the splint
and then I'll choose the type of restoration and for this I'm going to choose models and
appliances and then under the notes I'll just add a little note that I would like to have the
ash drawn nightguard and the last step is just to sign it with your own pen and it's just a couple
of buttons and the case will be digitally submit it to the laboratory for fabrication
so we're in our digital printing room and I'm here with Lee Palacio can you tell us about
your role here at Glide well I'm the manager for the night guard department great and dr.
Chi just scanned the patient and he sent the digital file over and we're gonna take a look
at the process from this point once you send the digital file to us here all right so we're over
here at the computer with the technician tell us a little bit about the process once we receive the
digital file well Megan once we receive the file we have our technician here design the model once
our technicians done designing the model we'll bring it here to envision tech and the model will
be built once a models built it will go down to our removal department dancer Department Nygaard
Department our flexible partial department from there we can go ahead and fabricate the appliance
and how long do we save the digital files for Megan we store the digital files for a year a
year so you're saying if it gets broken if it gets lost we can quickly refabricate it absolutely if
the applying gets lost or dog eats it they can go ahead and email us nice well I know Parker the
perfect puppy who's not always so perfect he's been known to chew on an appliance or two so
that's that's good news absolutely we can go ahead and fabricate a flexible parcel a night guard or
denture ASAP nice I like it all right back to you dr. Qi so we've now received the splint from the
laboratory and again with the astron clear splint material one of the unique benefits
is if the splint doesn't fit precisely the way you like it for this patient or the occlusion
is slightly off you can submerge it in hot water and we have a water bath here set at 150 degrees
if you don't have a hot water bath you can just use hot water from the faucet not scalding hot hot
enough where when you submerge this for a minute you're actually able to form and Bend the material
a little bit and that allows it to flex within the patient's mouth and get that Custom Fit that
you need for the patient so after the splint is submerged in the hot water the material is
softened and it should allow for an easy placement you can see it glides on the maxillary teeth very
easily destructive patience you bite down gently and apply a little bit more pressure and that way
if there's any discrepancies high areas on the splint the material will self-adjust and once
the adjustments have been made we will place the splint in cold water it retains the memory of this
current position so once the adjustments have been made then an open please we're gonna carefully
remove the splint from the patient's mouth and submerge it in cold water and that will lock in
the adjustments that were made whenever it was in the softened State so we were able to deliver
a night guard for the patient using a completely digital process by standing at chair side and then
sending the files digitally to the laboratory where they can begin fabrication immediately
and in combination with the unique material in the Astron clear splint we were able to offer a simple
delivery allowing the self adjustments for the patient making it comfortable for them and as an
added benefit the files that are sent digitally to the laboratory are stored for up to a year so in
the event that the patient loses or even damages the night guard the lab can fabricate that off of
the previous digital scans well that about wraps it up for this episode of chairside lies on behalf
of everyone here at glow laboratories we thank you for watching and hope you'll come back next week
you