hello and welcome to chairside live I'm Megan strong and I'm Will Schmidt registered dental
assistant here at ledwell dental and in today's episode professor Schmidt it's taking us to class
we're going to scan school that's right I hear that bill yeah well what's on the blackboard
today I tell you what today we're going to scan six units on the same patient using the
eye tarot element two scanner doctor Mershon has a patient with six anterior units awesome and I
hear you're also gonna teach us how to speed up entry of tooth information on the rx of course
and some tricks for tissue retraction because we are scanning each tooth individually it's a
jam-packed show let's get to it welcome back to another exciting episode of scan school the Bell
has rung let's get down to business throughout this series I have progressively presented cases
that range from learning the basic operations of the scanner up to actual scanning and submission
of prepared treatments for restorations if you are just tuning in for the first time
take a moment to glance at some of my previous episodes especially if you are a beginner with
the I Tarot element scanner today we are going to level up from a single prepared crown case by
now acquiring information for a six unit anterior cosmetic crown treatment let's start by entering
the specific information for each tooth we are scanning in today's treatment teeth 6 7 8 9 10
and 11 are the units to be restored the dentist has already prepared these teeth and I've waited
until after the preparations were finished so I could properly acquire and then record details
such as the SUP shade and the margin design you'll notice when I highlight the first tooth and select
the crown option the drop-down menu opens and a wide array of design features are shown that need
to be entered now this is the standard information that needs to be entered for any case whether it
is one tooth or ten teeth however entering all this information individually even for six teeth
can still be time-consuming so I Tarot has built in a feature to assist with expediting the input
of that information complete the first tooth data entry manually then go back to the previous menu
and select the next tooth once that menu opens you'll see a new drop-down feature in the lower
left hand corner of the screen named copy from tooth I'll open that up and select a previous
tooth that already has information entered now all the specifics that were entered for the
2000s it that menu and choose the next tooth in the series as I select more teeth you'll see that
bead copy from tooth menu includes the teeth that already have information entered this is important
to know because every tooth may not have the same specific information such as the stump shade take
for instance this tooth number nine I'm entering the information manually because the stump shade
is in d7 instead of in d2 as the previous unit six seven and eight are subsequently
down-the-line tooth number ten has the exact same specific information as number nine so I'm able to
simply select copy from tooth number nine in the drop down menu then finally tooth number eleven
has the same information as tooth number six so I copy from there additionally if you still want to
go back and change specifics on an individual tooth you can click on any of the units with
information previously entered and then change them manually don't worry this change will only
take place on the tooth you've selected and is not going to translate to any other units that
may have been copied to or from it I'm just going to finish entering the densest material request
in the note section here this doctor is asking for brookster aesthetic solid zirconia crowns
and that is another reason why I was so diligent about recording the best stump shades for each
unit in the meantime while I have been entering all the prescription information our dentist has
been placing the retraction cords and preparing for the scan process the double cord technique is
being used for these units today proper retraction is so critical because we really need to capture
all details of these margins and we don't have the luxury of injecting impression material into
the sulcus to make up for any overhang of tissue anatomical copper caps are also placed after the
cords are packed this patient is asked to bite together and the caps are left for a period of
about five to seven minutes so this is the point where a multi unit scan becomes a very
technique sensitive and it's important to perform these steps to the precise level that I'm about
to demonstrate each time if you remember from my single unit crown preparation scan episode
the eye Terrell will require you to scan the prepared tooth the working Archer quadrant the
opposing and then register the bite in the event that more than one unit is to be restored each
unit must still be scanned individually first this rule applies to no prep restorations as
well I'll click through the options here on the selection map to show that each unit from 6 to
11 is able to be singled out at this point I'm going to remove the series of copper caps this
leaves me still with two cords packed into each sulcus now since I'm dealing with multiple units
that have to be scanned individually I have to be very detail-oriented with these next steps at this
moment the maintenance of tissue retraction is my highest priority I have tooth number six selected
on the screen to start I'm going to remove the top cord from unit number six only I'm now
going to perform what I call the 5 second scan this scan is to acquire all the details of the
preparation of tooth number 6 this scan should be completed in roughly 5 to 10 seconds if possible
I'm not worried about capturing anything else except for number 6 exclusively at this point
once I'm satisfied that I've acquired the proper data I'll give it a quick look to confirm and then
press and hold on the green occlusal marker and move it to the center of the incisal or occlusal
position on the preparation moving on I'm going to perform these same steps for tooth number 7
I'll once again remove the top cord only and give a second look to make sure the removal of the cord
does not dislodge the remaining cord or even one in an adjacent sulcus once you're ready to scan
dry the area and once again perform a 5 second scan of this preparations details only review it
once completed and move the incisal locator dot as a final step I'll move quickly through these
next stages but the workflow looming is exactly the same for each unit remove the top cord check
from marginal visibility dry the area perform a five-second scan and then reposition the green
locator dot let's do this for tooth number eight nine ten and eleven I also want to mention that
the removal of only the top corn is a guideline if sulky ler bleeding is negligible and you are
able to acquire a better scan with no cores left in place then by all means take both out I do
however want to stress that it is important to perform cord removal on a tooth by tooth basis
now I'm not showing it here in this presentation but once all prep scans are completed and before
the full arts can remove all remaining traction cords that may still be present now that all the
individual units are scanned take one more glance through each one to make sure all of the marginal
details are captured to your satisfaction if any details need to be rescanned it's best to
simply erase that prep scan completely instead of trying to add to the existing or use the fill tool
i've taken the liberty are out of the mouth at this point i mentioned in a past tutorial that
i prefer to perform the full arch scan portion with no distractions such as retractors or mouth
mirrors if i can help it when scanning cases with preparations whether single or multiple i like to
perform the full arch scan on the working arch first and then continued to the opposing always
start distal to the most posterior tooth in the arch and on either side that you feel
most comfortable scan the occlusal surfaces angle slightly lingual on the anterior and then reach
the same distal destination on the contralateral side if you are proficient enough to continue
the scan by rotating to the lingual then it is perfectly acceptable to continue without
stopping the interproximal data can be reached by tilting the wand upwards towards the ceiling on
the maxillary arch or down towards the patient's chest for the mandibular arch then rocking
laterally side to side once the full arch lingual data has been acquired stop the scan and review
now begin scanning the occlusal surface until the scans meshed together and then move to the buccal
surfaces acquire the interproximal data by rocking the tail of the wand up and down as it travels to
the midline where the scan can be stopped perform the same process from the distal occlusal of the
contralateral side move towards the buccal surface and travel to the midline stopping when the buccal
scan reaches the previously acquired data take another look around the arch after completion
to make sure nothing needs to be filled in and if not continue to the opposing arch scan today the
lower arch is the opposing arch to be scanned I'm not going to focus so much on this arches scan in
today's tutorial the process remains just about the same as the working arch - the preparation
scans one change to this opposing arches scan is the addition of anterior incisal edge scans
any full arch scan without a tooth preparation requires an incisal edge scan start with the
wand on the incisal edge of either cuspid area and rock from incisal to lingual and then to the
buccal stop the scan and move to the contralateral side where the motion is replicated each of these
incisal edge detail scans should take no more than five seconds each to acquire the final information
to scan is the bite registration after selecting the bite registration option on the visual chart
place the wand in either vestibule and ask the patient to bite in centric occlusion start
posterior and move the wand in an S or a zigzag motion towards the anterior until the arches
meshed together this scan can be stopped after the mesh and in the process can be repeated on
the contralateral side it is important to always capture the bite registration bilaterally on any
full arch scan after ensuring that all scans have been completed and meshed properly select
the view icon and allow the unit to clean up the scans and present them in a high-definition format
from here you can view the occlusal clearances in a color map these clearances are set to the final
restoration material that has been chosen for this particular case the occlusal color map can also
be turned off if desired and each preparation scan can also be viewed individually in a post
processed high-definition state when you are often did the model one last review and impressed the
envelope icon to send this case to the lab for final fabrication thank you for that well not
a problem Megan and check out this week's free featured seee course clinical success with CAD
cam restorations by dr. Justin Shi that's right you got head over there and take that free course
cuz he's going through the entire clinical workflow for a CAD cam restorative process
so head on over to glycol dental comm and take the course that's for today's episode we're all
wrapped up so thank you so much for watching and we'll meet you right back here next time