hey there welcome to chair side life I'm Megan strong and I'm will Schmidt register dental
assistant here at Glanville dental and in today's episode we're following you from start to finish
as you scan a single unit crown prep that's right it's more of the eye tarot scan extravaganza today
I'll be scanning a number thirty crown prep and our doctors are going to show us two different
techniques for cord retraction sounds like a good one let's go welcome back to I tarot scanning
school I'm going to jump right into this single unit crown prep scan for this patients tooth
number 30 if this is your first time watching the I Tarot element in action take a moment and
review my previous episodes where I discussed the basics of a Tarot function and setup to get us to
this point I'm just going to enter this patient's information quickly I'll usually do this before
my doctor actually prepares a patient so it's all ready to go when they are now if you are sending
this case to your own chairside mill you'd select the chairside milling or gladwell do in office
solution option under the case type menu the due date for a chair side mill doesn't really apply
but it has to be entered the menu won't allow you to actually select today's date even if you are in
fact milling right now so I simply select the next day or any day for that matter the Attero will
automatically suggest and highlight a two-week turnaround time unless you specify a rush case
and change the due date manually under the send to menu select the lab that this will be delivered to
for today this scan will be headed to my home base bled weld in a lab in Newport Beach California I'm
going to give as much information as possible in this prescription portion I'll select the
tooth in question and click on the appropriate restoration today is a full-coverage crown that
has been prepared this is going to open a new menu to enter even more specific details about
this crown my doctor is requesting a Brooks or esthetic solid zirconia restoration the full
contour is a Konya tab is selected and later I'll specify in the notes as to exactly what product
is needed so according to my doctor's instruction I'm entering sham for preparation designs and in
the shade that we acquired from the Vita Guide do you use a different shade guide well that's
a really no problem click on the shade system and then select it from the drop down menu or
select other and enter it manually if any shade information has already been entered changing
the shade system will remove the existing entries from the rx for instance I can select other and
then manually enter ABL to body shade and even in size and gentle shades if they're really necessary
don't forget to take an end of the stump shade especially for those restorations that aren't
fused to metal copings there is never such a thing as providing too much information now press that
back button once all the entries are complete and then enter any specific notes about the case in
the notes section before moving forward this is your chance to specify the exact product as well
as any unique instructions that the lab needs to know even if this case is being sent right
to your own chairside mill enter all of these details and notes so you can refer back to them
at a later time from here I'm going to click on the Scan button on top of the screen and I
can leave the eye tira in this ready position to use from this point once my doctor's preparation
is done I want to quickly review two retraction techniques that our dentists here at global dental
choose before scanning contrary to many rumors about digital dentistry all other elements of the
dental procedure must remain the same up to the point that this scan is taken tissue retraction
is still a vital part of the process for those dental assistants that are an expanded function
this applies to you as well the first method recommended by our doctors is the dual chord
technique the initial chord is packed preferably with a hemostatic agent impregnated into it and
then cut to exactly contour the margin and then a second chord is placed over the first with just a
little extra tail left hanging out to make it easy to remove before scanning as a secondary
retraction step a compression cap can be placed and bitten into for a period of two to even seven
minutes these caps come in a variety of sizes as well as anatomical designs that will help to hug
the gingiva cleanly after the patient has bitten on the cap for the appropriate amount of time it
can be removed and then the top cord taken out as well give the tooth a quick air blast to remove
any debris or saliva and check once again to make sure the remaining cord does not cover the margin
at all once the scan is complete go ahead and remove that final chord the next technique that
our dentists are using involves a retraction paste application a brand such as track Siddhant works
well and has built-in hemostatic qualities the paste is applied around the margin and injected
into the sulcus as much as possible a compression cap is placed over the paste and then the patient
is told to bite together with pressure for two minutes only the most important part of paste
retraction is the complete removal of all remaindered pastes before starting the scan
process now you'll notice at this point that I'm taking out the lip and cheek retractor
that's already been put in place now this is a personal preference of mine and you may want
to experiment with scanning both ways however I found that if I minimize foreign objects in the
mouth while scanning my comfort level increases and the outcome is a better quality for these
posterior molars only a quadrant scan is required and the teeth suggested to be included in the
scan are highlighted in white on this chart model these highlighted teeth are merely suggestions in
cases where the preparation is the most posterior tooth in the arch it will still be a good idea to
capture a full arch scan just like you would while taking a physical impression of course
the idea here is to prevent a simulated bite collapse and poor occlusion on the final crown
I have a few selections to choose from as to where I'd like to scan first I could begin with
the opposing arch the working quadrant or even the actual tooth preparation even though the unit will
let you start at any of these options always always start with the individual preparation
scan and build out from there all this work we've put into tissue retraction and hemostasis he used
to be taking advantage of immediately click and select the tooth preparation it's colored in with
blue here on this chart and then prepare for your first scan I'll take a look at my hand position
and setup before we get started I'm holding the wand at the base with my dominant hand my poem
is towards the ceiling I'm seated at 12 o'clock in relation to the patient and the I tarot is set
up at either a 5 o'clock or 7 o'clock position this first scan is of the tooth preparation and
the preparation alone I like to call this the five-second scan place the wand directly over
the occlusal surface of the prep and attempt in roughly 5 to 10 seconds if you can to capture all
details of the tooth preparation this includes the margins the occlusal surface and the axial
reductions in this scan the moment after all these records have been captured don't worry
about the adjacent teeth or the contacts at this point as you take the preparation scan a green dot
will appear on the screen and attempt to locate the occlusal service of the prep if the dot does
not automatically find the exact center of the occlusal or incisal surface simply press and
hold a finger on the dot until it becomes mobile and then relocate it to a more preferred position
well now that I'm satisfied with the preparation scan I'm selecting the rest of the working arch
and continuing I'll usually give the quad a quick suction or an air-blast before setting
the wand on the occlusal surface just distal to the most posterior tooth in the arch and start
the scan I'm skinning the occlusal surfaces first and moving towards the anterior once I arrived at
the cuspid area with more incisal edge anatomy i'll angle the wand a little more lingually
inclined instead of facing straight down on that incisal edge start to bring the wand back towards
the posterior once you've reached the cuspid or lateral area and then scan the lingual making
bold twisting motions back and forth throughout the arch take a good look at my hand position
here I'm still using an underhand grasp with my fingers facing upwards and I'm making exaggerated
bold purpose-driven twisting movements in order to capture these difficult-to-reach embrasure
and contact areas now if you are having trouble acquiring interproximal anatomy first check for
saliva contamination and then increase the angles of your exaggerated twisting motion once I reach
my start point just distal to the most posterior tooth in this arch I'll stop the scan and reset
for the buccal Anatomy start this buckle scan on the occlusal surface first make the eye taro
work for you to first mesh your new scan with the information you've already acquired and then work
your way towards the anterior to capture the new buccal data a similar exaggerated motion
also captures the buccal embrasures and the contours this time instead of twisting the
wand make a rocking motion with the wand almost as if you are lifting and dropping the tail-end
as I make my way towards the anterior make a note of my hand position change this patient holds her
lip just a bit more tightly to her teeth and I'd like so I switched my hand just to hold the wand
tip steadier throughout the anterior section after a good amount of experience with the IT
element you'll also develop your own comfortable workarounds for more difficult areas perfect
hand position in my opinion is defined as your most solid organ ah McGrath in the moment that
acquires the highest quality data in the least amount of time with no patient discomfort I've
stopped the scan at the buccal interior and I'll visually review the complete scan and check for
any missed areas now as I rotate here I can see that the dislocate and Twentynine still need to
be filled in now since the eye taro shoots at an incredible six thousand frames a second I only
want to patch the missing data areas by using the fill feature I'll press and hold my finger
on the screen until a secondary menu opens and then I'll choose the fill option the unit will
take just a moment to process and suggest areas outlined in red here that may need to be filled
in once I start to scan again no matter where I aim with the wand only the missing data areas
will be added to the segment you can see those fill in nicely by really focusing on the missing
points and exaggerating the tipping or twisting techniques that I discussed with you earlier now
another review after filling shows all missing areas are filled in to my satisfaction I'm not
worried about any other areas marked in the red they don't interfere with the data and are more
so just scattered data from previous scans and moving on to the opposing arch in this case the
maxillary quadrant I've selected it on the visual chart and I'm not going to go into too much detail
about acquiring the scan from point it's the same principle as the working quadrant scan
but without the tooth prep scan step I'm starting disel occlusal of the most posterior tooth in the
quadrant scanning deliberately towards the cuspid area wrapping around to the lingual and heading
back towards the molars twisting for embrasure areas and then stopping the scan at the start
point to reset for the buccal i'm always starting again on the previously scanned occlusal surface
until the eye tiara recognizes the segments and meshes then wrapping around to the buccal and
moving towards the anterior where I'll stop I'm changing up the handgrip just a bit to steady
the wand to counteract the patient slip resistance a quick review shows small areas that need to be
filled once again select the fill option and give them a quick once-over to complete from
here I'm going to review all scans up to this point just to make sure everything I need is in
order I'm not worried about those read contact indicators on this prep scan because my full
working quadrant scan shows that these areas are complete okay let's bite these quadrants together
click on the bite registration button in the chart and the quads will appear opposite of each other
I'll ask the patient to open insert the wand in the vestibule and then ask the patient to bite
into Sidra conclusion I may even help to hold their bite together with a little pressure on
the chin from my stabilizing hand I'm starting posterior and facing directly at the buccal
surface of the arches this scan is taken in an S or a zigzag pattern moving towards the anterior
until the quads mesh stop the scan as soon as this mesh happens and review it everything I
see is acceptable so I'll move right along to the post-production stage I'm really happy here with
how little time it took to clean and produce this model to review I attribute this mostly
to my ability to acquire the information in the shortest amount of time 6,000 frames a second is
a lot of information to process as you're scanning skills increase the overall processing time will
begin to decrease these color codes overlaid on the arch can be used to show the clinician the
occlusal clearance and assists to make decisions about restorative materials or even refinements
and just by selecting different combinations the arches I can get a good look at every
angle before sending it off to the lab or to the practices gladwell dot IO in office solution for
a complete in-house same-day case thank you for that well another problem at all I love showing
these tips and tricks your patients are gonna love you for it and your lab is gonna love you
for it can't beat that well that wraps it up for today's episode so on behalf of everyone here at
Bible dental thank you so much for watching and we'll meet you right back here next time