CHROME Records for double arch case: Dentate Arches Opposing Edentulous

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This video will describe the CHROME records needed for a double arch surgery where the patient is dentate on one arch and edentulous on the opposing arch. As with all of our records, you can visit our website and under Chrome GS and then patient records. And then once you’re on the page, you can scroll through the page. You can see here’s an area for single arch, here’s an area for double arch, and then right below that is patient record checklist. You can print these off and you can use them as you’re collecting records, but right before submitting a case. With an edentulous versus an opposing dentate the records are a little trickier than normal, but the fundamentals are the same. We want photographs. We want a master cast of the opposing and we want a dual scan of the denture. So let’s go through each record.

The photographs are very typical of CHROME: left, right, center in occlusion, retracted, full face, full smile, exaggerated smile profile. Those are the six images. We don’t need other pictures. We don’t need pictures of the occlusion or edentulous areas. They won’t serve any purpose. And then please try to have the patient centered in the middle of the camera looking straight at the camera. And then with a full smile. We need to be able to make sure we have transition lines worked out. For the dentate arch make sure to please capture all land areas, all the land areas, the vestibule, the pallet, whichever arch we’re talking about, all the land areas because there’s going to be a pin guide designed to fit into the vestibule on many of these cases. So just think full arch immediate denture and you’ll grab the right impression. If the patient has a partial on the dentate arch, then you can seat it for the photographs.

You can also seat it for the CT scan unless it has metal. If it has metal, do not take a CT scan with it. But for the physical records, we want a study model with the partial seated and then a cast without it seated. Those are the two scans, the two records because what we do with our records is we will, in the dual scan, we’ll print the denture and mount it with your physical bite and your physical opposing. This is what we use to articulate, scan and work, move forward with. The denture arch. Please make sure the denture fits well. It doesn’t rock, there’s no movement. If it does move or if it needs to be relined, you can either do a hard reline, not soft, or you can realign it with blue or green moose. These are radiopaque materials and they show up in the CT scan.

The tooth position, we want it to be ideal. Doesn’t have to be perfect. We can do some pretty amazing things with our software to change tooth position. And must have a dual scan with the markers. And we’ll talk about the scan here in just a minute. But for the markers, you can either order our suremarks, which you just stick on the denture for bull scans. Or if you don’t have markers, you can use gutta-percha. Just use a number eight round burr about a millimeter deep in six areas around the denture. Fill it with gutta-percha and then just smooth it off. And this is, you can either do this in a denture or in a scan appliance, which is a duplicate of the denture. So that’s the edentulous arch.

For the CBCT scan. Be sure the patient is wearing the denture, it has the markers on it, and the patient is in occlusion with their chin on the chin rests. Do not separate the arches. That will be a re-scan. So scan them together in occlusion. This is a scan appliance. This is a denture, and both work equally well. When you export your dicom, you’ll export two sets because you’re going to take a dual scan. You’re going to scan the appliance once by itself, sitting on a piece of foam in the scanner. And then you’re going to scan the appliance also in the mouth seated. So there’s two separate scans. Both of these scans must have the markers. You can see the markers here, you can see them here. And this shows three markers, but there’s one here, there’s one here, there’s one here. So there are six randomly placed around the denture. So once you take both scans, you will export them to a folder perhaps on your desktop and in that folder on your desktop. In this case, we called it ROE CBCT scans.

And inside that folder, in this example, we have three scans. So this, just imagine that the scanner could only really scan one arch at a time as opposed to a whole skull. So they scanned one of the dentate arch and then two scans of the edentulous arch, the dual scan. And that’s in this example, you may only have two scans because you can scan the full skull and therefore you’d scan one with the patient wearing the denture, and then one of the denture by itself, two scans. But in this example, this scan here is the patient dentate. This scan is the appliance. And finally this scan is of the patient and the appliance. And if you could name all of those, that would be very helpful. Change that one more time to be consistent. Okay. Then you would create a new folder called Duffy CBCT. And inside of here, you’ll place all of your folders. And before we place this one, let’s have a look. So this here, this is a multi file scan, one through 201. So we know we exported this correctly as a set of single file d coms. If there was just one file in here, then you would go back and export again until you have multi file. So you should have a whole set of files in here that look like this.

So let’s go back up to where we were inside of here, the other two scans. And then this is the appliance scan. I’m going to put them all in here. So all the scans are now inside of the master folder, and now we’re going to zip the folder. You always have to zip in order to upload to our portal, so you’ll, you’ll right click, go to send to compressed zipped folder. It’ll look just like this on every PC computer. So now we’re zipping it. We’re compressing this folder to create this folder. It has a little zipper on it, and this is the folder that you’ll drag and drop on our portal in order to upload your files along with your photos and maybe an STL of the opposing dentate. But otherwise, on this type of case, you’ll probably upload just a CT and your photos, and then you’ll print the RX and mail in your opposing bite registration and models. This is a double arch dentate versus opposing edentulous records video.

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