What does Grammetry do cheaper than Photogrammetry?

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Transcript

Speaker 1 (00:02):
Hi everybody. Thank you so much for joining us. My name is Alan Banks. I work for ROE Dental Laboratory and today we are going to amaze you. We’re joined by doctors all over the country and really all over the world. As we announce a service that is called grammetry. I’d like you to think about something maybe a little bit a unique, imagine you wake up this morning, you go down to your car, it’s the same car you’ve had, but today your car can fly. That is what grammetry offers you. We call it barrier breaking, record taking, and we’re going to go through this whole process today and we’re going to show you how it works, how you integrate it into your current practice with your current technology or technology that you want to be, that you want to be involved with and purchase. You have options with us.

(00:50)
For the past year, we have worked with photogrammetry. We have made about a thousand cases and this is either in restorative protocols or in live surgery. About 800 of these cases are same day turnaround of photogrammetry records and us designing a prosthesis, emailing the doctor an S T L file and they printed in their office or some we’ve printed here at the laboratory and shipped it over, shipped quickly. Photogrammetry is very impressive. It’s a high level degree of accuracy. Micron level. They’ve proven it, it’s documented, we’ve seen it, that’s very impressive. But what really photogrammetry does have what we call a problem statement. Photogrammetry has a little bit of limited utility. You know, buy one of these scanners for, and you’ll see the last line there, 30 to $50,000 for a scanner and what does that scanner provide? That scanner provides very limited use. It gives you a multi-unit abutment or an implant in space.

(01:53)
It doesn’t give you the patient, the smile, the teeth, the soft tissue, the hard tissue, the bite registration, the video. It doesn’t give you any of this other information. What do you do for that? You use your iOS scanner. That’s where we’re going to come in. Photogrammetry again, although it’s wonderful, the equipment is clunky, it’s expensive, it’s all on back order. You can’t have one and really, again, UTI utility is limited and if you’re in a practice with multiple offices or multiple chairs doing live surgery, the last thing you want to do is keep multiplying $40,000. There is no point in doing it and we’re going to prove that today we’re going to talk about geometry. Geometry is using your iOS equipment to capture all the records needed on the day of surgery to order a prosthesis. We’ve done it many times. It’s been available for about a year in testing and in private practice and now we are bringing it out to the public and we have been very impressed with this technology and we’ll show you a little bit of a comparison and we’ll tell you the entire workflows.

(02:59)
The nice thing about geometry is that it’s very inexpensive. It’s 1%, it’s probably 0.7. The cost of your average photogrammetry product, you just don’t need the equipment. You already have it. It is also available. You can order it on our website today and you can have it tomorrow and you can start doing a case tomorrow afternoon if you wish. The benefits are, we think they far outweigh photogrammetry just from the simple fact that you don’t have to have the equipment, but you can make a model if you want to and you can have a physical record to extract to take out of the mouth to do some extra oral scanning. It is appropriate for day of surgery or restorative protocols. You can use it for robotics, you can use it for a guided surgery, freehand surgery, the yomi system, really just about any type of modality that you use for full arch surgeries. You can integrate geometry into this and you can achieve the same type of accuracy that you would from photogrammetry. Arguably, you can get a better result with a couple of methods that we’re going to show you.

Speaker 2 (04:09):
Let’s compare some accuracy. The case that you see in front of you was completed by Dr. Isaac Towel. The tooth part is from geometry. This was an intraoral scan of the geometry. OptiSplints all looted together with a medic scanner. The green or the blue-ish is from his icam and we brought bolt into the software. We did it for comparison reasons and we wanted to show the compelling accuracy of gram tree. So I’m going to kind of go slow here so you can see it with your eyes here that the two mesh blend almost perfectly together. And this is from an intraoral scan and today we’re going to talk about extraoral and intraoral. So if you can get this kind of precision in somebody’s mouth while they’re breathing on the camera, while there’s blood flowing during live surgery, then think of the, you can get with scanning the OptiSplint outside the mouth.

(05:20)
Pretty remarkable. The gram tree system and solution circles around the outy splint. The OptiSplint is a scan body. It’s extremely accurate. We’ve been working with scan bodies for two decades. The only way to make an implant restoration is with a scan body. There is no other method to make a custom abutment or a model or anything. And we have made as an industry millions and millions of cases with iOS and scan bodies. We know it works. There is no mystery here as far as that goes. And we’ve talked about it before already this it’s, it’s affordable, it’s applicable and it’s available. And with that, let’s let, let’s continue. The OptiSplint comes in a kit. It is set up for six implants, for a six implant surgery with screws. There’s special screws that’s important to know. Talk a little bit about that later. And it comes with these two frames.

(06:19)
These frames are for looting in the mouth. You’re basically making an IV J with a scan body that’s at its basic core. That’s what it is. And then the blue plugs, those are scannable analogs. Those are for restorative process when the time comes and the little blue ones in the middle are just handles to set the frames in. When you’re looting, that’s the kit. Now geometry is more than just a device and a scan body though the service around it, the road dental laboratory offers is the kit, the product, the actual physical product but also the design service. So if you’re at level three, four or five, you’re going to want design files and that is what we email you on the day of surgery or we email you as a restorative protocol to do try ins and prototypes and other options. We also have a printer verification component that we’ll show you. We work with a vendor and we will soon be selling scanners, lab scanners and you know, kind of have to decide if you want to go to that level or not. And then final file. So if you’re milling in-house, then you’ll want to have a final file.

Speaker 1 (07:34):
Our connection with doctors around the country, around the world is a digital connection these days. Yes, we still work with what we call level one, but there are five levels to the evolution of the dental practice of the dental industry and doctors and their practices fit in what we call the five different levels. We work a lot with level one, but they are not digital. They are analog acquisition level two. This is an entry point into geometry. This is where the doctor has an iOS scanner. They’re simply capturing the records, uploading them, we’re designing and fabricating the prosthesis and shipping it out to the doctor pretty quickly. Level three is the next step where a lot of photogrammetry doctors are and a lot of doctors want to get to right now immediately and it’s all available to you through geometry. That is when you can acquire, which is iOS, and you can also fabricate, which is print.

(08:30)
If you have a printer and we we’ve talked about that a little bit, which printers, if you have the printer, you’re a level three. If you want to take it to the next level, which is four, then you would purchase a lab scanner. Lab scanners are relatively inexpensive, especially compared to photogrammetry, but you also have a high utility. There are many things that you can digitize with a lab scanner. The geometry assembly, which is if you buy a scanner from us, you’re going to be at three to four microns. We sell one that’s a little bit further up, 5, 6, 7 microns, but you can be as close as three to four microns on your geometry and all the other things you want to put in the scanner. A denture a model. You want to make a splint, you want to put a scan body in with an impression for flipping it.

(09:19)
I mean all these things, there’s just a pile of things that you can put into a lab scanner. It’s what we do every day. And then there’s level five which we also support. There are some practices, lots of them out there now. There are, they’re gathering that have the ability to fabricate final restorations and in those cases sometimes the design part is the only hangup. We have a team of expert, full arch designers. We design everything but full arch and we can send you the file and you can mill in yours, Orcon mills or however you do your thing for your final restoration. We can provide the files for you. That’s level five. And this is the long-term integration of the dental office and the progressive contemporary dental laboratory like roe. Within

Speaker 2 (10:06):
The system we have certified four scanners. Now we can certify more, but they have to have a very high degree of accuracy and they have to be able to scan full arch and we have found that there can be challenges with that with some of the other scanners. Prime scan is, I don’t know, it’s argue out there. Is that the best one? It’s incredible. It really is, especially the way you can layer scans. The TRIOS is wonderful. Everybody knows about the trios. The medic allows you to stack multiple scans when needed. Study models, tissue scans, healing collar scans, optis, flint scans. It’ll stack it all up and it’s very intuitive and Dr. Dr T is going to show us a lot about that in the coming weeks. We have a nice partnership with Stroman. We’ve done a lot of test scanning with their scanner and it is extremely accurate. We used it to compare against lab scanners.

(10:58)
If you are in level two, then let’s go through real quick that level. That means that you are just acquiring scans. You have an iOS scan, you’re scanning the patient, scanning the opti blend, taking photographs, uploading, and then we are fabricating your prosthesis and we have a team here. It’s all they do all day, design, print, clean cure, beautify ship, and they are in the opinion of our customers the best. Now that’s level two. If you’re level three, then you have the printer. We are going to do all the design steps. We’re going to get the case all ready to go. We’re going to email you an S STL file. You will nest that STL file in your printer and off you go to printing, cleaning, curing, beautifying there. That has been our modality for about 95% of our cases during the past year. We recommend, I mean you’re going to require to have a printer that can print a final material.

(12:08)
The OnX tough that’s out now the flexera Luci tone, there are multiple materials out there. You want to have something that is really validated for full arch. You don’t want to get in trouble and not have a really ideal printer and resin for delivering these prosthetics. Level three also. Well, I mean since it includes printing, you’re going to want to make sure that your printer is accurate. We have been in these situations where the prosthesis comes out and it doesn’t fit and it is not from the records and it’s not from the design, it’s from the printer. And you can be off a millimeter if you just opened the box and started without validating. So the validation process is we sell this a simple device. It’s a stone cast with analogs that have been scanned with a three micron, three shaped scanner. We know that our file is accurate, it will fit if it’s printed properly.

(13:11)
You’re going and we’re going to send you the design file. This is for a desk screw. We can make it for different screws, the res, the Rosen, and even a few others. We don’t list them, but we can make it for several different screw companies and you will print and you will make sure that this fits on your model. On every single site you’re sitting passively, put a screw through it, do a one screw test, whatever you can to make sure that it’s correct. That will help. And you will know when you’re ready to go to surgery because that is passive level four. Level four means you have purchased a laboratory scanner. In our opinion, you should be somewhere between six and $15,000 in a scanner. The three 10 is a very affordable scanner and so are all of the shining 3D scanners. The five 10 gets a little bit more expensive.

(14:03)
Seven 10 a little more, but this is about micron level. Sorry, little bit reversed there. The five 10 is I think about a five to seven micron level and it is extremely accurate. We have this one here. We’ve been testing it. It’s really the level you want if you’re going to scan your OptiSplint and upload for a final restoration, not day of surgery, that’s optional, but for a final restoration at this point you’ll want a lab scanner or you’re just going to ship us the OptiSplint. We’ll get into that. We’ll, we’ll talk about the whole workflow. If you are milling finals, you probably already have a lab scanner, I’m sure that is where the OptiSplint comes out. We can design the prosthesis for you. If you don’t have designing capability or perhaps not that particular day, you upload the files to us, we send you the design file, you mill perfectly fine if you’re a level five.

Speaker 1 (14:57):
Let’s get into the modalities. The modalities are the different ways to integrate geometry into the full arch surgical workflow and we’re going to talk about a few. The first one, which is screws and tads, that’s the same type of process that you would use for photogrammetry, the same type sort of, and I think you’re going to like the twist. The other would be a guide where we go through the whole process of guided surgery planning for full arch where we are putting teeth in the right place. We’re designing and planning implants where they should be according to future tooth position. We’re measuring vertical space. We’re going through the whole process to make sure that the patient is set up for long-term success with prosthetic thickness, implant placement, implant rotation, all the things you really want to have for an effective implant surgery. And then there’s the tooth, tooth suppo, well not tooth support tooth is the reference.

(15:53)
The teeth stay in the mouth, some teeth and that is the vertical reference to before and after and then dentures, which is a very common way to do it either using an immediate denture, patient’s existing denture. And then the last one is a dynamic, dynamic surgery. We’re not going to talk about that, but I wanted to put it in the list here because if you are involved in robotics or GPS or any type of navigation, this can be plugged right into it. So the first one we’re going to discuss is the screws tads, the arch tracers, which is part of the geometry process if you choose to go that route. And then we’ll continue with the others

Speaker 2 (16:30):
Screws or OptiSplint, arch tracers as we call ’em. This modality is very, very familiar in the marketplace. If you’ve been involved in photogrammetry, if you’ve used a digital protocol to make restorations, so in this protocol you will place screws somewhere in the mouth or the geometry arch tracers. You can see these here. We’ll have another image of it coming up in a minute. But the key here is that this is the beginning of surgery. In this case it’s flapped. Over here on the right, the arch tracers, you have to flap first to set these screws. You just place them here in the retromolar pads or you place them back in the pallet or just beyond where the suturing is going to be, where the flap is going to be or down in the pallet. And those screws remain in the surgery during, in the mouth during the entire surgery.

(17:25)
That is key to saving the bite. All right, this is prior to digital impressions being captured with the bite. Now these screws can be purchased from a couple different companies. Salvin sells a nice screw with a big head osteogenic. Both these companies sell really good kits with all kinds of lengths. If you’re going to purchase our geometry arch tracers, then you’re going to want to purchase a 10 to 12 millimeter long screw. Those are available through either one of these companies. The head needs to be wider than two millimeters. We will be inventorying a screw soon that we can include along with the arch tracer, but for now, 10 to 12 millimeters on the day of surgery at a minimum, if we’re printing at a minimum, you’ll need a kit. You’ll need the OptiSplint kit. You’ll need what we are recommending is a stellar material and you want to purchase the white, not the pink.

(18:19)
You want to purchase a white because scanners pick up white better than pink. You’ll need need some other things. But for the OptiSplint portion of it, some forceps, a curing light, and really what you see here on the screen is what you need. And then of course if you’re going to print, you need a printer, but this is just to do the interoral capture. Those are the simple tools. Now this is where we turn what everybody in the marketplace has learned on its head. This is where the car can fly in a surgery. What you’re going to do for a surgical case is you’re going to place the three screws. You decide upper, lower pallet, distal you’ll, you’ll place the screws and you’re going to scan the upper, lower and the bite. Okay? The bite in centric is what’s normal. Normally comes over. We can open the bite in software a little bit, a couple millimeters, a few millimeters.

(19:23)
If you want to do a leaf gauge or a centric relation bite and you can capture that, that’s fine. Otherwise we’ll open the bite. All right, so screws are in, patient is scanned. Now you go through the entire surgery all the way until you have the multi-unit abutments in the mouth and you perform the OptiSplint, looting in the mouth. We’ll discuss that. But what I really want to convey here is that these are the three symbol records. You’re going to scan the full arch. You’re going to capture the healing colors in sutured tissue with the screws, and those are the two intraoral scans. And your patient is done. The extraoral scan will be of the OptiSplint on a bench under a controlled environment with your iOS scanner. You don’t have patient breath, you don’t have blood moving, you don’t have sutures, you don’t have anything.

(20:23)
You don’t have going on behind it or under it. That’s going to throw off the scanner. You’re going to have a pure scan on the bench top. That is where the precision comes in that nobody else offers. You cannot do this with photogrammetry. You cannot do this with looting. A bunch of scan bodies together, right? A bunch of healing collars together. It’s just not feasible. So this comes out of the mouth and you scan it and this is what you upload. Let’s go through a case. Patient is ready for surgery, full face, full smile picture. Now maybe they’re a little nervous on the day of surgery, so maybe you took this picture last week. Full face, full smile. We want the soft tissue. Want the lips? You want the eyes, you want the whole, we want the patient experience. We want the patient anatomy. So get us a nice photograph.

(21:11)
We were going to design this case behind the lips. Then put the screws in. Put the screws in and scan. Now I’m going to give you a little different option here that is being taught in a lot of these courses the week before, two weeks before the patient comes in, scan the upper, scan, the lower. We will design you a smile. We can give you some idea of bone reduction levels if you’d like. We can give you tooth position. We can really help set the case up for success because this patient came for aesthetics and this patient only has five teeth left. So let’s do a setup. Let’s make things ideal. Then on the day of surgery, when the patient comes in, scan, okay, and you’re going to scan with the screws. Upper, lower bite, it’s go time, go through the surgery, teeth come out, bone is adjusted.

(22:07)
Implants go in. Multi-unit abutments go in, and then at that point you are going to complete the OptiSplint intraoral process. You’re going to put an opti on each of the multi-unit abutments. You’re going to insert the honeycomb frame, you’re going to loot them all together. You’re going to remove it and you’re going to put another bench top. That is the simple process of capturing the implant position. We have the implant positions. We do not need to relate this back to the bite or the tissue or anything in an intraoral scan. The next step will be to scan the patient and pick up the healing collars and the screws just like the image there on the left. Okay, scan away. When you scan, you’re going to make sure you always pick up the screws or we lose the bite, okay? The screws will bring us back to the original scan.

(23:05)
If your scanner is struggling, if you’re struggling that particular day with capturing this, be prepared with a stock tray and a lot of impression material and pick it up. See back here, there’s two screws, four screws. This is Dr. Charles, Dr. Jermaine Charles, a friend of ours who completes these cases. He has four screws back here and he does four because in his long experience of doing these cases, he found that tripod was better with two instead of it went four instead of two. You will take this out of the mouth and you will take an iOS scan of the impression. And now we have the implant positions, we have the screws. We can bring this back into the original scan of the patient and then we can bring in the OptiSplint. So this is a matter of stacking files and we are very good at it and we have a very precise method for stacking these files together.

(24:03)
But think of the simplicity you have here, right? You do a simple I vj, simple, I vj take it out of the mouth quick, put the healing collars in and suture around. The patient is almost done at this point, take a PPVs or take an iOS. Patient’s done. That’s it. Patient goes home or patient goes and relaxes while we get the case ready. The healing collars in our system. There are many available and we will add more as we move along. But as long as you have one of these, then you’ll let us know which one they are in the rx. Then we are integrated with OptiSplint. Tell us which one and you’re good to go if you don’t have the healing collars. For some reason you don’t have healing collars on the day of surgery. There’s some other reason that you want to scan the OptiSplint in the mouth.

(24:55)
That’s fine. That’s how the product has been used for the past year in the mouth. Let me just go quickly go through this. OptiSplint is in, it’s been all looted together. You will clean off the screws. These are the palatal screws. Clean ’em off to make sure there’s no dried blood or anything, obscuring ’em. Okay? It’s all ready to go. Use your scanner scan. Now when you scan with an opti blend in the mouth or outside the mouth, you start in the middle and you scan the full area. You’ll see this is pink. Okay, we have changed to white, they both work, but white’s a little bit easier to scan. So you scan this area, scan the whole main plate, the main area of the OptiSplint. In this case, this was this a really nice scanner, the prime scan, so the doctor actually grabbed the screws there as well.

(25:45)
But once you scan the main area, then you start to come out, lemme show you here. Then you come out to a scan body and then you go back to the original area. Now in this case you’ll see they’re going to come back and then they’re going to go out to another one like this and then they’ll go back to the center, right? Go back to the center and just keep picking ’em all up. Now you’ll see in the rest of this video protocol was not perfectly followed. You see they went around to the labial and they captured a little bit of tissue, a little bit of bone area there. That’s where you can get some inaccuracy with intra oral scans. We don’t want any of those scans. We only want the OptiSplint. Okay, so I’m showing you a little bit here of what not to do.

(26:33)
Okay? Scan this, go out to each arm, out to each OptiSplint and come back and forth, back and forth until you have it, okay? And pick up the screws. All right? That is the intraoral process for scanning the OptiSplint. And when you do do it that method, then you have the option of scanning the scanning, the OptiSplint outside the mouth again, okay, you can scan it twice, but when you scan the OptiSplint in the mouth, then you also want to perform this scan here with the healing collars. Alright, so just let’s do a real quick recap. Photographs, day of or before, set up before if you wish, or as you can see here, this case here, this is all day of surgery records. Scan the patient before with the screws. Okay? Scan the patient after with the healing collars and the screws again to match the OptiSplint outside the mouth.

(27:34)
That is how this case is completed. If you scan the OptiSplint in the mouth, perfectly fine. Just also scan this and then because we like the accuracy scan, the OptiSplint outside the mouth again. But what you see on this screen is what you’re going to send these files in a folder on our website. You’ll upload. That’s it. Please call us to discuss any of this. Once we have the records, we will design your case. All right, there’s the screws. We have the case articulated with the screws. We have the case articulated. Now with the optis flint based on the screws, you can see ’em down here. That was our alignment. And then we quickly work with the geometries, design the prosthesis, and then we ship it to you ready to go. Coping free direct to multi-unit abutment, extreme precision.

(28:34)
Boom. Go to print. Now, because this is OptiSplint, you have the ability if you wish to make a model and with the model, if you want to have copings, put the copings on the multi-unit abutment analogs, seat the prosthesis down onto them and lut them together if you want. Want to have copings. If you don’t want to have copings, perfectly fine. That’s how most of our cases are done. If you do want to have copings, let us know. We’re going to design these interfaces a little bit differently here, but at this point all you have to do is nest print, clean, beautify seat, very smooth, accurate workflow. The next modality is the combi guide where we really set the case up for success. Let’s go through that whole protocol. Combi guide is in our opinion, the ideal way to go through a geometry case with combi guide.

(29:28)
We work with you to determine a prosthetic thickness, implant placement position, depth rotation, et cetera. Everything. This is part of our chrome guided SMILE system, but in this case it’s just osteotomy placement and bone reduction leveling. And the metal, as you’ll see, serves as the constant. We’ll kind of go through that. How do you start one of these cases? This would be just like any guided surgery case. You would start with rodent lab, cone beam, teeth apart, iOS scans, upper, lower in occlusion and photographs. This was a case completed by Dr. Grant Olson, one of our KOLs, our key KOLs for Chrome guided smile. And he was nice enough to share this nice workflow with us. So thank you very much for that. Dr. Olson, this image here, this is a case being planned. So we took all the records, we designed the case, got it ready for the online meeting.

(30:30)
We met Dr. Olson online, planned the implants, planned everything about the case. And then based on that we fabricated the pin guide, the fixation based osteotomy guide, and off he went to surgery and repeat on the slide. These are the tools you need. And then with a combi guide, let’s go through the process. So we already have pre-surgical files. You uploaded those to us to make the surgical guide, so you don’t need to scan. We already have these at the laboratory. All right, step one, the pin guide. This patient has already been reflected above the metal. Okay, so full labial reflection pin guide goes in seats the fixation base. Once the fixation base is seated, you will capture a labial digital impression of this and you’ll capture just the teeth, the bone, and the fixation base. If you find there’s an issue with this, you can always put screws in the pallet, the retromolar pads, wherever. Let, let’s not worry about that. We know this works. Okay, that’s your first scan. Now once it’s digitized, teeth come out, bone is leveled down to the fixation base. We carefully plan this as the bone reduction level.

(31:49)
And I put this in here just as the reminder before with teeth after teeth. The constant is the fixation base. This is the tad, this is the screw. This is everything you need to preserve the bite. Next step, osteotomy goes in, implants are in, multi-units are placed, and now we have even a better, even a better constant. Okay? Something easy to scan. Now the teeth are gone, which is the carrier guide. The carrier guide sits on the fixation base. This is the night trans transition for digitally acquiring from the OptiSplint or from the healing collar out to the fixation base. So you would scan this platform, not all of it, just some of it. And this won’t be in a clear color. It’ll, it’ll have some texture to it when it arrives and you scan it very scannable, you’re not scanning blood and movement underneath.

(32:42)
So kind of skipping back and forth here between live surgery and visualization here, but at this point you have an option. When this is in the mouth, you can put healing collars on this, put healing collars, put the carrier guide and scan away. And then you’ve captured, all right, the position that’s not for implant placement. This is not for componentry. This is only for preserving the bite and transitioning back. Okay, now you have an option here. You can either scan the OptiSplint in the mouth or you can scan the healing collars. You have a choice, whichever one you want to do both work. And at that point you’re finished. And this is all that’s uploaded to the right of the green bar because the left of the green bar, we already have this scan. This is what we used as mentioned before for the planning of the guide.

(33:33)
So this is 1, 2, 3, scanning the file of the fixation base in a teeth, the file of the fixation base superior guide and the healing collars, and then a scan of the OptiSplint outside the mouth, either with an iOS or with a lab scanner. Totally optional. This is totally optional. I’m throwing this in there because if you have a lab scanner, you can go to whatever degree you want to go to a finals or COA at any point. Now this image here could be on top of here, perfectly fine, scan it in the mouth, but as we know, we want to keep adding more and more accuracy. So these will be the three scans that you upload. Dr. Taran Agarwal completed a case last week and he is one of our KOLs as well for this process. If you know T-Bone, his experience, he is on the top tier. He is our kol, one of our KOLs for chrome, for chrome guided smile, for combi guide for lots of things. And he is going through this process with us with geometry. He’s adopted geometry. In fact, you’ll see on the last slide, we are having a two day event with him and his partner in two different locations teaching this protocol. Talk about that. Okay? Thank you very much for documenting this case.

(34:56)
Let’s just real quickly, let’s cover what he did. Okay? We went through the whole process of designing the guide, all those first stages and we’ll go through all that. But in surgery, once he set the fixation base, he took out his prime scanner, he scanned the fixation base, scanned the teeth to preserve the bite, right to PR so that we have the tooth position, we have the fixation base. And then he went through the whole process, the whole surgery, put the off these splints in, glued ’em together, scanned again with his scanner, look at the beautiful scans that scanner takes. It’s really incredible. It’s really one of the best out there. And those were the two scans that he needed. That’s it. Now I know we’re going to teach an extra oral scan moving forward, but this is how he did it. A high degree of accuracy, and this is what he sent us on the day of surgery, full face, full smile, left and right images.

(35:52)
Now of course, we already had these because we worked out the whole combi guide. So everything on the left we already had. And on the right is what’s uploaded on the day of surgery, the STLs. All right, and based on that and his lovely photograph, we designed the prosthesis behind the lips within the smile. All right? That’s almost mandatory at at this phase. And let’s just go through this to the layers. So we have a prosthe already designed, but here we are. That’s middle of surgery, picking up the fixation base and the teeth scanning the OptiSplint in the mouth, bringing it together with the opposing because we have the fixation base and designing the prosthesis. Okay? Very important. Now let me just to clarify, in case you’re just for protocol, when he scans this here, this scan, this scan also includes the bite, right?

(36:54)
We want the opposing teeth. Now do we to don’t necessarily have to because we have this scan at the laboratory and we can follow this bite registration that we’ve already made. So it’s an optional scan. You can take a bite registration and surgery. Not always the easiest thing to do, but that’s an option, okay? Bite or no bite during surgery. The third modality that we’re going to talk about today, because there are others of course, is the tooth or teeth reference. And this is where some of the teeth stay in the mouth to maintain the vertical reference as you complete the surgery. When you have a tooth reference case, what that means is that patient’s, some of the patient’s existing teeth are going to provide the before and after bite. So this is a pretty straightforward way to complete these cases. Now, this patient is not with these photos, but I just wanted to show an example of what a full smile, full face and then an exaggerated smile should be for these, I mean, this is an aesthetic anterior aesthetic zone case.

(37:53)
We want to see an exaggerated smile, so there’s no surprises cases with Dr. Solly Sullivan. You’ll see on the last slide, he is, he’s one of our KOLs on geometry. He has a course as well in Nashville today, the full Monty on geometry. You’re going to love it. Totally worth your time and the cost totally worth it. So he completed this case a few weeks ago. As you can see, the teeth are circled here. They are the constant, and that means that I’m kind of skipping ahead here, but just imagine that the patient started this way, so there’s no extraction, there’s no bone leveling. Implants go in, OptiSplints, go in, lut ’em together. In this case, they were, you see looted together here, use some composite. Composite works. No, no, no problem there. It’s also white, easy to scan. We like stellar. We like the quick light curability of it, the flowability of it, but it’s optional.

(38:51)
It was all cured in the mouth. And because there are teeth in here, it might just be good enough to just scan this in the mouth, include the teeth, take it out, move on. If you want to put healing collars in here, then that is an additional scan and you can scan that in the mouth and then you would scan the alti splint outside the mouth, which is really what we’re teaching is our protocol. Extra oral scanning of the implants, right? A unique protocol in the industry and the records are very simple. In this case, we’re going to have a four with the teeth, we know it’s the vertical. We have the photographs, and then here you really have the option. Do you want to scan it in the mouth or do you want to scan it extra orally or scan Both? Scan it in the mouth.

(39:35)
You can even scan around here carefully to pick up the tissue, and then you can scan it outside the mouth. We will not be too concerned about the lingual tissue of these cases. You can even suture around this to pick it up and then upload these files. Very simple. And then we will design. All right, so this is not a little more traditional scan body type surgery. You, you’ve seen this done a lot with regular scan bodies, but iOS scanners do not pick it up perfectly in a bloody environment picking up between regular scan bodies, they just don’t. And with this process, with the extra oral scan, it will be dead on. And then the final modality for today is the denture reference. This is something that is commonly used either in an immediate situation, right, media denture or in an existing case, patient has a denture.

(40:30)
Go right into surgery and use this as the record for the bite, the teeth, the tooth position. Really, that’s a nice way to set yourself up for success for these cases, especially restoratively. A patient can either have an existing denture or you make an immediate, we can design them, you can print them, we can design ’em and print ’em and ship ’em to you any way you like. No problem. We can also make you beautiful finished dentures. The patient can wear if you’re not going to deliver that same day or maybe even the next day. So there’s options there. Okay? Patient comes in, you have a denture that you’re going to use as the reference. That is your reference for the scan, the healing collars, the bite, the teeth, the two position, the vertical, everything. All right? Let’s go through a surgery, go through the normal process, whatever your process is, guided unguided, freehand, put the implants in, put the multi-unit abutments in.

(41:25)
Then you will pick up the OptiSplint in the mouth. Pick it up. Do not scan this in the mouth. There’s no need to take this out. You’ll scan it on the bench. Okay? Then you put in your healing collars. You’ll see these, he healing collars. There are some I cams, it’s part of the library. It’s fine. You can use them. You will scan. You’ll scan these. You will not scan these in the mouth. You won’t need to. That’s a tough scan, okay? It’s, it’s optional, but really what we want is all in one scan and in that situation you will load both dentures with impression material, okay? And you will seat them because this is really what we want. This gives us everything in one scan, so the upper is already in. Just simply load the denture with material, seat it and close and hold in position.

(42:21)
Now here’s the trick. This is very important. You want to try that denture in those dentures in prior to loading them with impression material. These dentures cannot rest on top of those healing collars. Okay? These healing collars are kind of tall. They’re very tall, so you probably want to use a lower profile healing collar for this process, but you do not want any burn through of the healing collars. These must be entirely in wash material. Otherwise, the denture is tipping on one or more of the healing collars and you’re not getting the proper bite. So do a wash impression. Right? Now you notice there is no screws or tads, we don’t need ’em. This is going to be an iOS impression of the healing collars outside the mouth in the denture. Alright? You’ve captured upper, lower next step scan the denture 360 scan, both of them, okay?

(43:16)
What we end up with is this. Now, you should also scan the denture outside the mouth, so you’re going to scan the upper lower. We don’t need any intraoral scans of the denture. Take ’em out. Scan one at a time, upper lower, scan the in tago scan the in tago, hold it in your hand, scan the bite. Yep, upload based on that. All right. You’re going to upload that, sorry. You’re going to upload that along with the OptiSplint scans out. Now you see these are intraoral scans. We don’t want them intraoral want them extraoral for the accuracy. Okay? This is what you upload. 1, 2, 3, 4, basically three files because these will all be in one event, and then the other event will be the OptiSplint upload that we make you a prosthesis. All right? Here are the records based on that, and those copings are just for visuals, just to show you how we have aligned the parts, and then we design your prosthesis, ship it to you to print.

(44:18)
There are no copings. That’s just a nice little pretty visual coping free, or as we mentioned before, make some models and make copings. No problem. Totally up to you on our website for all these things we just talked about, you’re going to upload it onto our portal. You’ll log in, it’s row dental lab.com. Up at the top of the screen it says, submit your case and in here you’re going to pick geometry. See the product here, you’ll have a dropdown. This is how fast you want it. This is which archer arches, what are we doing with? Where are the photographs? Which screw are you going to use, which healing collar, and then give us some instruction about the setup. You’ll drag and drop your STL files into this folder here and upload ’em, and off we go. We have a bookings page, which I’ll reference here in just a minute, and this’ll be a link so that you can pre-book your surgery. We don’t want any surprises. We want to know when you’re going to be in surgery, so you’ll let us know. Okay? We’ll get to that there at the very end. This is where you upload your files,

Speaker 1 (45:21):
And then finally the protocol to work towards the final restoration. We have hundreds and hundreds of these cases out in the world walking around, and at some point they’re going to transition to a final zicon, maybe a final titanium bar with zicon over the top. Different ways to make final restorations, but really today is the go-to is zicon, and with these protocols, with these digital protocols, we can make them coping free, right? The Prosa Bridge, or if you want to have copings for multiple reasons, they’re available with this system. If you want to still use the more of a protonic approach, face bow articulation, mounting, ex exclusive movements, all the things that you would go through for a final restoration, it’s available with geometry. It is not available with photogrammetry. It isn’t. You would have to use some type of analog record with photogrammetry to get all this on an articulator, but with geometry, the OptiSplint comes out of the mouth, it goes on analogs, it goes on a model. We make a restoration. We articulate. That’s possible, and in a lot of people’s opinion that is necessary, so we have a method for both.

Speaker 2 (46:42):
The first protocol, this is where you want high precision scanning for a final restoration, and in this case, I want to thank Dr. T, Dr. Isaac T. He’s been a long-term KOL for us as we roll out these incredible products, so thank you very much for documenting this case, Dr. T. This was a case. I’m going to show the whole workflow in a minute, but this was the final protocol for a final restoration, this sac, chrome natural originally, and the final steps, so what do you capture? You capture the prosthesis in the mouth, okay? The teeth, little bit of the tissue. That way you capture all the next, you capture the opposing, you capture the bite, all right? Now, while the prosthesis is out of the mouth with some scanners, if you start to scan the labial or the buckle of this or even the occlusal and you start to roll around to the in tago, it’ll start to erase this tissue.

(47:35)
If your system will do that, if you find that that works really well, then just keep scanning outside the mouth. After you put in these geometry of scannable analogs here, just plug them in. They’re plastic, you plug them in. This isn’t for precision implant position. This is just to maintain the bite. Scan a 360 until you see it floating on your screen. It is. It now has the opposing bite. It has all these scans all tied together and then wallets out of the mouth. Scan the tissue in the multi-unit abutments. All right? This gives us a tissue position and it that way we don’t rely unnecessarily on an tago of the prosthesis. For design, we rely on the sulcus and the tissue contours, and this is what you upload. The OptiSplint is put in a box and it’s sent to us. Go to the top of our website, print a UPS label, ship it.

(48:23)
We pay for it. It’ll be here in a couple of days off. We go to a final or a prototype. You can print the prototype in your office and we can make it for you. Okay? Simple as that. That’s the process for a final. Now, if you have a lab scanner, you can do all of this in your office and upload the files. Follow, just follow exactly what we just talked about for the process. While this is outside the mouth, you can put this in the scanner and scan it for some precision. 360, very handy you can, and then you put the OptiSplint in the scanner and you scan it. Okay? This is a medic five, 10 or seven 10, either one, and it is about a 17 second scan for each side to give you a just about a perfect stl, five microns, incredible. Upload all those files. We go to prototype or we go to final. Up to you. Let’s quickly go through what we just discussed.

(49:19)
Okay? Scan the prosthesis. Scan the prosthesis in the mouth. Pick up a little bit of the tissue. All right. Simple process, very easy. Scan the opposing. Kind of go through this kind of quickly because it’s kind of obvious. Then you scan the bite, just what we talked about. Now, you take the OptiSplint, take the OptiSplint, and you use the kit. The kit will have these little scan bodies inside of it. Plug one into each implant, into each, sorry, temp cylinder, and then continue scanning. Now, watch the screen on the left. As you roll around to the labial lingual, you’re going to start to erase the tissue. See how it all disappears because these scanners are smart. Now we have the prosthesis on the screen, but we also have it in. He’s just doing a little touch up there. We also have it with the bite and the opposing. Now, put the OptiSplints on the scanner in the mouth in the patient. This video

Speaker 1 (50:26):
Will be available on our website on the by itself and in the program. Screw them down, add some material to the horizontal wings. Place the frame. Loot the frame to the lins. Remember, this is in the mouth, and then you scan. Now, with this, you can scan the mouth, but really you want to scan it outside the mouth like we’ve been talking about. Okay, scan it and you noticed the protocol here. You scan the honeycomb and then you come out and scan each one of the wings alone like that, and then you’re done. You take it off.

(51:06)
Well, it’s already outside the mouth. You could scan the antalia. You don’t need to. That’s an option, but at this point, you would take it and you would ship it to us, or you would put it in your lab scanner and you’d be done. Thank you so much for joining us today. We hope that this opened your eyes, opened your mind to another way. What we think is at today, the best way to go through a digital workflow. Are we biased? Maybe a little bit, but I think we’ve proven that I, in an ideal environment with technology that you already have, geometry is the way to go. It’s much less expensive, which is important. Let’s face it. It’s important. It has all the benefits of photogrammetry and an analog method. You pick whichever one you want to do, and it starts today. There’s no waiting.

(51:58)
It meets you where you are. As we discuss wherever you are in the evolution of digital dentistry, we’ll meet you there, and we have a team. I would have a challenge to rival anyone in the country, maybe in the world for full arch design technology. We have an entire team. It’s all they do. It’s all they’ve been doing, and we plug you into that team, and we are friendly, we’re supportive. We take your call. We are a full-time support group. We have a open Facebook group where we are going to be posting cases as often as possible with the current modality, and then every single new modality. Every time we talk about this, it improves, and we’re going to share all that with you so that you can learn it in the Facebook group so that you can apply it tomorrow. You don’t have to go and take a course in order to learn this.

(52:51)
Not really, especially if you’re already into this technology. You don’t really need a course to do it, but if you want to go to a chorus, and we highly encourage it. If you’re entering this arena or if you’re changing modalities or you’ve been doing this and you’re curious about that, we have a couple of excellent programs coming up. We partnered with 3D dentists with Dr. Tara Agarwal and Dr. Sully Sullivan have two programs coming up. We hope you will sign up for them. In fact, if you use the code three D G R A M, you can have a nice discount on signing up. One is March 9th, the 10th in Raleigh. That is at T-Bones. Huge beautiful institute live. This will be live patient surgery and the whole workflow start to finish. How do you plug geometry into your practice? Go take this course, and the other course is with Dr. Sullivan. Same thing, plugging you into photogrammetry. Start to finish live patient printing, designing, seating, the whole thing. So if you click on this QR code, you’ll see our resources online. I think you’ll be impressed. This is for ordering, for booking, for scheduling, for learning. Everything you want to know about Gram Tree is on that link, so thank you again. I hope we opened your mind up to what we think is the best. Have a great day.

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