Grammetry III Introduction to Grammetry – The IOS alternative to Photogrammetry

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Hello, everyone. thank you so much for joining us on this program for a very impactful product. My name is Alan Banks. I work for ROE Dental Laboratory, and, been working for ROE for about 22 years in several different capacities. We’re a big happy family and a fairly, mid-size, larger laboratory and our passion is for pushing the envelope, you know, the fundamentals of, dental technology, but adding the digital component that really today’s market demands, and perfection demands. Today’s program is on Grammetry, what we call the barrier breaking, record taking product. Grammetry has been in the market for a little over a year, was in beta for a year before that. And it’s really a remarkable, service, remarkable product. Grammetry for us, for our dental laboratory is a whole service.

And I’ll talk about the service in this program, but really it centers around, at this point it centers around a particular scan body that you lute in the mouth. And, so we’re going to talk primarily about that and the service around it. So, the first part, I have two parts of this program. Part one is grammetry. What is it? How does it work? Why does it work? so I really want to educate on the product itself and the part of the market that it serves because, until recently, you know, the only way to make a perfect model, a virtual model was to take a physical model and put it in a lab scanner, right? And then photogrammetry came along, a number of years ago and the laboratory industry helped it become a product, which is scanning these dominoes in the mouth.

And then you have a digital representation of the implant while the multi-unit abutment positions, and implant in some instances. But really, it puts the multi-unit abutment in space, and then the laboratory or specific software ties it back to the patient, right? Because the little scan bodies here give you a position and space of the five or six or eight implants, but you have to have to bring it back to a patient. And that’s what the laboratory and software does after you do this capture. But, you know, the real dilemma, or we could call it the problem statement with this very accurate way of capturing implant positions. The problem statement is that it’s expensive, right? Expensive and the utility is low. So it’s a hot topic. There’s, as of right now, there’s about, there’s a couple thousand of these in the states, between the three different systems.

Imetric, Pic and the Micron Mapper, which I don’t have imaged here. Between those three, there’s just a couple hundred system, a couple thousand systems, because they’re anywhere from $30 to $55,000 to purchase. And I’m not even sure that there are $30,000 ones. It might be $35. And then there’s training, and then you have to order the new scan bodies every certain number of scans. And really the utility is low. And so I don’t like to pick on the product too much because it’s definitely a working viable solution. I mean we work with this technology every day, works very well. But as you can see here it’s cost prohibitive, limited availability, right? They’re generally on back order, hard to get. There is some continuous upkeep with purchasing new scan bodies.

The mobility is a little bit of a hindrance too, right? These are bulky and heavy and you have to oscillate them around the head or leave them stable and move the patient’s head around them In surgery. Bit of a learning curve. The softwares are not terribly simple to use. Again, I don’t want to pick on it, it’s just a little, the software will catch up and it’ll be a great software, I’m sure sometime soon. But really the utility is the difficult part, the challenging part, right? You spend $45-$50,000 on a piece of equipment and does one thing. It captures a multi-unit abutment position, right? So if you do a lot of these kinds of surgeries, then maybe the utility is there. Maybe, maybe it’s a good thing to look at. So grammetry offers a different solution, right?

A different way to get to the quote unquote perfect model. the perfect position of the multi-unit abutments, and I’ll have some images of what grammetry is, but grammetry is basically a scan body that you screw onto multi-units. You luted together in the mouth, you scan it extra orally with your iOS scanner. And based on that you can make a resin prosthesis, and then you use it physically to make a final restoration. Of course, we’ll go through all that. But it allows, you know, micron level accuracy. It works with all different workflows, you know: freehand, guided surgery, navigation. It’s appropriate for day of surgery or for restorative protocols, either one and it really benefits practices because it meets a lot, doctors where they are, right? Whether they just have iOS, whether they have milling capabilities, whether they’re designing capabilities, anywhere along the development of the practice this fits into with, with 1% the cost of a photogrammetry device.

And it’s available today, you can order it, you know, online now. And so what does it do? It gives you the position of the, the aqua color, the green color, analogs so that we can build something on top. And this is a, just because we’re talking about these two different systems right now, grammetry and photogrammetry. The green as you, the green is photogrammetry, and this is a grammetry prosthesis designed on it. And you can see a little sliver here is a difference. Not much, sub micron, I mean low micron variance, right? Very, very accurate service. And we’d like to compare it to photogrammetry because, ultimately photogrammetry is taken as at the micron level in the mouth, directly from a multi-unit abutment, right?

So we know that, especially based on their claims and their studies that, you know, 10 microns, 15 microns, maybe sometimes a little bit less, but you are talking about, you know, 5, 6, 7, 8 implants. So you have that, that, discrepancy when you have multiple implants. But we do know that photogrammetry capture is very low, and it doesn’t have the variables of the normal process: stone, PVS, Duralay, shrinkage, humidity, people, right? It removes almost all those issues that you can use, that you’re, you know, stacking all the variables to make, to make inaccuracies. You’re going right from multi-unit into a virtual world. So we know photogrammetry at least eliminates a lot of the error for that reason. Well, our contention is that the grammetry does a lot of the same, right? Because you are taking what you see here, which is a grammetry scan body.

You’re screwing it directly to the multi-unit abutment, you’re luting it passively in the mouth, and then you’re, and then you are, scanning it with an iOS for a resin prosthesis, which has worked brilliantly. And then you either put it in your lab scanner or you ship it to the lab. And then this is a scan body, right? So it’s direct, right? Then you can pour a model, you can use it to put copings in your prosthesis, a couple different uses of it, but you can put this right into your scanner. And then you’re really kind of direct, right to multi-unit. So you scan it with your iOS. It’s, like I said, it’s one of the reasons you get into this. It’s affordable. It’s available for all Nobel compatible multi-unit abutments, and there are lots of them. And then, and you can start right away probably with the equipment that you have, because you probably have an iOS scanner if you’re listening to this program.

So when you buy a Grammetry OptiSplint, OptiSplint is the scan body. But when you buy the Grammetry kit, this is what comes with the kit. You have scan bodies, we have kits with four, five, or six, depending on how many implants you’re working with, the particular special screws, right? We’ll talk about the screws a little bit more later. These plugs that go into a prosthesis for restorative, and then these frames that are luted to the scan bodies when you are in the mouth. Basically, this is what’s tying them all together. Alright? So that is the Grammetry kit.

The service around Grammetry is the, the scan body, our design services to send you files or for us to fabricate here at the laboratory, we have printer verification with a special calibration device that we developed. We support laboratory scanners. We even sell a scanner now. And then final files, right? So just kind of depending on where you are in the spectrum of the digital evolution, we can support you and we can help you grow and evolve into the next level. Primarily today most offices are at this level, level two, they just have iOS scanners and the laboratory does the design work and the laboratory prints. That’s a level two. And this is taken years to get, you know, most offices to this level. It’s about 65% of the market now that has iOS scanners, and then a far less number of offices also have the ability to print in office.

That’s really where this product can shine for quick turnaround time and cost savings, so that’s a level three. A level four is a doctor can print, and they are able to capture at a micron level, which means they have a lab scanner, okay? So the lab is still designing, but the dental office is able to prevent, you know, or avoid shipping any type of materials to the lab because they’re able to scan everything as a lab does. And then level five is manufacturing, right? So an office is equipped to manufacture all the files that we send. So let’s go through Grammetry, since we want to really explain the workflows, now that we kind of know what grammetry is. We want to go through some of the workflows.

And there are, there’s some creative things you can do with the system, right? But for the most part, these are the modalities. And that is using a tad or a screw or using a combiguide or using teeth or a denture as a reference or robotics. So you’ll understand all of this more as we go through each of these scenarios. Whenever you go through one of these processes during the surgery where this is a surgical workflow, right? When you go through the process, you have to preserve the bite, okay? because in surgery, the patient loses their teeth, and you need to have records before surgery and records after surgery that maintain the bite. Now, how do you do that when the teeth are gone? Well, let’s go through that process. So the first modality is, probably the most popular one.

And that is where a doctor will use these screws. Screws or tads. There’s different terminology. We also call them fiducial markers. But the idea is that these markers are in the mouth before surgery. They’re also in the mouth after surgery. Now, you can see there’s a lot here, right? I’ve seen cases where the doctor just uses one in the palate. But really to dial in the bite and to preserve the bite, I mean, preserve the bite, sorry, is you have multiple, and maybe that’s three right here in the pallet. Maybe it’s two in the palate. but the markers or the fiducial markers are placed and it’s captured, right? You have to capture that position before the teeth are extracted and the bone is leveled, or however the, whatever the surgery’s going to be. And then you capture these after, right?

So now you have a before and after, just like you have teeth in a regular type of situation, right? Instead, these kind of replace the teeth as the bite, okay? You’ll kind of see more as we go through. Now, these screws or tads they can be purchased from several different companies out there. You know these are three, don’t really sell these too many because it’s on a facial. So probably just kind of avoid this image here. You want to purchase a screw, which would be a short, wide one from Salvin, which is nice. Or if you already have the Osteogenic Pro kit, the profix kit, you can use this as well. So that’s the screw head that we use. And we will also have a little spacer a little bit later in the program that you can place under these that keep them elevated above the tissue and help with scanning.

All right? So you have to have some screws if you’re going to use that modality. And then really, you just need the OptiSplint kit. You need some material to loot, which you can use composite, but composite’s a little brittle. And, and it can come apart if it’s not used perfectly. So we really like this Atellar material. It’s, basically a non-shrink acrylic. You should have just a pair of forceps just for delivering this, this to the mouth. The frame, they have a little frame here, but sometimes these break. So I have those. And a curing light, that’s about all you need some luting materials they need a driver for to put the screw in. But what you need chairside is very limited to perform the luting process.

So this is just a little summary because we’re going to go into the details. But these are the three scans that you take during a surgery, during the day of surgery. So you put the screws in, you take a scan of the upper, lower and bite capturing the screws, you go through the entire surgery, and then you capture the healing, the screws again with some healing collars. Okay? And then you take a scan of the OptiSplint, that’s it, those three scans, okay? And they’re really the same scans you would take if you were doing photogrammetry, except you’re using your iOS for all of them, right? So let’s just go through a case, a patient, first thing in the morning. well, whenever it is, patient is anesthetized and the screws are placed here in the palate.

Now one issue is, it’s a lot of scanning to reach back here with your scanner and scan an entire palate so you can put them up on the ridge, unless this is going to be reduced, right? So therefore you can put them here on the walls of the pallet, or you can move them a little bit more anteriorly. But this is a nice layout, so maybe just a little bit more forward. Alright? So put the screws in and then you would scan upper, lower, capture the screws. Be very careful with this scan, right? You don’t want to, you want to make sure that it’s stitching really well and it looks really just pretty much perfect. Okay? And then, and here you can see the, so the screws are in here after surgery, okay? So we have the before, and then we, then you scan after as well and capture this.

And then you also seat the OptiSplint to capture the multi-unit abutment positions and luted together, okay? This is a stellar material. It’s a light cure material. And one of the things you want to be very cognizant of is that you don’t want to have this material out over any of the scan body area, right? Only back here on the vertical part, on the vertical part of the frame, and the horizontal part of the frame, right in here. Okay? So that’s nice and luted, and that’s removed. You don’t scan it in the mouth, you always scan it extra-orally.

Okay? And with this captured, or I mean, you can scan this last, right? You don’t have to take it right out and then go scan it because you’re in the middle of a surgery. So rest this, set this on the tray or on the counter, and then you will seat the healing collars that you’re going to suture around. So we work with a bunch of different healing collars. several, many different ones. Alright? So more than likely you have one of these in your armamentarium. And what you’ll do is you’ll seat them on the multi-units. Please use one in this family or the tissue will be off. The intaglio of the prosthesis will be wrong, and we could have other mistakes too. So please be sure, you’ll want to use one of these. If yours, if you have a different one, let us know.

But you’ll seat them and then you’ll scan, right? So then you perform the next scan, which is healing collars and the fiducial markers. If you have a tough time scanning this, because some scanners really struggle with moving blood, moving sutures, lots of tissue area, I would not use the iTero for instance. I would definitely have just make sure you practiced if you use the iTero, some other scanners will not work. We’ll give you a list, shortly. It’s in the program. but I, but you’ll struggle with that if you don’t use the right scanner. You can also take a PVS impression of it, right? So here you see they captured, the fiducials back here and then scanned. Okay? So that’s an option too, take it out and scan it, okay? And we will use these markers to take the postoperative record and we’ll use these just like tripod and bring it back into the preoperative, which provides us the implant positions under the teeth.

Okay? So here is luting it all together, right? He’s cleaning off the screws back here. It’s all luted. And then originally they were scanning in the mouth. That’s how it was. All it went through beta that way it actually went, did very well through beta with scanning in the mouth. But let’s face it, scanning intraorally is tough. and it’s not necessary, right? The patient is breathing on the lens, on the camera, and the patient’s moving and there’s blood and it just leads to inaccuracy. So just take it out of the mouth and scan it on the bench. And once surgery is finished and you’ve captured all these records, you’ll upload them to our laboratory,. Which is the pre-operative with the Tads, post-surgical with Tads, OptiSplint, some photographs. That’s it. If you have a lab scanner, pop the OptiSplint into the lab scanner, and then you’re at the micron level, and we’re making something very, very accurate.

All right? Two varies. It’s very accurate without, it’s very, very accurate with. All right, based on that we will take your records. We will design a prosthesis very quickly. In fact, we can do it in one hour. Just make sure you pre-book with us. But we can make it in one hour. And then you’re off and printing in your office and delivering maybe same day, maybe next day. Kind of, kind of different out there in the marketplace. I think a lot of offices want to do it same day. But let’s face it, by the time an hour goes by and then nesting, curing, cleaning, beautifying, it’s time. It’s a lot of time in the chair. So you’ll have to decide if that’s right for you or not. Okay? So here’s an in-office print, looks very nice, very nice work. And the patient did this was the same day.

There you are delivered. Smiling. Alright, so that is the, that’s the first one. That’s, I really don’t talk about too much about these arch tracers anymore. Change that. The next one is guided, right? Because this was, the first one was really a free hand workflow. We’ve also really perfected the, the combiguide guided workflow. And the combiguide is a metal or plastic, we also sell the plastic, which is a metal fixation base that’s delivered with this pin guide. This metal stays in the mouth, and then you use this as a bone reduction leveling. Okay? And then you use an osteotomy guide. And what this allows you to do is pre-plan for bone reduction volume, right? We have to know that the adequate amount of bone is reduced for the prosthetic thickness. Okay? And then, and then your implants are controlled, right?

Rotation depth, MUAs are in a nice place. You’ve worked out the AP spread. It’s a nice way to go. So probably about half and half right now, guided and freehand. All right? So let’s just go through this process. Just like with all surgical guys, we need a CT scan. We need preoperative records. It’d be nice to have a CR bite, but really we just mostly get CO and then we open the bite, or we do a little back and forth with you to work out the bite, some photographs. And then off we go to planning. So we’ll plan the case with you, make sure all the implants are in the right positions, happy with the whole plan. And then after that, we will send you the case. This is what shows up. There’s that picture again. Pin guide, fixation base, osteotomy guide. Real simple.

And we have, what’s nice is that in the lab, we already have the teeth. We’ve already completed a setup. I don’t really have an image of it here, but we’ve already completed a setup for this case, right? We already know the tooth position, the size, the shape, everything. All we’re waiting now is for the implant positions. So that’s a very efficient way to get the case done on the day of surgery for us, for turnaround time because we have the preoperative records. Two weeks, three weeks before. Okay? Day of surgery, the pin guide goes in and you can follow our combiguide or our CHROMEguided system to see how the pin guide works. because that’s very important. Pin guide goes in, delivers a fixation base. The fixation base is left behind.

At this point in surgery you’re going to take your iOS scanner, you’re going to scan the teeth and the fixation base just like this. Okay? You don’t have to be, you don’t have to gather the linguals and the palate and all that. We just want the teeth and the fixation base. This is our fiducial. Now for pre-surgery, okay? Pre-surgical. Then you use the fixation base as the bone leveling tool, right? Flatten the bone down to the metal, which is nice because it’s metal because you won’t grind it with a bur inadvertently and get resin in the site.

Then, so there’s, there’s just kind of before and after showing how it’s used as a bone reduction. Implants go in, MUAs receeded, the carrier guide goes on. Now, this is a clear carrier guide. We actually make it in a tooth color for easier scanning. But this goes in, then you scan thethe carrier guide in the mouth with the healing collars. All right? So put healing collars on the multi-unit, abutments, seat the carrier guide, scan, and be sure to pick up the fixation base. Alight, because that’s the fiducial. Alright? Right. So this gives us the implant position relative to the OptiSplint. The fixation base gives us the breadcrumb for the bite, right? And then we, and then we move on from there. The OptiSplint is then luted to all the implants and removed, right?

Take this back on the bench and scan it now or scan it after surgery. And then you upload your files. Okay? So there’s one more scan that you can add. I’ll explain that one. But we had the pre-surgical, right, with the setup you have, so this is already at the lab. We don’t need this. We have the first scan of the morning, which is a fixation base in a teeth. Second scan is fixation base, carrier guide, and healing collars. And then the third scan is of the OptiSplint. Now a fourth scan you can add in here is carrier guide comes off fixation, base comes off, suture around the healing collars, scan – that gives us the tissue. Right? Now we’ve planned the tissue for this case. So we know it’s flat, we know where it is, right? So we can kind of estimate two and a half millimeters of tissue.

But you can add another scan in here. Help us be a little bit more accurate. Alright? So just real quick, going through a case. Dr. Agarwal was one of our very first, so he sent us these preoperative records. We made the combiguide. We made him one in plastic. So he scanned this, he extracted a few teeth, but he kept these remaining for the bite. He did scan the OptiSplint. He’s a great scanner, right? So he scanned the OptiSplint in the mouth with the fixation base. Fine. We made it work, no problem, but normally you would take it out. And these are the records we’re working with right? Patient photographs. we have the bite to confirm before surgery, photographs, we have the records, we have the cone beam. and then we go to surgery. And then based on this, we made her a lovely smile. And here’s the fixation base scanned in the mouth, pre-operative right teeth scan of the OptiSplint, opposing. And then we designed the prosthesis. And you see the tissue gap, right? We’ve done this thousands of thousands of times. So we know the tissue gap and how to develop for it. But the other scan you could have captured is giving us the suture tissue, and then we’ll meet it.

All right? So that was the grammetry with combiguide with guided surgery. All right, let’s go over the next one. This one’s pretty popular too, because we know that if there are teeth in good occlusion before surgery and teeth in good occlusion after surgery, right? Then we’ve got a good reference for the bite. So in this case, you would leave teeth. This is Dr. Sully Sullivan, another one of our KOLs that’s been working through grammetry and a lot of different things with us. In fact, Dr. Sullivan and Agarwal do a little bit of teaching on this so you can look them up. okay. Leave teeth for the bite and perform the grammetry between them. Okay? And what that means is that you would scan, right, you would scan, lute this.

In this case, you scan it in the mouth and outside the mouth. So you scan, lute them all together, scan to pick up the teeth, the fiducials, the bite, not the bite, but the fiducial markers, which is basically the teeth. Okay? Unscrew it and then scan it outside the mouth for a little bit more accurate of a scan. Alright? What do you send us? You send us the preoperative with the teeth, the OptiSplint in the mouth, the OptiSplint outside the mouth, opposing and bite and photographs. And based on that we will design a case. Now in this case the posterior teeth were extracted after all the records were collected.

Alright? So there’s the records, and then there’s the restoration teeth extracted. This is what the patient’s going to have, I believe. maybe the teeth were left for good. Not sure that’s an option too. All right? Yes, we like this. Okay, the last modality. Now there’s different ones that doctors have developed, but these are the main ones that we teach that we espouse. So the denture reference, a lot of offices now are just ordering a denture, right? An immediate denture for capture and the records, because it’s very familiar, right? A lot of doctors are very good at taking bites with an immediate denture loaded with blue mousse material, some kind of PVS and that will pick up the healing collars, right? So then we have the healing collars, the denture, the teeth, the tissue. We have everything we need for a virtual articulation, a real articulation after surgery.

Let’s just go through this one really quickly. This would, this was a freehand case, Dr. Hanson up in Michigan. An edentulous, put the implants in, multi-unit abutments, perform the OptiSplint, then put the healing collars in, right? Upper and lower. Okay? Then what doctor did was, load the denture with this is, this is, load the denture with, material. The upper is already in the mouth, then seated. They’re both wet, right? Not set yet. And now he’s manipulating it and closing. Now, at this point, doctor has already tried in the upper denture, lower denture without any material to make sure that they’re not being, that they’re not hanging up on the scan bodies, or on the healing collars. because they’re kind of tall, right? So you have to grind out the inside of these duplicate dentures, or immediate dentures to make sure that they’re not wobbling on healing collars.

Alright? They need to fit just like dentures. So once that is set, okay, they’re removed. You scan the prosthetics 360, all right? And then you hold them together. Now you have an, I just scanned the whole thing. I don’t know why I scan the whole thing, but you have two options at this point. You can either re-insert them back into the mouth to scan the bite, which probably will not be comfortable for the patient, or just handhold them and scan the bite. And now we have everything we need to virtually articulate the case and marry with the upper and lower, representations of the MUAs, the OptiSplint scans. Alright? So upper, lower, scan 360.

There we go. All right, got them both seated. Had to do a little bit of a equilibration there in the posterior of the teeth. Happy with the bite. All right? And then scanned for the bite after he reinserted. All right, so based on that, we took this back in the lab. We have all of our records, right? Looks good. We captured the healing collars, both sides. We have the bite, we have the teeth, we have the smile, the tooth position, the midline. We have everything we need to make this case. It’s a really nice way to do it. Yes, this looks a little messy, but for us, this is, we can geek out on this and make some upper lower restorations really quickly. All right. So on this case, these are the simple records, right? 360 scan of both dentures with the denture. If it’s a single arch, then you would seat this back in the mouth and scan the opposing in the bite. That’s how we would bring this back to the patient for the articulation scan of the OptiSplints. He did it intraorally. But again, this was early on on, so those would be extraorally in both dentures, the denture reference.

Okay? just one more note on that. You know after these records were captured, doctor went to the grammetry page. Doctor had already booked the surgery, for instance, he knew it was going to be next Thursday, and we were going to receive the records at one in the afternoon, double arch. And then he uploaded the records to us, and we’ll go through a little bit of that in a minute. But once we have his records, right, this was a case we were just looking at, then this is what we do with it. We align to the implants. I mean, align the implants to the dentures and then do a design, send it off for approval if wish, if desired, or we just send the files. And these are not copings, those are just pretty colors of the inside of the restoration. But this is direct to multi-unit.

All right? So that’s, that’s the modalities, those are the different ways to accomplish these cases in surgery. So it’s important to know the process, right? Because you don’t want to just send us a case this morning, right? out of surgery. We will not be ready for you. We have a team, we have a whole room full of people that design these cases all day. It’s what they do. But they do it on a schedule. And we can handle some surprises, but we don’t like them. and we want to do our best work for you. So what that means is that you will go to our website,, click on products right here, go to the bottom right grammetry, okay? And then once you’re in there, then Bob’s your uncle, as they say, you can submit your case after you’ve booked it.

This is where you would submit your cases, on the day of surgery, right here is where you schedule for a two hour or four hour turnaround time, right? We’re going to change that to one hour, right away. We are going to upload, you’re going to upload additional files in case we didn’t get them here, in case we’re missing something like an opposing. Or if it’s a first time coming to ROE, then go here and create a new account. So most of this should be done a week or two weeks before you know, a surgery is coming up. Like if you know a surgery is coming up next Friday, today is for instance, Tuesday, book it schedule it. There’ll be times in there to do it, availability. And then on the day of surgery, click the green here and there’ll be a, basically an rx, right?

It’s going to ask you the important questions about your patient, about the surgery, about the implant, which arch, et cetera. And then you’re going to drag and drop your files. Please be sure to print off our checklists. Let me show you where those are real quick. Okay? Go to the, the grammetry page, which is right here. Grammetry page on our website. Once you are on here. Then everything you ever wanted to know about grammetry is on here. And photogrammetry, we have a photogrammetry page too. But everything you want to know, compatibilities, how-tos videos, submissions for books, patient booklets, how-to booklets we have, a webinar that we had that you can watch and learn, all the different printers and scanners that we recommend. Everything you want to know. Here’s, here’s some comparisons of other systems. Compatibility chart, a lot of things on here that will, that’ll help you.

So you don’t have to call and ask questions and, and look for people. You can self-educate right here. Webinars again. So there’s so much. I just keep going here and then finally there are checklists, right? So these are, they say workflows, but this is a checklist for the team based on tads and screws, comb guide, tooth reference, denture reference, and then a restorative workflow. All right? So print the checklist and that way you know exactly what to send when you’re submitting your case. No mistakes, because we, if we don’t have an opposing, we can’t make the case, right? If we’re missing the scan of the tissue and the healing collars, we really can’t make your case. I mean, we could try, but it’s going to be less than perfect, less than ideal. So use the checklists.

We do have a restorative workflow as well, and there’s a checklist on our website for this. It can be very useful. We do have some other techniques for a digital workflow, one called the iJig, which I would probably recommend, you know, over the OptiSplint grammetry workflow. But this does work as well. And then in this case, you would, you know, this is a patient who’s healed. They’re, they maybe they need a new prosthesis. Maybe it’s time to go to a final. Alright? So you would do the OptiSplint, scan the current prosthesis in the mouth with a little bit of tissue, scan the opposing, scan the bite, scan the tissue in the MUAs, and then you would scan the prosthesis 360 outside the mouth with those little plugs that come in your kit. And based on that, we’re making you a, either a new temporary or we’re making you a final restoration. Works great. So a wonderful technique. But as I said, you probably want to look up the iJig. That’s a patented product that we’ve made just thousands and thousands of times to go from an existing prosthesis to a new final or temporary prosthesis.

And you can do that either with iOS or with a lab scanner, you know, instead of shipping us the OptiSplint. Okay, Dr. Tawil, this is his case. And this is, he’s been working with us now since the very beginning on this wonderful product.

All right? Part two, let’s go in some technical stuff. And again, we have a lot of resources for you. Obviously you can rewatch this video. You can join our Grammetry Facebook, where we, that’s where we make our announcements. We share cases, difficulties, challenges, solutions. It is open, not a private, not a private group, but it’s going to be very helpful. If you click on this, dinosaur here, you can also order, a book that describes the whole process. You can book a one-on-one with, with someone here at the laboratory to discuss your specific needs and questions. We have a lot of Grammetry on YouTube, and then a lot of educational resources. So do not just sell you a product and then, you know, good luck. We support you through the whole process on our website.

You go to shop online and pick Grammetry and everything you want is, about Grammetry is on here. I would not order the arch tracers, but the OptiSplint, the kits, you can buy singles. You can buy kits and you can buy this. If you’re new to printing, you will want to buy this Grammetry print calibrator. You order this, it physically shows up in the mail. We email you the file to print, and you make sure that this fits passively No surprises on the day of surgery that your printing, cleaning, curing is not printing a roundhouse full, large prosthesis accurately. Okay? You have to know that. So that’s a good buy.

Alright? So let’s go through this, part two has several topics going to cover some of these in a little more detail than others. but the top issues, I want to go through that first. And that is, the issues that we see with cases. Because you’ll want to know these when you’re getting started. The main one is clean OptiSplint scans. When I go and talk to our designers, I say “what’s, what’s the number one problem?” They go, well, it’s the quality of the scan. Because you can imagine, if you’re an implant dentistry, if your team or someone did not scan a scan body at all or very well, you can’t register it and the patient’s coming back. Well the patient can’t just come back in a full-arch surgery, right? That’s not going to happen.

So you gotta have it done right the first time. So that means that you don’t have any tissue covering an OptiSplint, or you don’t have, it’s not covered in blood, or you don’t have the luting material covering one of the scannable areas. So just be careful. Double check, make sure they’re really clean, make sure the stitching was good, alright? And you’ll have a really good result. Healing caps, be sure to tell us which healing cap you’re using. We want the brand. And if it’s not in our dropdown list, then we need to either work with that company or you need to physically send us one of those healing caps for us to measure, right? Otherwise, we’re mounting the case digitally wrong. And we’ve had that happen and it is not a fun day at all.

Alright? So that’s very important. and the prosthetic screws, we want to know what prosthetic screws you’re using, right? Are you using the desk or the vortex? or the Dan Rosen, right? Pretty much those three. And I know there’s an, there’s an SIN they also make one, might be some others in the market coming around, but you have to tell us which one you’re using. Otherwise, the screw channel is the wrong size. Okay? So that happens too. And be sure to place tads, and, and capture them very well. We covered that. The scan, bodies that you put into a prosthesis, they must snap in, right? If that’s more of a restorative protocol. But if a patient has a prosthesis and you’re putting the analogs in, make sure that they’re all the way down. because if they’re not, then we have that implant in a wrong position.

And just a big question mark. Or we’ll get the tissue wrong in that area, be careful that OptiSplints are not too close together, right? They can’t touch, and if they are touching, adjust them. We’re going to, I’ll show you a couple cases on that. Be sure that you have all of your scans. We had to basically develop a customer service team to call for missing files and to communicate, but for missing files, you know, and we’re, because we know it’s tick-tock, right? I mean, you only have, we only have so much time before you need this file back, but we’re missing a bunch of records. And then just careful with bites, right? If the bite comes in wrong, you’re going to be adjusting, right? So we want to be very, very careful with bite registrations.

And just remember that the green light, what I mean is go time, right? Red light, green light doesn’t really start until the, let me give a, it’s one hour now, until we have all the records, until we say yes, the records are good. Which if you don’t hear from us, the records are good. Okay? Alright. So let’s go through, let’s just go through all these topics. First is an update. We now have a Neodent. And what that means, I didn’t clarify that really well. In the beginning of this, we make kits for Straumann, Neodent, Nobel, BioHorizon, MIS. The only difference in all those is to screw. Okay? That’s the only difference. The OptiSplint is the same. The actual physical scanbody’s the same. The only question is, which driver do you want to take out of your kit to drive in the OptiSplints?

That’s all that means. See right here. MIS is not on here. They just brought it back. Okay? But the OptiSplint itself is the same. All right? Very important. It’s also critical that you use their screw. We’ll talk about that. I got a slide on that. So they also are now including a healing collar in their kit. So if you want to use their healing collar instead of other ones out there, theirs is very nice. They’re very smart people and they designed one with the right color and the right design so that it’s easy to scan. So that’s a nice update. We also now have a kit for your first case, for every case that has, there’s a little video online to watch this, but inside the kit there’s a UPS label to ship it back to us already made.

And inside we have instructions for the most common, which is tads and a QR code for, for the other types, other modalities, okay? And then we have, some tape for taping it up. We have stellar for luting. These are all optional, right? So they’re ala carte. You can add what you want. OptiSplint kits, right? That’s depending on what system you’re buying will be in the kit. Okay? Then we have the return packages that kind of compress, gently compress the OptiSplint so they don’t get damaged when they come back. We have pliers for snipping, snips for snipping. The framework when you need to. We have a calibration kit, right? The calibrator, alright? And then just some extra little components if you bought more than, if you bought extra, scan bodies. And that’s what comes in the box when you order a new case from us.

Alright? Another one is we offer this tenting screw cap. So you put your screw through the hole and then you screw it into the palate or other places in the mouth. And then it’s a lot easier for the iOS scanner to scan that than it is just a screw head. All right? So we give this for free, just, email us or instant message us. We’ll share it with you, okay? We already covered this, but we increased our library, our number of healing collars to just a bunch of them, all the popular systems out there on the market. Alright? So, nice little update. You can be creative sort of. You want to be careful because make sure that we can, we know what you’re doing when you’re being creative, but, you know, it’s okay to trim an OptiSplint if they’re too close, right?

That’s one method. Just trim it, right here. take out your burrow, your hand piece, your high speed and grind. It probably ground that one in the wrong place, but that’s okay. This one was ground as well. Made a gap. Because you can’t have any tension. If you have tension, there’s a problem. They’re not going to be fully seated, right? You can also be creative with your placement of the OptiSplints, right? So if you have, you know, teeth that are being used as a bite, and maybe they’re going to be in the place where the implants are going to go, then put the OptiSplints in some other areas, right? But keep the teeth as to bite. You can see here that here’s the bite. There’s teeth here, teeth here, three implants, three OptiSplints. Then the teeth are extracted. Put the rest of the OptiSplints in and keep luting. We can marry all of this together. And then a scan of the healing collars bite, OptiSplint bite registration. And we can actually work with all this, right? So you can be creative this way too.

We’ve worked on some very tough cases, right? A lot of implant, zygo implant multi-units are compatible with Nobel, right? So use your OptiSplint. I mean, look how creative this was back here, right? We had to stretch from pterygoid up here to zygo up to nasalis, all in one case. Worked out really well. This is, Dr. Jackson down south, and, he’s done just marvelous work with Grammetry. Okay? So be creative. I want to just quickly just touch on the the parts of the OptiSplint, the technical data of the OptiSplint. So let me just define what areas are. This is called the horizontal. The vertical wing. The horizontal wing. These are the luting holes. This is the connection area, and this is the scan body, right? So we don’t use any of the rest of this as a reference for dialing it into the registering into the implant. We use only the top here, okay? And the bottom currently is only, I say Nobel compatible. But if you look at our compatibility list, which I’ll pull up, you’ll see it matches with, I don’t know, a couple of dozen implant systems out there because they’ve all copied the Nobel platform.

The screw that comes with the OptiSplint must be used with the OptiSplint. Do not substitute this with a different screw. You see the little bevel here. The bevel marries with the bevel inside the channel, and it centers the OptiSplint on the multiunit. If this is a right angle, you lose centering, all right? Or you might get lucky, but it will probably cut a groove inside of here and then you’re off center. We don’t want that. Alright? So the screw comes in this little tube here comes with the driver of your choice, right? It depends on if you want to use MIS 050, Neodent, Straumann. You pick whatever driver you want to use, that’s the screw in the box. Alright? And then what screw you’re going to use in the prosthesis, right? Grammetry, Dan Rosenand Dess.

We want to know which one. They all have their little pluses and minuses. And this is the one we recommend the most, the Grammetry because it has this little bit of, wedging and, convexity here. And it really nestles down inside the resin nicely. A little more of a wedging action here, and a little more of a right angle here, right? So we really like the Vortex screw, and you can buy these from us. you can buy these from us. Then you would buy these from the Rosen site. the nice thing about the Grammetry screw is that it’s the longest, thread out there and depends on if you’re using resin or zirconia or titanium to where you want to place the head, right? You can raise or lower the head based on what material, right? So if you’re in resin, you want the screw to be tall, really high.

Lot of material under here. If you’re working with Ti copings or titanium direct to bars direct to MUA, you want it to be low. It doesn’t need to be quite as high, you know? But that way you have more threads for long-term down in the multi-unit abutment. So that’s kind of the, the philosophy of the Grammetry screw by Vortex, okay? And just some screw, you know, some screw engineering here, you know, this is more of a rounded seat. So it disperses the pressure to the sides, to the bottom, to the outside, where this is all outside. And then this is all down right on that little ledge. Okay? So just different ways of looking at it.

All right? The nice other thing is that the Vortex screw does angled screw channel, right? So if you got, if you’re, if you’re screw, now, of course this is ideal, but a lot of them aren’t and they’re coming out of the facial, coming out of the lingual and, or in an interproximal someplace you don’t want it, we’ll change it for you. And the same screw works, comes with a special driver. Every vortex screw comes with a special driver called the T5, and they’re all made for ASC angled screw channel. Okay? So you have to, if you buy this, you have to buy the driver. Best records. As I’ve already mentioned a couple times, the records.

Please do not use a portal for sending your files. You know, don’t use these, one of 17 portals out there. Use ours. Go to the Grammetry page, tell us what you’re ordering, drag your files into here and send them. Because if we have to go looking for your files somewhere, it’s going to slow everything down, right? And we’re probably won’t have the questions that we need answered which implant, which screw, how fast you want it, details, right? So please use our portal, make sure you have everything in there. We don’t want to get piecemeal, we don’t want to get some photos in the morning and some STL files, mid-morning, and then the critical ones in the afternoon. Save them all and then deliverthem all at the same time, right? Rather than broken up throughout the day.

And then just make sure you pre-book, got a pre-book, right? No surprises. And then use our checklists. They’re fantastic. They are step-by-step, for the team to know exactly what to do. And then just a, you know, quick thing on photographs, we want to get some really good photographs of a patient. Cell phone’s fine, right? But full face, full smile. We want to see how the teeth and the lips are in the eyes. Don’t have the patient lying down, anesthetized, opening their mouth, trying to get a picture. Do it before surgery. Have them stand up against a wall. Smile, tell them something funny. And, and just get them to smile naturally without, with, with normal gravity affecting their lips, right? If they’re lying down in a chair, turning over to the right, looking at you with a smile, it’s bad, not good. Have them stand up. Alright? That’s enough on that. Thank you. And if we are dealing with, overjet overbite lip support, we’re changing a patient drastically, take a couple of profile pictures too. Helps a bunch. All right. Full face, full smile, even exaggerated. Another picture would be nice if it was just overly exaggerated for the, so we can know the transition line. Have the patient say uhhh, or you know, almost lips together at rest, and then a profile. Okay?

Good. Thank you. And send us a couple of retracted pictures in occlusion. That way we can really verify the bite. Alright, those are the photographs. Now capturing, records to bite. Please be sure to capture bilateral digital bytes. Don’t just stop on one side. This side will be open or closed. Okay? These scanners are not perfect, so go around the entire arch, get everything okay? Or we, or we will here, I have a little video here showing, alright, so watch, I believe I didn’t do much there. Okay? Anyway, it’s showing overbite, overjet. But you can also test this when you, when you, when you have your scanner, turn the patient down, turn the patient up, and look at the insides of the teeth, and then turn one arch on and off. You’ll see that the teeth are overlapping or they’re not even in contact at all. So bilateral, very important.

And then just again, be careful about collar heights because although they really should only, interrupt the registration of the tissue scan, if we have different healing collars it can throw off how we are, how what we think about this case and it, and it can really throw off a bite. It shouldn’t, but it can, and it has before. So be very careful with the healing collars. And then, and then some tips, right? These are, these are just some bite tips. Sit the patient up for the bite, because especially when they’re, especially when a patient doesn’t have many teeth or they have five different bites. Have the patient stand up. Sit up, practice, practice the bite, then capture it visually, confirm the bite during the scan, watch them bite, watch, make sure they’re doing something repetitive.

If you wanted to, open the bite, I would suggest doing it with a leaf gauge or some method that, allows you to get the patient in a centric relation bite. If you’re opening them a lot on the day of surgery, we’re not doing some type of diagnostics for, you know, a few appointments. Open the bite up and then just inspect it thoroughly before sending, look at the digital scans inside and out. Make sure there’s no overlap, because you don’t want to adjust, you know. You don’t want to adjust when you’re seating. You know, here’s, this is checking a bite. All right, so left, right? This is probably not too difficult of a bite, but look here inside, look right up in the molar area. See that, see the overlap?

It’s just a little bit, but if it’s a little bit in the back, it’s a lot in the front. And you’re going to be adjusting. You know, here’s another one, right? So this is, alright, is the patient really in a, in a crossbite, or did they, did they really bite like that? Normally? Probably. But let’s make sure, is this the proper overjet? Alright, look in the patient’s mouth, look on the screen. Is this correct or not? Alright, that’s just, just some tips on it. And then when we’re doing a combiguide, obviously this is going to be a tough bite, alright? Fixation base. This is the preoperative but these are very tough bites. Double check everything to make sure that the scanner didn’t get lost, that there was no, a break in the scan as you’re going around the arch. Very critical, especially on the combiguide ones. And then capture the records that are needed. You know we don’t need the fixation base and the OptiSplint in the mouth. It’s an extra oral scan, right? Make sure that if you scanned this fixation base with the healing collars, you actually captured all the healing collars. That’s why we make the carrier guide, right? So seat that and pick up everything. And you don’t have to, it’s not necessarily the more scans you give us, it’s the better scans.

You know, these are the scans for the surgery, not the ones that had an X, right? So just follow the, you know, follow the checklist. Okay? And then lab scanner. just quickly, you know, we’re selling some lab scanners. More doctors are picking them up. They have a high utility, you know where I say photogrammetry has a low utility one use. If you have a lab scanner, you can scan a denture for a duplicate. You could scan your models, you could scan bites, you could scan OptiSplints. You could scan scan bodies that you’ve picked up. There’s so many things that you can put in a lab scanner and send off and become a real digital lab. This is one of our good friends and doctors who, he does a lot of tricky cases with us.

And these are all of his, these are all of his tools, right? Trios, implant is gm, he’s got a Medit lab scanner. He uses the white healing collars. He has a frozen printer. He uses packed in sculpture, these tenting screws as well as these. And then this particular case is a combiguide and immediate transfer. So he used all of these tools in this case, which is a lot going on. So he sent us, the records, the upper lower and the bite. And we met him online and completed the online meeting. We sent him the combiguide with a denture, right? So he can do a denture wash. He went through his surgery, right? Just what we talked about before, the whole process. And he used the denture to send the records, right?

A wash impression inside the denture. He placed the denture inside the lab scanner. He placed the OptiSplint inside the lab scanner. And based on that, he’s based on scanning the OptiSplint. He’s just, micrometers away from, away from accuracy from capturing that on the multi-unit abutments. So really nice process here. The scans that he sent to us. And then based on this, based on these blobs, which don’t look like blobs to us, we, align them, align everything together and make him a prosthesis just like that. And then he prints it in office, right? But the lab scanner is really what dialed it in. We already kind of talked about how to schedule an upload. I kind of skip over that part, and then compatibility. So we work with a lot of different systems. You know, these are all the multi-unit abutment systems.

There’s more on the market. These are just the main ones, right? So as long as you have this implant company, that you’re placing these implants, then their multi-unit abutments are compatible with Nobel. Okay? these are the iOS scanners. We, we really just kind of, say don’t use iTero unless you are a very good iTero scanner. It really struggles with certain complicated scans like we do with this service. this is a new one. We sell this Shining one. Very accurate, very fast and very affordable. Probably the least expensive of all of them. But you can also buy the face scanner and the face scanner and the iOS scanner. They are compatible. So you scan and they automatically register and off you go, sending it to us. And their face scanner is the best on the market. I mean, I’ve seen them all. It is incredible for $5,000. OptiSplint, these are the different kits that you can buy. These are the healing collar compatibilities and there’s more as you saw. And then the prosthetic screws that you’ll need to screw in your temporaries that you’re printing.

Alright? I have some do’s and don’ts. We kind of go through this pretty quickly because we kind of talked aboutthem, but, we’re good, right? But we have to be careful of what we send in. So if it’s, if it’s not even available to be done normally very well, we can’t do it right? So this kind of really tricky situation, we can’t mask that. We can’t cover it. If implants are just grossly out of line, then something else has to be happened besides a restorative trick. And Grammetry won’t fix that. Definitely take advantage of angled screw channel. One of the do’s is let us know, yes, I want to angle all of these sites to make the prosthetic thinner, right in this situation. So take advantage of angled screw channel with the Grammetry screw, the Vortex Grammetry. As I mentioned, don’t mix and match healing colors, right? They have to be, they have to be identified and they really need to be the same, otherwise we have problems. Okay? Make sure you take bilateral bites, we talked about that. Make sure that you scan OptiSplints very clearly that there’s no materials covering.

I’m going to show just one more video about bites so you can see. Watch this. So there’s a lot going on here, but see what happens with the bite kind of throws things off. The vertical ended up being the same, but that’s because we had to find some middle ground to put them together. So just be careful with bites. And forgive me, I’ll just mention angle screw channel one more time. because we can do some wonderful things with changing the angles of screws, right? You don’t want this thin wall here or this thin wall here. You want this screw in the middle of the tooth and you don’t want this in an embraiser. We can fix all those with angled screw channel.

Okay? That’s this case. So we can fix that. Be careful with luting. Follow the rules. You know, this is a frame that is up on top of the scan bodies and the vertical wing. Put it down here where it goes. Right? Otherwise we have a real challenge with, working with these. It worked, right? We could see the, the scan bodies, but it’s just not the proper way to do it. Be sure we’re compatible. We do not work with Zimmer TSV yet. They’re coming out with a multi-unit that’s Nobel compatible. But if you’re in this situation, we can only make a prosthesis on these two implants. These sites are going to have big holes that you’ll have to pick up some temp cylinders. All right? So we have to be compatible follow, you know, follow the list. More tads are better. Kind of covered that. Make sure OptiSplints are not touching. You can always trim them. So it’s just kind of a little recap of do’s and don’ts when you use your scan caps. Put them on the intaglio, not on the, occlusal. Okay? So just some of the do’s and don’ts.


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