Questions and Answers about Grammetry

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Excellent.

Okay, I hope everybody can hear me. I have several questions. I got some good questions here. The first one is, how do you have the tissue? How do you have the tissues recorded? If you scan the splinted scan bodies outside the mouth. Okay. When you, if originally when we were scanning, we were scanning the OptiSplint in the mouth. That’s how they went through the whole beta. But the trouble with that is that a patient is breathing, so there’s steam, there’s blood and there are sutures and there’s maybe some sutures because you could suture under it. But there’s blood and there things are moving. And when things are moving, scanners are unhappy. So we now take the OptiSplint out, scan it on the tabletop. And so the question is how do you capture the tissue?

Well, at that point you place healing caps on the MUAs and you suture around them, and then you scan the tissue and the healing caps. And digitally those healing caps are registered back to the scan of the OptiSplint. So you’ll have, just imagine the optis OptiSplint’s a scan body. So the scan body is sitting on the MUA, the healing collar is sitting on the MUA. We registered those two, they’re both sitting on the MUA one has no tissue. The OptiSplint over on the counter, and then the one has the tissue, the healing collar scanned in the mouth. We put them together and that’s how we get the tissue. You can scan it in the mouth if you want to. but we really need to have the tissue, we like to have the tissue. originally, the inventors of it just scanned the OptiSplint in the mouth.

They made their best judgment that the bone was two millimeters below the margin and they would just, add two millimeters to the intaglio of the prosthesis, two and a half millimeters. So they just guess at the tissue thickness. our experience in training says that we want the tissue in there so that we’re building to it. because there’s lots of things that happen to tissue during surgery and sometimes it’s high, sometimes it’s low, we want to see it. So that’s the, the long answer. next question. How do the screws, place pre-op help for the bite record to keep? Okay, you know how you have, in normal scans you use the teeth for the bite, right? Obvious crown and bridge. Okay? When the teeth are gone, you lose your bite reference, obvious as well. So what the doctor will do is scan those screws and the teeth pre-op.

So now you have a scan of the teeth and the screws in one scan, pre-op, then the teeth are gone. Okay? So then in the post-op, you’re still scanning those screws in the back of the mouth or in the palate, no teeth, right? So we take the screws and we align them to the pre-op. So now the screws in the post-op, the screws in the pre-op merge, and now we’ve restored the bite from the pre-op from the, from the getting started scans that morning. Okay? So it just brings it back to that morning using the screws. Call it a fiducial, really is what they call it. So it’s a fiducial to take you back to where you were, a breadcrumb to take you back where you were.

Another question. Hey Dr. L, after scanning, are you making a try in or going straight to final? Oh, well, there’s two different protocols, right? If it’s surgical, then we’re just making either a STL for you to print in office, right? And deliver it that day or the next day as a immediate temporary. We also have the ability to fabricate here at the lab. Not everybody has a printer. So you upload, we design print, beautify stick in the mail a couple days, and really a patient doesn’t have to be loaded, you know, that day. In fact, probably the, the science will tell you that you don’t have to be loaded for 11 days. So what’s the hurry other than you have to eat? So those are really the two options. But not final, Dr. L not a final. the only way it’s gonna be a final is if it’s restorative. And if you’ve mailed us the OptiSplint, then we can go directly to a final, no zirconia, right? There’s other circumstances in there that we case by case, but we could go from scanning to final, just mail us the OptiSplint assembly.

Okay? Says, can you use the squiggles on the gum instead of tadd markers? I’ve seen those over the years. so what squiggles means is you use some kind of material that sticks to the tissue, probably all kinds of material that makes a blob. And the blob is a fiducial, right? So you have a blob in the morning and a blob in the afternoon. Well, I’ve seen it work. You know the rub is, and, and maybe it’ll work on the palate, right? There’s not a lot of anesthesia in the middle of the palate. So if you did a squiggly blob in the anterior, and as long as it didn’t fall off during surgery, then you have your before and after fiducial. Lower is a little trickier. You really can’t put a blob in the retromolar pad.

It’s gonna come loose, especially during surgery. So screws are better screws and tadss are better. I know that OptiSplint is coming out with a new, you know, grammetry it’s coming out with a new screw that’s very aggressive, wider, and has a nice geometry to it. A lot of the screw heads that we have now that you can buy, the screw head is small and it’s kind of tough to scan. So we’re gonna have something much larger that’ll be easy to pick up. All right? I would probably avoid squiggles. squiggles also move if the tissue is swelling from anesthesiology, from numbing and inflammation. Why is the OptiSplint system better than standard scan bodies since we use iOS? You know, standard scan bodies are going to get you close, but the fact is iOS scanners, they really don’t like tissue very much.

And you know you’re making a crown and bridge and if you have a long span of tissue, I don’t know if you trust it, long span, 3, 4, 5 teeth, spaces, Edentulous soft tissue. And there are, there’s a couple systems out there that have brought something to market, you know, in the past few years where you’re going from scan body to scan body, but the only way they found to make it work is to tie it all together with dental floss and Duralay or dental floss and some material or a goop, right? Something to bridge the gap, if you will, between the scan bodies, because if you’re just relying on scan bodies, especially in surgery. I mean, if you have six implants, six scan bodies, open flap tissue bleeding everywhere that scan, the scan’s gonna fail. It is not gonna track from left to right.

It will fail. It will not be, it will not be accurate. So may maybe some doctors have found that to work. It can’t be consistent. It just can’t. You have to have a uniform material that’s blocking everything underneath. You have to be able to scan just that and remember that. And so you say, well, you’re scanning scan bodies with suture tissue to merge back with the OptiSplint, but that’s not for the precision of the implant position or the MUA position that is only to give us tissue, right? So we’re going to merge the scan of those six scan bodies and tissue with the OptiSplint gives us tissue does not have to be perfect. Scans of the MUAs have to be almost perfect, you know, 30, 40 microns with resin. Let me see, I think there’s one more.

Oh, will there be a reply? Yeah, will there be a replay, a replay of the meeting? Yeah, we are going to put it in the cloud. I think it’s on YouTube and it’ll also be on our website. We keep all of our programs, actually the prequel to these two are on there and this will be on there as well (number three) and I think, I hope…There was more question, but I don’t know if I really understand it. It says, why did he extract before the OptiSplint?

And the only thing there I could think of is that, and I’ve got one more question too, is that we were thinking that, you were gonna use the teeth as fiducials. So if you’re gonna keep the teeth as fiducials, obviously they have to be there in before beginning of surgery. The same teeth have to be there at the end of the surgery as the track for preserving the bite. Last question, and unless there’s more happy to stay all day if you’d like. Why are the choice of MUA caps critical? Ha, right? Well, you saw we have a whole bunch, right? A whole bunch of caps, they’re critical because the STL file of them has to be in the library of grammetry, the OptiSplint, the grammetry. It has to be in the library.

If some mystery healing collar shows up and we don’t know the dimension, the height, we don’t really know where the top of that multi-unit abutment is, then we’ll guess and then the tissue is here or it’s here, we have no idea where the tissue is. And then you have a problem when you’re seating it. So we have to know the file, the company, the dimension of that healing collar to bring it back to the OptiSplint to make your tissue adaptation of the prosthesis close, right? It’s not going to be perfect, but it’s gonna be close. Let’s see. When you mean, you mean when you stitch both scans? That’s correct. That’s correct. When you stitch the scan of the tissue and healing collars, when you stitch those to the scan of the OptiSplint over on the bench, we have to know the manufacturer of that healing collar.

Do we have any more questions? This was fun, really like, really love getting all these questions. We are always available. We’re a friendly bunch of people here. So email or call or like I said in the end, we’re an open book. We want to help, wanna make things successful and, for you clinically. And as we said, we wanna meet you where you are. So depending on what technology you have, we can meet you there. Alright, everybody have a happy holiday and thank you so much again for joining us. Goodbye.

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