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Webinar sobre Flujo digital, TS link abutment — Transcript

by Hiossen México · 12,963 words · 2,002 segments · language en · Watch on YouTube

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0:06Hi, Moni, thank you very much. Good
0:09morning, everyone. Um, thank you for
0:11being here with us for this webinar.
0:14It’s a short talk, but we’re going
0:16to discuss the generalities of digital
0:17workflow. And specifically, we’ll
0:23talk about this prosthetic attachment
0:25designed called the TS Link Abutment.
0:29camera and I am going to share the
0:32presentation in full screen. Very well.
0:40Well, the agenda we are going to cover
0:41today consists of these four important
0:43points. First, we will talk about
0:46digital dentistry, the definition and
0:48basic concepts of what digital
0:50dentistry is, selection criteria for
0:55prosthetic abutments for digital
0:57workflow. The use of the TS Link
1:01Abutment, and, well, the selection
1:03options. And finally, we will talk
1:06about how to correctly cement a crown
1:11to an abutment, uh, to a ti-base, in
1:13this case the TS Link Abutment. Very
1:20well. When we talk about digital
1:22workflow, we talk about three phases. A
1:25first phase, which would be the
1:27digitalization of images, which is what
1:29we usually know as three-dimensional
1:31scanning or 3D scanning. And for this,
1:35we basically only have two options.
1:39Performing scans with intraoral
1:42scanners or extraoral scanners. We have
1:46to process that information. How do we
1:48process it? We process it using CAD
1:50design software. In this case, there
1:52are several types of CAD design
1:53software. What is CAD design software?
1:56Well, simply software that can take
1:58three-dimensional images and process
2:00them. When I speak of processing, I
2:03mean making designs based on those
2:05digitalized images. If you have perhaps
2:09heard in architecture that they use
2:11software called AutoCAD, where
2:13architects use it to create
2:15three-dimensional designs and floor
2:18plans for a house or whatever, well,
2:20it's practically the same, but for
2:22dentistry. And finally, that design
2:29made in CAD software has to be brought
2:31to reality. How do we bring it to
2:34reality? Well, we go from the
2:35three-dimensional. to a system that
2:38allows us to process a material to make
2:41the physical restoration. In this case,
2:45we could say there are two main ways to
2:47do it: either through milling with the
2:49different types of milling machines
2:51that exist, or through 3D printing. So,
2:56broadly speaking, the entire digital
2:59workflow in dentistry goes through a
3:01first part, which is obtaining digital
3:04images or three-dimensional
3:06digitization, processing with CAD
3:09software, and finally, bringing the
3:11restoration to reality through milling
3:14or 3D printing. The first part, which
3:20refers to scanning and digitization,
3:22well, what is this? It is the process
3:24of analyzing a real-world object to
3:26collect data on its shape and geometry
3:29to build a 3D digital model. Ideally,
3:32this 3D digital model must respect the
3:34dimensions of the real object. That is,
3:37if we are scanning, for example, a
3:40preparation that is 3 mm high and 6 mm
3:43wide, the 3D model must represent those
3:46exact dimensions, and the file
3:49generated from this digitization can be
3:52processed by design software; this file
3:56will generally be an STL file. I will
3:59explain later what an STL file is. And
4:04to begin with, what is a 3D file? Well,
4:07it is something very simple. When we
4:10have a two-dimensional image, we only
4:12have the dimensions of height and width
4:14, as is the case, for example, with a
4:17standard radiograph, like a periapical.
4:21We can see dimensions of height and
4:23width, but we lack the third dimension,
4:26which is depth; that is the third
4:28dimension. What is an STL file? STL
4:36stands for stereolithography, but it is
4:39also referred to as the standard
4:42triangle language or standard
4:44tessellation language, whose initials
4:47in all cases remain STL. It is the most
4:53widely used file format for 3D design
4:55and printing, but it is not the only
4:57one. There is also the PLY format,
5:02among others, but the most well-known,
5:05universal, and oldest 3D imaging system
5:09is definitely the STL. Each STL file is
5:17formed by a series of interlocking
5:19triangles that describe the surface
5:21geometry of an object or 3D model. So,
5:25these triangles that interlock with
5:28each other actually form what is known
5:30as a mesh. Therefore, it is very common
5:35for you to hear talk of a
5:36three-dimensional mesh or a triangle
5:38mesh when we speak of STL-type scans.
5:44And the more complex the design, the
5:46more triangles will be used, and the
5:48higher the resolution will be. Now, it
5:53is important to understand that an STL
5:56file is practically one of the most
5:58rudimentary, but it remains the most
6:00widely used. So these files will
6:04completely lack color and texture. They
6:08will only represent the geometry of the
6:10surface being designed or, in this case
6:13, being scanned. So, this is an example
6:17of the same image with two types of
6:20resolution. So, if you notice, in the
6:23image on the left, the smaller the
6:24triangles, the more complex the mesh,
6:26but consequently, the definition of
6:28your resulting model. And on the right
6:32side, well, if the triangles are larger
6:33, then the shape definitely has less
6:35resolution and less detail. When we
6:44talk about scanners in general, whether
6:46intraoral or extraoral, there is a term
6:48or something very important to consider
6:50, which is the accuracy of the digital
6:52impression. And this accuracy, in turn,
6:57is made up of two different values. A
7:00first value, which is trueness or
7:02fidelity, known in English as trueness.
7:04And this shows how similar a
7:06measurement is to the value of the
7:07measured quantity. That is to say, if
7:11we are scanning, for example, a prep
7:14and it has certain measurements of
7:17height, width, and taper, then that 3D
7:19representation resulting from the scan
7:22must correspond to the measurements of
7:25the actual object. This is what is
7:28known as trueness or fidelity. And
7:31precision shows us how similar repeated
7:34measurements are, or in other words,
7:35the reproducibility of the impression.
7:38What do we mean by this? Normally, when
7:42a scanner has good accuracy, with good
7:45trueness and good precision, we could
7:47scan the same preparation multiple
7:50times with the same scanner, and the
7:53resulting model in all scans should be
7:55practically the same. It is true that
8:00there is no scanner on the market that
8:03has 100%trueness and precision. All of
8:08them, regardless of the type of scanner
8:11or the brand of the scanner, will
8:14always have some type of variation.
8:18However, these variations can be within
8:21what is clinically acceptable. As a
8:25result, a scanner must have high
8:26trueness, but also high precision. That
8:30would be the ideal, right? It's what we
8:32are all looking for when we want to
8:34acquire a scanner, whether intraoral or
8:37extraoral. And to help you understand
8:43these concepts a little better, here I
8:46am going to show you a bit of a study
8:49that analyzed these very qualities of
8:51two particular scanners. In this case,
8:57they tested a PlanScan scanner from
9:00Planmeca and a CEREC from Sirona. Those
9:06who are a bit more familiar with the
9:08subject of digital dentistry will
9:10realize that these scanners are no
9:12longer the newest, right? I mean, those
9:15were the ones available at the time the
9:17study was conducted. What these two
9:19terms, trueness and precision, are
9:20trying to say is quite clear. So, the
9:22image on the right that you see in blue
9:24is the one obtained with the Planmeca
9:26scanner, and the one you see in color.
9:28We must take into account that not all
9:30scanners use the same scanning
9:32technology. There are scanners that use
9:36laser scanning that will not be able to
9:39capture colors, and other types of
9:41scanners that do have the ability to
9:44capture the colors of both the
9:46preparation and the gums. Although the
9:51resulting STL model doesn't actually
9:53have color, when you are processing the
9:56image, especially with a color scanner
9:58when talking about preparations rather
10:00than implant scans, having this color
10:03difference can be an aid to better
10:05identify margin lines when they are
10:07close to the gum. But whether it is
10:11laser or an optical image, however the
10:13scan was obtained, the resulting STL
10:15model will be completely devoid of
10:17color. This is simply something that
10:20helps you when you are digitally
10:22delimiting the model. So, what they did
10:26was scan; they made a preparation in a
10:29typodont, scanned it first with a
10:32high-precision desktop scanner, and
10:35then they did several scans of the same
10:38preparation with both the Planmeca and
10:41Omnicam scanners, and superimposed the
10:44different scans to see how much
10:47trueness there was from one to the
10:49other. So, what they did here was
10:54superimpose the scan of the preparation
10:55—that is, all the scans from the
10:57different scanners on top of each other
10:59. And in colors, it shows us, for
11:03example, red is where we have a greater
11:06discrepancy, and in purple or deep blue
11:09is where we also have a greater
11:12discrepancy, but let's say subtractive,
11:15and when the base values are maintained
11:18, where is it? Let's say one scan
11:21matched the other better. So, if you
11:23notice, there is quite a bit of
11:25discrepancy. However, when they
11:30analyzed this and saw the actual
11:32discrepancy that existed, they realized
11:35that even though yes, and we are
11:37talking about leading brands on the
11:39market, they all had a discrepancy,
11:41every single scan. However, they found
11:45that these discrepancies were not that
11:47chemically significant. Meaning, even
11:50though no scanner has 100%precision and
11:53accuracy, obviously the better the
11:56scanner, these discrepancies are
11:58smaller and not as creative. But well,
12:02the point is mainly to show you that a
12:05discrepancy does exist, even if you
12:07have an excellent quality scanner. So,
12:13in conclusion, it was found that this
12:15accuracy, the accuracy decisions
12:17analyzed with the scanners, were
12:19consistent and the differences between
12:21them were not that great, so there was
12:23no significant difference between the
12:25two intraoral scanners. So, at the end
12:29of the day, again, you may have
12:31discrepancies, but when you have a good
12:33scanner, they won't be that significant
12:36in the clinical workflow. And well, to
12:42give you, for example, a clinical
12:44sample of what a scanner with good
12:47trueness is like, in this case, I will
12:49present a case that was worked on in
12:52December of last year. This was a case
12:56of a patient who came in practically
12:58the last week of December. It is the
13:00father of a colleague who is also a
13:02dentist. Well, this dentist is a
13:04pediatric dentist and he tells me, "Hey
13:06, you know what? My dad is here in the
13:08city. My dad lives in Mexico City and
13:10his bridge just fractured. And talking
13:14with the patient, he had had this
13:16bridge for practically 15 years, a
13:18bridge that went from canine to first
13:21premolar. So, the patient is over 80
13:25years old, so it might not have been
13:27that feasible to place dental implants,
13:30plus he doesn't come to the city that
13:32often, so it would have been
13:33complicated. And talking with the
13:36patient, we thought the best option was
13:37to make a new fixed bridge again. The
13:40logic was, if a fixed bridge lasted him
13:4215 years, there would be no reason to
13:44think that this bridge couldn't last
13:46him the same number of years or more.
13:50So, the decision was made to re-prepare
13:53the preparations. In fact, this canine
13:57fractured, so we had to use a post,
13:59etc. And at that moment I still didn't
14:01have a scanner, so an impression had to
14:04be taken. I generated the stone model
14:07and went to a colleague who had this
14:09scanner, the Omnicam, and due to the
14:11dates I mentioned, which was December,
14:13the only laboratory that agreed to work
14:15for me on those dates was a laboratory
14:17in Nogales, Sonora. So, I took the
14:20impression in the morning, ran it,
14:23scanned it, sent the digital files the
14:26same day, and in less than 5 days I had
14:29the work at my house. So, if you look,
14:33this is the 3D representation, the STL.
14:38Here, the Exocad software defaults to a
14:39model color, because remember I told
14:41you that STLs lack color. So, you can
14:45ask the software for this STL to be
14:46green, yellow, pink—I mean, it
14:48doesn't matter, that’s the least of
14:49it. Obviously, the antagonist scan is
14:55taken, the bite registration, and this
15:00lab also generated a 3D print for me
15:04based on the 3D scan I sent them. And
15:10this is where the acid test was: trying
15:12the bridge on the model, because
15:14remember the lab never had the physical
15:17model; the only thing the lab had was
15:19the 3D scan. So, when the bridge
15:23arrived, it was like, well, just hoping
15:25that everything would fit well. And
15:29look how the seating of the fixed
15:31bridge matches on the stone model and
15:33the printed model, which they printed
15:35for me in a black resin that, honestly,
15:38I think looks nice in photos because of
15:40the contrast, but it’s not the most
15:42practical. Look there at the seal where
15:47the canine is, the seal on the other
15:53two units. So, what does this tell me?
15:57It tells me that this scanner obviously
16:00has very good precision and very good
16:04accuracy. Now, when we talk about
16:13intraoral scanners specifically, we
16:15find that there are closed-system or
16:17open-system scanners. Nowadays,
16:20practically all scanners are
16:23open-system. What is a closed-system
16:25scanner? A closed-system scanner. We
16:29are generally talking about a scanner
16:31that only allows the files you generate
16:34from the scan to be worked on
16:35exclusively with their design [software
16:38] and that you can export them to be
16:40processed only by one milling unit,
16:42which was what happened previously with
16:44Sirona. With Sirona scanners, you
16:49couldn't export the STL files to be
16:51processed by other software; you had to
16:54forcibly work within the Sirona
16:56ecosystem and mill only with Sirona.
16:59Nowadays, that is no longer the case.
17:03Depending on the brand, they may
17:04require a considerable annual fee. That
17:07is also a matter that has practically
17:09been eliminated, but previously both
17:11Sirona and 3Shape asked for an annual
17:14license that could cost around $ 1,000.
17:19Currently, that is practically
17:21eliminated. Although, obviously, if
17:25there is eventually an update, you will
17:27be asked for a fee to upgrade. And well
17:33, in general, there are two types of
17:36scanning technologies: optical scans,
17:38where you will generally have color
17:40scans, which, as I tell you, color
17:43scanning is only for image processing,
17:45but what the software actually works
17:47with is the STL; and laser-type scans,
17:50which will only give you scans without
17:52color, that is, without the, let's say,
17:55natural color of what you are scanning.
17:59You will have a color that the software
18:01will give you, which could be purple,
18:03it could be eh sand color, it could be
18:05blue, but it doesn't really give you
18:07that capture of the colors that are eh
18:09in the intraoral scanner. And being an
18:14intraoral scanner, logically the image
18:15acquisition will be directly from the
18:17patient's mouth. However, well, you can
18:20also use it to perform model scans, as
18:21you have already seen. And well, this
18:25virtually eliminates the need for
18:26conventional impressions. Why do I say
18:28virtually? Because not in all cases
18:31will it be possible to do intraoral
18:34scans. Right now, eh one of the issues
18:37that is, well, most difficult to solve
18:40with intraoral scans is the subject of
18:43edentulous patients. Why? Well, because
18:47with the edentulous patient, the
18:49software struggles to match the images
18:52and generate a digital model faithful
18:54to what the edentulous ridge is; in
18:56addition to correctly capturing the
18:58vestibule, because if you remember, an
19:00important part of complete dentures is
19:03that the dentures must reach just that
19:05vestibule, which is you finding that
19:07point where, let's say, the attached
19:09part ends and where the mobile part of
19:12the mucosa begins. So, with intraoral
19:15scans, it is practically impossible to
19:17manage to perform that scan. And the
19:19other situation where there is
19:21difficulty is in large edentulous gaps.
19:23Why? Because again, for example, we can
19:26have a situation of a distal free-end
19:28gap, that is, understand distal
19:30free-end gap as where our only last
19:32dental organ would be a second premolar
19:34, for example, and we no longer have
19:37molars. So, if you want to scan that
19:40free-end gap, the oral scanning
19:42software struggles to be able to do,
19:44let's say, the stitching or that
19:46matching of the images to again
19:48generate. Obviously, a lot of work is
19:52being done on that by the commercial
19:55companies, but we could say those are
19:57the situations where a conventional
19:59impression to be scanned later might
20:02still be necessary. And they are
20:07relatively less precise than tabletop
20:09scanners; typically, tabletop scanners
20:11are generally the quality standard in
20:13scan precision. However, intraoral
20:17scanners already have excellent
20:19precision and are now practically equal
20:21to tabletop scanners. So, let's see
20:25what an intraoral scanner is like. In
20:27this case, it's a demonstration of the
20:303Shape. Hm. Let's go. So, as you can
22:20see, for example, with a
22:22latest-generation intraoral scanner,
22:24you will be able to perform very fast
22:27scans, which is a difference that can
22:29be a deciding factor in choosing the
22:31intraoral scanner you want to use. Let
22:37me tell you, from experience, when I
22:39was teaching, we acquired an older
22:42generation intraoral scanner, a
22:44Carestream 3500 if I recall correctly,
22:47and although it was a scanner that had
22:50good precision, the truth is that it
22:52was somewhat slow when acquiring images
22:55. So, the truth is that this detracts
22:59points from the user experience, let's
23:02say, because it can be frustrating to
23:04take a certain amount of time to manage
23:07to complete a scan, right? So, the
23:11truth is that a scanner that is fast in
23:14image acquisition makes your workflow
23:16much easier. And a problem I have seen,
23:22or rather heard of, from people who
23:24have purchased second-hand scanners to
23:27enter the digital world without making
23:30a very large investment, is that they
23:33end up frustrated by the slowness of
23:36the scanner sometimes, and they end up
23:39stopping its use and prefer to take
23:41conventional impressions instead. So,
23:46perhaps saying that speed is something
23:48trivial, or that precision is more
23:50important, I don't think it's that
23:52trivial. Really, good scanning speed
23:57contributes a lot to the user
23:58experience and motivates them to keep
24:01using the scanner, because like
24:02everything, there is always a learning
24:05curve. And in this other video I am
24:09going to show you, it is a case where I
24:13went to a lab so they could scan the
24:16model of a prosthesis for a surgical
24:20guide for an edentulous patient. So, as
24:24you will see, also an intraoral scanner
24:27, although not designed for it, can
24:29also be used for scanning models. Once
24:35again, this is one from 3Shape. So,
25:22well, in this particular case, we also
25:24have part of the base so we can overlay
25:26it in the surgical guide design
25:28software, but this video was mainly to
25:30show you that it can also be used for
25:32indirect scans. What advantages do
25:35intraoral scanners have? For one thing,
25:38an intraoral scanner can also be used
25:40for extraoral model scanning. The
25:44scanning angle is variable, meaning we
25:46can manipulate the direction of the
25:47scan to better capture hard-to-reach
25:49areas. It can be very fast, especially
25:52with the latest generation of scanners.
25:56Color images help differentiate soft
25:58tissues from hard tissues, and for
26:00better or worse, there is now a large
26:03number of intraoral scanners on the
26:05Mexican market with different quality
26:07levels and, obviously, different price
26:10points. We generally find scanners that
26:14are Chinese-made at prices that don't
26:16exceed 200,000 pesos, like the Panda,
26:18for example, which is a brand I don't
26:20really know, but I know it's being sold
26:23in Mexico. There's the Shining 3D scan,
26:28Medit, and we also obviously find the
26:31premium brands, such as 3Shape,
26:33Dentsply Sirona, Planmeca, iTero, among
26:37others. So, the truth is that there is
26:40something for every budget, and that's
26:42not even counting the second-hand ones.
26:47And obviously, being, as you have
26:48already seen, a compact handpiece, it
26:51is easy to transport. So, you could
26:54have a single intraoral scanner for
26:56your practice and, if you have several
26:58operatories, you just move it—since
27:00they usually sell it with a laptop
27:02where the software is already installed
27:04—to the different rooms; it is so
27:06easy to transport that several dental
27:08labs do it. I know that in Monterrey
27:12there are, I believe, two dental labs
27:14that offer the service of going to your
27:16office and doing the scan for you. But
27:21there are also some downsides, right?
27:23To start with, they are generally more
27:25expensive; as I tell you, there is a
27:27lot of variability, so it depends on
27:30what you want and can afford. Capturing
27:34subgingival margins is a challenge
27:36because, obviously, an intraoral
27:38scanner can only capture what it can
27:40see. So you won't always be able to get
27:43rid of your retraction cords. When we
27:46talk specifically about scanning in
27:48implantology, since an attachment
27:49called a scan body is used—which we
27:51will talk about a little later—this
27:53really isn't a problem. Because
27:56obviously implants are subgingival, but
27:59the scan post has a certain height that
28:02is, let's say, sufficient for the scan
28:05and design software to recognize where
28:07the implant is via the scan post. And
28:12there is generally a difficulty in
28:14scanning reflective surfaces. So, if
28:18the patient has metal inlays or metal
28:21crowns, these reflective surfaces
28:24generally create greater difficulty for
28:28some scanners, and older generations
28:31can be very slow or imprecise. So, in
28:36the one I mentioned, the CS 3500—I'm
28:39sure that was the generation—it
28:42indicated it wasn't for full-arch; it
28:44told you it was for half-arch scans,
28:47which makes sense because, in daily
28:50workflows, it's more common to do
28:52single crown, bridge, or inlay
28:54restorations than full-arch
28:56restorations. But, for example, for
29:00orthodontics, this is no longer
29:01possible. As you know, nowadays in
29:03orthodontics, intraoral scanners are
29:05also widely used to perform digital
29:07planning or create aligners. And
29:12obviously, since it's a handpiece that
29:15one is moving constantly, all the
29:17technology the scanner carries is
29:20inside this handpiece. Which are the
29:24cameras that scan, a mirror, maybe
29:27depending on the scanner type, some
29:29projector that projects images onto
29:32surfaces to provide contrast for the
29:34cameras to scan; well, this gets
29:37decalibrated with use. So, it generally
29:43comes with a tip specifically for
29:45recalibrating the scanner. Often, the
29:50scanning software gives an alert when
29:52recalibration is necessary, and its
29:55ease of transport makes it more fragile
29:58than a laboratory scanner. Now, when we
30:03talk about laboratory or desktop
30:07scanners, we are typically talking
30:09about open systems. Because of how they
30:13scan, these necessarily require a
30:15plaster model. However, some already
30:19allow you to scan the impression
30:21directly without having to pour the
30:23plaster model. This allows for scanning
30:26without the patient being present. So,
30:28in a way, this means the workflow is
30:30better adapted to, well, a dental lab,
30:33and depending on the scanner model,
30:35some even allow you to scan, uh, models
30:38mounted on an articulator, which can be
30:40, well, efficient when we talk about,
30:43for example, full-arch restorations,
30:45meaning anything from fixed bridges on
30:47natural teeth to, well, obviously,
30:50all-on-four, all-on-six, where, well,
30:52obviously the patient is, well,
30:54virtually edentulous, has the dental
30:56implants, and for you to be able to
30:59scan what is the vertical dimension or
31:01the, well, yes, the intermaxillary
31:03distance of these edentulous models,
31:06well, it's more convenient to have them
31:08mounted on an articulator to, well,
31:10proceed with the design. Obviously, the
31:15workflow is more convenient for the
31:17dental lab and they are considered, as
31:19I tell you, the industry standard;
31:21sorry, they are generally more accurate
31:22than intraoral ones. And this is an
31:27example. Sorry. So, if you noticed, for
32:22example, this extraoral or desktop
32:24scanner, well, it has, let's say, an
32:26open scanning chamber, so it has an
32:28accuracy of 4 microns, which, well, is
32:30quite precise. And having this open
32:33chamber allows us to be able to place
32:35the entire articulator, something that
32:36isn't valid, well, for all desktop
32:37scanners. So, well, obviously it also
32:41depends on the workflow you require,
32:43well, which desktop scanner can best
32:46adapt to your needs. Well, what are the
32:50advantages of an extraoral scanner?
32:52They are considered more accurate than
32:54intraoral ones. The scanning speed is
32:56higher; you can scan very quickly,
32:58generally with an extraoral scanner. Uh
33:01, you can easily capture the finish
33:03lines because we are talking about you
33:06taking the impression, doing the die
33:08cutting, trimming the gingival margins,
33:10and you can easily capture or digitize
33:12these finish lines; it allows scanning
33:14directly from articulated models, well,
33:17normally this depends on the scanner
33:19type. They can be more economical than
33:22an intraoral scanner, however, nowadays
33:24there are cheaper intraoral scanners,
33:26as I tell you, for example, those that
33:28are under 200,000 pesos. than desktop
33:31scanners. And well, depending also on
33:35the scanner technology, it can allow
33:37you to scan directly from the
33:38impression. The cons: uh, they are not
33:41designed to be transported from one
33:43place to another. The fidelity of the
33:46scan depends on the fidelity of the
33:48impression and therefore the resulting
33:50model from it. So, this can be a
33:53deciding factor because, to get a good
33:56scan, we're talking about having had a
33:59high-quality impression and a good
34:02stone model. So, the errors we already
34:06know occur with impressions, if they
34:08give us an inaccurate model, the scan
34:10obviously won't be accurate either. We
34:13could talk about, for example, an
34:15alginate impression, an antagonist that
34:16wasn't poured immediately, or where the
34:18alginate pulled away from the tray; the
34:20model is clearly no longer faithful. So
34:23, if you scan that model, you’re no
34:25longer maintaining fidelity with
34:27respect to the patient's actual oral
34:29situation. Its size requires a
34:33considerable amount of space and,
34:35therefore, a specific area for its use.
34:37Generally, these scanners are more
34:39compact than before, but they are
34:41usually about the size of a toaster
34:43oven. For example, this 3Shape is about
34:45the size of a microwave, more or less;
34:47I mean, it’s not huge, but it's not
34:49the most compact either. If you've
34:52happened to see, for instance, the
34:54Ceramill scanner, it’s a very large
34:56one, or the Sirona one, so depending on
34:58the brand and the generation of the
35:00scanner, they can indeed be quite large
35:02. And the limited scanning angle in
35:06hard-to-reach areas forces you to use a
35:08sectioned model. If you remember, with
35:09an intraoral scanner, you manipulate it
35:11and rotate it at the necessary angles,
35:12right? To capture what you need, but in
35:16this case, no; although they do have a
35:18scanning pattern to capture everything
35:20better, you do need a sectioned model.
35:24When talking about dental preparations
35:26for scanning, first you have the solid
35:28model and then the sectioned dies, and
35:31then you match the solid model with the
35:33dies to have fidelity in the finish
35:35lines. And the options available on the
35:39market are generally more limited; that
35:41is to say, there are more intraoral
35:42scanners than benchtop scanners. Now,
35:45speaking specifically about scans in
35:48implantology, it will require a
35:50prosthetic attachment known as a scan
35:53body. This is essential for scanning
35:56implants, both intraorally and
35:58extraorally, as it gives us a reference
36:00for the four dimensions of the
36:02implant's position. What are those four
36:05dimensions? Well, the depth, the
36:07angulation, the distal position, the
36:09buccolingual or buccopalatal position,
36:11but also the internal geometry of the
36:14implant. So, for example, for internal
36:18hex implants, this scan body allows us
36:21to provide the software with
36:23information on how this hex is oriented
36:26. Every implant brand has a scan body
36:32—sorry, every implant brand has a
36:35different prosthetic connection, and
36:37therefore, obviously, scan bodies are
36:40not always compatible, and even within
36:42the same brand, there are different
36:45Osstem connection sizes. In the TS
36:50implant line, there are only two
36:52connections: the mini connection and
36:54the regular connection. So, only two
36:58scan bodies are needed, and obviously,
37:01you require as many scan bodies as
37:03there are connections to be scanned. So
37:07, assuming you have, for example, four
37:10implants in one arch, two mini and two
37:13regular, you will need four scan bodies
37:16: two mini and two regular. Now, when
37:25we perform the scan using a scan body,
37:28there are two ways to do it. You can
37:32scan with a scan body at the implant
37:35level, or you can scan with a scan body
37:38at the abutment level, which is exactly
37:40the abutment-level scan we use with the
37:43TS Link abutment. And obviously, this
37:47applies regardless of whether it is an
37:49intraoral scan or a model scan. Now,
37:58there are practically—as we have
38:00realized—scan bodies for scanning at
38:03the implant level and scan bodies for
38:06scanning at the abutment level, but
38:09when you select a scan body, you must
38:12obviously know which one to order
38:14depending on the system you are using.
38:19Within the Sirona ecosystem, there are
38:22scan bodies specifically for the CEREC
38:25system, okay? So those CEREC scan
38:28bodies are specifically for, as the
38:31name implies, CEREC. There is another
38:36family of scan bodies called, in the
38:39case of Osstem," Scan Body for public,
38:42"which is used when processing with any
38:45other scanning system. Now, if you have
38:50a Sirona CEREC scanner, for example,
38:53and you want to use the Scan Body for
38:55public, you can scan, but you won't be
38:58able to design the restoration within
39:00the software provided by Sirona. If you
39:05are already familiar with the Sirona
39:07system, you know that it comes, I don't
39:09remember if it's included with the
39:11scanner purchase or sold separately,
39:13but there is specific Sirona software
39:16for designing restorations. So, that
39:19software only recognizes scan bodies
39:21that are for CEREC. And generally, the
39:26titanium base or abutment used by CEREC
39:29comes with a special geometry for
39:32blocks that are specifically meant for
39:36milling on titanium bases with the
39:39CEREC milling unit. So, let's say CEREC
39:43in particular is a semi-open system;
39:46that is, you can scan and export, yes,
39:49you can do that too, and design with
39:52Exocad, 3Shape, etc. But if you want to
39:55stay entirely within the CEREC
39:57ecosystem, you necessarily have to
40:00acquire the scan bodies or the TiBase
40:02abutment, which is specific to CEREC.
40:06So, if that is not what you have, you
40:08will order the other scan body, which
40:10is the scan body for. I will show it to
40:13you right now. So, when we talk about,
40:19for example, scan bodies for
40:21implant-level scanning, there is
40:23obviously the option for mini, which is
40:25the yellow hexagon you see, and the
40:28scan body for a regular platform. And
40:32they also come in two lengths: 10 mm
40:35and 15 mm. This is, obviously, for a
40:40posterior area, for example, a shorter
40:4210 mm scan body might suit you better,
40:45or an implant that is very submerged;
40:47that is, one that was placed very
40:49subcrestally, as sometimes happens when
40:51we perform a placement......of an
41:01immediate implant, like an extraction
41:04of a molar, sometimes we have, well,
41:06maybe the 15 mm one or an anterior area
41:08. So, you have that versatility to
41:12choose, and again, this particular scan
41:14body......is, if you look at its shape,
41:21specifically for all other scanners and
41:23is not. And if you are going to work
41:28within the CEREC ecosystem—when I say
41:30CEREC ecosystem, I mean you are going
41:32to scan, process, or make the
41:33restoration within the CEREC software
41:35and mill with CEREC. Okay. If you have
41:38a CEREC scanner, for example, but you
41:40are going to process with Exocad, you
41:42order this impression abutment or this
41:44scan body. If you are going to be
41:47entirely within the ecosystem, it is
41:49necessary to order the specific scan
41:51body for CEREC, and in this case, it
41:52only exists in a single length, and you
41:54will notice that this scan body comes
41:56in two parts. This is the scan post for
42:01the mini irregular connection, and this
42:04is the scan body itself, which is,
42:06let's say, a small PEEK cap, and a
42:09general feature of Serec scan bodies is
42:12that the top part has a pyramid-like
42:14shape. So, all implant brands that have
42:19any type of abutment or scan body for
42:22the Serec system will have this exact
42:25geometry. In other words, it is a
42:27specification; it’s not from Hyen,
42:29Straumann, or Adin. It is a
42:31specification that Serec imposes on
42:33implant manufacturers regarding the
42:35scan body design so it can be processed
42:38by their software. So, that same cap
42:43fits both of these posts. Now, remember
42:49we are talking about implant-level
42:52scanning, and this is how it would work
42:55. Very well. Now let’s get into what
43:48really interests us in this talk, which
43:50is the one that I think is not being
43:55used enough, but I think it’s also
43:57because we don't know exactly how it
43:59works. So, what is the TiLink abutment?
44:05The TiLink abutment is a Ti-base
44:07designed 100%for a digital workflow.
44:12And something interesting is that this
44:14TiLink abutment already includes a scan
44:17body in the package, meaning you don't
44:19have to buy the TiLink abutment and a
44:21separate scan body; it already comes
44:23with one, okay? And that scan body is
44:26for single use only. So, every time you
44:28buy a TiLink abutment, it will come
44:30with a scan body. It doesn’t even
44:33make sense to save it and reuse it;
44:35it’s useless, because once you have a
44:37TiLink abutment, you automatically have
44:39the scan body that goes on top of it.
44:43What are the characteristics of this
44:44TiLink abutment or this Ti-base? Well,
44:46obviously it's made of titanium, and if
44:49you look at the image on the right,
44:52there are two gingival heights, a 1 mm
44:55gingival height and a...Remember that
44:59the Hosen implant system, in particular
45:02, follows a subcrestal placement
45:04philosophy, meaning 1 or 2 mm below the
45:08bone crest. So, if we follow the
45:11manufacturer's placement instructions
45:14for subcrestal, it is better to order
45:17the 2 mm TiLink abutment. Why? Because,
45:22for example, if you notice this image
45:23on the right, I don't know if you can
45:25see my cursor, I think you can. Uh,
45:29you'll notice how the implant on the
45:31right is subcrestal, and obviously,
45:32what happens if we take this subcrestal
45:35implant and place a tissue abutment
45:36with a 1 mm gingival height? Most
45:41likely, it will be difficult to seat
45:43that tissue abutment with the
45:45restoration because we'll be, let's say
45:47, hitting the bone that usually grows a
45:49bit over the implant platform, so it's
45:51better for you. Or even in situations
45:55where you might have an implant that is
45:57, let's say, supracrestal, but you have
45:59a gingival height of maybe 3 mm, well,
46:00it might be more convenient to have the
46:02tissue abutment with gingival height.
46:05What for? Well, so as not to be, let's
46:07say, pinching the tissue as well. So,
46:10there are two gingival height options,
46:12which are 1 mm and 2 mm. And we will
46:14also find that there are two abutment
46:16heights. Okay? So, the abutment height
46:18comes in 3 mm. And there is a 5 mm one.
46:243 mm, obviously, for example, is for
46:27when we have interocclusal space, but
46:29we obviously need to have enough
46:31interocclusal space to fit the 3 mm
46:33abutment height plus the prosthetic
46:35restoration on top. If we have more
46:39height, more interocclusal space, it's
46:41better to use the 5 mm one because
46:43remember that greater abutment height
46:45means more friction and better
46:47retention. You'll notice that this
46:51tissue abutment also has grooves on its
46:53entire surface, which are
46:54micro-retentions, and you'll see that
46:56it also has three lobes. So, these
47:00three lobes near the base of the
47:02attachment serve as an anti-rotational
47:04system that will prevent the
47:06restoration from rotating, right, on
47:09this attachment. And as, again, I think
47:13it should be clear by now, the Ti base
47:15comes for Cerec and comes in a version
47:18for everything else that isn't Cerec.
47:21So, for the Cerec one, there's mini and
47:23regular, and this is something
47:26important that you have to check with
47:28your representative. Uh, catalogs show
47:31certain things that aren't available
47:33yet in the Mexican market due to
47:35Cofepris issues or whatever you want,
47:37but the catalog tells us there's a
47:38hexagonal option and a non-hexagonal
47:40option. Generally, the hexagonal
47:44options, which we know as
47:45non-rotational, are for crowns, and the
47:47non-hexagonal or rotational options are
47:49used for bridges. Okay? And if you
47:55notice, this TiBase abutment comes
47:56again with its scan body that assembles
47:58. If you notice, it has the same
48:01geometry with that pyramid on the
48:03surface. Now, what is the workflow
48:07generally? How do you normally scan for
48:10an implant? Generally, what we do first
48:16is scan the emergence profile. That is,
48:19we have our implant with either our
48:21provisional or perhaps we just have a
48:23healing abutment. The first step is to
48:26remove this provisional and then scan
48:29this emergence profile. Once we scan
48:33the emergence profile, we put the
48:36Tinkman scan body on top and scan it
48:39again. And that is how it would have
48:43already been scanned. The antagonist is
48:47scanned, the bite registration is
48:48scanned, and in this way, you can now
48:54design the crown. In this case, well,
48:57if you notice, the CEREC one was used,
48:59so the crown was processed using the
49:00CEREC software. So, the software has a
49:09function called biogeneric that
49:11automatically designs the crown with
49:13the mesiodistal space and the occlusion
49:14. From here, you move on to the part
49:24where you place it, choose the material
49:26you are going to mill, and place it
49:28within the block where you want the
49:30crown to be. And from there, you follow
49:41the software's instructions to indicate
49:43what type of material and which milling
49:45machine you will use. Now, the CAD
49:52software follows, as we have already
49:55done the scan. So, since we have the
49:59scan, we generally have to use software
50:02to design the crown. So this software,
50:06as I mentioned, receives the images
50:07obtained by the scanner in STL format.
50:12Here, the actual design of the dental
50:14restoration is performed, and then that
50:16resulting design is generally exported
50:18as another STL file that can
50:20subsequently be read by either a
50:22milling machine or a 3D printer.
50:28Regarding CAD software, there are
50:30several; they are generally open or
50:32closed architecture, most are open
50:34architecture as I mentioned, for
50:35example, Sirona is closed architecture.
50:39Most include an initial fee for the
50:41basic design modules. This, well, I
50:44leave it in quotes, because we know
50:46that if you buy, for example, Exocad
50:56legally, it costs, I don't know, 60,000
50:57pesos for the software, but it includes
50:59...and if you want to keep adding
51:01modules, they also cost a certain
51:02amount to add. For better or worse, you
51:06can get it—it sounds bad, but it's
51:09the reality—illegally, pirated, for
51:11about 6,000 to 7,000 pesos, and you get
51:14access to all the modules. And well,
51:18design modules are generally sold
51:19separately, but as I say, if you buy it
51:21illegally, they almost always give you
51:22the whole package. You may require a
51:26mandatory annual fee or update download
51:28fees, and it generally requires a
51:30computer with hardware for advanced
51:32graphics, that is, a gaming computer.
51:35So, it's also a separate investment
51:37because we're talking about a computer
51:39with a graphics card that has enough
51:41power to handle this type of software.
51:45If you buy the cheapest one, we're
51:47talking about around 20,000 to 25,000
51:50pesos, which are generally entry-level
51:52computers; meaning, maybe it doesn't
51:54have the best screen or the prettiest
51:56design, but it gets the job done. But
52:00if you want a computer that has the
52:02best power, processor, and graphics
52:04card, plus an aluminum chassis, we're
52:06talking about a cost of 50,000 to
52:0860,000 pesos. So, well, it depends on
52:13each person, right? What it is that
52:14you're looking for. And among those
52:18programs, there's Exocad, which is
52:20definitely the most popular. There's
52:25also, uh, 3shape, I forgot the name for
52:27a second, I think it's called...No, I
52:32don't remember, but it's the 3shape one
52:33. That's fine. And this one, which is
52:40the Sirona one. So, there are several
52:42types of software for designing dental
52:44restorations. And finally, once we've
52:49done the design, we have to bring this
52:51restoration to life. And how is that
52:53done? Well, generally with a printer or
52:55a milling machine. So, at this point,
52:58milling machines are definitely the
53:00best option, and there are several
53:01types of milling machines. There are
53:05milling machines known as chairside or
53:06compact office units. And by compact, I
53:09mean you can have it right there in the
53:11office, but we're talking about the
53:13size of, I don't know, about two
53:15microwaves put together; that's about
53:16the size they are. That generally gives
53:20us" immediate "restorations, in quotes,
53:22because it also depends on what
53:23material you're going to mill, and they
53:25are generally more limited both in the
53:27type of materials you can mill and in
53:29the type of restorations you can make.
53:32Meaning, they are more oriented toward
53:34single-unit situations, such as crowns,
53:37veneers, inlays, onlays, or bridges of
53:39up to three units. A limited range of
53:41materials, because obviously, you won't
53:43be able to mill metals here. You start
53:46with these mills using lithium
53:48disilicate, already crystallized
53:50ceramics like Empress, resins, or these
53:53hybrid ceramics like Vita Enamic. And
53:57generally, because of the type of
53:59materials they mill, they allow for
54:01faster milling. Also, this type of
54:03milling machine is less precise than
54:04laboratory ones due to the number of
54:06milling axes they handle. So, this is
54:10an example, for instance, e.max CAD,
54:12which is lithium disilicate, and we
54:14have a material that is completely
54:16crystallized, which would be Empress
54:18CAD. What would be the difference
54:20between these two? Beyond, well, sorry,
54:22intrinsic differences in material
54:24strength. It is much stronger, for
54:27example, than Empress; but Empress has
54:29the advantage, if you can call it that,
54:32of having blocks that are multicolored.
54:34Meaning they already have, let's say, a
54:37color gradient, and you get a final
54:39restoration with differences in chroma
54:41and saturation. So, it gives you a
54:44restoration that, once milled,
54:45practically only needs polishing or
54:47glazing, if necessary. If it were
54:49necessary to do some staining, that can
54:51be done too, but virtually coming out
54:53of the mill, it can be processed for
54:55cementation. On the other hand, e.max
55:00CAD comes pre-crystallized, so it must
55:03first be crystallized, and it generally
55:06does not come in multicolor; it is
55:09completely monochromatic. So, to make
55:13these look nice, they must be stained.
55:15So, keep in mind that post-processing
55:18time is required after milling. Sorry.
55:27And laboratory milling machines are
55:29generally bulkier, but consequently,
55:31they offer a very wide range of
55:33materials, practically all materials,
55:35including metals. And the milling can
55:41be slower, but more precise. Ah, sorry,
55:53my throat is bothering me a little bit.
55:57So, this is an example, for instance,
55:59the Ivoclar milling machine. And look
56:01at all the materials that can be milled
56:02. You can mill, for example, resin,
56:06zirconia, ceramics, acrylics, metals,
56:10provisional resins, and even waxes,
56:13with properties similar to wax to be
56:16burned out and integrated into a
56:19conventional workflow, whether for
56:22casting or ceramic injection, like in
56:25e.max Press. On the other hand, we have
56:303D printers, which have a more limited
56:32use, since the only materials we can
56:34work with are liquid resins that can be
56:36photopolymerized. Generally, depending
56:40on the type of printer, we could say
56:42there are two types of printers: those
56:44that use lasers and those that use LEDs
56:45. So, these resins must be coordinated
56:50with the polymerization wavelength of
56:53your printer and, obviously, the
56:55resinous material itself. Although
56:58there are printers for metal as well,
57:00they are more industrial; it's not
57:02something very common, though it does
57:03exist. And there is a very wide range
57:09of printers. So, here I am showing you,
57:12let's say, three samples of the most
57:14popular printers on the market. We have
57:18, for example, Anycubic, which is a
57:20printer that is, I believe, LED, if I
57:22remember correctly. And this printer,
57:25if you look for it on Amazon right now,
57:27costs about 3,000 pesos, so it's
57:29affordable. Then there's Phrozen, which
57:32is, let's say, among the affordable
57:34ones, it is the most used because
57:36several dental resin manufacturers
57:38already have validated parameters for
57:41Phrozen's wavelength. Those images are
57:45the Sonic Mini 8K; let's say this is
57:47one of the newest from Phrozen, but the
57:50generation below this, or the one
57:52immediately below it, would be the
57:54Sonic Mini 4K, which costs around 9,000
57:57pesos. And on the other hand, we have a
58:01representative, the most popular, let's
58:03say, of these printers made
58:04specifically for a digital dental
58:06workflow. Those other two printers,
58:09Anycubic and Phrozen, are, let's say,
58:11generic 3D printers, right? I mean,
58:14it's not specifically for dental use,
58:16but as you know, everything for dental
58:18use increases the price, and this other
58:20printer is in the range of 250,000 to
58:22300,000 pesos. So, we are talking about
58:26completely different things here. Now,
58:31you have to keep in mind that if you
58:33want to have a workflow and, let's say,
58:34you want to do everything in your
58:36practice, you say," Okay, I'll do the
58:37scan. "Obviously, besides what's
58:41necessary for the scanner, the design
58:43software, and perhaps a milling machine
58:45or a printer, you have to take into
58:47account that you need to acquire other
58:49peripheral elements. What would those
58:52peripheral elements be, for example? A
58:54ceramic furnace, which will be used to
58:56crystallize those pre-crystallized
58:58ceramics like e.max CAD or Cercon ht; I
59:00mean, there are several ceramics that
59:02come pre-crystallized. You will also
59:06use it for staining and customizing
59:08milled ceramics, and if at any point
59:10you prefer using injected lithium
59:13disilicate instead of milled lithium
59:15disilicate, you can. And there is a
59:18logic behind why one would make this
59:19decision. You know that injected
59:21lithium disilicate has greater fracture
59:23resistance than milled lithium
59:24disilicate. And this is due to how the
59:27silicate crystals develop within the
59:30ceramic when it is injected versus when
59:32it is milled and subsequently
59:34crystallized. So, the other day I was
59:37watching a video from a very large
59:39dental laboratory in the United States,
59:42and they said they only use injected
59:44e.max specifically because it has
59:46higher resistance. So, if you ever
59:49wanted to work with that philosophy of
59:51only using injected e.max, you would
59:52need a ceramic furnace that has
59:54injection capability. And you obviously
59:58have to consider the crystallization
1:00:00and cooling times; that is, you
1:00:01crystallize it, the crown comes out
1:00:03red-hot, and then you have to stain it,
1:00:05fire the stain, and wait for it to cool
1:00:07before you can cement it or try it in
1:00:09the patient's mouth. So, those are
1:00:14examples. The one on the left is an
1:00:16injection furnace, and the one on the
1:00:18right is a conventional furnace without
1:00:20injection capability. And this would be
1:00:24, for example, what I mentioned
1:00:25regarding crystallization. This is how
1:00:27it would look in purple right after
1:00:29milling. And why was this done? Why in
1:00:31this way? Well, because lithium
1:00:34disilicate is very hard, so it is
1:00:36faster and easier for the milling
1:00:38machine to mill a pre-crystallized
1:00:40e.max block and finish crystallization
1:00:42later, rather than having, for example,
1:00:44a fully crystallized e.max block; it
1:00:46would be harder for the mill, take more
1:00:48time, and cause more wear on both your
1:00:50motor and your burs. Now, if you are
1:00:55also going to handle zirconia, you will
1:00:57also need a zirconia sintering furnace.
1:01:00And those furnaces are not the same as
1:01:02ceramic furnaces; it is a sintering
1:01:03process. And depending on the type of
1:01:07furnace and the brand, the sintering
1:01:09cycle can take several hours. It is
1:01:11very common to mill zirconia during the
1:01:14day and start the sintering at night so
1:01:16that in the morning you already have it
1:01:18; and why must this be done? Because
1:01:20pre-sintered zirconia comes in blocks
1:01:22that are apparently colorless. So, once
1:01:26it is milled, it ends up in this white
1:01:29color and in a dimension larger than
1:01:31the final dimension. Once it
1:01:35crystallizes, the restoration takes on
1:01:38its proper color and achieves its final
1:01:40dimensions. And if you look at 3D
1:01:44printing, you also need a unit for
1:01:47washing the resin. Why? Because when
1:01:50you get your 3D print, it has an
1:01:53oxygen-inhibited layer, and these
1:01:55resins are known to be quite irritating
1:01:58to the skin. So, you have to remove all
1:02:01that uncured resin from the surface of
1:02:04your 3D print. Generally, there are two
1:02:08ways this is normally done: with
1:02:10isopropyl alcohol and a spray bottle,
1:02:12washing the entire surface very well,
1:02:14or ideally, acquiring a specific
1:02:16washing unit and a separate
1:02:18light-curing unit. Currently, for
1:02:21example, both Anycubic and Phrozen have
1:02:26this multipurpose unit called Wash and
1:02:28Cure, which allows you to wash the
1:02:30restoration and perform the final
1:02:32light-curing in the same unit; because
1:02:34when you take your print out of the 3D
1:02:36printer, it isn't fully cured and
1:02:38requires an additional final
1:02:40polymerization cycle. Now, what are the
1:02:45general types of crowns we use for
1:02:47implants? In general, there are three
1:02:49types of crowns: screw-retained,
1:02:51cement-retained, and
1:02:52screw-cement-retained. When we talk
1:02:54about Ti-Base abutments, we are talking
1:02:56about making screw-cement-retained
1:02:57crowns. Why? Because we are going to
1:03:00place a crown that we will cement to
1:03:02that Ti-Base abutment, but it will
1:03:03still have access to the prosthetic
1:03:04screw. So, we call them
1:03:06screw-cement-retained, which in English
1:03:08they even refer to as" screw-cementable
1:03:11. "So, the substantial difference
1:03:13between a cement-retained and a
1:03:15screw-retained crown. Although these
1:03:19crowns are cement-retained because you
1:03:21ultimately cement the crown to the
1:03:23abutment, having this access to the
1:03:26prosthetic screw—that is, a chimney
1:03:28or a hole in your restoration—refers
1:03:30to a crown that doesn't have this
1:03:32access to the screw, where you normally
1:03:35go to the patient's mouth, screw it in,
1:03:37torque it, and perform the cementation
1:03:39chairside. So, there are techniques for
1:03:42how it should be cemented in the mouth.
1:03:45There are specifications, such as the
1:03:47cement lines shouldn't be too
1:03:48subgingival, which allows you to clean
1:03:50the cement inside the mouth; but once
1:03:52cemented, you no longer have access to
1:03:54the prosthetic screw. To access it, you
1:03:57would have to drill through the crown,
1:03:59and that’s only if you know where to
1:04:00drill, perhaps if you remember or know
1:04:02roughly where the screw access was. And
1:04:06, in most cases, you end up destroying
1:04:08the crown, having to redo the crown
1:04:10entirely. And with screw-cemented ones,
1:04:14the cementation is usually extraoral,
1:04:16and since it is extraoral, it doesn't
1:04:19matter if the finish line is gingival,
1:04:21because you don't have to worry, since
1:04:23you are performing extraoral
1:04:25cementation. So here is another example
1:04:31, a seated crown; you can see, the
1:04:32abutment also touches the implant, it
1:04:34is torqued, and the crown is cemented
1:04:36in the mouth, and well, you no longer
1:04:38have access. So, since you also don't
1:04:41have this perforation, the cement
1:04:42generally flows toward the gingiva. So,
1:04:45if you remember, the gingiva normally
1:04:48adheres to the surface of implants just
1:04:50as it does to natural teeth. So, on a
1:04:54natural tooth, we have a real
1:04:56attachment between the gingiva and the
1:04:59root surface, and this allows for
1:05:01cement extrusion when we cement a crown
1:05:04on a natural tooth, which we can remove
1:05:06regardless of how subgingival that
1:05:09crown might be. On an implant, since
1:05:12this gingiva, let's say, is more
1:05:14fragile and not well attached, excess
1:05:16cement that is very subgingival will go
1:05:18down to the implant. That cement, as it
1:05:20is known, is one of the main causes of
1:05:23peri-implantitis, due to the retention
1:05:25of cement remnants on the surface of
1:05:27the prosthetics or implants when
1:05:29cementations are very subgingival. So,
1:05:32it is quite a complex issue, cemented
1:05:34crowns. On the other hand, with these
1:05:36screw-cemented ones, you cement outside
1:05:38the mouth and finally screw the
1:05:39restoration into the patient's mouth.
1:05:48Now, what is the prosthetic space
1:05:50needed for what we use? As I mentioned,
1:05:52we have two prosthetic heights of 3 and
1:05:555 mm, and gingival heights of 1 and 2
1:05:57mm. So, the ideal space for a lithium
1:06:01disilicate crown; the minimum space is
1:06:041.5 mm, but 2 mm is ideal. When we talk
1:06:09about hybrid materials like ceromers or
1:06:11Enamic, since it is a less hard
1:06:13material, so to speak, it requires a
1:06:15bit more thickness to have good
1:06:16strength. So, it does require more. So,
1:06:21if we do the math, the minimum space
1:06:23required from the implant platform to
1:06:24the antagonist's occlusion is 5.5. to 6
1:06:28mm. Why? We have that the gingival
1:06:32height, for example, with 2 mm of
1:06:35gingival height, plus the abutment
1:06:37height of 3 mm, is 5 mm, plus the
1:06:40minimum thickness of a crown of 1.5 mm,
1:06:42is 6.5. So, we are talking about a 5.5
1:06:46minimum from the implant platform. So,
1:06:50if we already had, for example, an
1:06:52interocclusal space of less than 5.5 mm
1:06:54from the implant platform to the
1:06:56antagonist, then obviously this
1:06:58abutment won't work for us. And keep in
1:07:01mind, this abutment should not be cut;
1:07:03I mean, it's either three or five. And
1:07:06why shouldn't it be cut? Because since
1:07:08we are working digitally, the software
1:07:11will fabricate your crown. Taking into
1:07:14account the dimensions of the abutment.
1:07:16So, you cannot digitally cut the
1:07:18prosthetic abutment in the software.
1:07:23And well, as I tell you, this is
1:07:25available only for the digital workflow
1:07:27because it doesn't have a burnout
1:07:29coping. There are others, eh, in other
1:07:31implant brands and this is important
1:07:33because sometimes, oh, why this brand
1:07:34does and this one doesn't? Well, brands
1:07:37are different and they make their own
1:07:38decisions. In other brands, there are
1:07:41titanium abutments or Ti-bases that
1:07:42give you the digital workflow option
1:07:44with a scanbody, but they also give you
1:07:46the analog workflow option by including
1:07:47, for example, or selling you a burnout
1:07:49coping separately. There is no burnout,
1:07:52and as I mentioned, it also depends on
1:07:54availability. Eh, at this moment, you
1:07:58would have to verify that with your
1:07:59representative, but as far as I
1:08:01understand, currently only the Ti-base
1:08:03abutment is available. Hexagonal, that
1:08:07is, the one that is non-rotational, and
1:08:09therefore, since it is non-rotational,
1:08:12it is only available for single crowns.
1:08:17However, we know that in general, for
1:08:19example, when we have two implants,
1:08:22specifically speaking about Hiossen,
1:08:24the prosthetic connection is an 11-
1:08:27degree cone. So, if we had, for example
1:08:32, two implants that had a divergence
1:08:34between them of no more than 11 degrees
1:08:37, we could use hexagonal prosthetic
1:08:39abutments for a fixed bridge, because
1:08:41that would allow for the seating of
1:08:43both abutments. And if the divergence
1:08:48is greater than 11 degrees but less
1:08:49than 22 degrees, then we would
1:08:51necessarily need prosthetic abutments
1:08:52that are......not, that are rotational
1:08:57or non-hexagonal. So, check with the
1:09:01representative if the Ti-base abutment
1:09:04for bridges is in the catalog. In
1:09:08general, what I would recommend is that
1:09:10if you have a bridge......with little
1:09:14or a lot of divergence, always order
1:09:16prosthetic abutments that are
1:09:17rotational because they facilitate the
1:09:19seating of those components. And well,
1:09:26how can we use this Ti-base? We can use
1:09:29it for both full-contour restorations,
1:09:32as long as the prosthetic access is
1:09:34also in an area that is not...of
1:09:38aesthetic or functional importance;
1:09:40that is, screw access in an anterior
1:09:43case or in a posterior case that might
1:09:45end up, for example, toward the
1:09:47occlusal. But we can also do what is
1:09:52called or known as a customized
1:09:54emergence profile. We can make, for
1:09:57example, an emergence abutment in the
1:09:59shape of a stump with the finish lines
1:10:01near the gingival margin, as if we were
1:10:04making a custom stump. This is
1:10:07extraorally cemented to your titanium
1:10:09base and is a crown that is cemented
1:10:12intraorally. So this gives you certain
1:10:16advantages with screw-retained crowns;
1:10:18obviously, since they don't have a hole
1:10:20in the middle—sorry, cemented crowns,
1:10:22since they don't have a hole in the
1:10:23middle, are stronger because you have
1:10:25material in the occlusal area. However,
1:10:30this situation is the same as with any
1:10:32crown where if you want to re-access
1:10:34the prosthetic screw, you will have to
1:10:36drill through your crown. When would
1:10:40this be useful? Also, for example, in
1:10:42an anterior case, say a central incisor
1:10:45, where the anatomy of the alveolar
1:10:47ridge did not allow you to place an
1:10:49implant that gives you access to the
1:10:51prosthetic screw through the palatal
1:10:53side. That is to say, the angulation of
1:10:57this ridge makes it so that the
1:10:59prosthetic screw access is through the
1:11:01incisal edge. Well, you could
1:11:04potentially use this technique where,
1:11:06by using the abutment, you make your
1:11:08custom stump and a crown that will be
1:11:10cemented at that moment. Keep in mind
1:11:14that generally, the lab will charge you
1:11:16double for this; they will charge for
1:11:18both the crown and the stump separately
1:11:20. And to finish up with the objectives
1:11:23of this talk, we are going to discuss
1:11:25how to perform a correct cementation.
1:11:28So, the first thing I recommend before
1:11:31cementing any crown to a titanium base
1:11:33is one, to verify the correct seating
1:11:35on the titanium base, and two, to try
1:11:38it in the patient's mouth before
1:11:40cementing. Why? Because sometimes you
1:11:44think the color turned out well, but
1:11:46once placed in the patient's mouth, the
1:11:48color might not be adequate, and if you
1:11:49have already cemented it, it can no
1:11:51longer be sent back because there is
1:11:53cement and resin. Then the cement
1:11:55expands and the crown cracks, and
1:11:58sometimes the resin oven gets
1:12:00contaminated. So, first, you should try
1:12:03in the crown. If we see that a color
1:12:05adjustment is needed, well, we make the
1:12:07adjustment, and once we are satisfied
1:12:09with the color, we proceed with the
1:12:10cementation. There we can see that the
1:12:13crown is seating well. In this case, it
1:12:16is a porcelain-fused-to-metal crown. To
1:12:19the titanium abutment, we seal the
1:12:25access to the screw with Teflon tape.
1:12:29In this case, it's Teflon. It comes in
1:12:30white and different colors. I like this
1:12:31yellow one because it is a little bit
1:12:33thicker than the white one. And for
1:12:38these titanium bases, it is generally
1:12:41good to sandblast them, because this
1:12:43sandblasting will help us have better
1:12:46cement retention. And besides
1:12:51sandblasting, it is also ideal to use a
1:12:54specific primer for metal and zirconia.
1:12:59There is a protocol for zirconia as
1:13:00well as a protocol for lithium
1:13:02disilicate. Okay? When we talk about
1:13:05zirconia, zirconia generally has a
1:13:07decontamination protocol and also a
1:13:10conditioning protocol so that it has a
1:13:12good chemical bond with the luting
1:13:14cements. For zirconia, it is normally
1:13:19used either to sandblast the inside of
1:13:21the crown just before cementation, or
1:13:24you can also use specific cleaners like
1:13:26Ivoclean or similar. Which will remove
1:13:30the phosphates from saliva and blood,
1:13:32allowing for a good interaction with
1:13:34the zirconia primers. And this same
1:13:38zirconia primer, which in this case is
1:13:40Z-Prime, can be used on both zirconia
1:13:42and the titanium base. If it were, for
1:13:47example, a lithium disilicate crown,
1:13:50the silicate is conditioned as we
1:13:52normally do, meaning 5%hydrofluoric
1:13:55acid for 20 seconds. You rinse it, or
1:13:59you can wash it in an ultrasonic bath
1:14:03for 5 minutes with alcohol, or we can
1:14:06apply phosphoric acid for a minute and
1:14:09rub the surface to remove the ceramic
1:14:13sediments left by the hydrofluoric acid
1:14:16. After that, we apply silane, and now
1:14:18that it is silanized, we can proceed
1:14:20with the cementation. For example,
1:14:22RelyX Self-Adhesive, there is a huge
1:14:25variety of cements. In this case, I use
1:14:27this one; I've been using it for a
1:14:28while and it has worked quite well for
1:14:30me. It is Panavia SA, which comes in
1:14:33manual mix and automix presentations.
1:14:36So, the ideal thing is to put this
1:14:38cement on the surface of the attachment
1:14:40and also put cement on the inside of
1:14:41the crown. So, once we do this, we
1:14:44place it. If you notice, we are doing
1:14:46an extraoral cementation. And this is
1:14:49very important because what you see
1:14:50here is the same thing that would
1:14:51happen in the patient's mouth. The
1:14:55problem is that in the patient's mouth,
1:14:57the cement—with the gum tissue in
1:14:59this area—will fill the implant
1:15:00threads. So, we seat it correctly by
1:15:04applying firm pressure, and we will
1:15:06remove the cement that flows through
1:15:08the chimney with a microbrush. And once
1:15:14the cement is removed, we should be
1:15:16able to see the Teflon inside the
1:15:18channel that gives us access to the
1:15:20prosthetic screw. If for some reason
1:15:23the cement polymerized early, it
1:15:24doesn't matter. You can remove it here
1:15:27with a round bur. We remove the excess
1:15:31cement, leaving a gap due to oxygen
1:15:33inhibition. We apply a glycerin gel
1:15:37there, in this case, Johnson&
1:15:39Johnson’s KY, and we will seal the
1:15:42margins. Once we perform this
1:15:45light-curing, we have to polish the
1:15:47connection area. And by polishing, we
1:15:53ensure that there is no cement
1:15:54retention left. In fact, if you notice,
1:15:58during this polishing, I removed the
1:16:00part of the ceramic that was right at
1:16:02the margin. At the end of the day, this
1:16:05will remain subgingival. So, the gum
1:16:08tissue is more or less at this level
1:16:10here. Just imagine, doing this
1:16:12intraoral cementation would have been a
1:16:13disaster. And finally, we can go ahead
1:16:16and cement it—sorry, I mean screw it
1:16:17directly into the patient's mouth. We
1:16:20use 35 Ncm for the regular platform and
1:16:2220 Ncm for the mini platform. We place
1:16:26Teflon over the prosthetic screw and
1:16:29seal it with resin. I recommend always
1:16:34using a different resin color than your
1:16:36crown; for example, if the crown is A3,
1:16:38use one that makes it easier to
1:16:40identify the prosthetic access later.
1:16:44To finish, let’s summarize everything
1:16:46we saw today. The digital workflow
1:16:49includes digitization through 3D
1:16:50scanning or indirectly using
1:16:52traditional working models. There is a
1:16:55great versatility of prosthetic options
1:16:56, from metal-free materials like
1:16:58ceramics and non-ceramics to
1:16:59conventional porcelain-fused-to-metal
1:17:01and metal-ceramic restorations. A scan
1:17:05body is always required when you want
1:17:07to restore a dental implant digitally.
1:17:09You can scan with a scan body at the
1:17:11implant level or at the abutment level.
1:17:14The ti-base already includes one, and
1:17:16there are scan bodies available for
1:17:18both the implant and abutment levels.
1:17:22Don't forget to verify that there is
1:17:24sufficient prosthetic space, as we just
1:17:26mentioned. And remember that if the
1:17:29prosthetic screw access is not occlusal
1:17:31or palatal, the indication in this case
1:17:33would be to make a cement-retained
1:17:35crown, either by using the Ti-base
1:17:37abutment for a custom emergence profile
1:17:40or other types of solutions, such as
1:17:42conventional angled abutments. Okay?
1:17:47And with this, we conclude today's
1:17:48presentation. If you have any questions
1:17:54outside of I'll send you the
1:17:59it's just that
1:18:00if you want, I'll send them to you.
1:18:02Doctor Rey has a question, Doc.
1:18:08Yes, good morning, everyone.
1:18:10Yes. Ah, I have a doubt there, I don't
1:18:12know if I didn't hear it or if you
1:18:13didn't mention it. When we are doing
1:18:15the digital workflow and we have
1:18:17already scanned the scan body.
1:18:20Yes, we've scanned it. You know that in
1:18:23the library you have to choose if it is
1:18:24mini or regular. You already chose it,
1:18:26for example, Mini
1:18:28and you are choosing them. But after
1:18:29that, there is a small window where
1:18:32they give you like
1:18:34like five, five, um, like five options.
1:18:38I, when do I choose one for each? That
1:18:41was when I did a test and it didn't fit
1:18:43,
1:18:44I mean, I had to do several to get it
1:18:46right. So, that is one of my questions.
1:18:50Okay. Uh-huh. The other one. Okay.
1:18:53Or let me
1:18:54Yes. I mean, suppose that
1:18:57No, go ahead, go ahead.
1:18:59Let's see, tell me.
1:19:01Uh-huh. That is one of the, of the
1:19:02doubts I have. If you want, I'll tell
1:19:04you the other one in a moment. No, no,
1:19:06no, tell me. Okay. Well, the scan body,
1:19:15let's say it would be, when it's for
1:19:17Ti-base, then you would have to choose
1:19:20in the software which link you chose,
1:19:27either mini or regular platform, the
1:19:29gingival height you have there, the
1:19:31abutment height. So, let's say you
1:19:35could have the option of, let's assume,
1:19:37if it were a Ti-base for mini, you have
1:19:40to choose, I tell you, those of 1 or 2
1:19:43mm and also the height that is 3 or 5
1:19:45mm; and also, generally, maybe in that
1:19:48same library, you also get the option
1:19:51of whether it is hexed or non-hexed.
1:19:56That is why all those options appear.
1:20:02And I have the libraries, I can share
1:20:04them with you without a problem so you
1:20:06can upload them to your software.
1:20:09Uh-huh. When, when I already chose
1:20:12these, for example, 2 mm of gingival
1:20:15height and 3 mm of this height. Uh-huh.
1:20:20And I also already chose if it's a
1:20:21hexagon or if it's not a hexagon, but
1:20:22then I think it gives you another, it
1:20:24gives you another little window where I
1:20:26tell you that
1:20:29it gives you the last window where you
1:20:31have to choose, there are like five
1:20:32options and there you have to choose
1:20:33one. When is it going to be one for
1:20:36each one? Or are you going to give me a
1:20:37catalog so I can choose it? Well look,
1:20:46I have the library. Now, you would
1:20:48really need to check if you know how to
1:20:51do it, well, load that library to be
1:20:54able to select the abutments, and if
1:20:56not, I'll be honest with you, I have
1:20:59Exocad, but it was installed for me. So
1:21:03, the technical parts, I don't really
1:21:04touch them with this person who advises
1:21:06me, and he is the one who loads the
1:21:07libraries, do you see what I mean? So,
1:21:10I can't tell you exactly how to load
1:21:15them, and surely the person who did
1:21:17your installation can help with that
1:21:19part, on how to load the library
1:21:21directly into Exocad. If we are talking
1:21:24about Exocad specifically about that
1:21:26little window you mention about the
1:21:27options, once you have chosen all that,
1:21:29honestly, I don't know because that
1:21:31doesn't come up for me. It's as if once
1:21:34I've chosen the corresponding abutment,
1:21:36I just continue with the processing of
1:21:39the crown. So that other window you
1:21:41mention doesn't appear for me. Ah, okay
1:21:47. Because yes, I use Exocad and I kind
1:21:49of had that issue, but better
1:21:52specifically Zoom.
1:21:56Uh-huh. Well, also, if you can give me
1:21:59your WhatsApp number, I can just tell
1:22:01you there what I'm doing and I feel
1:22:03it's quick.
1:22:05Yes. Uh-huh. Okay. So, if you want, you
1:22:08can share it with us now. Uh-huh. The
1:22:11other problem. And it's that sometimes
1:22:22Yes, Doc.
1:22:24Yes, it's that the audio seems to be
1:22:25cutting out.
1:22:26Hello.
1:22:28Yes,
1:22:32yes.
1:22:33Uh-huh.
1:22:36What is your other question?
1:22:39Uh-huh. And the other question is, when
1:22:42do you choose a milling machine?
1:22:44Because
1:22:45Yes, can you hear me here?
1:22:53Yes, I hear you fine, Doctor.
1:22:56Ah, okay. As I was saying then, when do
1:22:59you choose a milling machine when it is
1:23:02four-axis or five-axis depending on
1:23:04each job? Because we have the four-axis
1:23:09Wieland here, but for example, I have
1:23:12had problems milling large arches, for
1:23:14example, like All-on-4 or All-on-6.
1:23:19Would a five-axis one be recommended
1:23:20here, or is there a trick to do it on a
1:23:23four-axis one? Okay. No, honestly, I
1:23:31believe the five-axis one is better,
1:23:34because the more axes the milling
1:23:37machine has, the better the access to
1:23:42different parts of the milling,
1:23:43especially when it comes to milling
1:23:45implant components or similar, then yes
1:23:50, definitely, the more axes, the better
1:23:52the precision. If I recall correctly,
1:23:55it also gives you the option to do
1:24:01high-fidelity milling, which is slower,
1:24:03and generally, you know, the cartridge
1:24:05comes with the different burs, and it
1:24:07picks the smaller ones to do the fine
1:24:09milling. So, well, yes, if you don't
1:24:15want to have precision issues, the
1:24:17ideal choice is a five-axis milling
1:24:19machine and high-precision milling,
1:24:21right? I don't know if this is
1:24:26universal, but I saw it with the
1:24:28zirconia milling machine, where we
1:24:30could choose the quality of the milling
1:24:32; if you choose a lower quality, the
1:24:34milling is faster, but it's, let's say,
1:24:36coarser, if you know what I mean.
1:24:43Yes, I think so.
1:24:49Very good. Okay, Doc. Got it. Thanks.
1:24:55Any other questions?
1:24:59Doctor, there is a question in the chat
1:25:01that says when the patient has a metal
1:25:03restoration on a tooth that will be in
1:25:05contact with the restoration and the
1:25:07scanner doesn't detect it, is there
1:25:08something to make the image visible
1:25:10where there are metal restorations? Ah,
1:25:20it’s not so much that it doesn't
1:25:21detect it, but sometimes, how can I
1:25:23explain? It’s like metal restorations
1:25:29or metal surfaces are reflective and
1:25:31sometimes they don't scan accurately,
1:25:33creating glare, so to speak. There are
1:25:36contrast powders that help you opacify
1:25:42that metal, and that allows you to
1:25:44perform the scan correctly. Also, if
1:25:49you don't have this contrast powder, a
1:25:52trick I've seen is, for example, using
1:25:54occlusion sprays like Occluzion or any
1:25:57other type of spray, you just apply the
1:25:59spray, place it over that restoration,
1:26:04and it facilitates the scan. Obviously,
1:26:06if it's red and the scanner is a color
1:26:08scanner, that crown will show up as red
1:26:14, but it’s perfectly fine if it's
1:26:17necessary.
1:26:23Thanks, Doctor. And there is another
1:26:27question that says, for completely
1:26:29edentulous patients, is there a
1:26:30protocol in the high-tech space to do
1:26:33it completely digitally, and is there
1:26:35any article you recommend for that same
1:26:37scanning protocol where the patient is
1:26:39completely toothless, or edentulous?
1:26:48Okay. For the completely edentulous
1:26:49patient, if possible. The truth is this
1:26:55is more complicated with intraoral
1:26:57scanners; it is very difficult to get a
1:27:00good model scan because, imagine, the
1:27:02intraoral scanner captures each image
1:27:08and it has a dimension of one or two
1:27:10centimeters at most, right? And what it
1:27:13does is stitch the images together, the
1:27:15complete image, and the software is
1:27:16generally designed to recognize teeth.
1:27:22So, teeth are what provide the
1:27:23reference," Okay, this image goes here,
1:27:25"but when you have an edentulous ridge,
1:27:27it is a lot of work for the software to
1:27:29stitch it together. So, I would tell
1:27:32you that for an edentulous patient, it
1:27:35would be advisable to take conventional
1:27:37impressions using all the techniques we
1:27:39know for an edentulous impression, that
1:27:44is, individual tray, border molding,
1:27:46etc., bases and rims, mounting it on an
1:27:49articulator, and doing a laboratory
1:27:52scan. I think that would be the best
1:27:58way to do it, and once you have it
1:28:00mounted on the articulator—which also
1:28:03depends, for example, on whether your
1:28:06laboratory has all the Girrbach
1:28:08equipment, so they will surely use the
1:28:10articulator scanner. So, I don't know
1:28:14if this is universal, but for example,
1:28:16the laboratory I work with lends me
1:28:18their facebow. I have one from Ivoclar,
1:28:22so it's not compatible, let's say, with
1:28:24the Amann Girrbach system. I take my
1:28:28facebow, with their facebow, and it is
1:28:30mounted on a special attachment that
1:28:32goes inside their scanner; but, in
1:28:34general, in a nutshell, it would be
1:28:36conventional models, bases, the correct
1:28:39vertical dimension, and from there, do
1:28:41the articulator mounting and scanning
1:28:43of the mounted models, because there is
1:28:45no room for error there; you already
1:28:48have the intermaxillary relationship.
1:28:5641 40. Now, if I, for example, I am not
1:29:13saying that it cannot be done; yes, it
1:29:17can be done with the intraoral scanner,
1:29:18but you will realize that you will
1:29:20struggle more. I mean, when I have
1:29:23scanned an edentulous model, it is
1:29:25harder to get a good scan. Sometimes
1:29:28you have to repeat it several times
1:29:30because, as I say, it doesn't stitch
1:29:32the images well and suddenly it creates
1:29:34areas like Double scanning, meaning
1:29:38literally, for example, you have the
1:29:40ridge where, as you go down to the
1:29:41palate, a step sort of forms. So yes,
1:29:45it is more, there is even a technique
1:29:48I've seen, I saw in an article where
1:29:51they used, where they put like little
1:29:58circles on the ridge with a marker and
1:29:59that, it kind of gave the scanner a
1:30:01guideline of what followed, if I
1:30:02explain myself, to help it like do this
1:30:08stitching of the image of the ridge,
1:30:09but controlling the patient's mouth.
1:30:21Well, any other questions?
1:30:25Doctor Antonio raised his hand. I don't
1:30:27know if I have a question.
1:30:29Doctor, good afternoon. Uh, I would
1:30:32like to bother you. Uh, I have
1:30:34laboratory and clinical practice,
1:30:36but we have some details with the
1:30:38libraries in Exocad. Uh, I work with a
1:30:43doctor, a colleague, and on some
1:30:45occasions when we perform the scan with
1:30:48the scan body directly in the mouth, at
1:30:51the moment of selecting the Ti-Base
1:30:54library, the crowns end up high.
1:30:59So, uh, well, sort of investigating and
1:31:02for
1:31:04now, how can we say it? Because of the
1:31:07case itself, we realized it's because
1:31:09of the height added by the attachment,
1:31:11right? Because the presentation of the
1:31:15scan body comes with that additional
1:31:17height. Is there a library so we can
1:31:21scan the scan body directly and perform
1:31:24the design without having to go through
1:31:26or have uh, scan bodies, a scan body
1:31:29library, so to speak, or of attachments
1:31:32? Um, how can I say it? Like having the
1:31:36attachments. Imagine we could select
1:31:39our attachment without having it
1:31:41physically. I don't know if I explained
1:31:44myself. What do you think? It kind of
1:31:53cut out. Don't ask, because it kept
1:31:56cutting out. So,
1:31:59yes. Let's see, can you hear me? What
1:32:01you're saying is
1:32:03Yes, my connection is bad. Because
1:32:06there's bad weather here right now. Yes
1:32:08, I hear you.
1:32:09Ah, okay, doc. Yes, look, what happens
1:32:12is when I'm using the libraries, for
1:32:15example, can you hear me, Doc? Doc, can
1:32:19you hear me? I hear you,
1:32:25doc. Uh, what I was saying about Exocad
1:32:30,
1:32:30yes, I hear you.
1:32:32Uh, is there one we can use, one we can
1:32:34use for direct scanning in the mouth
1:32:37without having to use the attachment.
1:32:49Let's see, what I am understanding is
1:32:51if there is an Exocad library to be
1:32:53able to scan without the need to use
1:32:57the Ti-Base abutment, that is, for
1:33:00example, to do a scan directly
1:33:04that's right, doctor.
1:33:12Okay. Look, I'll tell you if the scan
1:33:15body exists. which is directly to the
1:33:19implant platform so you don't have to
1:33:21use the Ti-base at a given moment, and
1:33:24normally it should be inside Exocad.
1:33:26But if not, as I was mentioning, I have
1:33:31that library; I honestly haven't
1:33:33verified if it comes in that body that
1:33:35goes directly to the implant, because
1:33:37what I have been using all this time is
1:33:40this Ti-base. So, honestly, I couldn't
1:33:43tell you if it exists in the library,
1:33:45but it should be there anyway. That's a
1:33:47good question. I will verify it, Doc.
1:33:50Um, if those of you who have this or
1:33:53would like to contact me to look at
1:33:55these questions later, I'll give you my
1:33:58WhatsApp contact. It is 844 277
1:34:0639. So, I'll repeat it. 844 277 39. And
1:34:22unfortunately, it sometimes happens
1:34:24that, since we get married to a
1:34:26workflow, we don't always explore other
1:34:28parts of Exocad; because I mean, those
1:34:31of us who have used Exocad before have
1:34:34realized that it also has a really
1:34:36steep learning curve. I mean, it's not
1:34:38a very friendly software, it is
1:34:41difficult to start using it, and I
1:34:44honestly still consider myself to be
1:34:47learning, because there are a ton of
1:34:49things, but for that same reason, it is
1:34:51complicated to learn. So, right now,
1:34:54what I know is what I've been using.
1:34:58Okay, Doc, thank you very much.
1:35:00Have him write the WhatsApp.
1:35:07Yes, Doc, please, because I didn't hear
1:35:08it. I'd love to review it and help you
1:35:11with any questions. Okay, there it is.
1:35:26I already put it there in the chat.
1:35:32Okay. Any other questions? I saw
1:35:43someone asking," Do you recommend
1:35:44buying an intraoral scanner for
1:35:46edentulous cases? "Well, if it's for
1:35:48edentulous, eh, I'll tell you, you're
1:35:49not going to struggle, I mean, it's not
1:35:55that it won't work for you, it will
1:35:57work, but for scanning edentulous
1:35:58models. Okay. Any other questions you
1:36:12have? No. Okay, very good. Well, um, if
1:36:26we don't have any more questions, eh,
1:36:29as I said, I just left my WhatsApp in
1:36:31the chat. I'd be happy to, um, send me
1:36:37whatever questions you have there and I
1:36:39commit to looking into them to give you
1:36:41the correct answer, because I also
1:36:43don't like making things up.
1:36:50Thank you very much, Doctor. Um, well,
1:36:52we thank you for the webinar you gave
1:36:55us today. Well, if there are no more
1:36:58questions, that would be all, Doc. We
1:37:00conclude the webinar you just gave us,
1:37:02and thank you very much once again.
1:37:06Thank you all very much and have a
1:37:08wonderful day.

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