Watch as Dr. Alex Touchstone completes a full-arch scan using the new Planmeca Emerald Scanner. Discover new ways for scanning upper and lower arches, and capturing the bite registration quickly and accurately.
Hi, I’m Dr. Alex Touchstone. My assistant Rebecca and I are going to demonstrate full- arch scanning both upper and lower arches along with inner-occlusal record using the Planmeca Emerald scanner. We’re just going to walk through our normal workflow and the first thing I want to think about whatever I'm doing this is how to get good retraction and isolation.
So I use typically three things for the retraction of the cheeks and the lips. I'll either use an OptraGate that we're all familiar with or in some cases a Spandex retractor especially if I'm working solo or if Rebecca is doing this and she's working solo this works really well as well. The third option would be something called a ComfortView retractor by Premier.
Today we’re going to use the ComfortView retractor. So I’m going to show you how to place this. Squeeze it in the middle and then insert one side and then twist, insert the other side and then you just pull forward to get the lips out of the way. There you go. We're all set. Now Rebecca is going to go ahead and dry off the upper arch for me and that she's doing that I'll grab my Emerald scanner.
There are two buttons on this scanner one is to activate the scan, cause it to go active, the other is to switch between scan libraries and also to allow you to delete unwanted data, if your active in the scanning process.
First, we’ll just start the scanner. The key is you want to go from the canine on one side over to the contralateral side and as you do so you want to capture some of the palate along the way.
Alright so we’re going to to do that first over here. I'm just over here on this canine and a wrap around and capture some pallet there as I go across the anterior teeth and now we've gotten to that area. Now we’re going to go all the way to the back. Open real big for a second. See I didn't even ask her to open large until I went to the second molar because I don't want her to have to strain. Now we're going to go back and catch the buccal on that second molar.
All right then the first molar. Now I want you to notice there's a little piece of artifact there hanging out in space that's of course, a piece of the retractor. There's a feature, a new feature, on Emerald that allows me to delete that and I'll show you what that looks like and how to use it.
There is a button here on the bottom. I push that button while the scanning is active the deletion feature becomes active. You can see that on this little Trash Can icon on the screen. It’s a little hard to see right there but it's now orange. That tells me that that feature is now actice. If I scan around this area again you see how that just went away. Now I’ve added some new information on top of it but you get the point. If you have an artifact that you don't like you want to get rid of it just activate that deletion feature and you'll be able to do so. Let’s see if I can capture the facial surfaces of these teeth. It’s looking pretty good.
Now we need to get the linguals. Let’s go back one more time and get the linugual surfaces. Just like that. Very good - got a great patient. Okay so now we got two thirds of our arch. Now we’re going to come back around I'm going to switch this around so the cable is not in my way and I need to get this thing to start again. What I mean by that is I got to have a place that it can find itself. So I am going to go to the anterior some of that palate and you can see very quickly it found it’s place. Now we can continue on with our scanning. I’m going to go across the occulsal surfaces of the posterior teeth.
Open real big again for a second.
We’ll get that second molar and then grab the buccals and swing back around there. I slipped a little bit on the tooth but that's fine it's still did what it needed to do. We'll come around and capture all of that. There we go. Now we got to get those linguals.
If you ever get lost or the computer ever gets lost, just sit still for a second. Try to sit still in the same area that you see the last scan was made. If that doesn't work then go back up to anterior where you know it caught before and then swing back again. OK. That's how you get the system to to find its way if it gets lost.
Okay so we got that now we got our full arch scan. Let's take a quick look at it and that looks pretty good. There are a couple little spots that I could fill in but I think that's sufficient for our demonstration. So at this point we might elect to erase any unwanted data and then we'll capture are our lower scan.
There is also a new feature on the system. When the scanner is not active if I push the same lower button. Watch what happens - it’s going to switch to the lower scan catalog. OK so I can switch between upper and lower very quickly and I don't have to go back to my laptop in order to do that. So we’ll wait a moment for to generate the model for the upper and then we're going to capture the lower. While we're doing that Rebecca is going to go ahead and suction and dry and get us ready for a lower scan.
Now we got one additional issue with the lower that is the tongue. We got to think about how we're going to deal with retracting that tongue and my go-to instrument for that is a Minnesota retractor. … She also has some lingual toris so I want to be careful about that. As you can see if I need to I've got really good retraction with this retractor if I need it.
And of course we're going to do the same sort of thing we did just a moment ago ... we're going to start in the anterior. … OK, here we go. We’re moving this retractor a little bit out of the way. … We’ll start over here accross the anterior teeth capturing some of the lingual.
… we’re going to go all the way back [to the] second molar … I'm going to rotate around and capture the buccals and the facials of those anterior teeth. Now I got to get to linguals. This is arguably the most difficult part I'm going to use the retractor little bit. Allow it to find its way and now we can get right up in there and capture the lingual all the way back to that second molar. And it's looking pretty good so far. Now I'm going to switch around and can capture the other side she's got a suction little bit for me ...
If we have trouble or the computer has trouble finding its way one technique is to turn it off and turn it back on again. Come all the way back to an area that you started from. OK I got it oriented now I'm going to twist around so I can move in the other direction and I’m going to move all the way around.
And we’ll capture those posterior teeth the occlusal surfaces first and she happens to have a healing abutment back here for an implant. Don't necessarily need that - just wanted to point that out.
Notice how easily this is scanning that metal. That's new. That's a definitely new feature. The anteriors or rather these buccals posteriors. Then swing around and capture the lingual last.
OK let's take a look at what we got. Now this we’re going to have to clean up a little more perhaps ... because of the fact that there's more retractor in the way as you can see but I think we can agree that we're in a good place in terms of the data that we have so le’ts go ahead and clean that off a little bit.
Whoa we got a little sloppy there cuz I'm trying to do this behind my back but you get the idea.
Alright so now we have a lower arch. Now the last thing we need to do is capture our bite registration. So we’re going to generate a model and will capture the bite registration next.
Some patients can't close all the way with the retractor in place. So you might want to test that Go ahead and close for me. She can however so I’m going to leave this in place. I like that. Are you okay like that? [nods]
Now in the new software we have two bite registrations possible. We have buccal one and buccal two. The idea here is that you get a bilateral bite as opposed to a single bite and that works really well whenever we're trying to relate these full arch casts.
So let's go and grab the buccal one. Now noticed I'm not going to use the mouse. I'm going to use the button and now we're buccal one - the lower button on the scanner.
Close all the way down.
I'm making sure that her mandible is seated. Put your chin down a little bit okay.
And we'll start here I will capture some of that buccal bite. Now, as I do this we should see a live fly in of our models. … We don't see that yet so let's go to the other side. There we go it just flew in both the upper and lower. OK we did that. So now we're going to capture buccal two the contralateral. This time we're going to do that without the retractor just to show you the technique for that so of this time I'm going to have her open and then I'm going to insert this first close all the way down
Rebecca will reach under and make sure that she's fully seated, she stays seated. Then I'm going to turn on the scanner. Alright and we're going to work our way around and we're going to wait until we see those two models fly in against the buccal bite. If you watch really closely on the screen we should see that here in a second. There's one of them. OK and there's the other one.
I'll stop there. I got my thumb in there too didn’t I? Alright so let's ... take a look at that and we might want to clean that up a little bit get rid of my thumb. OK now we’ll generate the model and then we'll take a look.
So now we got our upper and lower scans, we’ve got our bite registrations and according to the screen right here it says that we're good, that we have an accurate relationship of the upper and lower because of this little green dot. However, I always double-check this so we're going to just take a quick look by just you know the evaluating this in terms of the heat map. You can see looks a little heavy right here doesn't it? So what we can do is we can refine that alignment and we do that with this new tool called alignment refinement. Alright so we’re going to click that now watch what happens. It's going to try to find best fit relative to those existing occlusal contacts. So I will let that process happen.
So now we're able to scan full arches very efficiently, very accurately and I hope your experience is similar to mine. If you need any help let me know.
Alex Touchstone, DDS, FICOI, is a recognized pioneer in chairside dental CAD/CAM technology — and one of the most sought-after educators in digital dentistry. He is the founder of LearnDigitalDentistry.com which provides interactive online training courses for dental professionals all over the world. He holds several U.S. and international patents and also shares his ideas through lectures and hands-on courses. Dr. Touchstone practices dentistry at Touchstone Dentistry in Hattiesburg, MS.