CADstar Academy. CS Ultra Advanced Module

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1 CADstar Academy CS Ultra Advanced Module

2 Table of contents 1.0 Introduction to the documentation Contact Abutment - introduction Create new job order Scan abutments Rescanning Mushbite as Antagonist Cropping the Mushbite Stone Model as Antagonist Scan the scanbodies (marker) Capturing adjacent teeth Gingiva scan Alignment of the implant Capture control and export to exocad Modelling abutments Detect Implant Position Define Emergence Profile Tooth placement Generate Abutment Bottoms Free-Forming Secondary Insertion Direction Abutment Design Abutments Free-Forming Merge and save restorations Create abutment suprastructure Crown Bottoms Connectors Merge and save restorations Virtual articulator Use virtual articulator in exocad Align antagonist/dynamically grin-in Waxup Creating an order Scan Waxup Page 1 of 67

3 7.3 Use Waxup in exocad Pre-Op Model (Pre-operative Model) Adapt to Pre-operative Model Copyright This original document is copyright protected. All rights reserved, in particular duplication and distribution rights as well as the translation. No part of this manual may be reproduced in any form (through photocopy, microfilm or any other method), electronically stored, edited or distributed without the prior written consent of CADstar GmbH. All violations can result in legal action. Page 2 of 67

4 1.0 Introduction to the documentation In the Advanced Module, modelling and working with the following restorations and functions are described. Abutments Virtual articulator Waxup / Pre-op Model This documentation is aimed at dental technicians and dentists and serves as support documentation when working with exocad software. It is assumed that working knowledge is present in dealing with Windows and typical Windows applications, as well as the CS Ultra Scanner and the CADstar exocad Basic Module. Available forms of this document This document is available in the following forms: as a PDF manual online at Icons As additional assistance, we have integrated the known helper icons from the exocad wiki site into this manual. Note for useful tips Possible error warnings, fitting problems, stability Indicates useful keyboard shortcuts (HOTKEYS) which can help speed up your work 1.1 Contact Support Hotline: Austria Germany Fax: support@cadstar.dental Weekdays from Monday to Friday between 8am and 5pm You can find more information at Page 3 of 67

In the demo, an individual one-piece titanium abutment and a custom two-piece zirconium abutment (on adhesive base titanium) are scanned and modelled.

5 2.0 Abutment - introduction This section explains the scanning and modelling of individual abutments. To model abutments, you need the "Abutment module" from exocad along with our compatible scanbodies for the implant system. In the demo, an individual one-piece titanium abutment and a custom two-piece zirconium abutment (on adhesive base titanium) are scanned and modelled. As a suprastructure (superstructure), a 3-digit bridge will be created. Once the abutments have been constructed, it can then be modelled in the software. Don't let yourself be unsettled In the job order creation of abutments, a suprastructure must ALWAYS be selected first, regardless of whether you want to produce a superstructure or not. Once modelling of the abutments has been completed you can then decide whether or not you want to then create a suprastructure from the previously modelled abutments. This step is explained again later. Page 4 of 67

6 2.1 Create new job order As usual, enter your customers, patients, etc. in the job order sheet In the DEMO, a mushbite is used as an antagonist Choose the tooth that is to be processed In the restoration options on the left, the restoration type, material, and also the colour for the suprastructure must first be chosen for the abutments (see Figure 1) Then on the right under "implant based?", you must select the desired type of abutment (see Figure 2) If a separate gingiva mask is used, then "Yes" must be additionally selected under "scan gingiva separately?" (see Figure 3) The following abutment types are available: On custom abutment standard abutment Custom abutment (manual positioning) Standard Abutment, The position of the screw channel can be manually set Screw Retained Screw retained crown/cap/telescope Screw Retained (manual positioning) Screw retained crown/cap/telescope, the position of the screw channel can be manually set If you select "Screw Retained", as type of abutment, then the previously selected restoration on the left is later calculated in the modelling as screw retained Page 5 of 67

As an example, the job order is created as follows: Tooth 14: Primary: Titanium abutment / / secondary suprastructure: Full crown - CADstar zircon Tooth 15: Primary: Anatomic Pontic - CADstar zircon

7 As an example, the job order is created as follows: Tooth 14: Primary: Titanium abutment / / secondary suprastructure: Full crown - CADstar zircon Tooth 15: Primary: Anatomic Pontic - CADstar zircon = secondary suprastructure Tooth 16: Primary: Zircon abutment / / secondary suprastructure: Full crown - CADstar zircon Select "Yes" in "Scan gingiva separately" to scan an additional gingiva mask Now select the abutment material (CADstar Ti Abu or CADstar Zirkon) For CADstar Zirkon, the colour for the Zirconium abutment still needs to be chosen (ColorAbutment) As you can see, the job order has now been created: If the job order creation is finalised, click "Save" in the tool bar, and "Scan" to start the scanning process Page 6 of 67

scanner has started correctly, the message "Scanner has started correctly" will appear in green.

8 3.0 Scan abutments Start the scan software The scan software starts automatically and the welcome screen is displayed Click on the blue icon to load the previously created project A diagnostic message will be shown in the middle part of the dialogue window If the scanner has started correctly, the message "Scanner has started correctly" will appear in green. If an error occurs, a description of the error will be shown in red. Most of these messages are self-explanatory and allow the user to independently remedy the error. Page 7 of 67

The wizard is launched by clicking on the "Next" button This wizard will guide you through the scanning process Place the prepared jaw WITHOUT scanbodies and WITHOUT GINGIVA into the model holder.

9 The wizard is launched by clicking on the "Next" button This wizard will guide you through the scanning process Place the prepared jaw WITHOUT scanbodies and WITHOUT GINGIVA into the model holder. (labial side of the model is pointed in the direction of the scanners camera or the locking screw of the model holder) Make sure that there are no reflective points on the model as this can lead to holes in the scan. For reflective surfaces (wax, metals, etc.), we recommend spraying the surface with our "CADstar scan spray". Never spray directly into the scanner! Page 8 of 67

To rotate the model press right mouse button, to move the model, hold down the

10 In the Project Wizard on the left hand side, you will find the individual scanning steps to be processed Click on "Scan" to initiate the first model scan To rotate the model press right mouse button, to move the model, hold down the right mouse button and the mouse wheel button. Rotate the mouse wheel to zoom. Page 9 of 67

In order to obtain better scan results, the scanner can be tuned to the color of the plaster. For conventional laboratory plasters the "Default" setting can be left on.

11 In order to obtain better scan results, the scanner can be tuned to the color of the plaster. For conventional laboratory plasters the "Default" setting can be left on. Especially by very dark objects we recommend setting the object color. Make sure that the first model scan is of good quality as the subsequent scans are referenced on this. Click on "Next" when the quality of the scan is sufficient Check the scan and crop with the slider if necessary We recommend cropping only a small portion of the model so that the program has enough data available for subsequent synchronisation Click "Next" to continue with the antagonist Page 10 of 67

3.1 Rescanning If gaps appear in a specific area and a rescan is desired, you can click on "Integrate" to perform a rescan To do this, position the model in the direction of the camera, the scanners

12 3.1 Rescanning If gaps appear in a specific area and a rescan is desired, you can click on "Integrate" to perform a rescan To do this, position the model in the direction of the camera, the scanners axis responds directly to your mouse movements Rescanning can be repeated any number of times for all scans (except articulator) CAUTION! DO NOT use the "Integrate" function with articulators and inadequately fixed models. The articulator and /or the models could fall out of the scanner and become damaged! An additional recording can be started by clicking on the camera icon The yellow crosshair shows the recording direction Page 11 of 67

rescanning, then click on the green check mark

13 You will see the difference immediately after rescanning BEFORE AFTER If you have finished with rescanning, then click on the green check mark Click on "Next" to continue with the antagonist Page 12 of 67

14 3.2 Mushbite as Antagonist Place the complete model (with mushbite) into the scanner and click "Scan" After the bite has been scanned, there is again the possibility to perform a rescan e.g. using "Integrate" Click on "Next" when you are happy with the scan Page 13 of 67

Skip the "Cut Height" step and do not cut the mushbite The program requires a sufficient amount of scan data to be able to synchronize automatically Only cut the mushbite in the

15 Skip the "Cut Height" step and do not cut the mushbite The program requires a sufficient amount of scan data to be able to synchronize automatically Only cut the mushbite in the next step Skip this window and click on "Next" After clicking "Next", the below message appears... This message confirms the successful automatic alignment of the scan Page 14 of 67

Clicking the right mouse button opens the extended context menu

16 3.3 Cropping the Mushbite After the automatic alignment of the model has taken place, the bite may be cropped. Clicking the right mouse button opens the extended context menu where you can choose various tools for cropping and trimming the scans Page 15 of 67

Using the "Free closed line" tool by pressing and holding the

is then selected when releasing the left mouse button Then, the

marked areas can then be deleted with "Delete Selection" Click

17 Using the "Free closed line" tool by pressing and holding the left mouse button, allows you to draw a boundary line The area is then selected when releasing the left mouse button Then, the selected area can be reversed by clicking "Invert Selection" The marked areas can then be deleted with "Delete Selection" Click on "Next" when you have finished cropping the mushbite Page 16 of 67

3.4 Stone Model as Antagonist If you want to use a plaster model as an antagonist, you must when you create the job order in CADstar order management, first select the scan mode "Two stone models, in

Only place your articulator or fixed models in the scanner after the initial initialisation of the axis! The articulator and the fixed plaster models could fall out and damage the scanner!

18 3.4 Stone Model as Antagonist If you want to use a plaster model as an antagonist, you must when you create the job order in CADstar order management, first select the scan mode "Two stone models, in occlusion". By doing this, you have the opportunity to make your physical articulator or to place two together pinned models into the scanner. Start the application by clicking on "Scan" CAUTION! Only place your articulator or fixed models in the scanner after the initial initialisation of the axis! The articulator and the fixed plaster models could fall out and damage the scanner! In order to place the articulator into the scanner, you need our optional ArtiBase Plate. Contact our sales team regarding price and availability. Optional accessories ArtiBase Plate Itm.No.: CS_ULTRA_OPT_05 Page 17 of 67

articulator scan should, as shown on the image, display enough scan data for

19 Place the articulator or fixed models in the scanner and then click on "Scan" If you are using an articulator, if possible, remove the retaining pin The articulator scan should, as shown on the image, display enough scan data for both jaws If you wish to perform the scan again, then click re-click on "Scan" Page 18 of 67

The program automatically overwrites the previous scan WARNING! DO NOT use the "Integrate" function with articulators and inadequately fixed models.

20 The program automatically overwrites the previous scan WARNING! DO NOT use the "Integrate" function with articulators and inadequately fixed models. The articulator and /or the models could fall out of the scanner and become damaged. Click on "Next" Place the lower jaw into the scanner and click on "Scan" Click on "Next" after a successful scan Page 19 of 67

Skip the "Cut Height" step and cut the lower jaw in the next step The program requires sufficient scan data to be able to synchronize automatically Only cut the antagonist in the

21 Skip the "Cut Height" step and cut the lower jaw in the next step The program requires sufficient scan data to be able to synchronize automatically Only cut the antagonist in the next step Skip this window and click on "Next" After clicking "Next", the below message appears... This message confirms the successful automatic alignment of the scan Page 20 of 67

22 After the automatic alignment of the model has taken place, the antagonist may be cut. You can now cut the antagonists as described in Point 3.3 Click on "Next" when the step has been completed In the next step, you are prompted to scan the upper jaw Repeat the steps as described previously for the lower jaw When finished, click on "Next" and continue to the scanning of the scanbodys (Point 3.5) Page 21 of 67

3.5 Scan the scanbodies (marker) Now screw the scanbodies WITHOUT gingiva onto the model

the model If possible, remove only the directly adjacent teeth In the wizard, select the

Not yet captured scanbodies appear red, whilst captured scanbodies are later shown in green

23 3.5 Scan the scanbodies (marker) Now screw the scanbodies WITHOUT gingiva onto the model Make sure that the three flat spots on the scanbodies are aligned with the buccal side of the model If possible, remove only the directly adjacent teeth In the wizard, select the scanbodies to be scanned. Not yet captured scanbodies appear red, whilst captured scanbodies are later shown in green Click on "Scan" to start scanning the scanbodies If required, the scanbodies can then be rescanned (see Point 3.2) Click "Next" when the scanning is complete Page 22 of 67

Skip the "Cut Height" step and do not crop the scanbodies The program requires a sufficient amount of scan data to be able to synchronize automatically The scanbodies can then be cropped

24 Skip the "Cut Height" step and do not crop the scanbodies The program requires a sufficient amount of scan data to be able to synchronize automatically The scanbodies can then be cropped in the next step Skip this window and click on "Next" After clicking "Next", the below message appears... This message confirms the successful automatic alignment of the scan Page 23 of 67

only the lower part of the scans, this prevents synchronisation problems later on Repeat the steps as

25 In the next step, the scanbodies need to be segmented Using the selection tool, select the scanbodies (left mouse button) Repeat these steps for all scanbodies Click "Next" to crop the scanbodies on demand Crop away only the lower part of the scans, this prevents synchronisation problems later on Repeat the steps as necessary for the other scanbodies Once the cropping of the scans has been finalised, click on "Next" Page 24 of 67

We recommend first downloading the reference copy and checking the proximal contacts to the adjacent teeth.

26 3.6 Capturing adjacent teeth You can now scan the adjacent teeth or clone the reference model to save time by using "Copy From Reference". We recommend first downloading the reference copy and checking the proximal contacts to the adjacent teeth. If these are available, continue by clicking "Next". Otherwise place the model, without the die, into the scanner and click on "Scan", the scan will subsequently replace the reference copy. Page 25 of 67

slightly faster calculation times at the end of the wizard and

27 Next, you have the option to manually crop the adjacent teeth again. Cropping the scans reduces the amount of data, resulting in slightly faster calculation times at the end of the wizard and exocad. Once again click on "Next" when the step been concluded Page 26 of 67

3.7 Gingiva scan In this step, the gingiva must

start scanning the gingiva The gingiva can be

28 3.7 Gingiva scan In this step, the gingiva must now be scanned Place the model with the attached gingiva in the scanner If possible, remove only the directly adjacent teeth Click on "Scan" to start scanning the gingiva The gingiva can be rescanned if required (see Point 3.2) Page 27 of 67

Click "Next" when the scanning is complete Again, skip the "Cut Height" step and DO NOT crop the gingiva The program requires a sufficient amount of scan

29 Click "Next" when the scanning is complete Again, skip the "Cut Height" step and DO NOT crop the gingiva The program requires a sufficient amount of scan data to be able to synchronize automatically The gingiva can be cropped in the next step Skip this window and click on "Next" After clicking "Next", the below message appears... This message confirms the successful automatic alignment of the scan Click "Next" again You have the option to crop the gingiva in the next step Once the scan has been cropped then click on "Next" The next step is the Acquisition Check If all of the data are correct, click "Next" Page 28 of 67

3.8 Alignment of the implant There are two ways to perform the alignment of the implants. You can decide whether you want to perform the alignment directly in the scanning software or later in exocad.

Firstly, select the used implant system and then click "Next" If you need a breakdown of our implant libraries, you can download a translation list from www.cadstar.

30 3.8 Alignment of the implant There are two ways to perform the alignment of the implants. You can decide whether you want to perform the alignment directly in the scanning software or later in exocad. Synchronisation in exocad is also described later. Firstly, select the used implant system and then click "Next" If you need a breakdown of our implant libraries, you can download a translation list from In the next step, you must synchronise the scan with the scanbody from the on file library IMPORTANT: If you ant to produce 1-piece titanium abutments, choose the library suffix "Ti", for 2- piece zirconia abutments on a titanium adhesive foot, choose the suffix "Zr" The reference model is shown in the upper two Windows. On the left you see the reference model, and on the right is the scanbody from the on file library. Set one reference point on the left hand side and then one more at the same point on the right hand side. We recommend indicating at least two points. The result is then displayed in the lower window. CAUTION: Then click on "Best Fit" to perfectly position the stump. Click "OK" to continue. Repeat these steps for further scanbodies, if necessary Page 29 of 67

3.9 Capture control and export to exocad In this section you can see all the scans collated together: Scanbodies, adjacent teeth, bite/opposing jaw Please recheck the

Should a scan still show holes or be misaligned, you can simply press the back button in the wizard and repeat the respective scan or the alignment.

31 3.9 Capture control and export to exocad In this section you can see all the scans collated together: Scanbodies, adjacent teeth, bite/opposing jaw Please recheck the scan data for complete accuracy. Should a scan still show holes or be misaligned, you can simply press the back button in the wizard and repeat the respective scan or the alignment. All other scans will be saved and do not need to be rescanned. If all of the data is correct, click "Next" The software generates a net over all the scanned data and prepares it for exocad In the last step, the data can be exported to exocad. Please check the final scan data one last time and then click the "exo" icon Page 30 of 67

step, select the used implant system for the required tooth and the corresponding diameter If you need a breakdown of our implant libraries, you can download a translation list from www.cadstar.

32 4.0 Modelling abutments 4.1 Detect Implant Position If the alignment of the implants was not already carried out in Point 3.8, then this must now be carried out in exocad modelling If you have already carried out the alignment of the scanning software, then this step will be skipped automatically in exocad In the first step, select the used implant system for the required tooth and the corresponding diameter If you need a breakdown of our implant libraries, you can download a translation list from IMPORTANT: If you ant to produce 1-piece titanium abutments, choose the library suffix "Ti", for 2-piece zirconia abutments on a titanium adhesive foot, choose the suffix "Zr" Then you must synchronise the scanbodies with the on file library To do this click on the scanbodies lowest round surface Page 31 of 67

The program then calculates the libraries scanbody automatically into the

accurately Once the position is correct, click on next and repeat the

defined for all teeth, click "Next Press down the <Ctrl> key when you click

33 The program then calculates the libraries scanbody automatically into the scan By clicking on "Best fit matching" the file is positioned more accurately Once the position is correct, click on next and repeat the procedure with the other scanbodies If the implant positions have been defined for all teeth, click "Next Press down the <Ctrl> key when you click on "Best fit matching", so that the precision of the synchronisation will appear in colour Page 32 of 67

34 4.2 Define Emergence Profile The emergence profile of the abutments must be set in this step. Proceed with setting the emergence profile just like with stumps After setting the fourth point, the automatic suggestion of the program is calculated Page 33 of 67

35 Do you want to customise the profile? Then switch to the "Correct/Draw" tab and use the same tools as with plaster dies Click on "Next" to set the next emergence profile If the profiles have already been defined, click "Next" to continue to the next step Page 34 of 67

4.3 Tooth placement In this step, the teeth must be placed for the suprastructure (superstructure) This step must be carried through regardless of whether or not you want to produce a superstructure

to optimise the position of the teeth For this step please make sure that the axial position of the teeth, the alignment of the row of teeth, as well as the distance to the antagonists are rough set

36 4.3 Tooth placement In this step, the teeth must be placed for the suprastructure (superstructure) This step must be carried through regardless of whether or not you want to produce a superstructure at a later time The program now loads teeth from the library and automatically positions these on the model By using the tools,"move tooth", "Rotate tooth" and "Scale tooth" you have the opportunity to optimise the position of the teeth For this step please make sure that the axial position of the teeth, the alignment of the row of teeth, as well as the distance to the antagonists are rough set If you want to subsequently make the suprastructure (superstructure) in abutment modelling, you must invest more time in this step. The teeth placed here serve as a starting point for the ensuing automatically created abutment form. This can of course still be aligned. To help you work more efficiently use HOTKEYS to switch between the three tools. The "Move tooth" remains the activated tool. By pressing and holding <Ctrl> you can now rotate the teeth, and by holding <SHIFT> the teeth can be scaled Page 35 of 67

To check the distance towards the antagonist, additional helper

toolbar You will now see a visualisation of the spacings Based on

or to what extent the teeth are already pressing by means of the

37 To check the distance towards the antagonist, additional helper windows can be displayed Click on "Show distances" in the right toolbar You will now see a visualisation of the spacings Based on the colour scale and the display you can see the existing spacing, or to what extent the teeth are already pressing by means of the antagonist After positioning is completed, click on "Next" Page 36 of 67

38 4.4 Generate Abutment Bottoms In this window the abutment base, the part which is below the gingiva, can be aligned The gingiva is transparently represented here so that a better design is possible. The slider (under "Shape") enables you to manually change the form Any changes made with the sliders affect all the abutments of the restoration Page 37 of 67

If you want only want to change one abutment, do not use the slider, use the "Free-form" mode instead by checking the checkbox

left-clicking on the abutment removes material.

You can view the spacing or the penetration of the abutment base to the gingiva by checking the "Visualize" option The blue

39 If you want only want to change one abutment, do not use the slider, use the "Free-form" mode instead by checking the checkbox Left clicking on the abutment base enables material to be applied Simultaneously pressing the SHIFT key on the keyboard and left-clicking on the abutment removes material. Pressing the <Ctrl> key while a left clicking on the abutment base applies material not just locally, but all around. You can view the spacing or the penetration of the abutment base to the gingiva by checking the "Visualize" option The blue coloured areas show distance whilst red coloured areas indicate the penetration and thus the pressure the abutment base exerts on the gingiva. The colour scale in the wizard shows you the corresponding values of the colour tone Page 38 of 67

By checking "Limit?" you can apply a fixed value which can or cannot be exceeded If you want the abutment base to rest directly on the gingiva, then check the "Visualize" and "Limit?

40 By checking "Limit?" you can apply a fixed value which can or cannot be exceeded If you want the abutment base to rest directly on the gingiva, then check the "Visualize" and "Limit?" boxes and set the sliders in "Above" and "Below" to 0 The abutment bases can also be dragged and aligned to the control points by using the left mouse button When clicking and dragging on one of the arrows, you can only draw in the direction shown Pink on the control point indicates the movement to the gingiva scan is linked Double-clicking on the pink checkpoint, or clicking the small dot below releases the lock and the control point can be moved independently of the gingiva You can customise the edge profile, if you want, on the "Advanced". If you require additional information, click on the question mark located to the top right of the wizard window. You are then automatically directed to the exocad wiki page. If you are done with this step, click "next" to continue Page 39 of 67

41 4.5 Free-Forming In this window, you can customise the suprastructure with the "Free forms" tool. There are four selectable tabs available in the Freeform window: "Free" "Anatomic" "Adapt" "Attachments" With the individual tools in the "Anatomic" tab, you can finely adjust the previously placed teeth With the left mouse button, click on the tooth to change its shape Use the buttons "Cusps", "Tooth Parts", "Entire Tooth" and "Ridge" to select the areas to be changed A useful HOTKEY is available in the "Entire Tooth" mode. Hold the <Ctrl> key to rotate the tooth and <SHIFT> to scale the tooth. The model remains anchored to the preparation boundary. The program tells you about the HOTKEYS when you hover your mouse over the corresponding buttons. Page 40 of 67

42 In the "Free" tab, you have the possibility to fine tune the model with a virtual wax-knife. You can choose between the tools "Add/Remove" and "Smooth/Flatten" To apply material click the tooth with the left mouse button, to remove hold the <SHIFT> key Using the sliders enables you to set the desired amplitude Change the brush shape for example to "point of knife" to work on fissures During activated "Smooth/Flatten" and whilst holding the <SHIFT> key, you can apply strong flattening of the areas Pressing and holding the <Ctrl> key allows you to gently smooth out the tooth. During this, consideration is taken on the anatomical shape. The "Smooth/Flatten" tool can be used very well in order to remove disruptive model fragments Page 41 of 67

There are three submenus available under the "Adapt" tab Pontic Under the "Pontic" submenu, you can adjust the pontics relative to the gingiva With "Spacing (negative = intersection)", you select the

43 There are three submenus available under the "Adapt" tab Pontic Under the "Pontic" submenu, you can adjust the pontics relative to the gingiva With "Spacing (negative = intersection)", you select the value of the distance from the Pontic to the gingiva A positive value means that the Pontic still has a certain amount of spacing to the gums, a negative value means that the pontic is pressing into the gingiva. A 0 value sets the pontic directly onto the gingiva Checking the "Pull down to gingiva" offers the possibility to pull down the pontic to the gingiva, that have too much spacing. Best results are attained when the pontic is already roughly aligned via the "Anatomic" tab After you have entered the desired value, click on "Adapt to gingiva" so that the change is applied Page 42 of 67

44 Occlusal This submenu allows you to align the restoration to the antagonist (if scanned). Use the slider to adjust the distance to the antagonists (for anatomical and reduced parts) With the "Cut intersections" button you can grind into the anatomy Applying the "Shape-preserving adaption" button, attempts to preserve the shape of teeth. The tooth is reduced accordingly to achieve the desired value. Approximal In this submenu, you can perform the alignment for approximal contact Page 43 of 67

In the "Attachment" tab, different movable Attachments can be added

action decides whether the attachment parts are added or removed

size of the attachment part The insertion direction of the

45 In the "Attachment" tab, different movable Attachments can be added to the construction When selecting "Add" or "Remove", this first action decides whether the attachment parts are added or removed With "Move", "Rotate", and "Scale" you can move and changes the size of the attachment part The insertion direction of the attachment part is changed by using the buttons "Top,"View or "Surface" Page 44 of 67

selection With the option "Cut on gingiva" the distance of

46 Attachment parts must first be placed and then set using the left mouse button Click on "Apply" to confirm the selection With the option "Cut on gingiva" the distance of the attachment part can be aligned to the gingiva Page 45 of 67

4.6 Secondary Insertion Direction In this step the insertion directions of the abutments and the subsequent superstructure are set For bridges, the "Unique insertion direction for bridge" option

The bridge s stumps will all therefore have the same direction of insertion As an aid, the program will automatically calculate an initial proposal.

47 4.6 Secondary Insertion Direction In this step the insertion directions of the abutments and the subsequent superstructure are set For bridges, the "Unique insertion direction for bridge" option is set by default. In other words, the construction is optimised for 3-axis milling machines. The bridge s stumps will all therefore have the same direction of insertion As an aid, the program will automatically calculate an initial proposal. Depending on the situation and the complexity, the initial proposal can be calculated with either better or worse results In any case, check the proposal and change it if you wish To manually change the insertion direction, rotate the view to see the occlusal view of the model. Then, click "Set current view as insertion axis" Page 46 of 67

applies If both stumps are to receive an individual direction of insertion, then the option "Unique insertion direction for bridge" must be

48 You can also change the direction in which you select the green dot above the arrow, and drag in the desired direction with the left mouse button CAUTION: If you set the insertion direction using the arrows, clicking on the "Set current view as insertion axis" button no longer applies If both stumps are to receive an individual direction of insertion, then the option "Unique insertion direction for bridge" must be unchecked. Each individual tooth must then be selected and edited using the drop-down menu Click on "Next" when this step has been completed Page 47 of 67

4.7 Abutment Design Here, you can now align the abutment shape with control points With the "Angle" value, you can change the angle of the side surfaces with the slider The value "Distance to

4 (Abutment base) Click on "Next" when this process has been completed Should you wish to further align the insertion direction during this step, simply click on the blue background using the

49 4.7 Abutment Design Here, you can now align the abutment shape with control points With the "Angle" value, you can change the angle of the side surfaces with the slider The value "Distance to chewing surface" defines the distance of the abutment to the virtual anatomy The "Bottom" and "Advanced" tabs again make available to you the options as in step 4.4 (Abutment base) Click on "Next" when this process has been completed Should you wish to further align the insertion direction during this step, simply click on the blue background using the right mouse button and then click on "Secondary insertion direction..." 4.8 Abutments Free-Forming Here, you can edit the abutments and the pontic with the "Free-Forming" tool When you are finished, click on "Next" Page 48 of 67

50 4.9 Merge and save restorations In the last window, all parts are put together and merged into one element. There are two tabs to choose from. Under the "Next step:" tab you have following options: I'm done: Generates the milling data and subsequently closes the modelling Design suprastructure now: Takes you to the modelling of the superstructure Proceed to production: Takes you to the exocad Nesting Module (optionally available) Free-form restaurations: Opens the "Freeform" tool for further post editing Expert mode: Takes you to the Expert mode (free mode) Design model: Takes you to the exocad Model Creator module (optionally available) If you only want to create the abutments, then click "I'm done" and then "Next" The construction will now be stored as an.stl data set in the project folder and the modelling window closed If you want to create the suprastructure straight away, then click on "Design suprastructure now", and then "Next" If you want to make small changes to the abutments, such as smoothing or adding/removing material, you can set this option in advance and make those finishing touches to your work by clicking on "Free-form restaurations". When you are finished with Freeform, click on "Next". You will be taken back again to the previous window. Page 49 of 67

Under the second tab, "Saved Files", you can delete already merged parts by clicking the "Remove Existing Merged Parts" button The "Optimize for better free-forming and 3D printing" option gives you

51 Under the second tab, "Saved Files", you can delete already merged parts by clicking the "Remove Existing Merged Parts" button The "Optimize for better free-forming and 3D printing" option gives you the possibility to optimise your work for selective laser melting. Constructions can be better edited afterwards with the "Free-Forming" tool. For selective laser melting, the output data must have special properties: No holes or open edges Elements must be completely connected No inner surface or intersections Caution: CADstar does not currently offer laser melting Now click on "I'm done" and then click "Next" The construction will now be stored as an.stl data set in the project folder and the modelling window closed If you still want to make small changes such as smoothing or adding/removing material, you can set this option in advance and make those finishing touches to your work by clicking on Free-form restorations finished parts". When you are finished with Free-forming, click on "Next" You will be taken back again to the previous window Page 50 of 67

5.0 Create abutment suprastructure Should you want to finish by creating the suprastructure (superstructure) in connection to the abutment modelling, then in the last step of the

1 Crown Bottoms The fit parameters are set out in the first step. The parameters entered are already predefined by CADstar. You are free to adjust and change these parameters.

52 5.0 Create abutment suprastructure Should you want to finish by creating the suprastructure (superstructure) in connection to the abutment modelling, then in the last step of the wizard, click on "Create suprastructure" and then "Next". The placement of the model teeth as described in step 4.3 has a great influence on shaping the suprastructure. 5.1 Crown Bottoms The fit parameters are set out in the first step. The parameters entered are already predefined by CADstar. You are free to adjust and change these parameters. Above all, customers are advised to send the milling jobs to us and to only make changes to the parameters in consultation with our support team. If you agree with the parameters click on "Next" Page 51 of 67

5.2 Connectors In the "Connectors" window, you can edit the connectors. Connectors are automatically applied anywhere you have defined splinting in the job creation.

53 5.2 Connectors In the "Connectors" window, you can edit the connectors. Connectors are automatically applied anywhere you have defined splinting in the job creation. You can customise individual connectors in a different ways. The minimum thickness can be set either through the cross section or the height/width You can toggle between the two modes and adjust the value using the slider You can also choose from different pre-defined forms To apply the adjustments, click on "Apply cross-section/shape change" To change the location of the connector, simply click on the connector and drag it in the desired direction By dragging the connector, both sides are changed. To change the connector on one side only, press and hold the <Ctrl > key and then click on a tooth to change the position of the point of attachment. Page 52 of 67

54 The "Free" tab offers the possibility to customise the connector. Grab each point using the mouse in order to move it in the desired direction To add more control points, press and hold the <Ctrl > key and click on the line you want to add the point to. To simultaneously move several green dots, hold down the <SHIFT> key and move a point Once you have moved all the connectors to their desired positions click on "Next" to move on to the final step Page 53 of 67

5.3 Merge and save restorations In the last window, all parts are again put together and merged into one element. The two known tabs are again displayed.

55 5.3 Merge and save restorations In the last window, all parts are again put together and merged into one element. The two known tabs are again displayed. Under the "Next step:" tab you have following options: I'm done: Generates the milling data and subsequently closes the modelling Proceed to production: Takes you to the exocad Nesting Module (optionally available) Free-form restorations: Opens the "Freeform" tool for further post editing Expert mode: Takes you to the advanced mode (free mode) Design model: Takes you to the exocad Model Creator module (optionally available) If you want to finalise the modelling, then click "I'm done" and then "Next" The construction will now be stored as an.stl data set in the project folder and the modelling window closed If you want to make small changes to the suprastructure, such as smoothing or adding/removing material, you can set this option in advance and make those finishing touches to your work by clicking on "Free-form restaurations". When you are finished with Freeform, click on "Next". You will be taken back again to the previous window. Page 54 of 67

Under the second tab, "Saved Files", you can delete already merged parts by clicking the "Remove Existing Merged Parts" button The "Optimise for better free-forming and 3D printing" option gives you

56 Under the second tab, "Saved Files", you can delete already merged parts by clicking the "Remove Existing Merged Parts" button The "Optimise for better free-forming and 3D printing" option gives you the possibility to optimise your work for selective laser melting. Constructions can be better edited afterwards with the "Free-Forming" tool. For selective laser melting, the output data must have special properties: No holes or open edges Elements must be completely connected No inner surface or penetrations Caution: CADstar does not currently offer laser melting Page 55 of 67

There are three different Articulators to choose from: Two plaster models into articulator A = Artex Two plaster models into articulator P = KaVo Protar Two plaster models

57 6.0 Virtual articulator To use this function you will need the exocad module Virtual articulator. To use the "virtual articulator" in exocad, you must first select your articulator under "Scan mode" during the job order creation stage. There are three different Articulators to choose from: Two plaster models into articulator A = Artex Two plaster models into articulator P = KaVo Protar Two plaster models into articulator S = SAM After you have established your job order and chosen your articulator as the opposing jaw, you can perform the scanning process just as you did with the plaster opposing jaw. Point 3.4 again describes scanning with a plaster model as the opposing jaw. Page 56 of 67

58 6.1 Use virtual articulator in exocad After the modelling has been launched, in the first window you have the option "Start virtual articulator now" Click on the button to start the function Page 57 of 67

Firstly, we recommend to carefully check that the jaws are positioned correctly in the articulator If you want to correct the position then click on "Rearticulate models virtually" You can now move

59 Firstly, we recommend to carefully check that the jaws are positioned correctly in the articulator If you want to correct the position then click on "Rearticulate models virtually" You can now move the model using the left mouse button, and while holding down the <Ctrl> key you can rotate the model Confirm with "OK" if the positions of the models is in order Then you can enter the physical values of your articulator in the window and apply Page 58 of 67

60 Once you have entered the values, click on "Start articulator movement simulation!" so that the values are applied to your model The program will now automatically perform the jaw movements To finish, click on "OK" The window, "Repeat Articulator Movement" now displays During the modelling you can independently simulate jaw movements by using the slider bar Then click "Next and proceed as usual with the modelling Page 59 of 67

6.2 Align antagonist/dynamically grin-in The great advantage when working with the virtual articulator is the possibility to dynamically grind the modelling based on

If an articulator type was selected when you first created the job order, then later in the modelling and under "Free-Forming" "Adapt" "Occlusal" the option

61 6.2 Align antagonist/dynamically grin-in The great advantage when working with the virtual articulator is the possibility to dynamically grind the modelling based on the previously performed articulator motion. If an articulator type was selected when you first created the job order, then later in the modelling and under "Free-Forming" "Adapt" "Occlusal" the option "OCCLUSION TYPE" will be available In the "Free-Forming" step you can now dynamically grind-in the restoration based on the previous articular motion Choose either "Cut intersections" or "Align whilst preserving tooth form You can then continue as usual and complete the modelling Page 60 of 67

7.0 Waxup For many users, it is a big chunk off their workload, if they can apply the already pre-modelled wax frameworks, crowns etc. directly into the exocad software.

62 7.0 Waxup For many users, it is a big chunk off their workload, if they can apply the already pre-modelled wax frameworks, crowns etc. directly into the exocad software. This step describes how to create your modellation using the help of a Waxup A fully anatomical 3-digit Waxup bridge is modelled as an example 7.1 Creating an order If you want to apply a fully anatomical application over your sculpted Waxup, choose "Waxup" as indication If the modelled "Waxup" is later to be reduced, then choose "Reduced waxup" For bridge pontics, choose "Pontic Waxup" For pontics, there is no separate option whether reduced or not reduced If the adjacent teeth have been applied fully anatomic "Waxup", then the pontics are not reduced If the teeth have been applied "Waxup reduced", then the pontics will be reduced in the modelling later Page 61 of 67

63 7.2 Scan Waxup The prepared jaws is placed in the model holder (labial side of the model to the scanners camera or the model holders locking screw) Start the scan application and perform the first model scan (see Point 3.0) Click "Next" until "Upper Wax Up on Model" Place the model with the attached Waxup, WITHOUT the adjacent teeth, in the scanner and click "Scan" Page 62 of 67

Ensure that as much data as possible is available for the Waxup scan. To achieve a better result we recommend spraying the Waxup with "CADstar Scan spray".

Use the "Integrate" function to rescan missing areas Continue after the Waxup has been scanned as for crowns/bridges In the " Insert upper Waxup or copy it from the

64 Ensure that as much data as possible is available for the Waxup scan. To achieve a better result we recommend spraying the Waxup with "CADstar Scan spray". The better the Waxup scan is, the more accurately the Waxup can later be applied in the modelling. Here, investing some more time in the scan is recommended. Use the "Integrate" function to rescan missing areas Continue after the Waxup has been scanned as for crowns/bridges In the " Insert upper Waxup or copy it from the waxup reference acquisition" step, you can either rescan the Waxup on the Multi-Die Adapter or as previously done with the adjacent teeth, create a copy of the previously created scans Page 63 of 67

65 Click on "Next" when this step has been completed Additionally, the underside of the Waxup can be scanned in the step "Waxup Bottom Integration" In most cases, to get enough data for the later modelling, it is enough if the top of the Waxup is scanned If you wish to skip this step then simply click "Skip" Complete the scan and then change in modelling Page 64 of 67

to edit the Waxup with the "Freeform" tool You can now proceed just as in crowns/bridges To

66 7.3 Use Waxup in exocad Switch to "CAD" within modelling Proceed step by step as by crowns/bridges After the "Waxup calculation" step has been carried out you have the ability to edit the Waxup with the "Freeform" tool You can now proceed just as in crowns/bridges To remove small errors in the Waxup, it is recommended to use the "Smooth/Flatten" tool Page 65 of 67

8.0 Pre-Op Model (Pre-operative Model) The second way to customise your modelling for a Waxup uses the option, "Scan a pre-op model?" in the indication selection.

67 8.0 Pre-Op Model (Pre-operative Model) The second way to customise your modelling for a Waxup uses the option, "Scan a pre-op model?" in the indication selection. The advantage of working with a "Pre-Op model" is that you can decide which parts of the anatomy should be aligned to the Pre-op model. You can also use the Pre-op scan to display purely as an aid. CAUTION: Do not use this function if you want to implement complex Waxup s. If you want to fully apply your pre-sculpted Waxup, it is then necessarily use the restoration "Waxup" as described in Point 7.0. For a "Pre-Op model", additionally select "Scan a pre-op model?" (under the indication selection) when creating the restoration Then perform the scanning process just as in the previously described "Waxup" Page 66 of 67

8.1 Adapt to Pre-operative Model When the scan has been completed you can start the Waxup and continue in the wizard to the point, "Adapt to Pre-operative Model".

on "Adapt tooth models" If you want to align only certain points of the model to the "Pre-op model", then click on "Exclude selected parts" You can now use the Brush tool to mark areas that should

68 8.1 Adapt to Pre-operative Model When the scan has been completed you can start the Waxup and continue in the wizard to the point, "Adapt to Pre-operative Model". The difference when working with a "Pre-op Model", unlike with the "Waxup" function, is that the teeth anatomy is automatically aligned If you want to align the model to the Pre-op Scan, then click on "Adapt tooth models" If you want to align only certain points of the model to the "Pre-op model", then click on "Exclude selected parts" You can now use the Brush tool to mark areas that should NOT be aligned to the Pre-op model Hold down the <SHIFT> key to delete selected points Once you are satisfied with the selection press "Adapt tooth models" You can then proceed with the modelling as usual by clicking on "Next" Page 67 of 67

69 CADstar Österreich CADstar GmbH Sparkassenstraße Bischofshofen Tel. +43 (0) Fax +43 (0) info@cadstar.dental CADstar Deutschland CADstar GmbH Münchener Straße Bad Wiessee Tel. +49 (089) info@cadstar.dental

ATLANTIS WebOrder. ATLANTIS ISUS User guide

ATLANTIS WebOrder. ATLANTIS ISUS User guide ATLANTIS WebOrder ATLANTIS ISUS User guide Contents ATLANTIS WebOrder Entering an ATLANTIS ISUS order 3 ATLANTIS ISUS implant suprastructures 4 ATLANTIS ISUS Bar 5 ATLANTIS ISUS Bridge 7 ATLANTIS ISUS