Hi Voices of the Bench community. This is John Isherwood with the PR team here at Ivoclar. As we wind down the year, all of us at Ivoclar want to thank you for your partnership, your trust, and your continued support. We wish you and your family a very happy, healthy, and safe holiday season. I'd also like to take a moment to thank Elvis and Barb for continuing to make this podcast so special, bringing our community together to share ideas, learn from one another, and grow as a profession. From all of us at Ivoclar, have a wonderful holiday season. And as Santa likes to say, May your days be merry, your nights be bright, and may all your smiles sparkle like freshly fallen snow. Ho, ho, ho.
Welcome to Voices from the Bench, a dental laboratory podcast. Send us an e-mail at info at voicesfromthebench.com and follow us on Facebook and Instagram. Greetings and welcome to episode 402 of Voices from the Bench. My name is Elvis.
My name's Barbara.
You outside right now? Where are you?
Yeah, I'm really sorry guys that are technical problems, but I am at the Heartland. Winter Conference in Orlando.
What is this Heartland Winter Conference? What is this? What are you doing?
Oh, they just bring, there's like 6,000 Heartland doctors here.
Holy moly.
And they bring everybody and. They do like awards and lectures and seminars and it's basically a doctor conference.
I get you.
But it happens in Orlando.
Oh, and does Knight have a booth?
Yeah, so we've got a real, we've got like five or six people here. I just came because we're relaunching the lab that I run. It's called, currently called Comprehensive Aesthetic Center and we are changing it to Signature Aesthetic Studio. So I'm here just to talk about that, meet my doctors and relax and talk to you.
That's a mouthful. What was that again?
Yeah, I know. Signature Aesthetic Studio.
Oh, sounds fancy.
Studio's a nod to my dad because it was Knight Dental Studio.
Oh, was it?
So I wanted studio in the name for my dad.
Nice. I always think that labs are one step fancier when they have the word studio.
I agree. And how are you?
I'm doing really good. I mean, it's freezing cold in Indiana. I mean, we're topping up in the low 30s and I am busy, busy, busy end of the year, wrapping things up.
Good for you. And I'm sure you went for a run in the 20 degrees.
I did, and I'm probably going to do it again today.
Good for you.
You can be really cold when you get started.
I know.
You mentioned something about a competition. Like you won something.
I won the aesthetic case of the year. So Heartland's got a program and they teach younger doctors how to do 10 unit veneer slash crown cases, smile design cases. And we did 15 this year. There were 70 cases altogether with all the different labs. And my case won. Yay.
So out of 70 different patients, I mean live patients, everything seated.
Yeah, it's live patient. Yep. Pretty cool.
That is pretty cool.
Right? So yeah, so I'm proud of that. So they just gave us a nod on stage and it was pretty cool. It's a lot of work though.
How involved were you with seeing the patient and everything?
We do everything digitally, but I have to deal with the doctors and we go to the seat date and we get to do the before and after photos and show them what we need for the preps and look at the scans and then, you know, design the case, meld the case. seat the case, finish the case, glaze the case, everything I do every day.
Yeah, so basically you did everything.
Yeah, basically. Yeah, it's so funny, I'm going to be rude, but the lab gets a very small shout out at this event. The Dr. gets to go on stage and get an award and we got a tiny little, hey, thanks to Barb at Lexer.
Really.
Kind of annoys me.
That is kind of.
I'm sure doctors don't listen to this podcast, but I feel like the lab kind of gets to death.
Because we all know that, I mean, they just cut the tooth, everything else. Come on.
Right. Yeah. So it was kind of a bummer. I was kind of, I was just like, really? But it's all right. I'm still proud.
As you should be.
Proud of my team and proud of my lab.
Is that doctor local to you or did you have to travel?
Travel. Most of them we had to travel to, yeah. And then get the case seated, meet them at the convention, get everything rolling. So yeah, it's quite the event. Heartland does a really good job. I must say.
Did the doctor even buy you a drink at this event? Like cheers.
No, but he texted me and said, we won, we won. And then he just came by our booth with his trophy and we took a picture together. Yeah, it's crazy, but whatever.
Did you do a little middle finger in the background?
I wanted to. All of you dental techs out there, we're the unsung heroes. We kick, you know.
Yeah, you take your victories when you can. So he's probably not on the podcast talking about it. So there you go. Congratulations, Barb.
All right. Thank you. So talk to me about this week.
Well, while you were away and probably working on a case for this Heartland competition, I actually got this super nerd out about photogrammetry.
Oh my god, we know you did.
Yes, So Syn Dental USA loaned me a Micron Mapper earlier this year to try out and for me to convince my lab to get one for doing our full arch cases. I absolutely love this thing. Yep. It has made everything easier and more predictable. So we wanted to talk to the company that brought it to market and we ended up with two people that were on the podcast back in 2022.
Nice.
Patrick Dewey is the president of Cyn Dental USA and talks about all the practical uses of the Micron Mapper, both chairside for clinicians and also for labs. But he's also joined by everyone's favorite go-to ExCAD expert, Blake Rodney. Both of them worked with the company on the development of the Micron Mapper, but we got to get in deep into the benefits, how it works, the tolerance measurements, how the Micron Mapper stacks up to others, and how this can not only make your work better, but how it helps you get more cases by providing a better workflow. So join us as we chat with Patrick Dewey and Blake Rodney. So Barb, CAM has been a big topic for us in the past few weeks. And now that we're such experts on this matter, I actually recently learned about an exciting new partnership.
Oh yeah? What's that Mr. CAM expert.
Well, you don't have to be a about it, but... Everybody knows our good friends at Ivoclar.
Yes, of course we do.
Yep, good people and they probably also know about their Ivotion dental solution.
Do you mean the one where the discs are already split into two colors so that you can design and mill a complete denture all in one shot?
Yeah, it's crazy how that works. Don't know how it works, but you're right. That is it. There's no bonding of the teeth to the denture base.
Well, I bet that makes everybody body's life easier including mine what a goopy mess that that can be you.
Betcha so until now you can only Mill Ivotion dentures on a closed system however Ivoclar has been working with follow me Technologies to implement the workflow into hyperdent cam wow that means you'll be seeing it on a lot more open machines.
All right, so give it up. That's amazing. But do tell. Do you know which ones?
Well, I know for starters, we're going to see it on the Roland DWX 53 series mills, which a lot of people have.
Yep.
And the Imagine I mills.
So that is crazy awesome. These Hyperdent dudes are everywhere, right?
I mean, not just everywhere, but everywhere. They're like PMMA chips stuck to my...
Oh, we got it. Hard stop. Nobody wants the mental picture you're about to paint for us. I can hardly believe 2025 is almost over. As the end of the year approaches, dental labs everywhere are feeling the rush. Schedules are full, deadlines are tight, and there's absolutely no room for error. So that's when dental professionals lean on the one thing they can rely on most for productivity and reliable milling solutions.
You know, every December, it's the same story. Long hours, high volume, and zero room for mistakes.
Yep.
But with the Roland DG-shaped mills, we know that we can count on consistent results. The DWX53DC is a workhorse with 24-hour automated milling. It's like having another technician on your team. It keeps our lab running while minimizing our overhead and maximizing ROI.
Exactly. Reliability means profitability. Everybody knows that. And when our mills run smoothly, we stay sane and on schedule and profitable. No redos, no downtime, just precision and on-time case deliveries. And that's no accident. Roland's long-standing reputation for quality is built on Japanese engineering and craftsmanship. It's a legacy of meticulous design and unmatched performance. Every spindle, every detail, every calibration reflects decades of refinement. It's not just about technology, it's honestly about trust.
I've tried other systems and nothing beats our Roland. They just keep going. They are the workhorse that never quits.
Honestly, Elvis, it's the MVP of milling, especially when you're racing to wrap up the year strong and there aren't enough hours in the day.
This season, when precision and reliability means everything, choose the solution that's proven to deliver. Choose Roland's DG Shape, the workhorse of dental milling. Crafted with Japanese precision, the most trusted brand worldwide. For more information, visit RolandDental.com. Voices from the bench. The interview. Super excited today to welcome back two gentlemen. We just mentioned that it was on back in July of 2022 to update us on all things SIN or S-I-N. We welcome back Blake Romney and Patrick Dewey. How are you guys?
Doing good. Hey, it's good to hear from you again.
Absolutely. Always good to hear from you. So we have a whole episode here, the backstory of where you all come from. Blake, I think you're a... pretty new into the industry back then, maybe, right? Just like a couple years.
Last time we spoke, I'd just been working a couple years in the industry. So my degree is in engineering graphics. I'm definitely not a dental technician, but it all really made sense. Like the mouth's so mechanical and all the bits and pieces and parts and 3D scanning and manufacturing. I just fell in love with it.
Yeah, and now pretty much every time I'm on Instagram, you're teaching a course and you're teaching lots of people and it's like amazing to me. that go from mechanical engineering? Is that what you said too?
Mechanical drafting. So yeah, like 3D design for mechanical objects.
Now you're changing Exocad to the world. That's insane.
Yeah, we're doing classes every month now in Scottsdale, Arizona and all over the US that teach at a bunch of universities like Nova and UNC Chapel Hill. It's been a really awesome opportunity. A huge part to Patrick, like helping me set that up.
Yeah, what'd you see in this guy, Patrick? I mean...
I'll tell you what, first things first, something has not changed since the last time. What was it, Elvis?
22, so.
Is that when it was?
Three. Over 3 years ago, yeah.
Over 3 years, there's one thing that has not changed, and believe me, a lot of things changed with Blake, for the better, of course. But one thing that has not changed, he still cannot pour up a model to save his life.
I don't plan on learning either.
All right, we're going to end this and you're going to practice until you get perfect and then we'll talk.
Perfect.
So Patrick, tell us what's been up with Sin, S-I-N. I know I always call it Sin, but it's technically S-I-N. What's going on with that?
Yeah, we have to reinforce the abbreviation of S-I-N, Simplicity Innovation Nanotechnology, because when we go to the Baptist belt and they mention sin. It just doesn't roll off the tongue well, or we get a little bit of a frown. But it's, yeah, with SIM 360, a lot has been changing, a lot for the better, thanks to people like Blake and the rest of the team. It's nothing has changed from our core. So SIN 360, we sell products, we train on products, we support on products. And our fourth pillar is that we innovate. Everything stayed the same. We've just focused a lot more on that fourth pillar of innovation. We're still dealing in the same worlds of CAD software, CAM software, photogrammetry. But as we'll get into in this podcast, We've definitely dove deeper into each one of our individual verticals, such as hyper dense, such as photogrammetry, fit check, I know we're going to get into. Just kind of robusted our tooling a little bit, kind of elevated each individual line, and we've gone deeper. And there is some things on the R&D side, Blake and I, we're going after with full force.
Nice. Let's remind everyone, I mean, SIN started as an implant company, right? You mentioned all this stuff and you make implants.
Yeah. Yes, we've got a huge implant line. We've got some new things, just we can touch on the implant line.
Yeah, please.
We've got a full implant line of root form implants. We just launched the Versalis line of implants last week.
Last week.
A lot of people see the last week. Oh, this is new. You'll see a lot of the race car themed advertisements and videos from our KOL like Juan Gonzalez, Rajan Sheth, some of these individuals. And we've still got our remote anchorage line of zygomatics, our pterygoid line. We've got, yeah, and all the other things, something that is coming in the very new future. I know most of these listeners are generally on either clinicians doing their own lab work or laboratory technicians. So if there is some clinicians on here, which I do know some that love your show, so I know there's a few in there at least.
Probably highly offended half the time, but that's okay.
No, I think everybody's realized the difference in the future is those that understand the laboratory size.
Oh, I love it. Yeah.
Yeah, it is the pinnacle focus for anybody who wants to advance their practice in dental implant and digital dentistry for sure. But yeah, one of the new things that's coming is the Patsy kit where in a clinical setting, a surgeon can walk into an operatory, bring one surgical kit, knock out a pterygoid case, zygomatic case, or a traditional root implant all with one tooling. Nowadays, if you go into pretty much any surgeon across the US, they've got usually two minimum, sometimes up to four or five surgical kits out.
You know, that's always confused me. You're right. They all have way more surgical kits than I would think they need. And they almost need one for depending on what sleeve is being used is like depending on what kit you use, is it guided? Is it not guided? Is it keyed? Is it not keyed? And it's like, what do you place? I place implant A. Which kit? I got six of them. It's insane. So one kit is doing all of these.
Yes, but not on the guided side. So this is for traditional working called patsy. Yeah, freehand patsy.
I consider people that do freehand patsies. Yeah, okay.
There we go. But yeah, man, you lead us where you want to take us, but I think we're going to venture down the rabbit hole of... Digital and some of the specific tooling and some advanced things.
I do want to touch on real quick this new implant.
Yes.
How are we still coming out with new implants? What's different? I mean, really? Thread pitch? I mean, how can you improve on what's already out there?
So a couple things. There's a few things that are very traditional basics. that help both on the restorative side and the laboratory side and on the surgical side. And that's one of the first pillars we brought in. Same thing as our last implant lines. It's one implant connection for all indications. So whether it's a narrow 3.5 diameter implant, whether it's a seven millimeter wide implant, whether it's a pterygoid or whether it's a zygoma, the laboratory just needs to order the same exact You don't have a narrow platform, regular platform, and a wide, like some other companies, like Nobel, for example.
One screw for all of them.
Exactly. One prosthetic connection for all of them.
This is where I insert the applause, right here.
It makes it so much easier on the lab side, like way less prosthetic.
So much easier. Wow, it's insane.
One of the other things is the thread pitch, the macrogeometry of the thread. We've made some very subtle changes as far as the Versalis line compared to some of the other market leaders. And we wanted it to be very simple, easy to use for one implant to cover all bone densities. So whether it's D1, D2, D3, or D4, or super soft bone and super hard cortical bone, one bullet can get very high predictable stability in all indications. Interesting. The only thing that you'll change is the drilling protocol, which there's two. There's regular implant drilling protocol, and then there's dents. So it's a very simple system. Other than that, there hasn't been too much of a change. Yeah. We are perceived a little bit of that, call it the Robin Hood of implant dentistry, or trying to really lower the price point to make it more achievable for patients to get involved. So that savings should usually gets passed down. But I mean, Elvis, when you talk to Blake or you talk to me or anybody else in the company, it's best to start with who we don't focus on. So a clinician that's just coming out of dental school, they haven't done many implants and they want to get into implant dentistry. Yes, they can get a great price from us, but Our solutions aren't really geared for that because the solutions, like when you talk to Blake or you talk to anybody else on the team, the solutions and our focus and our full product line, those beginning customers don't have the problems that our solutions address. So that brings us to the point, who do we focus on? We focus on the top of the pyramid, so to speak. So we focus on the high volume, high clinical acumen, most complicated clinical cases, or even on the lab side, laboratories that are dealing with high volume clinical scenarios, complicated, or they want to, I don't know, bring their photogrammetry files into their construction info on their CAM software, those are the areas that we thrive. And those are the areas that we bring the most value.
Yeah, no, it makes perfect sense. I mean, I would imagine that a dentist just now getting an implant would appreciate your simplicity.
Yes.
But at the same time, they're only doing those single units. I don't know if it's the right term, but the implant is overkill, maybe? I don't know.
No, not the implant system for sure is anybody could pick it up and run with it with high predictability. But when you look at our overall solution, on the photogrammetry. So if somebody's just doing single implants, Blake gets on the phone with him and he's talking about CT alignment workflow, I mean, it's just going to go over their head. And that's not very applicable. But for somebody like yourself and a lot of your listeners, I know a lot of them and Blake knows a lot of them. If they're not advanced already, they're advancing themselves and dealing with some very complex stuff. So I think it's very pertinent for this call.
Blake probably taught most of them.
Yeah, it was a big part of our training is doing exocad design and we try to give out a lot of information and workflows and stuff for free. we're here to train and help people.
Were you doing those back in 22 when we last talked?
Yeah, absolutely. So all I've ever really done is like full arts, complicated cases. You know, I started at a process office in-house in like 2018. I've never worked designing dentures or single units or anything. All I've ever done is like full arch digital workflows. It's really all I know. So if you come to me about custom abutments or something, I'm sorry, I just can't help you. know, like I just, I don't know what a good one looks like, but it's just not our area of focus, like Patrick's saying.
That's hilarious. You probably don't even know that you can do anything without a MUA.
Yeah, I really, really worry about multi-unit up, honestly.
Yeah, something else about Blake, though. Oh, so I usually run into you every year at midwinter at lab day.
Yeah.
And the funniest thing, though, over the years, watching Blake go to lab day, he goes there by himself and usually breaks off and leaves by himself and he'll just go wander. By the end of the show, he's got people pulling him left and right for selfies. And he's got like this following that you don't really realize is there until you go to lab day and you see Blake getting pulled left and right to everybody. It's quite interesting.
Yeah, but also just online. I mean, I see it all the time. People are thanking Blake for the help they received, and you're always doing stories where, ask me a question, whoever you are, and I'll answer it. I mean, that's some just good stuff to have out there that allows people to succeed.
Thank you. Yeah.
I bet you, I mean, you get a kick out of it, Blake.
No, it's nice, and Lab Day is great. I mean, it's our people, right? So, a lot of times we're at these general conferences that are doctor-focused. That's not mine and yours, people's Elvis. Lab Day is our weekend to shine.
Yes, sir. So, in twenty-two... And I remember we talked, ICAM was mentioned A lot. Was the Micron Mapper even around?
Let's see, the Micron Mapper was just coming out at the end of 22, so we'd have to look back at what month it was released.
July. So we probably weren't talking about it.
Yeah, it was in development then, but we might have hinted at it. Yeah, we, you know, a lot of us came from ICAM. We either worked for it or sold ICAM. And I have nothing bad to say about their products. It's just we went to develop Micron Mapper. we just tried to fix everything that we didn't like about it, right? So we made it lighter, smaller, faster, easier to use, and we expanded on the functionality of it. Like most photogrammetry systems on the market, just they're one-trick ponies. They only do one thing, they scan multi-unit abutments, and they do it really well. But now that you've had your hands on MicronMapper, you see we can do things like verifying your manufacturing accuracy. You know, we can scan soft tissue after surgery. We have some really cool new locator scan bodies coming out. We're doing snap-on dentures with photogrammetry. We just keep expanding the capabilities of photogrammetry.
Who decided you needed to make your own and how do you even go about doing that? I mean, this is kind of outside the scope of what most dental companies do.
Yeah, so without getting too in the weeds, We could just say there was, we were backed into a corner. At the end of the day, like you mentioned, Elvis, Blake is online helping people. I mean, he'll post videos if Exocad has an update that's conflicting with like a Windows. operating system, he'll go online and post it for everybody to see like, hey, everybody, I'm getting a ton of exocad tickets today and everybody's reaching out to me. There is an issue with the new Windows update and exocad or whatever it may be.
Sure, yeah.
But he's always willing to help the community. And that's one of the core things about the companies. We want to make sure integrity's at the core. We ran into a situation where if anybody, any of your listeners remember, and they were in the photogrammetry world back then, Anytime you go to buy a photogrammetry unit, the expectation is that there's going to be a delay. It was concluded before you even called your vendor.
Yeah, everyone's like, six months away? Yeah, I remember. Yes.
So that built and built, and we were the number one distributor in the US at that time. And the delays for us were, I mean, we're talking eight to nine months, we had customers that we collected deposits from. And without going too much into the details.
Yes, I did do it yourself.
We just noticed. Yeah, we noticed. No, no, it wasn't that actually. No, this is based out of necessity. Like we would have customers that are looking at us for answers like, hey, I gave you $35,000 or 50% of it up front and I'm waiting nine months. And then we started seeing new distributors pop up with units right away. We were like, wait a minute. I thought there was a back order shortage. Yeah. So, without going too deep there, we were in a situation of necessity. So the only person we could find that was qualified enough, and it just happened to be the best partnership ever, which is Clare Nevada, Toronto, Canada. Dora and Deco, which Blake knows very well and interacts with him and Razvan and their team, extremely knowledgeable with photogrammetry. They actually use photogrammetry for spine surgery and a lot of uses in the medical world.
Interesting.
So we went to them and said, we're looking for a function where we can capture implant positions in the oral cavity. And they looked at us like, that's it? You know, that's easy.
You don't want a spine.
Yeah, exactly. So we were super excited to find the right individual. And then between Blake and myself and some others, we were able to kind of bring together a finished product. And that was predominantly in the manufacturing side. It was all manufactured by Clarinav out of Toronto. And I think it was around October was the first time that we kind of got our hands on that, on the first demo units. And Blake signed off on it, and the rest of the team was like, hey, we've got something good. And we started to really those going into the end of the year and then to Q1 the following year. So strictly by necessity is where we kind of prevailed and found a good solution. Now the difference is, A, is obviously the weight. ICAM, just like Blake said, ICAM is a good product that works. We've tested it. We know its accuracy is really good. It is not superior to MicroMapper. It's just different. MicroMapper has things like you don't have to calibrate it because there's an algorithm built in. If you go inside of a practice and it's 72 degrees, you go outside and it's 90, you're still going to get the same results because of that algorithm. Where with ICAM, you actually have to calibrate it to make sure that you factor in temperature changes and stuff like that.
Every time you use it, you have to calibrate it. And it's quite a process too, right?
It is. It is. But I would say to ICAM's defense, ICAM is pretty much the next best thing outside of MicroMapper. When you get into Tupole and some of these other ones that have tried to launch, it's a big drop-off behind.
Yeah, that's fascinating. I had no idea it was a Canadian process. product. That's cool.
Yep, it is.
So you got it in, you tested it. Well, let me tell you the story on how I found out about Micron. I mean, I knew about it. You see it online. I mean, you guys are great advertisers on social media where I spend too much time. But you see it and you see it. But my lab got into grammetry and was really into that. I'm not going to say what system, but it worked. Most of the time, and it started making me nervous because we do a lot of the same day surgeries, we design the office prints, and they go to deliver these full arches. And it's like you get three of the screws down, the 4th one not quite going. So you unscrew the other two to see if it fixes that, to screw in that last one. And then you kind of, you play, it didn't give me the confidence delivering these things all the time. I'd start getting nervous when we started delivering these things, but a majority of them delivered and went down and yeah, you know, win for all. A surgeon called me, never worked with them before, asked if we could do a design for him because his regular lab was unavailable. Went in there, took my Grammetry kit. He had a micron mapper. That was my first time seeing it. And wow. I mean, it was just like, it made that wonderful noise that I've come to love and ding, and it was done. And we designed it, we printed it, went in, not a single issue. Very passive, very easy to use. That's when I said, I got to get one of these. I have to convince my lab to get one. So that's what led me to reach out to Blake, who was on the podcast previously, was pushing the micron mapper, and I said, dude, I got to get one of these things. I got to show it to my lab. Blake was nice enough to let me borrow one for a couple of months. And I'm going to tell you, not only did it help the cases we were doing, once people found out I had this thing, I started getting calls left and right. Everybody wanted me to use it in their office. And it has grown that business huge just because I was doing it at a surgeon's office. They loved it. They told their GPs about it. So when we went to go do stage two or the final, boom, they want me there with it just to confirm. I mean, This thing is amazing.
Yeah, it's definitely a game changer. Blake could actually walk you through. I mean, I don't know if he's prepared to do that today, but he could walk you through all the deep, the micron accuracy differences between all the options.
He's better be prepared because that's what we're about to get into because I nerd out on this thing.
I know, and that's one great thing about microfiber is we provide a lot of really awesome data and we're really transparent about the data we produce.
This thing does everything in microns, right?
Yep, that's correct.
Which, from what I understand, one micron is 0.001 millimeter.
Yep, that's correct.
Fractions. of measurement. I mean, tiny measurements.
Yeah, it sure is. And it's actually, it's honestly overkill. Like the quality of the data that we get from this system is like well within a clinically acceptable range. It's honestly overkill in the accuracy and precision.
Is there such a thing?
Good question. I mean, compared it to your grammetry story, right, where we're using inter-oral scans to collect implant data, you know, it's a huge improvement over this. So if you're looking for like reliability and precision, I mean, it's a system for that. I appreciate you saying about how many getting calls you're getting on the lab side. Because a lot of times in this industry, we just think about photogrammetry as something that you would use as a clinic, right? And then a clinical purchase. But there's actually a huge market for labs to buy these things. So for where a lab technician may traditionally go into an office and maybe they bring their denture conversion materials and everything, they can just roll up with a laptop and a scanner and collect all this data and do the whole thing digitally. I mean, we have so many labs we work with now that instead of doing chairside conversions, they roll up with a laptop and a scanner and do it all digitally.
I will never do a conversion again. Thank you.
Glad to hear that.
My life is, it's not worth it. It's not worth the stress. It's not worth all of that. And I mean, I love the people that can do it and do it well. To me, it's just what I want to do for a living. It just beats all. So speaking of the micron accuracy, what is the top tolerance levels maybe? Or what's the MicronMapper? How good is it?
Yeah, so just today I did an install for a customer this afternoon and they had the MicronMapper with the split scan bodies. And one thing that really sets us apart is that we're really transparent with the quality of the data you get from MicronMapper. So a lot of systems in the market, they just make up these numbers and they tell you, hey, we're 10 or 15 or 20 microns of accuracy. They don't give you any way to test it yourself. But just like I showed you with the MicronMapper, we actually provide you with a model where we know the XYZ coordinates for the six implants on that model. So that's our control in this experiment, right? So you can take your MicronMapper, scan that model, and then the software will compare your scan against those known values to tell you how accurate your MicronMapper is. So in the install I did this afternoon, for example, the customer was getting 18 microns of accuracy Six implants, well within a clinically acceptable range. If you were to review like the currently available literature on this, it seems that 50 microns of accuracy. on average is clinically acceptable. So at 18 or 20, we're well under double what's considered clinically acceptable for accuracy.
Do you know what most intraoral scanners get?
Yeah, it depends. There's so much variability in those, right? So one thing about intraoral scanners and doing like grammetry and stuff is there's so much human error involved with it. I mean, there's a lot of scan strategy with these things, right? It depends if the tissue's healed or if it's soft tissue right after surgery. It's moving around like a waterbed, right? So in a controlled environment on a healed ridge, intraoral scanners are not that bad. But when you get to like really bloody post-op scans, it's really where they start to fall apart on that cross arch accuracy. So, you know, intraoral scanners are just scanning basically a bunch of like inch wide sections and then piecing all those together. So it never, you know, it measures like 2 to 4, 4 to 6, 6 to 8, 8 to 10, you know, around the arch. like that, but it never really measures the distance from like 2 to 15. And that cross arch accuracy is critical with the passivity of our full arch restoration. So like in your grammetry example, where three of them might sit fine and one of them's kind of off, that's the kind of stuff we always see when you're capturing implant data with an intraoral scanner.
Yeah, so there's no general number of like intraoral you're hitting?
I've seen 'em all over the place. Like I wish I could get, I definitely could pull up some studies. Oh, oh, the highest.
350 to 400.
400, yeah, absolutely, yeah. So we have examples where we've used systems in the market, 'cause we obviously buy all these to test, right? And we own every photogrammetry system, we own every long scan body system too. And yeah, there's been cases where we've pushed almost 400 microns RMSE There's no way that thing's going to seat, right? No.
Yeah, that's why we don't.
Want to use inter-oral scanners for full arch implant data. An extra-oral scanner that can see all of the implants at one time and record the relationship between them is critical for full arch cases.
So Elvis, one of the key things, just for a good analogy, especially if there's any newer incoming lab techs or even clinicians that are not too versed in this area, To compare a good analogy for intraoral scanning, it's identical to the technology on an iPhone. When you go in to take a pano image, if you have that feature under photos on your iPhone, you click the pano, there's an arrow in the middle of the phone as you scroll around the view of what you're trying to take a really wide picture of. And Blake can explain this better than I can, but it's basically stitching photos together to give you one big photo. But if some if you're capturing the Hollywood sign of the Hollywood Hills, the H, you've got the big white letters, you're trying to pan across and capture that, and a bird flies through the picture or somebody walks in front of you, or you move too fast. there's going to be some distortion in that image. And that's the exact distortion that Blake's referring to that you get in a live patient setting. And it gets exponentially increased when there's saliva, there's tissue that's being stretched by the obture gate or by the assistant that's pulling the cheeks apart so you can get the camera in there. Or if there's a lot of blood. So there's so many factors. that are not making it easier and more accurate. It actually decreases it.
Interesting. It's a good analogy, but I know exactly what you're saying.
Yeah, like when you do a panoramic and they end up with two heads because somebody moved. Yeah, same idea.
Or your cat's really long. Yeah. Let's talk about the markers. They're a little different. A lot of systems people refer to them as dominoes.
Yeah, so dominoes, checkers, scan bodies, it's all the same thing. Just like in dental, I feel like everything has 10 names, but yeah.
But I remember when I got the loaner and now that I'm setting up the one that we finally bought, they're unique. Like you have to register. They're not just like a standard scan body, I guess.
Yep, every scan body is individually calibrated. So we need such high accuracy with these. So like the 10 scan bodies you own are the only 10 in existence like that. Every scan body ever made has its own calibration file that goes with it and it's critical for the high accuracy we need.
Is this common for all photogrammetry or?
Yeah, actually most of the systems on the market do something similar. They do it in batches and things. But yeah, so like an intraoral scan scan body, you know, they're all the same, doesn't really matter. But yes, I mean, being transparent on the market. Pretty much all the photo entry systems have like batches of scan bodies. They may be done as a set or individually done, but yeah, still have their own calibration files that go with it.
Because basically all it looks like is... little squares, I guess they're squares, on the facing of these things. It almost looks like a QR code scan thing. It seems almost too simple.
Yeah, so the reason why we have to do that is because of errors in manufacturing. So imagine when we make these scan bodies, those little checkers on the top might be slightly left or slightly right, when they get laser etched on there. So in order to compensate for those errors in manufacturing, right, we calibrate every scan body individually and the software it offsets for those errors in manufacturing.
You have to have the unit offset for the manufacturing errors while making these things.
Of the scan bodies, yes. That's how precise we are for this. We look at every little step and yeah, absolutely, because the laser etch might have put it slightly to the left, right? So we need to calibrate that scan body and have data that relates it back to the correct like multi-unit position in three-dimensional space.
Interesting.
Another way to look at this, Elvis, is if you compound each individual step that can contribute to loss of accuracy. If you go down the list, it's actually pretty high. So when you manufacture, let's just talk about, because there's multiple scan bodies for Micromapper, different types. Let's just talk about what we've referred to them as the correct term is the Tekapeak unibody scan body. It's all Teca Peak material. So it's not regular Peak, which a lot of lab techs are familiar with. It's called Teca Peak, which is a more dense material. Interesting. It's biocompatible. Those are usually manufactured within a 50 micron accuracy. So if you didn't look at the QR code, you just looked at the outside diameter or the flat side face or the top to bottom height. they're going to be varying about 50 microns across the board. So if you take that and if we didn't calibrate them individually to get a perfect 000 XYZ point for each one, Then you take your scan across, say, six implants, then you've got six additional, it's going to be a 6x, I don't know if that's the right math, but it's going to be exponentially increased as far as the total deviation or the total RMSE. Then you go ahead and take that information, you add it to a printer that prints at 50 micron of accuracy. So it could be plus or minus 50, plus or minus 50 on the first manufacturing of the scan body, you're at a total of 100. Then you go ahead and you cure the resin, on your temp, you can have over 100 microns of deviation. So each step that we can control and shrink that deviation, the better. And then if you go to the final, there's even deviation with centering. So centering, each step, you're introducing deviation. So the goal is to provide a finished end result solution that's as accurate as possible. Now, one thing that I wanted to add to Blake's original point on that model that you got when you purchased your MicroMap, or even on the loaner one, it's like a stone model, and there's a patient name on there, and it's usually 7 digits. When you type that into the software and you scan the scan bodies you put on the model, like Blake mentioned, that tells you if those scan bodies are scanning accurately. So it verifies, or maybe the unit was dropped, and you can find out if you damaged it or something like that. model, it's important that I bring this up because that model is calibrated to 8 microns of accuracy plus or minus. I say that because that model was calibrated on a 12 foot by six foot slab that's like four inches thick of pure granite. That's all done in Clarinav's headquarters. That's one of the most accurate machines in the world to get a clear accuracy number out of that model. So I know that, Blake knows that. And when we see another photogrammetry device that comes out and says, our photogrammetry device can produce a six micron of accuracy result, We're like, wait a minute, you can't even test that. We know they don't have that granite slab, let alone to be able to have something to perform better than that and then get a result on a scan that's better than the best scanner on the market in the person's mouth. We know it's just not possible. So it is important because customers that are maybe not educated here will come to us and say, How accurate is MicroMapper? And Blake will say, Okay, let's show you, we'll scan it, he'll produce a nine to say twenty-eight micron result, a scan right then and there, and they'll say, Well, wait a minute, you know, the company down four boosts down is saying they can give me a six micron of accuracy result in a patient. But we know that's just not true. So again, back to the transparency, it's important to understand the science if you really want to understand what's real and what's not real.
Well, let's do this. podcast, we truly believe in accurate data and transparency. I'm such a nerd. Let's do it right now. Okay.
Let's do it.
Are you going to scan one?
He's ready.
There it is. What number am I looking at?
So in the top left, did you put in your model name as your patient name there?
Yep.
Okay. And then it should say something like RMSE and then give you a value.
RMSE 31.
Okay, so a little higher than normal, but yeah, I mean, that's still well within a clinically acceptable range. Is this your old computer that you had where we did the demo one?
Yeah, but I registered these new ones.
Oh, you did register the new scan bodies? Cool. All right. Yep. So yeah, a little bit higher than normal, but I mean, well within a clinically acceptable results.
Maybe they're not screwed in all the way.
Yeah, I would encourage you to make sure that they're seated correctly, the data is registered correctly, and then try to hold it the correct distance and everything.
I'll edit this, but I want to see if I can get a better number.
No, I mean, we're fine.
That's fine, yeah.
Even 30 is not bad.
Elvis, that's not a bad number.
Well, when you say it's a little high, I get up.
Yeah, I mean, you're going to consistently get somewhere between 15 in the 30s.
18, so...
Yeah, maybe they weren't seated correctly the first time. If you want to read me, then we can... Yeah, 18 feels a little lot better.
Thirty-one, and all I did was screw it in a little bit more.
So maybe the scan body wasn't seated. You see all these tiny, tiny changes that make a big difference with the quality of the data. That's like we can track such small changes in the scan bodies with the system.
Do you recommend that they kind of torque these things down to make sure they're down all the way?
We recommend that you do 10 Newton centimeters.
Really? Okay, that's good to know. Because I've just been having people hand tighten.
Yeah, I mean, hand tighten is fine.
There's a great 10.
Yeah, 10 is what we recommend.
Interesting. That's a great point.
And Elvis, one of the things that the tighter you torque that screw down, the scan body is only, it's going to come to a firm stop once it stops. It's not going to go down anymore. The higher you go on torque, Believe it or not, what you're doing is you're stretching the titanium on the threads of the screw.
Yeah.
You're not compressing the scan body. So that once it's tight enough, it's not going to like change. If you torque it to 20, it's going to get a better accuracy. Over a certain level of torque, all it's doing is just stretching the threads of the screw. It's not compressing the scan body, so to speak.
Interesting, yeah, that's a good point. The scan bodies are about the same width as a multi-unit, right? So you're not really too large inside the mouth.
Yeah, did you get the new split scan bodies with your microman?
No, I did not. No, I did not. But here's my question. I've run into a few surgeries where these implants are so close together, we can't put too... scan bodies next to each other.
So we actually have a function in the software to account for this. So let's say you're in a situation where maybe you have six implants total and two of them, either way, either one's blocking the view of the other one or you have two multi-units that are so close together you can't physically screw in both at the same time.
My solution was to cut one.
I mean, we have a function so you don't have to do that, but I mean, yeah. So what you do is in MicronMapper software, software, you enter your patient's name, you tell it, let's say upper jaw, and you tell the total number of implants you have. So you'd say like 6 implants, even though you can only physically screw in five at one time, right? So you're telling you want to scan 6, but you want to screw in five of the scan bodies. You'd pick up your MicronMapper. You'd scan all five of those until they turn green, that little circle that builds up around it. So now the MicronMapper knows where those five are in relationship to each other. You don't touch anything in the software. You just set the camera down.
You turn it off, right?
You don't even have to turn it off. You can just leave it on or turn the light off. It doesn't matter. And so you just set the camera down. And then you've got a offending scan body, you can take it out, okay, and put another scan body in that six spot that we haven't captured yet. Then you pick up your MicronMapper and just keep scanning. So in this situation, you know, four of those would not have changed, right? One scan body just moved to another location. So the software is able to measure the relationship between the four scan bodies that haven't moved and that new one you added in. So yeah, absolutely. You don't need to cut your scan body or anything. We have a function in the software built exactly for this situation.
So do you have to use a different scan body in that new location or can you move one to the other?
Yeah, so you technically can move one, but it seems to be best practice just to grab a new scan body for that sixth one. Every once in a while, the software will get confused and say like, hey, why did that scan body just move a half an inch to the right? Sure. So, I would recommend that you would grab a new scan body for that six spots.
That is awesome. I wish I knew about that. I did not cut any of the ones I borrowed. I will say that they're all coming back in full. But we were close. We ended up moving a multi-unit. We ended up, you know, just turning.
It at one six hour turn. Oh, yeah, you should have called me. Yeah, we have a function built in the software just for this.
I got to act like I know what I'm doing when I'm in these offices. I can't call a friend. We've.
Been in just about every situation so far with the number of cases we've done it and the amount of people on our team. We pretty much have a solution for every situation you might get into surgically.
Yeah. When we scan these units, a window pops up showing the location of all the implants and then there's usually a red line and an arrow with a number. That's given me, what, the most divergency between 2 scan bodies.
Yeah, have you ever went to design a bridge and your multi-units are in such kind of like a Y shape that that no matter what, it won't see. Or maybe you have to like hook it on one side and put your bridge in a certain way. So after you take a MicronMapper scan, it actually shows you your two most divergent multi-unit abutments. So in a perfect world, you know, it's not humanly possible, but let's say all your multi-unit abutments are exactly parallel. You know, so you'd have 0 degrees for your maximum divergence. After you take your MicronMapper scan, it'll show you your two most divergent multi-unit abutments. So if that's a really high number, like over 30 degrees or something, you may want to consider, changing a straight to a 17 or 17 to 30 or rotating one or something.
Or just rotating, yeah.
Yep, so you get a better path of draw on your bridge and we don't have that Y-shaped multi-unit position.
Is there a number that once you see it, there's like no way nothing's going to see it on that?
Yeah, it gets a little complicated because even between brands of multi-unit abutments, that kind of shape of the cone on top, you know, would change the path them insertion a little bit, you know, and then angled and straight multi, it's a little bit different. But as a general rule, you want to keep that under that number under 30 degrees.
Yeah, I have a surgeon now that once we do this and he sees that low number, it's a high five moment. He's so proud that he got a low number.
One of the other things to consider is a lot of times when the laboratory comes in to do the restorative steps, it's often too late to change implant placements. Now, one of those areas that could be an issue, and we all hear about it every day lately, remote anchorage and pterygoids and zygomas is becoming more and more popular. And what happens is when you place your traditional root form all on four setup in the, say in the maxilla, and then they put two pterygoids in the back, That also, it doesn't just cause issues with seating at the final, but it can also cause issues if they don't have the type of mill that can mill divergent angles. Like we sell IMIS, they can mill up to 160 degrees with their C-clamp. If they don't have that capability, they may not be able to mill the bridge to fit on the pterygoids and the root form implants in the interior. So that's another factor why that's very important to know the max divergence.
And that's why you are all recommending HyperDent, right? 100%.
Good stuff. Anybody that's not using HyperDent is gonna be bald like me really fast.
We actually just had Jordan on the podcast, so we know all about it.
He is phenomenal.
Yeah, absolutely. Let's talk about FitCheck. The one you loaned me came with it, and I honestly thought, what am I going to need this for? I'm printing these things in an office. Why would I bother to scan something to see if it would work when I can just put it in the mouth? Quickly realized that there's lots of uses for these things. So Blake, you want to explain exactly what FitCheck is?
Yeah, FitCheck's my favorite product we've ever made. I mean, there's nothing like this on the market. What FitCheck does is it verifies the manufacturing accuracy of your prosthetic. So, you know, you would take a micron mapper scan of your patients, just like normal micron mapper scan. You would bring that data into Exocad, you would design your bridge, and then let's say you mill it out of zirconia, and then you center it. You take the FitCheck scan bodies and they actually get screwed into the bridge. A lot of people think that they're like reverse scan bodies, but they're not. So you screw them into your bridge and then you use your MicroMapper to scan your bridge. So what the MicroMapper software will do is compare the scan of your bridge against the scan you took of the patient to let you know if there's been any errors in manufacturing. Because with this workflow, we don't have any models. There isn't like a stone verified model that you can, let's say, put your bridge on and do the Sheffield test or something, right? So we can use photogrammetry to verify the manufacturing before you even bother to do MEO or something on your bridge. So if it works near and centering, we can find out immediately.
What tolerances are we looking for? Because I know I've reached out to you a few times after using it and I'm like, Is this good? Is this going to seat? Because it gives you a lot of data. And I don't think the average person like myself knows what half of this stuff means.
Yeah, no, that's a great question. We get that a lot. So, you know, we have this ability to take all this data and we have to think about like what's clinically acceptable here. So there isn't one paper that says like this is a clinically acceptable amount of accuracy. But from what we can see, on average, I see most like zirconia bridges being about 50, 60 microns RMSE, like the average inaccuracy caused by milling and centering.
So 50 to 60 is that average?
Yeah, first milled zirconia. Now milled PMMA, I've seen it be as good as nine microns. But you know, milled PMMA doesn't have that whole extra step of being scaled up by 20%, you know, and then centered and shrunk back down. So yeah, the most accurate manufacturing we've seen is from milled PMMA.
What about printing?
Yeah, printing.
This is the surgery moment, you know.
Yeah, printing is probably the least accurate. And I think we all knew this, right? I mean, printing. Did we though?
I thought printing was supposed to be super accurate. I mean, that was the whole idea. Less waste, super accurate printing.
I mean, it's pretty good. You know, it's a lot better than it used to be. But let's take like 1 printer, for example. I mean, a great printer, everybody uses like the Sprint Ray Pro 2.
Sure.
So the Pro 2, it has 35 microns of accuracy on the X&Y axis.
Especially known for anything that you print on it.
Yep, anything you print on there, you can't do any better than 35 on the XY. And for most of these bridges we're printing, especially for same day, it's 100 on the Z. Oh my gosh. So you will, you'll never get better than that, right? That's a whole other podcast to find out what the Z is. Geez. Yeah, I mean, with 3D printing, you could lower that. So let's say you could go into your 3D printing software and you could set your Z-axis resolution to be 50 microns. Well, a 50 micron Z-axis print is going to double your print time. So if you were at a 20-minute print at 100, you'd be at a 40-minute print on 50, but it would be twice the resolution on the Z-axis. But you can't adjust the XY-axis resolution.
Okay, it would be more accurate, but longer print. But both are going to seat.
Yeah, I mean, and these materials are used for 3D printing. They're not as like rigid as zirconia or something, right? Yeah. And it goes back to the question of like, what's clinically acceptable? You know, and those numbers are clinically acceptable still. Obviously, everybody's doing this, right? But when we're looking at these tiny numbers, you know, obviously we want to get as good as we can. And you remember, just like Patrick was saying earlier, these errors are all compounding. So if we didn't individually calibrate every scan body, right? we didn't have these algorithms in the MicronMapper, if we didn't have the things like fit check to verify our manufacturing accuracy, right? Like all these steps in the process with your milling and your sending and everything is all compounding and it's just going to introduce error at every point. So we have tons of things built in to try to reduce that amount of error.
I know I'm trying to get numbers out of you, but if I fit check a printed restoration, At what number will it not fit?
That's a great question, but we definitely want to try to keep it under 50, but odds are it's not going to be. We've seen plenty of prints up into 75, even look totally fine on an X-ray when you verify after. With 3D prints, I definitely would start to be concerned when it gets over 100 or even close to 100. But for milled stuff, you know, it should be much better than that.
Should be getting around 50, 60.
Yep. Exactly.
Yeah, Elvis, I'll give you one example, a very clear, concise example that was very telling to me. First off, any analog workflow, you have what's called a verification model, where you'll take some sort of GC material or whatever it is, some sort of resin. You'll put your open tray impression copings on top of the multi-unit. You'll loot them together. Some people like to run floss around them first.
Why are you looking to give everybody nightmares, man? We all wanna get past that. I don't wanna do those anymore.
And then you'll number them and then you'll section them. You'll take them off and then you'll put them back on and you'll re-loot them together. It's just, that's the step that we all did. I mean, all of us did this for years. Yeah, but that was the verification step. That was the make sure that everything fits that one last insurance policy before you go manufacture your bridge and then deliver it to the referring doctor, for example, or the restorative doctor. In the digital world, it's hard to comprehend the fact that without FitCheck, there is no way to verify.
No, till you put it in the mouth.
Yeah, exactly. So that come to Jesus moment. So Blake went out to a good customer of ours that does their own in-office milling. They do their roll-on X surgeries in office, and they had a mill from another company and a whole workflow, and they were using our implants, and Blake goes out there and... He's like, okay, because the guy calls us and he says, because it's a big support team. So if somebody's in surgery, something goes south, they call us right away or put a ticket in and we reach out to them. So he's like, this thing, our restoration is not fitting. It's way off. And we've had it on five cases. We're all freaking out. We don't know what it is. Without the fit check, there's no way to find out. This guy literally, this specific customer says, you know what, our mills, it has to be our mill. We've had problems with it, lots of errors. We're tired of this software, it's a closed system, we're just gonna get a mill, so the guy's gonna spend 100 grand with us, and Blake's like, Wait a minute, let me just go out there and make sure we're understanding this the same way.
No, Blake, make the sale! Come on, man.
The problems would have kept happening if they didn't fix this. So we realized it wasn't the mill. So Blake went out there. He brings FitCheck. He starts looking to make sure the basic stuff. He's using the right libraries and Exocad. The right steps are being completed. They have the right files. Everything's lining up. And then he starts testing the prints and the finals with FitCheck. He automatically realizes, Blake, you can continue it. I'll let you finish the story.
Yeah, yeah.
Do you remember this?
Yeah, I do. So actually, Patrick, some of their bridges weren't fitting. They had this mix of bridges that were fitting and not, and they kept having all these problems with their zirconia, right? They're ready to buy a whole new mill and everything. So I go up there and just like Patrick says, I verify all the data and everything, and then I start doing fit check on some of their stuff, right? So I screw these scan bodies into some of their titanium bars. and the fit check comes back okay. I start screwing the fit checks into their zirconia bridges. Some of them have a huge amount of error and some are totally fine. Turns out they had two zirconia ovens. All right, 2 centering ovens and all the bridges from one of those ovens gave a huge amount of air and fit check.
Oh, snap. Yeah.
Yep. So it took out one of their, exactly, you have to calibrate them. But yeah, one of their zirconia ovens needed to be calibrated and was throwing off all of their bridges. Like, no, I don't know how many pucks they wasted, you know, and how much time they wasted trying to figure this out. But yeah, we used spit check to solve that problem. And without fit check, I'm not really sure. sure how you would have really determined that this is where the air was coming from?
Well, I'm not at the same location of the lab I work at. So I'm a couple hours north using the photogrammetry. And when we decided to go with Micron Mapper, the lab owner was like, well, should we get one or should we get two? And I'm like, fit check, the lab needs one. And it's all because I went chairside to deliver a final and it didn't fit. And it's like, we gotta remake it. We know the data's right, but it's centered wrong or something went wrong. I mean, no one's fault, but he could have checked that before we wasted the patient's time, my time, staining it, meoing it. I mean, the thing was beautiful, but it's such a saver. It's just unbelievable how those little things you just screw in on the other side.
Yeah, before you even bother doing Mio or anything. Yeah, we have a huge lab we work with in Alabama. I mean, does a massive amount of cases and the bridge doesn't go out of the door unless it's fit check, you know. I mean, one doesn't leave until he gets fit check because they don't want to mail something out, waste an entire, you know, patient appointment just to find out that there was the bridge warps during 3D printing or centering.
It only makes sense. It only makes sense. Let's not waste everyone's time.
El Salvas, it is highly recommended. A lot of, as we all are, we're all trying to push the boundaries, but we need something to verify. So when we push the borders, push the next steps to the next generation of workflows. For example, we have a lot of customers. We tried it. reinforced. You need to put a stabilizer on your zirconia. A lot of people are going finals within 24 to 48 hours. And some of them are even milling and centering with no stabilizer. And especially if you're trying to push the envelope there, you need to have fit check just to verify that stabilizer was or wasn't needed or they put enough beads in the centering tray. I mean, there's so many reasons for a laboratory to have.
Yeah, especially on these big cases. We're making a lot of money. We're charging. Virgin a lot. Let's not do it twice. Let's not do it three times. Yeah.
Yes, exactly.
It's good stuff. I have not tried the tissue mapper. What exactly is that?
Blake, do you want to give some disclosures first on who should use it and who it's not for? Because it's something that it's a phenomenal. Blake, why don't I do this? Why don't I just talk a little bit about the data from an intraoral scanner and then I'll pass it to you and then you can go down the rabbit's hole because Because Elvis Blake can go deep here, that's why he's on.
I love it.
Yeah, go ahead, Patrick.
Yeah, so as we're always doing on our innovation pillar, on our four pillars of the company, we're always trying to improve the workflow, not just make more money, but we want to make our customers more efficient, more predictable. We have everybody's identified the weakest point. in the full arch workflow is the post-op intraoral scans. Just like we were talking about with like the grammetry workflow or looting scan bodies with resin on a honeycomb in the mouth and scanning that with your intraoral scanner. Anything day of surgery is in a bloody wet environment with a patient that's either sedated or lightly sedated and not quite, you know, it's hard to work in that situation, that environment. Yeah, so when we go into that post-op scenario and capture an just like on an iPhone in pano mode, you have to get it perfect. And even then, sometimes you struggle. I talked to Sarah. She's also one of our clinical trainers. She was in a case today, and she was talking about the Trio 6. It took her 30 minutes, even with the Trio 6, to capture a post-op impression. So we know that that's an obstacle in the workflow. It's not the most efficient process. point in reference. So there's the second most inefficient point of all on four workflows is having to place fiducial markers or leave teeth for reference markers and then go back and do a whole nother surgery postoperatively after you've placed all your implants, your multis and done your done your scans because you then have to extract those teeth that you left in the posterior for alignment points. Do you follow me there?
Yeah, I'm getting excited.
So the two most inefficient points in the workflow are having to place bone fixation screws, a lot of people call them breadcrumbs or fiducial markers. And the second most inefficient step is a post-op intraoral scan. So that's where this came from, but those are the two things we're trying to solve for. So Blake, I'll pass it to you. talk about where the tissue mapper, you have to do a certain workflow to use it, and then how you can use that data, and how we've overcome those two steps.
Are you saying this thing replaces fiduciary markers?
Kind of. The workflow does. They're really more, the whole workflow does. Currently with digital workflows, let's say for a full arch case, there's three things we need at minimum, right? We need some kind of implant data. We need some kind of bite information for the relationship between our jaws, and we need some kind of tissue information. So like bite, tissue, and implant data. That's what you need at minimum. If you have 3D face scans and pictures and stuff extra, great. So currently, Photogrammetry really is just giving you implant data. You're still getting your bite and your post-op tissue from your inter-oral scanner, right?
Yeah.
So we see that inter-oral scanners being kind of the weakest link in the whole digital workflow. So where a lot of companies are trying to like make inter-oral scanners great again with like these long scan bodies and honeycombs and things, we're going the opposite direction with that. Where we're trying to eliminate inter-oral scanners from the workflow. So in the workflow that Patrick's talking about here, We replaced the post-op inter-oral scanner, or a scan, they would traditionally be done with your Trios or something, with a MicronMapper. So earlier, we're trying to expand the capabilities of photogrammetry. MicronMapper is the only scanner that can do a map of the tissue post-operatively. All the other ones are great for implant data, but it's the only one that can actually scan tissue post-operatively too. So, you know, at that point, we're replacing it. Yeah. So at that point, you know, we're talking about replace one of those steps. So instead of taking a post-op intraoral scan for tissue, we're taking a post-op micron mapper scan of the tissue. Well, that still leaves the bite as like another thing that we need to solve, right? It's another piece of that puzzle. So with this workflow, we're actually getting the bite from the CT. So you'll see this online, like it's really pioneered by guys like Jeffrey Tobin with the SegMark workflow, or Ola Hatim, where they're taking a bite from a CT instead. So with this workflow that we've all been doing now, we're not using any inter-oral scans. We're getting our bite from the CBCT, we're getting our implant data from photogrammetry, and we're getting our post-op tissue with photogrammetry. So it allows us to eliminate the inner oral scanner entirely and not have to worry about these bloody post-op tissue scans or fiducial markers or the breadcrumbs or leaving teeth or basically zero work preoperatively for the doctor not having to screw in those reference points into the bone.
Okay, before surgery, CBCT scan, lab gets that, they're able to Pre-design everything off of a CBCT scan.
Yep, they sure are. So, you can bring that into Exocad as like your pre-op, and it almost works as like a face scan too, especially if they have one with a large field of view. Yeah, I mean you can see the nasal spine for your midline, eyes, everything. You can mount stuff in a virtual articulator. I mean, even in Exocad, you can mount up their CT. and make sure that the condyle positions are correct and stuff, right.
But what if they have a bunch of PFM and that CBCT scan is all scattered and...
Okay, great point. So this workflow isn't great if there's a ton of zirconia crowns or something, right? This workflow is great for natural teeth or if they just have some zirconia crowns. But I will admit, you know, I mean, these are real patients we have. It's biology. Everybody's a little bit different. You shouldn't just have one workflow that works for every single patient that's ever come into your office, you know? But if they have a couple crowns or something, it isn't a problem. But you're right, if they have a ton of PFM, it does cause a lot of scatter in that pre-op CT. The clinic would take that pre-op CT at the bite you want to restore the patient at. So if you want to open their vertical or anything, you would actually do it for that pre-op CT. The lab would take that CT, segment it, and bring in an exocad, and you can actually go ahead and pre-design A wax up, like a digital wax up before surgery, based off of that CT.
Interesting. Okay. So you get all that ready, you go in for surgery. There's no pre-scan needed, nothing.
You just, you don't need to bring the neural scanner into the room. Yeah, the doctor can just put the patient in the chair.
I'm still going to bring it, Blake. I cannot not bring it, but go ahead.
You can bring it as a backup if you want, but yeah, they can put the patient, you know, in the chair. numb them up, put them to sleep, and start chucking teeth. I mean, like in, remove all their teeth, do all the bone reduction, place implants. I mean, no fiducial markers or anything like that.
Yep.
Place other implants, place their multi-unit abutments.
Put on the scan bodies, do your photogrammetry.
Yep. Yep.
Then suture around those things.
Sure. And then you'll pull out your tissue mapper.
While the original scan bodies are still in.
Correct.
Okay. Yep.
Then you'll go ahead and you're like, you're walking through it. Keep going.
I mean, it looks like a little wand with a little fish at the end.
Exactly. So it's a wand that you basically touch points on the tissue with to map out what the surface of the tissue looks like. So it basically just creates a flat plane at the surface of the tissue in relationship to the scan bodies. So the MicroMapper can track the relationship between the pointer, the probe that you're using to touch those points, and the scan bodies. So a question I usually get is like, is it an accurate representation of tissue? In one sense, it's not because it doesn't capture every little nook and cranny and groove in the tissue. But honestly, we don't care about that. You know, the tissue is going to be different in 12 or 24 hours. I mean, when you go into Exocab, you're already going to smooth it out to have a nice, you know, intaglio surface. It's ovate and cleansable, right?
Yeah.
What's really neat about it, though, is that the doctor can actually chair side with that probe actually push down a little bit to go ahead and call out the amount of tissue pressure that they want the lab to do. Oh wow. So normally at Exocad we would go in there to the basal, we might set negative 0.5 millimeters or something and do some amount of tissue pressure. because the inner oral scan would just capture like what the surface looks like, right? Well, the tissue mapper, the doctor can actually push in a little bit and tell the lab chair side how much tissue pressure they want. So in Exocad, we just cut it flush.
And how many points do you have to do around the arch?
So we usually recommend that you do one on the mesial and distal of each implant. And then if there's like a long span that you would do one in between that, you can put as many points as you want. I mean, more data is better in most cases, but it doesn't make a huge difference. At minimum you put one on the mesial and distal of each implant and then maybe one in between implants on a long span.
But when you're looking in exocad, what do you have? You have a line.
You have a flat plane. Just imagine there's a flat plane in kind of a U-shape with your scan bodies already attached to it. So that's another big advantage too, is that normally with these workflows, your photogrammetry data and your inner oral skin of the tissue would be two different files that you would have to align in Exocad. But because both of these are... taken with the same system, they're actually already aligned with each other. So that's for a double arch, that's actually two less aligned meshes steps you would have to do in Exocad.
But how do you align it to the CBCT scan?
Yep, great question. So the thing about this workflow is that you would have to take a post-op CBCT with your same micron map or scan bodies in it. So you have the pre-op CBCT taken at the correct bite relationship you want to restore met. You would take a post-op CT You know, that's just a max and mand floating in space with no relationship to each other. In exocad, we were aligned that post-op max and mand back to our preoperative CT that had a bite. Then we align our tissue mapper with our micron mapper data, and it's really easy just to adapt the intaglio surface of your prosthetic to that new implant data.
Fascinating.
Now, Elvis, most customers doing full arch If they're doing a high volume of full arch, they're always doing a pre and a post-op CT anyway.
Day of surgery, they usually do a post.
No, not always day of surgery, but this requires you to if you want to do this and that. Now, not only does it require you to do a post-op CBCT, it also requires you to stabilize the head in a certain position. So if it's a standard stand-up CBCT, Not everybody can do it. You have to have, there's only a select few. Like there's the X-Cat that you can actually, as a mobile CT, while the patient's sedated, you can do a CT. A lot of customers that have the sit down iCats, they come with the Velcro ***** ** the head so you can stabilize them. Most of these patients are giving, say, general anesthesia or some sort of-?
Yeah, they can barely get to the bathroom.
Exactly, yeah. So it's not for everybody, but when we're knocking out that innovation pillar, we're always trying to advance it forward, especially for those complex higher users that have high clinical acumen, high clinical volume to make them more efficient. That's where this is applicable. It is not for everybody, but It is efficient for those high volume, high clinical practices that this is a core focus for them. So that's why you see a lot more clinicians going towards something that has a Velcro ***** ** the CT, bigger frame of view.
Well, now I want to do one like that.
Yeah, here's the one thing that we never deal with. Once we started using photogrammetry, it was never even a talk or discussion, like is it passive or not? Like for the last couple years, I can't remember the last time that came up. That's back when we were doing verification things. The other thing we're not worried about is CT alignment. The midline, the can't, and the bite are dialed in every time. It is so active.
Yeah, I imagine it is.
As long as they know what they're doing.
I mean, you're capturing everything. You got everything to line up in that head.
Everything. Yeah, especially like sometimes there's patients that have aesthetically like their nose, maybe they had a broken nose a few times in the past and their nose is off to the right or the left. I mean, it's sometimes it's visually hard to manually nail that midline, but this, like Blake talked about, you can use a nasal spine. There's different pieces of anatomy that you can dial in and really get that perfect, regardless of the soft tissue exterior of the face, we can make sure it's in the right spot that it needs to be.
I love it. I love it. And gentlemen, if Barb was here, she'd be yelling at me because we're way over an hour and I could keep going because I just love talking about this stuff.
Yeah, we're total nerds about this stuff. We love it.
Yeah. Thank you, Elvis. No, thank you for bringing this thing out, letting me borrow it, just getting used to the workflow. I mean, it's changed the way we've done it at Derby. Hugely. I mean, it's just, it's a game changer. And like I mentioned before, it's not just making what we do easier. It's helping us sell cases, helping us get into other offices. I mean, you walk in, they just think you're the coolest thing ever because you have this wonderful device that they have not seen. And it's, I mean, I'm going to say it, just I recommend everyone get a Micron Mapper. It's awesome.
Appreciate it, Ellis. Thanks for having us on. And hey, if we want to get back into the numbers and do another deep dive, we're always here. But most importantly, we thank you for your support and Again, if you're ever chairside, we've got our support team that's on standby. So if something does come up, we're here for you.
Someone other than Blake I can reach out to.
Yeah. We have a whole team of people. We've got a whole team.
Elvis, I've never not answered your call. I'm always here to help you.
I know, but you teach so many courses. I don't ever know where you're at.
Yeah, we have a whole team. I'll make sure you have the main line.
Excellent. Gentlemen, Blake, Patrick, thank you so much. Let's do it again in a couple of years. Thank you.
Awesome. Thank you, Elvis.
Have a good one.
A huge thanks to Blake and Patrick for coming on our podcast and entertaining my co-host, Elvis, and his need to know too much about photogrammetry. I think you already know too much, my friend, but--.
I always want to know more.
I know. It's amazing to see how far Blake has come and how much of a resource he has become in our industry. If you're on Instagram, be sure to give him a follow at CADCamBlake. That's awesome. I love that name. And enjoy the fun and the information. Obviously, it's no secret that Elvis believes in the Micron Mapper. So if you guys are doing those all on X full arch cases, look into the Micron Mapper to take them to the next level. Visit them at sin360.us/micronmapper to learn more and to see about getting one in your lab.
It is a game changer. Highly recommended.
No doubt.
All right, everybody. That's all we got. Barb, go take your big award and enjoy the weekend.
Thank you. Have a good one. See ya.
The views and opinions expressed on the Voices from the Bench podcast are those of the guest and do not necessarily reflect the official policy or position of the host or Voices from the Bench LLC.