1) Does the patient require radio-opaque markers?

​​a. If the patient is edentulous, or does not have enough teeth to create a triangle of alignment (molar on each side, and a central or lateral), then radio-opaque markers will be required on gingiva. See separate instructions for placing radio-opaque markers.

2) Intraoral scan

a. Perform tissue scans. Be careful not to remove radio-opaque markers. If the patient has enough natural dentition to get a bite scan at this time then do so.

3) CBCT scan

a. If any radio-opaque markers fell off during or after the intraoral scan then make sure sufficient markers remain.

b. Make sure the patient bites the bite stick for the CBCT scan to separate the arches for more accurate alignment with the intraoral scan using incisal edges and cusps.

4) Which method should I use to establish the bite and desired VDO?

a. If the patient has enough natural dentition then the digital bite scan obtained during the intraoral scan will suffice.

b. If the patient is edentulous, or doesn’t have enough dentition to be able to obtain an accurate digital bite with the desired VDO then:

i. MOST ACCURATE: Generic ideals can be fitted and temporarily cemented, allowing for a bite to be obtained via a second intraoral scan. This also helps the lab with desired midline, smile line, etc. These generic ideals can be obtained from the lab and kept in inventory. There are small, medium, and large arch sizes. This scan does not replace any scans taken in step 2 above, and can only be used to establish the VDO.

ii. Wax rims can be fabricated, or can be requested from the lab, then shipped back to the lab after adjusting for desired VDO, midline marked, etc.

iii. LEAST ACCURATE: A scan of the patient’s denture(s) can be taken using the intraoral scanner. This must be of the entire denture, outside of the mouth, all sides, including the intaglio surface.

c. If doing a single arch we will need an intraoral scan of the antagonist dentition for occlusal design.

TIPS:

A) We recommend doing the intraoral scan before the CBCT scan, so if any radio-opaque markers fall off you don’t have to do unnecessary CBCT scans.

B) If a radio-opaque marker falls off DO NOT replace it. We only need 3 (triangle of alignment), so place extras in case some fall off.

C) The lab never needs an intraoral scan of a denture in the patient’s mouth unless the patient is planning on keeping the denture on the opposing arch, in which case it will be used as an antagonist in planning occlusion for the 3 on 6 arch.

D) Please obtain maximum information on intraoral scans, including the entire palate, and as much of the vestibule as possible. This allows for maximum accuracy, and placement of surgical guide anchor pins