CEREC Ortho software — where do you send your scans?

Clinical , Current Issue
Editor’s intro: Dr. Patrik Zachrisson  shows how CEREC Ortho is a very versatile software that has many uses apart from the popular Invisalign.

The powerful software used in CEREC for orthodontic applications is used widely for Invisalign®, but there are several other uses that can easily be accessed. Dr. Patrik Zachrisson looks at some of the other recipients that you can incorporate in your digital workflow

Figure 1: CEREC Ortho choices of pre-installed recipients

The use of an intraoral scanner allows a fast and easy way for you and your staff to accurately obtain patient data; it improves turnaround times for the planning setup plan and allows the patient to avoid uncomfortable impressions. Further benefits are showing the high-tech equipment in your surgery, being very precise, and reducing the need for costly impression materials.

More and more dentists are waking up to the digital revolution, and patients are starting to expect it too. The implementation of CEREC in your workflow is usually straightforward and, using the CEREC Omnicam, the digital models are directly available and therefore ready for use for planning as well as for discussion with the patient. For ortho-dontic scans on CEREC, the add-on software CEREC Ortho by Dentsply Sirona is needed if you want to send to Invisalign®, but there are several other uses too. It is worth noting that some labs accept scans sent directly with CEREC Connect.

The CEREC Ortho software differs greatly from the conventional scan you get when using CEREC Premium software 4.5, CEREC Connect, or CEREC software 4.6, in that you have to follow a strict pattern in order to get a detailed model. It is easy to learn, with tones and arrows and symbols guiding you through the correct pattern, and can be delegated to a suitable assistant. Invisalign claims that the guided-scan pattern has resulted in far fewer rejections of scans and greater accuracy while still being faster than two-phase silicone impressions.

When scanning, you have two windows displayed: one showing a live video picture and the other a guide showing where to scan as a live progress. Once the scan is done, the digital color 3D model is trimmed by defining the borders, and then any inconsistent areas can be rescanned to create a good “watertight” model. Both jaws are scanned, and then the bite is registered bilaterally to ensure that the full-arch alignment is correct. When the models are completed, you can also easily add a model base, which is useful if you are using the scan for other applications. When starting a CEREC Ortho scan, you have a number of pre-installed recipients available.

The imminent introduction of the new CEREC 1.3 will provide a significant upgrade from previous versions and is expected to include an automatic treatment simulation of the situation to further enhance the consent process and improved case acceptance.

But where does the scan go … ?

After acquisition and creation of the model, you have to select a laboratory to send your scan to. Specially tailored interfaces are pre-installed recipients that allow easy transfer of data from the clinic. The recipients vary a little depending on which version of software you are using. Most clinicians use mainly Invisalign and Sirona Connect Portal, but there are a number of other applications too.

Figure 2: Guided scanning acquisition (left) and Figure 3: Verification of bilateral bite (right)

Figure 4: Eclipse lingual fixed brace (left) and Figure 5: Memotain® fixed lingual wire from CA (right)

Figure 6: Milled Tanner appliance on a 3D-printed model made using CEREC Ortho.

The now familiar clear aligner Invisalign treatment is based on a scan or impression that is sent to Invisalign, and a treatment plan done on their web portal. These will then be combined in the lab, and a treatment plan for the clear aligners is set up and delivered in the ClinCheck® software by Invisalign. Invisalign currently accepts only digital intraoral scans from CEREC, 3Shape, and iTero® in Europe. The CEREC Ortho is needed if you are submitting Invisalign cases from a scan in CEREC to Invisalign to ensure highest accuracy and reduce the number of rejected scans.

Sirona Connect Portal is used for uploading your digital impressions (scans) to one of the over 2,000 laboratories of choice, and you can easily add your own favorite labs, and see what services they accept. I often use the CEREC Ortho scan if I need greater accuracy in a full-arch situation. A benefit is the improved bite registration that is achieved with a bilateral bite.

Figure 7: Incognito lingual brace (left) and Figure 8: Invisalign clear ortho (right)

For milled TMJ appliances such as a Tanner appliance, the bite registration is particularly useful and can be sent directly through SironaConnect Portal. MTM Clear Aligners are custom-made clear aligners by Dentsply Sirona. MTM is using an “open pathway” architecture and integrated “force points” rather than attachments to allow teeth to move easily and naturally into the desired position. Dentsply Sirona also makes the similar Ideal Smile clear aligner. For a fixed alternative, Dentsply Sirona makes the Eclipse lingual for planning and positioning of small, smooth, fixed lingual brackets.

Further lingual options are DW Lingual with its flat design and an arch wire bent by “computer-assisted bending robots” — a spot of trivia that will surely impress patients.

The lingual 3M Incognito is designed to allow comfortable, invisible lingual fixed brackets fully customized for each patient for a wide range of cases. The system uses gold low profile bases that are designed to maximize the efficiency and, at the same time, be almost invisible.

ClearCorrect is an easy-to-use, clear aligner system that is more affordable than Invisalign. The system works well; you plan your treatment and get a digital setup, maybe not as slick and with as many options as the Invisalign ClinCheck, but an alternative worth trying.

Dolphin 3D is a tool for simply processing digital 3D data such as medical CT scans, cone beam CT scans, MRI, and facial 3D scans. It allows case administration, practice management, analysis, and visualization for easy treatment planning, documentation, and presentation.

You can find software for planning surgical guides for implants and order them from the SICAT lab Portal. You can use the SICAT Function for tracking motion of the temporomandibular joint for diagnostics and therapy. Furthermore, it is possible to assess the upper airway space for the appliance-based treatment of sleep apnea using SICAT Air.

Stratasys makes some amazing high-end 3D printers such as the Objet30 for making quality models and surgical guides and the J700 for production of clear aligners. As purchasing, running, and maintaining printers like these isn’t practical for most of us, it can be useful to send a scan and let labs produce orthodontic and crown/bridge models as well as guides. In orthodontics, we easily end up with a lot of physical models, so digitizing is a great way of keeping precious office space, and then the models can be quickly produced when needed.

OnyxCeph provides an all-in-one dental imaging software for case-related 3D/2D data, allowing virtual treatment planning for occlusion and jaw alignment, virtual setups, aligner planning, placing virtual brackets and wires, generating transfer and treatment trays, evaluation of treatment progress, and of course, presentation of cases, patient education, and documentation.

The final pre-installed recipient is CA Digital, where you can order CA® ClearAligners. It has a clever system where three different material thicknesses are used over a 4-week period to gradually move teeth in a safe and comfortable way.

CA also allows the clinician to either order finished aligners or just models if you want to produce the aligners in your practice lab using a thermoforming machine and retain full control over the process and reduce the cost. CA also makes the beautifully cut Memotain® retainer wires in Nitinol, a shape-memory alloy, to allow very close fit and detailing, accurate positioning, and high durability of a lingual retainer wire.

Conclusion

CEREC Ortho is a very versatile software that has many uses apart from the popular Invisalign. It benefits greatly from the bilateral bite registration and the detailed guided scan. It can sometimes be difficult to get a quick scan, but it gets better with some practice. The guided-scan pattern you have to use slows you down but provides a predictable result that is easy to implement in your digital workflow. The pre-installed recipients in the CEREC Ortho software make it easy to connect to some of the big companies as well as your favorite labs using Siron.

Besides using CEREC Ortho, Dr. Zachrisson uses other interesting materials in his practice. Read about a new type of fixed retainer here.