Newsletter #4

The #1 Urgent Question About iCAM

Hey there—

Once a week at around 5:15 pm I get a call from someone that goes like this: "Help! I need to mill this temp from surgical scans today and my Exocad library isn't being detected." Some iteration of that involving an Exocad project launched from iCAM.

This week's issue will help with that!

Gratitude Quote of the Day:

“Gratitude is not only the greatest of virtues, but the parent of all the others.” — Cicero

Totally agree. If I'm lacking gratitude it's a downhill spiral from there.

iCAM Geometric Switching/Change Geometry

Normally from the iCAM software you would want to launch the Exocad project. That way the MUA positions are already included and there is no need to mark and identify scan bodies like you would normally do with any other non-photogrammetry case.

However, in some situations that may not work best. Here are some possible reasons:

1. The screw DEM file/geometry you prefer isn't in iCAM software or the one that they have differs from your personal preference. I experienced this early on with the 19.018 Dess screw. The iCAM library had a different thickness which didn't allow as many threads to come through the hole for Straumann SRA's (these are shorter with deeper screw seat). You can definitely contact iCAM to update your library but that usually isn't an immediate option if you need to fabricate something under a time constraint.
2. You get an Exocad error when launching the project generated by iCAM. This usually manifests itself in Exocad freezing or you get an error indicating that the library cannot be located.
3. You pre-milled or predesigned the prosthesis in a different coordinate system. This can be fixed by bringing in all the files and merging them in the iCAM software but my personal preference is to instead bring the iCAM data in the pre-established coordinate system.

The solution is to export the healing cap scan with scan bodies in the same coordinate system and then identify in Exocad like you normally do. It's a fairly simple process which I've documented in this video here:

Here's the dropbox link if you want to download it: https://www.dropbox.com/scl/fi/yojpn8j6kj58cc23bhoos/Geometric-Switching-Video.mp4?rlkey=mcuwc8n8eaz1am9sb01jbg0mq&dl=0​

I also often get asked for a checklist of items to bring to surgery with the iCAM. Here are some essentials for me:

1. Small folding table. Provides extra space for the iCAM laptop and calibration plate. I usually try to position this near the patient's head so that I don't have to move very far to scan from calibration.
2. Extension cord with additional outlets (at least three). Similar to number 1, allows you to move to the optimal spot.
3. Extra drivers for the scan bodies. I find that most people don't like the small one that comes with the scan bodies. I bring extra Straumann SCS drivers. The shortest Straumann one seems to work well.
4. Small plastic jar for dropping in the scan bodies after scanning. The worst is when the assistant drops these into a metal cup containing other stuff like used drills or anchor pins. Allows you to keep things separate before sterilization. Also be sure to pop out the screws.
5. Some sort of retraction device. I've been using the Optragate from Ivoclar for years and it's served me well. I know there are others out there so pick one that works best for you.
6. Bring your own intraoral scanner. Seems overkill, but I've been in cases where the existing scanner was older or had issues. Anyone with an iTero makes me very nervous. I have a Trios scanner and we installed the iCAM software on the same laptop. Scanners are so affordable now. You can get a Sirios scanner from Straumann for sub $15K. The monthly cost is significantly less than not being able to get the scans you need. Watching someone scan an edentulous arch post surgery with an iTero makes me want to go into a dark room and close my eyes.

Note: the above checklist also useful for grammetry cases like Optisplint.

That's your five minute boost! Next week's topic: what the literature tells us about zirconia fracture and which arch is most prone to catastrophic failure.

-Charles