02 - The end is where we begin (part 2)

Having an intraoral scanner is not necessary, it just makes life much much easier. Not only because you can have an immediate access to the 3D files, but also because take a digital impression with brackets on it’s comfortable for both you and the patient.

The end is where we begin (part 2)

In the previous post I talked about Why and What I am doing for post-treatment retention. In this second part I describe how to manage ordering it, in a step-by-step tutorial.

How to order it

The impression and the .stl files (3D files)

Having an intraoral scanner is not necessary, it just makes life much much easier. Not only because you can have an immediate access to the 3D files, but also because take a digital impression with brackets on it’s comfortable for both you and the patient. Just the opposite of a an alginate impression with brackets on! The advantage of scanning the lingual component without any interfering is amazing when getting to this stage. Just note that the lingual component will not be enough to produce the wire. Or better, the wire can be produced, but, without the incisal edges, you would miss the transfer jig, that is necessary to transfer such a high technology in the mouth of your patient in the proper way. So remember to scan not only the lingual surface, but also the vestibular with brackets. It does not matter if you will never get to perfection because of the sneaky surface of the brackets, they just need a raw scan of the vestibular surface - being able to fill in holes - to print a resin model of the teeth and place a jig transfer on it. By the way you don’t need to scan the whole arch for a retainer, but just the zone concerned + one tooth distal to be sure to have enough data (typically I scan 4 to 4 for a 3 to 3 wire). Last but not least detailing with an intraoral scanner is higher that what you can get from an alginate or silicone impression (we’ll discuss about it in a future post).In any case, finding a dental technician converting your physical impression into a .stl file is really easy. Even before buying an extra-oral scanner for any of my practices, I never sent a physical impression to Germany, simply because I found it annoying and time consuming (if not for me, for my assistant) to organize and manage shipping. If you wish to use in any case this old style way, just look on the website for instructions for shipping. Otherwise lets collect the stl from your technician or from your scanner and go on with the next chapters.

Register on the website

(to do once, only the first time)

The website is in German (standard language) and in English (https://ca-digit.com/en/) but you can always switch between the two languages in the upper right corner of the page.Before to be able to place an order you should register into the website. Here’s the link to easily register without looking around the website (https://order.ca-digit.com/cat/customer/account/create/?___store=en). Please note that if you work in multiple offices (as me), you need to register each office with a different email and thus repeat the procedure, as their internal website does not work like the invisalign user interface, that allows you to switch between shipping and invoice addresses (or better it has it but it does not work). They should definitely fix it and make it easier in the future.Where in the end of the section they askAdditional Information[All Products] Would you always like to send us STL data?I suggest you to answer YES

Submit the order

You are now ready to sign in through the treatment manager (up in the page close to the language selection or here https://order.ca-digit.com/pat/#!/signin).Select the button Start with a new caseAnd fill in all the information required, as you are not allowed to go to the next page if you do not provide them all.

I personally never correct the birthday of the patient (that as a consequence has his wire ordered in the same day in which he was born / when I place the order), as I think it has no sense to multiply dozens of time unessential data from my patient database with third party commercial partners.As ID I use the first two letters of the surname and of the name. Please not that you cannot use always the same ID (as I was wishing to do in the very beginning). Thus I think this easy way it’s effective to avoid to think which ID should I attribute this time, not to create a duplicate ID?Now the interface will tell you that the patient have no running treatment and you can both click the button +New Treatment or the link Why don’t create one? to proceed to the next step.

You are now into a three-step procedure to complete the order. In step 1 and 2 just select Memotain.

In step three you can select if the wire is for the upper or lower arch or for both of them. After selection click ok.

In the next and pre-final stage you should just select the Daten option (Model se inviate le impronte in silicone), to say that your going to upload .stl files. Then you should select the wire section if 2-2, 3-3 or 4-4 (the standard proposal is 3-3 and if you do not modify it, you will receive a canine to canine retainer).Finally if you have some special treatment hint, you can write them in this dedicated section. My more frequent comment is “Please send me the design of the appliance before production whenever I see special case with a pretty deep bite, that should be looked at carefully when planning and building the upper wire, to avoid future breakages.Confirm shipping and billing address, insert the discount code if you have any* and finalize the prescription by clicking order.You will be transferred to a page that says “Your order has been transmitted successfully, now you can upload the 3D data to your order.” Close the window and click on the Upload model data button where you can drag&drop your .stl files.

One arch is enough for the lower arch, but they always need two arches to build upper wires as occlusion check is part of the quality assessment.Do not forget to click on the upload all button as this is needed to really upload the file (drag and drop is not enough).

And now?

(while waiting for the wire to be shipped)

You can now wait, hands in the pockets, for the wire to be delivered to your office in 5 working days of production + 2 of shipping. Scheduling the patient at a 2-week interval is it more than safe, as in Germany they do not have so many festivity as in other countries (I am thinking of Italy, ahah).There’s the possibility that ca-digit writes you because of a problem encountered while creating the wire (generally the upper wire).As they have a 2-years warranty policy on wire breakage, they want to be sure that the wire have enough space to bonded safely. Thus in case of a deepbite, they should sometimes pass over the retroincisal papilla, lingually between the two central incisors. In this case they prefer to share this by email with you and they need to ask your approval.

Or sometimes they tell you that they cannot do it up to the canine but only until the incisors. If you want them to produce the wire in any case, you can reply to go on, but be aware that on that specific case you will lose your 2-years warranty, because of your choice. It’s fair.

How much does it cost to me?

Last but not least, let's come to one very important question. How much do you cost me, dear Memotain? This is a question that is better to be answered directly by ca-digit as it's a general policy of the manufacturer-professional customer relation, as make it public can generate polemics or misunderstanding with the final customer.Justo to let you know, it's not cheap and it's not superexpensive. At the beginning, I personally found it really expensive according to the average price charged by an Italian technician, while it's in line with Swiss prices. As a consequence I began immediately to use it for my Swiss patients. It didn’t pass a long time before getting to it as a standard also for my Italian patients. The quality of the detailing of the CAD-CAM wire largely overpass any fine bending human hand, and the nitinol alloy guarantees a much stronger resistance to breakage, especially in those tricky interdental spaces.Furthermore, the implicit guarantee that you give to patients by bonding them a fixed wire, can find in memotain a much stronger ally than in any other wire on the market at the moment. I really feel it’s the unsurpassed state of the art retention wire since some years and the quality choice to be made. That’s not science, is my personal unsponsored opinion coming from a 1% problem rate that I registered since bonding the first wire in my mouth.Clinical details will come in the last chapter of this mini-series (to be continued).

More to Read

Read about my experience as a 3D orthodontist, covering topics from intraoral scanners use to customized appliances.

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