Accuracy of intraoral scanning in completely and partially edentulous maxillary and mandibular jaws: an in vitro analysis

Effect of different surface locking patterns on the trueness of complete arch digital implant scans: An in vitro study

STATEMENT OF PROBLEM

The effect of different surface locking patterns on the trueness of a digital implant scan of a completely edentulous arch remains uncertain.

PURPOSE

The purpose of this in vitro study was to evaluate whether locking surfaces with different patterns affected the trueness of complete arch implant digital scans.

MATERIAL AND METHODS

An edentulous maxillary cast with 4 implants (2 anterior implants parallel and 2 posterior implants tilted at 17 degrees) was fabricated. Four implant-level scan bodies were fixed onto the implants, and the cast was scanned with a desktop scanner to create the reference file. Four groups (L0, L1, L2, and L3) were formed, each with a distinct locking surface configuration, and all scans were made using the same intraoral scanner. L0 kept all 4 implant-level scan bodies during scanning. L1 involved removing the right first premolar (RPM) scan body, scanning the other 3 implant scan bodies, then reattaching the RPM's scan body, and continuing scanning. In L2, the RPM and right lateral incisor (RIC) scan bodies were removed, followed by scanning the left implants to create a locking surface, and scanning the right implants. In L3, only the left posterior molar's (LPM) scan body was retained and scanned; then a locking surface was generated, and then the remaining implants were scanned. A metrology software program (Geomagic Control X) was used for comparison. Statistical analyses were performed using the Kruskal-Wallis, the 1-way ANOVA, the Welch ANOVA, the Friedman test, the repeated-measures ANOVA, the Bonferroni post hoc test, and the Games-Howell post hoc test (α=.05).

RESULTS

Significant 3D surface deviations were observed in the coronal bevel (CB) region and in the entire scan bodies when assessing trueness in the L0, L1, L2, and L3 groups (P<.001). L2 exhibited the highest discrepancies in 3D surface deviation for CB (0.030 ±0.002 mm) and implant scan bodies (0.357 ±0.052 mm) and distance deviation, while the highest mean angular deviation values were found in L0 (0.924 ±0.131 degrees).

CONCLUSIONS

Locking half of the arch showed the highest trueness discrepancies when performing digital scans for complete arch implant-supported prostheses.

A technical and clinical digital approach to the altered cast technique with an intraoral scanner and polyvinyl siloxane impression material

This technique digitalizes the clinical and laboratory steps of fabricating removable partial dentures (RPDs) with the altered cast technique. An intraoral scanner was used to capture the mandibular Kennedy class II partially edentulous arch. An RPD framework was fabricated digitally and then combined with a custom tray with a wax occlusal rim. A conventional polyvinyl siloxane altered cast impression was made and then digitalized both intraorally and extraorally, followed by a digital interocclusal record. The resulting scan was modified to produce an additively manufactured cast. The teeth and gingival components were then designed and fabricated with a combination of additive and subtractive manufacturing, followed by the conventional acrylic resin pour technique. The definitive prosthesis was completed with minimal conventional techniques and without the use of gypsum, prefabricated teeth, or a physical articulator. The technique reduces the number of appointments and achieves the functional extension of the prosthesis through border molding, which is not possible with intraoral scanning.

Palatal vault configuration and its influence on intraoral scan time and accuracy in completely edentulous arches: a prospective clinical study

PURPOSE

The aim of this prospective clinical study was to compare the influence of palatal vault forms on accuracy and speed of intraoral (IO) scans in completely edentulous cases.

MATERIALS AND METHODS

Based on the palatal vault form, participants were divided into three equal groups (n = 10 each); Class I: moderate; Class II: deep; Class III: flat palatal vault. A reference model was created for each patient using polyvinylsiloxane impression material. The poured models were digitized using an extraoral scanner. The resultant data were imported as a solid CAD file into 3D analysis software (GOM Inspect 2018; Gom GmbH, Braunschweig, Germany) and aligned using the software's coordinate system to determine its X, Y, and Z axes. Five digital impressions (DIs) of maxilla were captured for each patient using an intraoral scanner (TRIOS; 3Shape A/S, Copenhagen, Denmark) and the resultant Standard Tessellation Language (STL) scan files served as test models. Trueness was evaluated by calculating arithmetic mean deviation (AMD) of the vault area between reference and test files while precision was evaluated by calculating AMD between captured scans to measure repeatability of scan acquisition. The scan time taken for each participant was also recorded.

RESULTS

There was no significant difference in trueness and precision among the groups (P = .806 and .950, respectively). Average scan time for Class I and III palatal vaults was 1 min 13 seconds and 1 min 37 seconds, respectively, while class II deep palatal vaults showed the highest scan time of 5 mins.

CONCLUSION

Palatal vault form in edentulous cases has an influence on scan time. However, it does not have a substantial impact on the accuracy of the acquired scans.

Impact of the superimposition reference area on intraoral scanning accuracy in a partially dentate maxilla

STATEMENT OF PROBLEM

The alignment of 3-dimensional (3D) files involves selecting a reference area before performing a local best fit alignment during the digital scan superimposition and is essential for comparing digital scans. Scan alignment relies on both reference area location and the alignment algorithm. However, a consensus on the impact of different reference areas on intraoral scanning accuracy is lacking.

PURPOSE

The purpose of this in vitro study was to assess the impact of 3 superimposition reference areas on the accuracy of 3 intraoral scanners for a partially dentate maxilla.

MATERIAL AND METHODS

A Kennedy class II resin cast was scanned using 3 intraoral scanners (Primescan, TRIOS 3, and Emerald) outputting 30 digital scans (10 per scanner). Test scans from intraoral scanners were subsequently compared with a reference digital standard tessellation language file generated by a laboratory scanner with validated accuracy. The files were superimposed using best fit alignment for each intraoral scanner using 3 different superimposition reference areas (whole region of interest, palate, and all teeth). Accuracy was assessed by using a 3D analysis program (Geomagic Control X; 3D systems) for each scanner at 4 preselected areas. Test and reference scan differences were depicted on color maps and quantified via root mean square deviations. Differences were analyzed using regression analysis with the post hoc student t test and Bonferroni correction (α=.05).

RESULTS

The TRIOS 3 and Emerald produced positive deviations in the palatal color maps, whereas Primescan produced more uniform color maps, regardless of the superimposition strategy used. Primescan exhibited the best accuracy (trueness and precision) in both palatal and bounded edentulous areas, regardless of the superimposition reference area. The TRIOS 3 recorded the highest distal extension trueness (ranging from 42.9±7.7 µm to 65 ±19.5 µm), and Primescan achieved the highest precision (ranging from 28.5 ±9.8 µm to 48.9 ±16.9 µm), regardless of the superimposition area. Emerald demonstrated the highest teeth trueness (ranging from 31.6 ±6.8 µm to 69.6 ±11.5 µm), while Primescan produced the highest precision (ranging from 17.9 ±6.1 µm to 30.7 ±9.2 µm), regardless of the reference area used.

CONCLUSIONS

The chosen reference area for best fit alignment significantly influenced digital scan accuracy (P<.001). Primescan displayed the highest palatal and bounded edentulous area accuracy, with TRIOS 3 recording the highest distal extension trueness. Emerald recorded the highest teeth trueness and Primescan recorded the highest distal extension and tooth precision. All conclusions were independent of the superimposition strategy used.

Accuracy of Complete-Arch Scans Obtained by Intraoral Scanner and Smartphone Three-Dimensional Scanning Applications With Different Smartphone Position Setups: An In Vitro Study

INTRODUCTION

The high cost of intraoral scanners (IOS) for complete-arch scans makes them less accessible for many dental practitioners. As a viable alternative, smartphone scanner applications (SMP) provide comparable scanning capabilities at a significantly low cost. However, there is limited data on the accuracy of SMP, especially when used in various smartphone positions. This study aimed to compare the three-dimensional (3D) and linear accuracy of complete-arch scans acquired by an IOS and SMP (KIRI Engine, KIRI Innovations, Guangdong, China) at three shooting angles (0°, 45°, and 90° for SMP_3A) and two shooting angles (30° and 60° for SMP_2A).

METHODS

A stone dental cast was scanned with a laboratory scanner as a reference, with 11 scans performed by an IOS, SMP_2A, and SMP_3A. In 3D analysis, trueness and precision were evaluated through superimposition with the reference scan and within each group, respectively, using the best-fit algorithm of Geomagic Wrap software (3D Systems, Inc., Rock Hill, SC). Trueness in linear discrepancy was assessed by comparing the occlusal-cervical and mesiodistal dimensions of reference teeth (canine, premolar, and molar), intercanine width, and intermolar width on the digital casts to measurements of the stone cast, while precision was measured using the coefficient of variance. Differences between groups were analyzed using the Friedman test, followed by the Dunn-Bonferroni post hoc test with a significance level set at 0.05.

RESULTS

IOS exhibited significantly lower trueness than SMP_2A (p = 0.003) with significantly greater width discrepancies on canines (p = 0.001) and molars (p < 0.001). Discrepancy patterns differed among the three scanning methods. The IOS showed greater discrepancies on the occlusal surfaces of posterior teeth. While SMP_3A demonstrated higher variation on the palatal surfaces and interproximal areas of posterior teeth. For precision, SMP_3A (p = 0.028) and SMP_2A (p = 0.003) showed a significantly lower precision in 3D analysis, but a comparable reproducibility in linear measurement to IOS.

CONCLUSION

TRIOS IOS (3Shape, Copenhagen, Denmark) exhibited lower trueness in 3D and linear accuracy analyses for complete-arch scans. The positions of the smartphone significantly enhanced trueness at the undercut region. SMP_2A and SMP_3A can be a potential alternative for precise linear measurement in complete-arch scans with selective use.

Impact of intraoral scanner, scanning strategy, and scanned arch on the scan accuracy of edentulous arches: An in vitro study

STATEMENT OF PROBLEM

The scanning strategy used when making complete arch digital scans affects the accuracy of the scan, and the accuracy of the strategy may be influenced by the scanner used. However, these effects have not been investigated thoroughly with complete arch edentulous scanning.

PURPOSE

The purpose of this in vitro study was to determine the effect of scanning strategies and the scanned arch on the accuracy of complete arch edentulous scans using 2 intraoral scanner (IOS) systems.

MATERIAL AND METHODS

Two IOSs were used (TRIOS 4 and Emerald S) to scan maxillary and mandibular typodonts using 6 scanning strategies (test scans), and conventional impressions of both arches were also made. By using a metrology software program, test scans were superimposed onto a reference scan, and the root mean square (RMS) of the absolute deviation values was calculated to express trueness. The sample with the best trueness was used as reference onto which the remaining samples from the same group were superimposed, and the RMS of the absolute deviation values was calculated to express precision. Statistical modeling was applied using the fixed effects models (α=.05).

RESULTS

The main effects of scanner and strategy significantly impacted the trueness RMS values (P<.001), with significant interactions between them (P=.012). The main effects of scanner, strategy, and arch significantly impacted the precision of RMS values (P=.004), (P=.033), and (P=.023). Conventional impressions and the TRIOS 4 scanner had comparable accuracy, while the Emerald S scanner was inferior to both. P-O-B had the highest overall accuracy and strategy ZZ had the worst. Better precision was found with the maxillary arch.

CONCLUSIONS

The scanner type and scanning strategy significantly impacted the accuracy of the digital scans of completely edentulous arches, with a significant interaction between scanner and strategy. The arch being scanned had a significant effect on scan precision but not on scan trueness.

Effect of supramucosal height of a scan body and implant angulation on the accuracy of intraoral scanning: An in vitro study

STATEMENT OF PROBLEM

Intraoral scanners (IOSs) provide a digital alternative to conventional implant impression techniques. However, the effect of the supramucosal height of the scan body and implant angulation on the accuracy of IOSs remains unclear.

PURPOSE

The purpose of this in vitro study was to measure the impact of the supramucosal height of the scan body and implant angulation on the accuracy (trueness and precision) of intraoral digital implant scans in partially edentulous models.

MATERIAL AND METHODS

Two maxillary partially edentulous casts with 4 implant analogs were fabricated, 1 with 4 parallel implants (P-groups) and 1 with 2 implants distally inclined 18 degrees (A-groups). An implant scan body was positioned on each implant analog (CARES RC Mono Scanbody). For each cast, 3 subgroups were determined based on the soft tissue moulage fabricated for each reference cast exposing 3 mm (P-3 and A-3 subgroups), 5 mm (P-5 and A-5 subgroups), and 7 mm (P-7 and A-7 subgroups) of the implant scan bodies. The 2 reference casts were registered by using a coordinate measurement machine and desktop scanner (7 Series Dental Wings) and then scanned using an IOS (TRIOS 4) (n=15). Linear and angular discrepancy values and root mean square (RMS) error values between the implant scan bodies measured on the reference and experimental scans were computed with an inspection software program (Geomagic). Mann-Whitney U tests with Bonferroni correction were applied for planned comparisons (α=.05/9 ≈ .006).

RESULTS

For linear discrepancies, statistically significant differences were found between groups P-3 and A-3 (P=.004) and between P-7 and A-7 (P=.005). For angular discrepancies, statistically significant differences were found between groups A-3 and A-5 (P=.002) and between P-7 and A-7 (P=.003). The RMS error analysis found no statistically significant differences among the groups.

CONCLUSIONS

Implant angulation of 18 degrees did not significantly affect the accuracy of the intraoral scans in terms of 6 of the 9 planned comparisons, although the angled groups had lower mean values. Also, the supramucosal height of the scan body did not significantly affect the accuracy of the intraoral scans in terms of 17 of the 18 planned comparisons. Results may vary with different implant scan body designs.

Accuracy of edentulous full-arch implant impression: An in vitro comparison between conventional impression, intraoral scan with and without splinting, and photogrammetry

OBJECTIVES

The purpose of this in vitro study was to compare the trueness and precision of complete arch implant impressions using conventional impression, intraoral scanning with and without splinting, and stereophotogrammetry.

MATERIALS AND METHODS

An edentulous model with six implants was used in this study. Four implant impression techniques were compared: the conventional impression (CI), intraoral scanning (IOS) without splinting, intraoral scanning with splinting (MIOS), and stereophotogrammetry (SPG). An industrial blue light scanner was used to generate the baseline scan from the model. The CI was captured with a laboratory scanner. The reference best-fit method was then applied in the computer-aided design (CAD) software to compute the three-dimensional, angular, and linear discrepancies among the four impression techniques. The root mean square (RMS) 3D discrepancies in trueness and precision between the four impression groups were analyzed with a Kruskal-Wallis test. Trueness and precision between single analogs were assessed using generalized estimating equations.

RESULTS

Significant differences in the overall trueness (p = .017) and precision (p < .001) were observed across four impression groups. The SPG group exhibited significantly smaller RMS 3D deviations than the CI, IOS, and MIOS groups (p < .05), with no significant difference detected among the latter three groups (p > .05).

CONCLUSIONS

Stereophotogrammetry showed superior trueness and precision, meeting misfit thresholds for implant-supported complete arch prostheses. Intraoral scanning, while accurate like conventional impressions, exhibited cross-arch angular and linear deviations. Adding a splint to the scan body did not improve intraoral scanning accuracy.

Impact of Scanbody Geometry and CAD Software on Determining 3D Implant Position

The implementation of CAD software in the digital production of implant prosthetics stands as a pivotal aspect of clinical dentistry, necessitating high precision in the alignment of implant scanbodies. This study investigates the influence of scanbody geometry and the method of superimposing in CAD software when determining 3D implant position. A standardized titanium model with three bone-level implants was digitized to create reference STL files, and 10 intraoral scans were performed on Medentika and NT-Trading scanbodies. To determine implant position, the generated STL files were imported into the Exocad CAD software and superimposed-automatically and manually-with the scanbody geometries stored within the software's shape library. Position accuracy was determined by a comparison of the 3D-defined scanbody points from the STL matching files with those from the reference STL files. The R statistical software was used for the evaluation of the data. In addition, mixed linear models and a significance level of 0.05 were applied to calculate the p-values. The manual overlay method was significantly more accurate than the automatic overlays for both scanbody types. The Medentika scanbodies showed slightly superior precision compared to the NT-Trading scanbodies. Both scanbody geometry and the type of alignment in the CAD software significantly affect digital workflow accuracy. Manual verification and adjustment of the automatic alignment process are essential for precise implant positioning.

Effect of printing layer thickness on the trueness of 3-unit interim fixed partial dentures

STATEMENT OF PROBLEM

Three-dimensional printing has facilitated the fabrication processes in dentistry. However, knowledge on the effect of layer thickness on the trueness of 3D printed fixed partial dentures (FPDs) is lacking.

PURPOSE

The purpose of this in vitro study was to compare the effect of printing layer thickness on the trueness of 3-unit interim FPDs fabricated by using additive manufacturing with that of those fabricated by subtractive manufacturing.

MATERIAL AND METHODS

The right first premolar and first molar teeth of a dentate mandibular model were prepared for a 3-unit restoration and then digitized by using an intraoral scanner. A 3-unit interim FPD was designed to fabricate 40 restorations by using either the additive (NextDent C&B MFH) with layer thicknesses of 20 μm (n=10), 50 μm (n=10), and 100 μm (n=10) or subtractive manufacturing technique (Upcera) (milled, n=10). After fabrication, the interim FPDs were digitized by using the same intraoral scanner and were superimposed over the design data by using a 3D analysis software program. Root mean square (RMS) was used to analyze the trueness of the restorations at 4 different surfaces (external, intaglio, marginal area, and intaglio occlusal) and as a complete unit (overall). Data were analyzed with the Kruskal-Wallis and Wilcoxon tests with Bonferroni correction (α=.05).

RESULTS

The 100-μm-layer thickness interim FPDs showed the greatest overall (P≤.015), external (P≤.021), and intaglio occlusal (P≤.021) deviations, whereas the milled interim FPDs showed the lowest (P=.001). No significant differences were found among the test groups for marginal RMS (P≥.108). The differences between the 50-μm-layer thickness and 100-μm-layer thickness interim FPDs for the intaglio surface deviations (P=.064) and between the 20-μm-layer thickness and 50-μm-layer thickness interim FPDs for each surface tested were not statistically significant (P≥.108).

CONCLUSIONS

The printing layer thickness had a significant effect on the trueness of the additively manufactured interim FPDs. However, subtractively manufactured interim FPDs presented higher trueness than those additively manufactured, regardless of the printing layer thickness.

Obtaining more accurate complete arch implant digital scans with the aid of a geometric pattern: A dental technique

A technique to obtain more accurate complete arch implant digital scans and virtual casts is described. In order to obtain complete arch implant digital scans with greater accuracy, short-span intraoral digital scans are superimposed with the aid of a geometric pattern. Therefore, the technique takes advantage of the accuracy of intraoral scanners to obtain digital scans of reduced spans. Two virtual designs of the geometric pattern have been made available online: one for maxillary arches and one for mandibular arches. From these virtual designs, new virtual designs of geometric patterns of different sizes and shapes can be created to better fit different arch forms and implant positions.

THE ACCURACY OF INTRAORAL SCAN IN OBTAINING DIGITAL IMPRESSIONS OF EDENTULOUS ARCHES: A SYSTEMATIC REVIEW

OBJECTIVES

Accuracy is a crucial factor when assessing the quality of digital impressions. This systematic review aims to assess the accuracy of intraoral scan (IOS) in obtaining digital impressions of edentulous jaws.

METHODS

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022382983). A thorough retrieval of 7 electronic databases was undertaken, encompassing MEDLINE (PubMed), Web of Science, EMBASE, Scopus, Cochrane Library, Virtual Health Library, and Open gray, through September 11, 2023. A snowball search was performed by tracing the reference lists of the included studies. The Population, Intervention, Comparison, and Outcome (PICO) question of this systematic review was: "What is the accuracy of intraoral scan in obtaining digital impressions of edentulous arches?" The Modified Methodological Index for Nonrandomized Studies (MINORS) was employed to assess the risk of bias.

RESULTS

Among the studies retrieved from databases and manual search, a total of 25 studies were selected for inclusion in this systematic review, including 9 in vivo and 16 in vitro studies. Twenty-one of the included studies utilized the 3D deviation analysis method, while 4 studies employed the linear or angular deviation analysis method. The accuracy results of in vitro studies indicated a trueness range of 20-600 μm and a precision range of 2-700 μm. Results of in vivo studies indicated a trueness range of 40-1380 μm, while the precision results were not reported.

CONCLUSION

According to the results of this study, direct digital impressions by IOS cannot replace the conventional impressions of completely edentulous arches in vivo. Edentulous digital impressions by IOS demonstrated poor accuracy in peripheral areas with mobile tissues, such as the soft palate, vestibular sulcus, and sublingual area.

A Systematic Review of the Use of Intraoral Scanning for Human Identification Based on Palatal Morphology

A common application for intraoral scanners is the digitization of the morphology of teeth and palatal rugae. Palatal scans are most commonly required to fabricate complete dentures and immediate transitional dentures and serve as a reference point for assessing orthodontic results. However, they are also frequently included by accident, even though the main purpose of intraoral scanning is to reconstruct dentition using computer-aided manufacturing (CAM). The literature shows that the identification of disaster victims has frequently involved palatal rugae impressions. As the skull provides sound insulation, the rugae are resistant to heat, chemicals, and stress. Antemortem data might be difficult to find during a forensic inquiry, particularly in disaster victim identification cases. In contrast with DNA and fingerprints, there is a greater likelihood of having a dental record that contains palatal scans. With specialized software, the scans can be exported as open stereolithography (STL) files. Considering that a full case consumes up to about 100 MB of hard drive space, long-term storage should not be an issue compared to a plaster model. Additionally, dentists widely use online databases to exchange data for smile design, implant registration, and orthodontic purposes. This will produce a digital database that grows quickly and is readily usable for forensic investigations. The uniqueness of forensic features is frequently challenged; however, palatal morphology's unique trait could make it possible as it is characteristic of individuals as well as the most distinguishing factor. This review will highlight how rugae, palatal morphology, mirroring, superimposition, and geometrics can serve in forensic identification.

Improving the accuracy of complete arch implant digital scans by using auxiliary clips for intraoral scan bodies: A dental technique

A technique to improve the accuracy of complete arch implant intraoral digital scans and the accuracy of their virtual casts is described. Obtaining accurate complete arch implant intraoral digital scans with an intraoral scanner is challenging because of the smooth and movable tissues of edentulous areas. The described technique uses auxiliary clips attached to intraoral scan bodies to cover interimplant edentulous spans with immobile tooth-like geometric references that are more favorable for intraoral scanning. The technique is designed to be user friendly and compatible with any intraoral scanner.

Influence of scan technology on the accuracy and speed of intraoral scanning systems for the edentulous maxilla: An in vitro study

PURPOSE

To compare the accuracy of three intraoral scanners in terms of trueness and precision relative to the scanner acquisition technology and scan capture mode. Scan speed of each scanner was also evaluated.

MATERIALS AND METHODS

An edentulous maxillary arch was digitized (reference model) and 3D-printed using an SLA-based 3D-printer (XFAB; DWS, Italy) (n = 10). Each model was scanned using three intraoral scanners, each with different scan technologies: confocal (Trios 3; 3Shape, Copenhagen, Denmark), parallel confocal (iTero; Align Technology), and triangulation (Medit i700). Scan time and scanning accuracy (trueness and precision) were calculated using digital subtraction technique (Geomagic Control X v2020, 3DSystems, USA). One-way analysis of variance (ANOVA) test was used to detect differences in trueness, precision, and scanning time between the tested groups (p < 0.05).

RESULTS

ANOVA results showed statistically significant differences in trueness, precision, and scan time among the tested groups. Confocal scanning technique (Trios 3) showed the highest trueness and precision (root mean square estimate [RMSE] 0.094 and 0.096, respectively) followed by iTero displaying parallel confocal technique (RMSE 0.113 and 0.133, respectively); the difference was not significant (p = 0.849, p = 0.488). Further, Trios showed the longest scanning time (100 s) compared to iTero and Medit i700 (p = 0.011 and 0.002, respectively). Medit i700 presenting triangulation scan technology revealed lowest trueness and precision (RMSE 0.268) (p = 0.000, p = 0.001) and fastest scan time (59 s) close to iTero (66 s) (p = 0.802).

CONCLUSIONS

Scanner technology had an influence on the accuracy and scan speed of the acquired intraoral scans. The Trios 3 scanner featuring the confocal acquisition technology displayed the highest trueness, precision, and longest scan time. Medit i700 IOS with triangulation acquisition concept featured the lowest trueness, precision, and fastest scan speed. There is no ideal scanner with the best combination of accuracy and scan speed.

Influence of age, training, intraoral scanner, and software version on the scan accuracy of inexperienced operators

PURPOSE

To evaluate the effect of operator age on the scan accuracy (trueness and precision) of inexperienced operators when compared with experienced operators, and how training, intraoral scanner (IOS), and software version affect scan accuracy.

MATERIAL AND METHODS

Thirty-four operators were sorted into groups: G1 (operators <25 years old, no experience), G2 (operators >40 years old, no experience), and G3 (experienced IOS operators). They conducted partial-arch scans before and after a 4-session training with two IOSs (Trios 3 and True Definition) and two software versions. These scans were compared with the reference scans obtained from conventional impressions and a laboratory scanner (IScan D103i) to evaluate trueness (mean root mean square values) and precision (standard deviation of root mean square values) with a software program (Geomagic Control X). Kruskal-Wallis and post-hoc Dunn's tests were used to evaluate the effect of age on the scan accuracy of inexperienced groups when compared with experienced operators, while the effect of training, IOS, and software version on scan accuracy was evaluated with Wilcoxon or Mann-Whitney U tests (α = 0.05).

RESULTS

Before training, G1 and G2 scans had similar accuracy (p ≥ 0.065). After training, G1 scans had higher accuracy when IOS data was pooled and had higher precision with TD (p ≤ 0.004). Training increased the scan accuracy (p < 0.001), while newer software increased the trueness of inexperienced operator scans (p = 0.015).

CONCLUSIONS

Age affected the scan accuracy of inexperienced operators after training, indicating that extended training may be required for older operators. Training increased the scan accuracy, and newer software increased the trueness of inexperienced operator scans.

Trueness and precision of combined healing abutment scan body system scans at different sites of maxilla after multiple repositioning of the scan body

OBJECTIVES

To evaluate the accuracy of the scans of the combined healing abutment-scan body (CHA-SB) system located at different sites of the maxilla when SBs are replaced in between each scan.

METHODS

Three SBs were seated into HAs located at the central incisor, first premolar, and first molar sites of a maxillary model inside a phantom head, and the model was scanned extraorally (CEREC Primescan SW 5.2). This procedure was repeated with new SBs until a total of 10 scans were performed. Standard tessellation language files of CHA-SBs at each implant location were isolated, transferred into analysis software (Geomagic Control X), and superimposed over the proprietary library files to analyze surface (root mean square), linear, and angular deviations. Trueness and precision were evaluated with one-way analysis of variance and Tukey tests. The correlation between surface and angular deviations was analyzed with Pearson's correlation (α=0.05).

RESULTS

Molar implant scans had the highest surface and angular deviations (P≤.006), while central incisor implant scans had higher precision (surface deviations) than premolar implant scans (P=.041). Premolar implant scans had higher accuracy than central incisor implant scans on the y-axis (P≤.029). Central incisor implant scans had the highest accuracy on the z-axis (P≤.018). A strong positive correlation was observed between surface and angular deviations (r = 0.864, P<.001).

CONCLUSION

Central incisor implant scans mostly had high accuracy and molar implant scans mostly had lower trueness. SBs were mostly positioned apically; however, the effect of SB replacement can be considered small as measured deviations were similar to those in previous studies and the precision of scans was high.

CLINICAL SIGNIFICANCE

Repositioning of scan bodies into healing abutments would be expected to result in similar single crown positioning regardless of the location of the implant, considering high scan precision with the healing abutment-scan body system. The duration of the chairside adjustments of crowns in the posterior maxilla may be longer than those in the anterior region.

Effect of industrial scanner and framework material interaction on the marginal gaps of CAD-CAM complete arch implant frameworks

STATEMENT OF PROBLEM

Structured-light and computed tomography industrial scanners have been used as reference scanners to measure marginal gaps between implants and superstructures. However, the effect of framework material on the scanners' ability to detect gaps and on precision has not yet been evaluated.

PURPOSE

The purpose of this in vitro study was to investigate the interaction between the industrial scanner and framework material on measured marginal gaps of implant-supported fixed complete arch frameworks made from titanium and polymethylmethacrylate and on the precision of scans.

MATERIAL AND METHODS

A completely edentulous maxillary model with 4 implants and multiunit abutments at the first molar and canine sites was digitized by using a laboratory scanner. Implant-supported frameworks were milled from titanium and polymethylmethacrylate (n=5). Each framework was secured on the left molar site abutment. The marginal gaps between the frameworks and abutment sites without a screw were measured by using an industrial structured-light scanner and an industrial computed tomography scanner. The effect of the scanner, the framework material, and their interaction on measured gaps was analyzed by applying linear regressions and weighted least square methods. The F-statistics was used with Bonferroni corrections for precision analysis (α=.05).

RESULTS

No significant effect of scanner, material, or their interaction was found on the marginal gaps at the canine sites. The titanium framework gaps detected by using the computed tomography scanner were greater than those detected by using the structured-light scanner at the right molar site (estimated difference in means=0.054 mm; P=.003) and overall (estimated difference in means=0.023 mm; P=.033). The structured-light scanner's precision was higher than that of the computed tomography scanner when titanium frameworks were scanned (P=.001). The computed tomography scanner's precision was higher when scanning polymethylmethacrylate frameworks than when scanning titanium frameworks (P=.03).

CONCLUSIONS

Framework material and industrial scanner interaction affected the measured gaps. The computed tomography scanner detected greater marginal gaps with low precision when scanning titanium frameworks than the structured-light scanner. The sample size, the use of only 2 types of materials, and a laboratory scanner to obtain the computer-aided design file should be considered when interpreting the results.

Comparison of the Time and Accuracy of Intraoral Scans Performed by Dentists, Nurses, Postgraduates, and Undergraduates

OBJECTIVE

This study aimed to assess the scanning time (ST) and accuracy of 10 repeated upper and lower dentition scans by four groups of operators with different professional backgrounds.

METHODS

There were a total of 32 participants, including dentists, nurses, postgraduates, and undergraduates (n=8). They received the same training about intraoral scanning and then performed 10 repeat scans on the plaster maxillary and mandibular dentition models in a manikin head, with the first five scans being the T1 phase and the last five scans being the T2 phase. Each ST was recorded. Trueness and precision were evaluated by root mean square (RMS) value gained from alignments of corresponding virtual models. For statistical analysis, the paired-sample t-tests, one-way ANOVA, and Pearson correlation tests were employed (α=0.05).

RESULTS

Limiting the comparison in scan phase and scan target the sequence of STs for the four groups was the same (p<0.05), by which undergraduates, postgraduates, nurses, and dentists were in descending order. Undergraduates gained the best precision, followed by postgraduates, dentists, and nurses, in both maxillary and mandibular scanning (p<0.05). Compared with corresponding items of the T1 phase, the trueness of the T2 phase was much higher (p<0.05), while the ST of the T2 phase was much shorter (p<0.05).

CONCLUSIONS

The operator's professional background affects the precision and scanning time but not the trueness. Most dental personnel have good access to the intraoral scanner. As the number of scans increased, the accuracy and scanning efficiency also improved.

Accuracy of Intraoral Scanner for Recording Completely Edentulous Arches-A Systematic Review

Scanning edentulous arches during complete denture fabrication is a crucial step; however, the quality of the resulting digital scan is still questionable. The purpose of this study is to systematically review studies (both clinical and in vitro) and determine whether intraoral scanners have clinically acceptable accuracy when recording completely edentulous arches for the fabrication of removable complete dentures. An electronic search in medical databases like PubMed, Scopus, and Web of Science (WOS), using a combination of relevant keywords, retrieved 334 articles. After full-text evaluation, twelve articles fulfilled the inclusion criteria for this review (eight clinical studies and four in vitro studies). A quality analysis of the included studies was carried out using the QUADAS-2 tool. The accuracy values varied between different intraoral scanners. Different regions of the edentulous arches showed differences in trueness and precision values in both in vitro and clinical studies. Peripheral borders, the inner seal, and poorly traceable structures like the soft palate showed maximum discrepancies. The accuracy of intraoral scanners in recording clear anatomic landmarks like hard tissues with attached mucosa was comparable to conventional edentulous arch impressions. However, higher discrepancies were recorded when digitizing mobile and poorly traceable structures. Intraoral scanners can be used to digitize denture-bearing areas, but the interpretation of the peripheral border and the soft palate should be carefully carried out.

Evaluation of the accuracy of intraoral scanners for complete-arch scanning: A systematic review and network meta-analysis

OBJECTIVES

This network meta-analysis (NMA) aimed to compare the complete-arch scanning accuracy of different intraoral scanners (IOSs) to that of reference standard tessellation language (STL) files.

DATA

Studies comparing the trueness and precision of IOS STL files with those of reference STL scans for different arch types (dentate, edentulous, completely edentulous with implants, and partially edentulous with implants) were included in this study.

SOURCES

An electronic search of five databases restricted to the English Language was conducted in October 2021.

STUDY SELECTION

A total of 3,815 studies were identified, of which 114 were eligible for inclusion. After study selection and data extraction, pair-wise comparison and NMA were performed to define the accuracy of scanning for four arch subgroups using four outcomes (trueness and precision expressed as mean absolute deviation and root mean square values). Cochrane guidelines and the QUADAS-2 tool were used to assess the risk of bias. GRADE was used for certainty assessment.

RESULTS

Fifty-three articles were included in this NMA. Altogether, 26 IOSs were compared directly and indirectly in 10 network systems. The accuracy of IOSs scans were not significantly different from the reference scans for dentate arches (three IOSs), edentulous arches (three IOSs), and completely edentulous arches with implants (one IOS). The accuracy of the IOSs was significantly different from the reference scans for partially edentulous arches with implants. Significant accuracy differences were found between the IOSs, regardless of clinical scenarios.

CONCLUSIONS

The accuracy of complete-arch scanning by IOSs differs based on clinical scenarios.

CLINICAL SIGNIFICANCE

Different IOSs should be used according to the complete arch type.

Influence of the dental arch and number of cutting-off and rescanning mesh holes on the accuracy of implant scans in partially edentulous situations

OBJECTIVES

To evaluate the influence of the dental arch and cutting-off and rescanning procedures on the accuracy of complete-arch implant scans in partially edentulous arches.

MATERIAL AND METHODS

A maxillary and a mandibular partially edentulous typodont with implant abutment analogs placed in the right and left first molar and right central incisor sites were digitized to create reference models by using an industrial optical scanner (7 Series Desktop Scanner; Dentalwings). Two experimental groups were scanned using an intraoral scanner (IOS) (TRIOS 4; 3Shape A/S): the Maxillary group (Mx) and the Mandibular group (Mb). Four subgroups were generated depending on the number of rescanned mesh holes: No holes (Mx-G0, Mb-G0), 1 hole (Mx-G1, Mb-G1), 2 holes (Mx-G2, Mb-G2) and 3 holes (Mx-G3, Mb-G3). A 3-dimensional metrology software (Geomagic Control X; 3D Systems) was used to measure the difference between the reference and the experimental scans computing the root mean square (RMS) error calculation. Two-way ANOVA and a post-hoc Tukey test were used to analyze the trueness data (α=0.05). Levene test was used to evaluate the prevision (α=0.05).

RESULTS

The Mx group obtained a trueness mean value of 54 ± 17 µm and a mean precision value of 54 ± 17 µm, while the Mb group presented a trueness mean value of 67 ± 23 µm and a mean precision value of 66 ± 22 µm. The Mx group demonstrated significantly better trueness than the Mb group (P<.001). The G0 and G1 subgroups had the highest trueness values among the subgroups tested. No significant difference was observed between G0 and G1, G1 and G2, and G2 and G3 subgroups in trueness and precision. However, the G0 had significantly better trueness and precision values compared to G2 and G3 subgroups. In addition, the G1 had significantly better trueness values than the G3 subgroup. However, the Levene test revealed no difference in the precision mean values among the subgroups tested.

CONCLUSIONS

Implant scanning trueness was affected by the dental arch and the number of rescanned mesh holes using the IOS tested. A higher number of rescanned mesh holes decreased the scanning trueness. The stitching algorithm of the IOS software tested after the mesh hole scan demonstrated a significant error, especially when multiples mesh holes are involved in the same arch.

CLINICAL SIGNIFICANCE

Given that cutting-off and rescanning techniques can reduce trueness, clinicians should consider whether these techniques are necessary in complete digital workflows. This is particularly important when fabricating multiple single implant-supported restorations in the same arch.

Accuracy of Computerized Optical Impression Making in Fabrication of Removable Dentures for Partially Edentulous Jaws: An In Vivo Feasibility Study

The use of computerized optical impression making (COIM) for the fabrication of removable dentures for partially edentulous jaws is a rising trend in dental prosthetics. However, the accuracy of this method compared with that of traditional impression-making techniques remains uncertain. We therefore decided to evaluate the accuracy of COIM in the context of partially edentulous jaws in an in vivo setting. Twelve partially edentulous patients with different Kennedy classes underwent both a conventional impression (CI) and a computerized optical impression (COI) procedure. The CI was then digitized and compared with the COI data using 3D analysis software. Four different comparison situations were assessed: Whole Jaw (WJ), Mucosa with Residual Teeth (M_RT), Isolated Mucosa (IM), and Isolated Abutment Teeth (AT). Statistical analyses were conducted to evaluate group differences by quantifying the deviation values between the CIs and COIs. The mean deviations between the COIs and CIs varied significantly across the different comparison situations, with mucosal areas showing higher deviations than dental hard tissue. However, no statistically significant difference was found between the maxilla and mandible. Although COIM offers a no-pressure impression method that captures surfaces without irritation, it was found to capture mucosa less accurately than dental hard tissue. This discrepancy can likely be attributed to software algorithms that automatically filter out mobile tissues. Clinically, these findings suggest that caution is required when using COIM for prosthetics involving mucosal tissues as deviations could compromise the fit and longevity of the prosthetic appliance. Further research is warranted to assess the clinical relevance of these deviations.

Comparison of the learning curve of intraoral scanning with two different intraoral scanners based on scanning time

BACKGROUND

The appearance of intraoral scanners (IOSs) in dental offices was an important milestones for the digital innovations in dentistry. Knowing the learning curve for intraoral scanning is crucial, because it can serve as a guideline for clinicians before buying a new IOS. The aim of the present in vivo study was to determine the learning curve required by dental students for intraoral scanning with the 3Shape Trios 4 IOS and the CEREC Primescan IOS, based on scanning time.

METHODS

A total of 20 dental students with no previous experience in intraoral scanning participated in the present study. 10 students scanned with Trios 4® IOS (TRI) and 10 students took digital impressions with Primescan® IOS (CER). Every student created 15 digital impressions from patients. Prior to taking the impressions, theoretical and practical education was provided. The total scanning time included the upper and lower arches as well as bite registration, for which average values were calculated. Statistical analysis was performed using the Stata package with a mixed-effects generalized least squares regression models.

RESULTS

The average total scanning times were the following: TRI - 205 s for the 1st impression, 133.6 s for the 15th, CER - 289.8 s for the 1st impression, 147 s for the 15th. The model-based estimate of the difference between the two in case of TRI was 57.5 s, and in CER was 144.2 s which is a highly significant improvement in both cases (P < 0.0001). The slope of the scanning time vs. learning phase curve gradually approached flatness, and maintained a plateau: TRI - from the 11th measurement and CER - from the 14th measurement onward.

CONCLUSIONS

Given the limitations of the present study, we found difference between the learning curve of scanner types which are operate various principle of imaging. In case of the TRI fewer digital impressions (11 repeating) were sufficient to reach the average scanning time of an experienced user than using CER (14 repeating).

TRIAL REGISTRATION

The permission for this study was given by the University Ethics Committee of Semmelweis University (SE RKEB number: 184/2022).

Influence of arch location and scanning pattern on the scanning accuracy, scanning time, and number of photograms of complete-arch intraoral digital implant scans

OBJECTIVES

To measure the influence of arch location and scanning pattern on the accuracy, scanning time, and number of photograms of complete-arch implant scans acquired using an intraoral scanner (IOS).

MATERIALS AND METHODS

A maxillary (maxillary group) and mandibular (mandibular group) model with 6 implant abutments on each cast was digitized using a desktop scanner (control scans). Six subgroups were created based on the scanning pattern used to acquire the scans using an IOS (Trios 4): occluso-buccal-lingual (OBL subgroup), occluso-linguo-buccal (OLB subgroup), bucco-linguo-occlusal (BLO subgroup), linguo-buccal-occlusal (LBO subgroup), zigzag (ZZ subgroup), and circumferential (C subgroup). The control scans were used as a reference to measure the discrepancy with the experimental scans calculating the root mean square error. Two-way ANOVA and the pairwise comparison Tukey tests were used to analyze the data (α = .05).

RESULTS

Significant discrepancies in trueness (p < .001), precision (p < .001), scanning time (p < .001), and number of photograms (p < .001) were found. The maxillary group obtained poorer trueness and precision values, higher scanning times, and a larger number of photograms than the mandibular group. The C subgroup obtained the best trueness and precision values, but was not significantly different from the OLB, BLO, and LBO subgroups. The ZZ subgroup obtained the worst trueness and precision values (p < .05). The C subgroup obtained the lowest scanning time and number of photograms (p < .05).

CONCLUSIONS

Arch location and scanning pattern influenced scanning accuracy, scanning time, and number of photograms of complete-arch implant scans.

Intraoral Scans of Full Dental Arches: An In Vitro Measurement Study of the Accuracy of Different Intraoral Scanners

The aim of this in vitro study was to evaluate the accuracy of different intraoral scanners (IOS), according to different scanning strategies and to the experience of the operator. Six IOS setups were used in this study. Ten scans of a complete epoxy-resin-made maxillary dental arch were performed with each IOS, using four different scanning techniques (manufacturer-suggested scanning strategy, cut-out rescan technique, simplified scanning technique, novel scanning technique). Scans were also performed by an expert operator in the field of digital dentistry. An operator with no experience in the field of intraoral scans performed 10 scans following each of the scanning strategy suggested by the manufacturer. The master model was scanned with an industrial high-resolution reference scanner to obtain a highly accurate digitized reference model. All the digital models were aligned with the reference model using a software aimed at comparing the STL files. A total of n = 300 scans were performed. Once the data were pooled, Medit i700 and Primescan obtained the best results in terms of both trueness and precision, showing no statistically significative differences (p > 0.05) to the first and the second scanning technique, Medit i700 scanner allowed to obtain the best values both in terms of trueness (24.4 ± 2.1 μm and 21.4 ± 12.9 μm, respectively) and precision compared to other IOS (23.0 ± 1.6 μm and 30.0 ± 18.0 μm, respectively). When considering the third scanning technique, Medit i700 recorded the best values in terms of trueness while Primescan recorded the best values in terms of precision (24.0 ± 2.7 μm and 26.8 ± 13.7 μm, respectively). When considering the two operators, significant differences between the two were found only with Medit i700 (p < 0.001). The examined IOS showed statistically significant differences in terms of trueness and precision. The used scanning strategy is a factor influencing the accuracy of IOS. Considering the expertise of the operators, clinically scanning strategies are not operative sensitive in terms of accuracy.

Virtual 3-dimensional representation of a completely edentulous patient for computer-aided static implant planning

A technique is described to create a virtual 3-dimensional representation of an edentulous patient by aligning the facial, intraoral, and cone beam computed tomography scans guided by an additively manufactured scan body. Having the virtual patient facilitated the prosthetically driven implant planning, the additive manufacturing of the surgical implant guides, and the interim dental restorations.

Effect of measurement techniques and operators on measured deviations in digital implant scans

OBJECTIVES

To evaluate the effect of different measurement techniques and operators on measured deviations in vitro implant scans.

METHODS

A 2-piece system that comprises a healing abutment (HA) and a scan body (SB) was mounted onto an implant at right first molar site of a polymethylmethacrylate mandibular dentate model. Model was digitized by using an industrial scanner (reference model scan, n = 1) and an intraoral scanner (test scan, n = 20). All standard tessellation language files were imported into a 3-dimensional analysis software and superimposed. Three operators with similar experience performed circle-based and point-based deviation analyses (n = 20). Deviations measured with different techniques were compared with paired samples t-test within each operator, while the reliability of the operators was assessed by using F-tests for both technqiues (α = 0.05).

RESULTS

Point-based technique resulted in lower deviations than circle-based technique for all operators (P = .001) with to higher reliability among operators (ICC = 0.438, P = .001). The correlation among the operators was nonsignificant when circle-based technique was used (ICC = 0.114, P = .189).

CONCLUSION

Lower deviations were detected with the point-based technique. In addition, different operators' measurements had higher correlation when point-based technique was used compared with circle-based technique.

CLINICAL SIGNIFICANCE

Point-based technique may be preferred over circle-based technique for research studies on scan accuracy of implants, given its higher reliability. The accuracy of measured deviations may increase if the number of planes are increased, which can facilitate point generation at different surfaces of the scan body.

Trueness of intraoral scanning of edentulous arches: A comparative clinical study

PURPOSE

To compare the accuracy of intraoral scanning (IOS) of the edentulous arch with the hybrid protocol of cast digitization (CD), and to investigate the effect of arch type and area on trueness.

MATERIALS AND METHODS

Participants that were edentulous in both arches were recruited. Two impression protocols were used; the IOS as the test protocol with an IOS device (TRIOS 4; 3Shape, Denmark), and the CD as the control, including tracing compound (TRACING STICKS; Kemdent, UK) for border molding, polyvinyl siloxane (Hydrorise Monophase; Zhermack, Italy) for impression, and cast digitization with a laboratory scanner (ceramill® map400, AMANNGIRRBACH, Germany). Scanned files were exported to a 3D inspection software (Geomagic Control X; 3D Systems, NC) for trueness analysis. The CD file (reference file) for each participant was split into 2 areas; the dynamic area representing the mobile tissues at the peripheral border, and the static area representing the rest of the arch. Statistical analyses were performed with 1-sample t-test for the difference between CD and IOS protocols, paired sample t-test for the difference between the static and dynamic areas for each arch, and an independent sample t-test for the difference between the maxillary and mandibular arches for each area, with α = 0.05. Effect size was calculated with Cohen's d (d), with 0.2 as small, 0.5 as medium, and 0.8 as large.

RESULTS

A total of 21 participants were included. The difference between the IOS and CD protocol was significant for all subset comparisons (p < 0.001, d: 2.5-6.2, large effect size). Dynamic areas had lower trueness in comparison with static areas (p < 0.001, d = 4.57, large effect size for the maxillary arch, p < 0.001, d = 3.96, large effect size for the mandibular arch). Mandibular arch had lower trueness in comparison with the maxillary arch (p < 0.001, d = 1.45, large effect size for the static areas, p = 0.009, d = 0.85, large effect size for the dynamic areas, p < 0.001, d = 1.71, large effect size for all areas). Color difference map showed marked positive deviation in the buccal dynamic areas of both arches, and nonmatching areas with evident overstretching.

CONCLUSIONS

While the IOS of edentulous arches could be feasible for attached mucosa, providing a functional shape for the peripheral border remains a challenge, with a thinner and more outward border for the IOS in comparison with the CD protocol. The IOS of the mandibular arch is more difficult and has lower trueness in comparison with the maxillary arch.

Accuracy of intraoral scanning methods for maxillary Kennedy class I arch

Background/purpose

The optimal strategy for scanning removable partial dentures remains unknown. This study investigated scanning strategies for patients with a maxillary Kennedy Class I arch as well as the measurement deviations of three scanning strategies.

Materials and methods

A standard maxilla model was positioned with a holder in a dental chair to simulate a natural patient position and posture. Standard Tessellation Language files for reference models were formatted with a desktop scanner, and model operation files were obtained with a TRIOS 3 Pod intraoral scanner and superimposed using Exocad computer-aided design software. The three scanning strategies evaluated in this study (Strategy M, T-R, and R-T) were used for nine scans each, and the resulting data were recorded. The deviation of the three strategies was statistically analyzed through one-way ANOVA and Tukey post hoc testing.

Results

The trueness of Strategy M, T-R, and R-T was 52.6 ± 31.0, 54.9 ± 27.6, and 50.1 ± 22.3 μm, respectively. No statistically significant differences in trueness were detected among the three groups (P > 0.05). However, Strategy T-R had the evenest distribution of all measuring points. The deviations of the measurements obtained by three scanning strategies were mostly between 30 and 70 μm. The precision of the three strategies was similar as well.

Conclusion

Trueness did not differ significantly among the three strategies. However, Strategy T-R is recommended for use with a TRIOS 3 Pod scanner because of its reduction of the seesaw effect and high stabilization of the RPD framework.

In vitro scan accuracy and time efficiency in various implant-supported fixed partial denture situations

OBJECTIVES

To compare the accuracy and time efficiency of different digital workflows in 3 implant-supported fixed partial denture situations.

METHODS

Three partially edentulous maxillary models with 2 implants (Model 1: implants at lateral incisor sites; Model 2: implants at right canine and first molar sites; Model 3: implants at right first premolar and first molar sites) were digitized (ATOS Capsule 200MV120, n=1) for reference scans. Test scans were performed for direct (Primescan (DDW-P) and Trios 3 (DDW-T)) and indirect (IDW) digital workflows (n=14). For IDW, stone casts (type IV) were obtained from vinylsiloxanether impressions and digitized (S600 Arti). The scan/impression and post processing times were recorded. Reference and test scans were superimposed (GOM Inspect) to calculate 3D point, inter-implant distance, and angular deviations. Kruskal-Wallis and Mann-Whitney tests were used for trueness and precision analyses (α=.05).

RESULTS

Tested workflows affected trueness (P≤.030) and precision (P<.001) of scans (3D point, inter-implant distance, and angular deviations) within models. DDW-P had the highest accuracy (3D point deviations) for models 1 and 3 (P≤.046). IDW had the lowest accuracy for model 2 (P<.01). DDW-P had the highest accuracy (inter-implant distance deviations) for model 3 (P≤.048). Direct digital workflow mostly led to lower angular deviations (P≤.040), and higher precision for models 2 (mesiodistal direction) and 3 (P<.001). The time for direct digital workflow was shorter (P<.001), DDW-P being more efficient than DDW-T (P=.008).

CONCLUSION

Direct digital workflow was more accurate and efficient than indirect digital workflow in tested partial edentulism situations with 2 implants.

CLINICAL SIGNIFICANCE

Tested intraoral scanners can be recommended for accurate and efficient impressions of anterior and posterior 3- or 4-unit implant-supported fixed partial dentures.

Intraoral Scanners for In Vivo 3D Imaging of the Gingiva and the Alveolar Process

This study aimed to assess the reliability of two intraoral surface scanners for the representation of the alveolar process in vivo. Complete maxillary scans (CS 3600, Carestream and TRIOS 3, 3Shape) were repeatedly obtained from 13 fully dentate individuals. Scanner precision and agreement were tested using 3D surface superimpositions on the following reference areas: the buccal front teeth area, the entire dental arch, the entire alveolar process, or single teeth by applying an iterative closest point algorithm. Following each superimposition, the mean absolute distance (MAD) between predefined 3D model surfaces was calculated. Outcomes were analyzed through non-parametric statistics and the visualization of color-coded distance maps. When superimpositions were performed on the alveolar process, the median scanner precision was below 0.05 mm, with statistically significant but negligible differences between scanners. The agreement between the scanners was approximately 0.06 mm. When single-tooth superimpositions were used to assess the precision of adjacent alveolar soft-tissue surfaces, the median error was 0.028 mm, and there was higher agreement between the scanners. The in vivo reliability of the intraoral scanners in the alveolar surface area was high overall. Single-tooth superimpositions should be preferred for the optimal assessment of neighboring alveolar surface areas relative to the dentition.

Do digital impressions have a greater accuracy for full-arch implant-supported reconstructions compared to conventional impressions? An in vitro study

Aim

The purpose of this study was to compare the accuracy of conventional implant impressions with digital impression techniques made using two different intraoral scanners.

Setting and Design

In-Vitro study.

Material and Methods

A scan of master cast containing four implants was made using two intraoral scanners: CEREC Primescan (Dentsply Sirona, USA) and 3Shape Trios (Copenhagen, Denmark) with PEEK scan bodies attached to the implants. Model was scanned ten times using different scanners. The accuracy of the chairside scanners was compared with highly accurate laboratory scanner. The scans were transferred into the software (Geomagic Control X 20, 3D Systems, Rock Hill, SC, USA) for analysis. The linear deviations and the angular deviations between the scans (scan of each model made using high-definition scanner and the master model scan) were calculated to determine the accuracy. Trueness was used as a parameter to compare the accuracy of different scanners (comparing test and reference).

Statistical Analysis

Analysis of variance was performed with Bonferroni's post hoc test for multiple group comparisons.

Results

Distribution of the mean overall absolute linear deviation was significantly lower in the conventional impression group compared to the CEREC Primescan scanner group and 3Shape Trios group (P < 0.05 for both). Distribution of the mean overall absolute linear deviation was significantly lower in the CEREC Primescan scanner group compared to the 3Shape Trios group (P < 0.05). Distribution of the mean overall absolute angular deviation did not differ between the three groups (P > 0.05 for all).

Conclusion

Conventional impressions showed significantly greater accuracy compared to the digital impressions made with both the above intraoral scanners for implant-supported restoration of an edentulous arch. In addition, the digital impressions with the CEREC Primescan scanner showed greater accuracy as compared to the 3Shape Trios scanner.

The Trueness of Scans using One Intraoral Scanner in Different Partially Edentulous Conditions

PURPOSE

To investigate the trueness of intraoral scanning in 8 commonly seen partially edentulous conditions.

MATERIALS AND METHODS

A maxillary dentoform was modified into the 8 commonly seen partially edentulous conditions. Each modification was scanned with a laboratory desktop scanner. Each modification was then scanned 10 times (n = 10) with an intraoral scanner. All scans were exported as STL files and then imported into a surface matching software using the best-fit alignment method. The dimensional differences between the study STL files from the intraoral scanner were compared to the corresponding reference STL files. The measurements were calculated as the root mean square (RMS) and defined as the trueness of the intraoral scans. In addition to the RMS values, qualitative assessments were completed on the color maps. The color maps produced by the surface matching software were used to visualize the areas of deviation between scans from the intraoral scanner and their corresponding reference files. One-way analysis of variance (ANOVA), followed by pair-wise comparisons using Fisher's Protected Least Significant Difference were utilized to compare the differences between the groups in RMS values (α = 0.05).

RESULTS

Partially edentulous condition significantly affected the trueness of the intraoral scans. Group 8 (Class IV) had significantly lower RMS (0.1878 ±0.0455 mm) than all other groups (P < 0.001). Group 2 (Class II) and Group 7 (Class III modification I) are not significantly different from each other (Group 2: 0.5758 ±0.0300 mm; Group 7: 0.5602 ±0.0231 mm, P = 0.571), while they both had significantly higher RMS than all other groups (P < .001). The remaining groups showed the RMS values were within the range of 0.3001 ±0.0891 mm (Group 6 - Class III with Long Edentulous Span) and 0.4541 ±0.1039 mm (Group 1 - Class I).

CONCLUSION

Different partially edentulous conditions affected the trueness of the scans generated from the selected intraoral scanner. Class IV edentulous condition had the highest intraoral scan trueness. It is unknown if RMS values are clinically significant, and the validity of using intraoral scans directly for PRDP fabrication will need further studies. This article is protected by copyright. All rights reserved.

Effect of Scanned Area and Operator on the Accuracy of Dentate Arch Scans with a Single Implant

Studies have shown the effect of the operator and scanned areas on the accuracy of single implant scans. However, the knowledge on the scan accuracy of the remaining dental arch during single implant scans, which may affect the occlusion, is limited. The aim of this study was to investigate the effect of scanned areas and the operator on the scan accuracy of a dentate arch while scanning a single implant. A dentate model with an anterior implant was digitized with a laboratory scanner (reference scan). Three operators with similar experience performed 10 complete- and 10 partial-arch scans (left 2nd molar to right canine) with an intraoral scanner (TRIOS 3), and these scans were superimposed over the reference. The accuracy was analyzed at 22 points in complete-arch and at 16 points in partial-arch scans on 2nd molars and incisors. Data were evaluated with 2-way ANOVA and Tukey HSD tests (α = 0.05). The trueness of the total scanned area was higher in partial- than in complete-arch scans (p < 0.001). The trueness and precision of the scans were higher in the anterior site compared with the posterior in complete- (trueness: p ≤ 0.022, precision: p ≤ 0.003) and partial-arch (trueness: p ≤ 0.016, precision: p ≤ 0.016) scans of each operator and when the operator scan data were pooled. The complete-arch scan’s precision was not influenced by the operator (p ≥ 0.029), whereas the partial-arch scans of operator 1 and 2 were significantly different (p = 0.036). Trueness was higher in partial- compared with complete-arch scans, but their precision was similar. Accuracy was higher in the anterior site regardless of the scan being a partial- or a complete-arch. The operator’s effect on the accuracy of partial- and complete-arch scans was small.

A Digital Workflow for the Fabrication of a Milled Removable Partial Denture

Complete dentures fabricated with the additive or subtractive method have been widely used and proven to be clinically acceptable. However, fabrication of removable partial dentures (RPDs) using computer-aided design and computer-aided manufacturing is limited by its technique sensitivity as the pink resin, which encases part of metal framework, cannot be fabricated digitally. This article introduces a digital workflow to fabricate an RPD with the subtractive method. A complex structure of the offset metal framework and denture base with teeth sockets was milled with this technique. Artificial teeth were milled with a resin disk according to the computer-aided design data, resulting in the customized occlusal surface. This digital technique can be an alternative to the analog fabrication method as the RPD was fabricated digitally, keeping the original structures and reducing resin shrinkage on the intaglio surface.

In vitro accuracy of digital and conventional impressions in the partially edentulous maxilla

OBJECTIVES

This in vitro study compared the dimensional accuracy of conventional impressions (CI) with that of digital impressions (DI) in a partially edentulous maxilla. DIs were made by two intraoral scanners, Omnicam (OC) and Primescan (PS).

MATERIALS AND METHODS

CI and both intraoral scanners were used to take 30 impressions of two identical reference models. CIs were poured with type 4 gypsum and the saw-cut models were digitized. The reference models simulated a maxilla with six prepared teeth that accommodated a cross-arch fixed partial denture. Center points of five precision balls and center points at the margin level of each prepared tooth were used to detect changes in dimensions and tooth axis between the reference model and the scans.

RESULTS

For DI, the largest deviations (176 µm for OC and 122 µm for PS) occurred over the cross-arch. For CI, the largest deviation (118 µm) occurred over the anterior segment. For shorter distances up to a quadrant, DI was superior to CI. For longer scan distances, DI was comparable (2 sextant and anterior segment) or inferior (cross-arch) to CI. Vertical and tooth axis deviations were significantly smaller for CI than for DI (p < 0.001).

CONCLUSIONS

The impression method affected the impression accuracy of a partially edentulous maxilla with prepared teeth. DI is recommended for scans up to a quadrant. Larger scan volumes are not yet suitable for fabricating a fixed partial denture because of the high scatter of accuracy values.

CLINICAL RELEVANCE

In contrast to conventional impressions, digital impressions lead to comparable or better results concerning scans up to a quadrant. Consequently, for larger scan volumes, several smaller scans should be performed or, if restoration-related not possible, it is recommended to take conventional impressions.

Trueness and precision of combined healing abutment-scan body system depending on the scan pattern and implant location: an in-vitro study

OBJECTIVE

To test the effect of scan pattern and the location of the implant on the trueness and precision of implant scans when the combined healing abutment-scan body (CHA-SB) system is used.

MATERIAL AND METHODS

A partially edentulous maxillary model with CHA-SBs secured on implants at 3 different sites in the left quadrant (central incisor, first premolar, and first molar) was fabricated. The model was scanned with an industrial light scanner to generate a master reference model (MRM) file. An intraoral scanner (TRIOS 3) was used to perform the test scans (n=8) with 4 different scan patterns (SP1, SP2, SP3, and SP4) with an intraoral scanner. The test scans were superimposed over the MRM file with a metrology software to calculate the distance deviations of the CHA-SB system. Data were analyzed with a 2-way analysis of variance and Tukey's honestly significant difference tests for accuracy (α=.05).

RESULTS

Trueness (P=.001) and precision (P=.018) were significantly affected by the interaction between the scan pattern and implant location. The implant located at the central incisor site (56.7 ±35.9, 36.2 ±18.6) had higher trueness than that of located at the premolar site (94.1 ±20.4, 100.3 ±20) when SP2 (P=.037) and SP4 (P=.002) were used. The implant at the molar site (71.9 ±25.7, 147.2 ±49.7) had trueness either similar to (when SP2 was used, P≥.276) or lower than (when SP4 was used, P≤.024) those of others. Scans of the central incisor and premolar implants had the lowest trueness when scanned with SP1 (P≤.009), while the scans of molar implant showed higher trueness when performed by using SP2 and SP3 when compared with SP4 (P≤.005). When SP4 was used, the implant at the molar site had lower precision (43 ±18.9) than the implants located at the central incisor (14.1 ±11) and premolar sites (15.4 ±11.3) (P=.002). Scan patterns affected the scan precision of central incisor implant (P=.009), as SP4 (14.1 ±11) led to a higher precision than SP1 (47.7 ±27) (P=.006).

CONCLUSIONS

The scan accuracy of combined healing abutment-scan body system was affected by scan pattern and implant location. SP1, which involved palatal and rotational scans resulted in the lowest trueness for central incisor and premolar implants, while the scans of the central incisor implant showed the highest trueness among different sites when SP4 was used. However, the scan pattern and implant site had a minor effect on precision. Scan precision at different implant sites only differed when SP4 was used, which resulted in the lowest precision for molar implant.

Reliability and Time Efficiency of Digital vs. Analog Bite Registration Technique for the Manufacture of Full-Arch Fixed Implant Prostheses

Objective: Information about full-digital protocols for bite registration with intraoral scanners on multiple implants in the edentulous jaw is scarce. The purpose of this comparative in vivo study was to investigate the reliability and time efficiency of a novel full-digital bite registration technique for the manufacture of full-arch maxillary fixed implant prostheses. Material and methods: In ten patients, a full-arch maxillary fixed implant prosthesis was manufactured on multi-unit abutment level through an analog prosthetic workflow. The bite registration was performed with use of a screw-retained polymethyl methacrylate (PMMA) verification jig with detachable wax rim. To articulate the definitive edentulous maxillary implant cast in centric relation at the appropriate occlusal vertical dimension (OVD) to the mandibular antagonist cast, a type II articulator (Artex, Amann Girrbach) was used. Three to six months later, a full-digital bite registration was performed with use of dual-function scan bodies and bilateral connected bite pillars. The bite pillars screwed into the scan bodies were used to adjust and articulate the edentulous maxillary implant arch to the mandibular antagonist arch at the defined OVD. Treatment time for analog and digital bite registration technique was measured in each patient. The reliability of the digital bite registration technique was evaluated by 3D comparison of two sets of stereo lithographic (STL) files obtained from each patient. The three-dimensional deviation was defined along the X-, Y- and Z-axes (Geomagic Control X, 3D Systems Inc., Rock Hill, SC, USA). Results: The treatment time for digital bite registration using dual-function scan bodies and bite pillars was significantly shorter than analog bite registration with verification jig and wax rim (60.30%, SD 5.72%). Minor differences between the two techniques were observed with a linear deviation range of 1115 µm (SD 668 µm) overall, 46.2 µm (SD 731.3 µm) along the X-axis, −200.3 µm (SD 744.3 µm) along the Y-axis and 67.1 µm (SD 752.2 µm) along the Z-axis. Bilateral balanced contacts were registered in all patients during full-digital bite registration. Conclusions: The novel digital bite registration technique with dual-function scan bodies and bite pillars allows for a full-digital workflow for full-arch implant supported restorations. The digital bite workflow was 60% faster, and the overall deviation was around 1 mm, which can be considered clinically acceptable.

Triangular mesh reduction of digitized maxillectomy defects for prosthetic rehabilitation: A 3D deviation study

OBJECTIVES

To evaluate the effect of different amounts of triangular mesh reduction on the trueness of digitized complete-arch dentate and edentulous maxillectomy defects models.

MATERIAL AND METHODS

Twenty gypsum maxillectomy defect models (dentate and edentate group: n=10) were digitized using the Trios 3 intraoral scanner, scanning the teeth, mucosa and maxillectomy defect. These datasets (reference, R₀) were saved as standard tessellation language (STL) files, and triangular mesh reduction was performed using Meshmixer's reduction tool. Digital test-datasets with file sizes reduced by 50%(R₁), 75%(R₂), and 90%(R₃) were generated (each: n=20). Each test-dataset was compared to the R₀ file using 3D evaluation software (GOM Inspect), applying automated pre-alignment followed by a global best-fit alignment, and root mean square (RMS) 3-dimensional (3D) deviations were calculated. Statistical analyses were performed, at a level of significance of α=0.05.

RESULTS

The number of triangles, and STL file size were synchronized with each other and inversely proportional to the amount of mesh reduction. The resulting mean percentages of the STL file sizes were 50.00% for R₁, 24.93% for R₂, and 10.00% for R₃. There were no 3D deviations at 50% triangular mesh reduction. The 3D deviations increased with the amount of mesh reduction: at 75% reduction the median deviations were lower (dentate:0.0016mm, IQR:0.0015-0.0018; edentate:0.0016mm, IQR:0.0015-0.0016), than at 90% (dentate:0.004mm, IQR:0.0038-0.0041; edentate:0.003mm, IQR:0.0036-0.0039). A statistically significant increase in 3D deviations was observed with higher degrees of mesh reduction (p<0.001).

CONCLUSIONS

Triangular mesh reduction results in a significant increase in 3D deviations if the reduction is more than 75%.

CLINICAL SIGNIFICANCE

Digital models of patients with maxillectomy defects can be saved with a mesh reduction of 50% without affecting the trueness. The use of a 50% mesh reduction decreases the required storage capacity by 50%.

Accuracy of full-arch digitalization for partially edentulous jaws - a laboratory study on basis of coordinate-based data analysis

Objectives

To compare the accuracy (trueness and precision) of direct digitization of four different dental gap situation with two IOS (intraoral scanner).

Materials and methods

Four partially edentulous polyurethane mandible models were used: (1) A (46, 45, 44 missing), (2) B (45, 44, 34, 35 missing), (3) C (42, 41, 31, 32 missing), and (4) D (full dentition). On each model, the same reference object was fixed between the second molars of both quadrants. A dataset (REF) of the reference object was generated by a coordinate measuring machine. Each model situation was scanned by (1) OMN (Cerec AC Omnicam) and (2) PRI (Cerec Primescan AC) (n = 30). Datasets of all 8 test groups (N = 240) were analyzed using inspection software to determine the linear aberrations in the X-, Y-, Z-axes and angular deviations. Mann–Whitney U and two-sample Kolmogorov–Smirnov tests were used to detect differences for trueness and precision.

Results

PRI revealed higher trueness and precision in most of the measured parameters (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\overrightarrow{V}}_{E}$$\end{document}V→E 120.95 to 175.01 μm, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E(x) − 58.50 to − 9.40 μm, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E (z) − 70.35 to 63.50 μm), while OMN showed higher trueness for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E (y) regardless of model situation (− 104.90 to 34.55 μm). Model D revealed the highest trueness and precision in most of the measured parameters regardless of IOS (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E 120.95 to 195.74 μm, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E (x) − 9.40 to 66.75 μm,\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E (y) − 14.55 to 51.50 μm, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overrightarrow{V}_{E}$$\end{document}V→E (z) 63.50 to 120.75 μm).

Conclusions

PRI demonstrated higher accuracy in the X- and Z-axes, while OMN depicted higher trueness in the Y-axis. For PRI, Model A revealed the highest distortion, while for OMN, Model B produced the largest aberrations in most parameters.

Clinical relevance

Current results suggest that both investigated IOS are sufficiently accurate for the manufacturing of tooth-borne restorations and orthodontic appliances. However, both hardware specifications of IOS and the presence of edentulous gaps in the dental model have an influence on the accuracy of the virtual model dataset.

Accuracy between intraoral and extraoral scanning: Three-dimensional deviation and effect of distance between implants from two scanning methods

Aim

Evaluate the accuracy between the intraoral and extraoral scanning regarding the three dimensional (3D) deviation and distances between the implants, through 2 scanning methods.

Settings and Design

An in vitro study.

Materials and Methods

An edentulous mandibular model was used to install four implants and abutments, recommending 6 distances between the implants. Scans were performed using an intraoral (SI) and extraoral (SE) scanner for each studied group: Scanning with the scan bodies (SB) and device (SD) (n = 10). The files were imported into a surface evaluation program to assess 3D deviations and measure distances between implants.

Statistical Analysis

Precision was assessed as the difference between files (Kruskal-Wallis test), while trueness was assessed from the difference between scans, applying the Wilcoxon and Mann-Whitney test.

Results

As for the 3D deviations, SI showed accuracy, for the faces and positions of the implants in relation to the SE, in both scanning methods (P < 0.05). Regarding the capture of distances between implants, the SD scan obtained better trueness than the SB group (P < 0.05).

Conclusion

We concluded that the type and scanning methods used did not influence the 3D deviations, while for distances, scanning with the device had better trueness.

Effect of implant location and operator on the accuracy of implant scans using a combined healing abutment-scan body system

OBJECTIVES

To investigate the effect of implant location and operator on the accuracy of implant scans conducted with a combined healing abutment-scan body (CHA-SB) system.

MATERIAL AND METHODS

A CHA-SB system was fixed on implants at left central incisor, first premolar, and first molar sites in a dentate maxillary model. An industrial optical scanner (ATOS Core 80) was utilized to scan and generate a reference model (RM). The model was scanned by three operators (n = 8) using an intraoral scanner (TRIOS 3). A software (GOM Inspect) was used to superimpose IOS test scans over RM and calculations (distance and angular deviations) were carried out to evaluate the accuracy of the scans. Data were compared with a 2-way ANOVA and Tukey HSD tests were employed to resolve significant interactions for trueness and precision (α = .05).

RESULTS

Implant location affected the trueness (P ≤ .001) and the precision (P ≤ .020) (distance and angular deviations). The scans of the implant at the central incisor site had the highest trueness (distance and angular deviations) (P ≤ .016). The scans of the implant at molar site had the lowest precision (distance deviation data) (P ≤ .012). The scans of the implant at premolar site had lower precision (angular deviation data) than the scans of the implant at central incisor site (P = .016). Operators' effect on the accuracy of scans was not significant (P ≥  .051).

CONCLUSION

Implant location affected the scan accuracy of the combined healing abutment-scan body system. The scans of the implant at central incisor site had high trueness. The posterior the implant location, the lower was the precision of the scans. The accuracy of scans of different operators was similar.

CLINICAL SIGNIFICANCE

Higher deviations found in scans of posterior maxilla compared with those in the anterior region may require increased chairside adjustments when crowns are to be fabricated using the scans of the tested healing abutment-scan body system. However, clinical studies are necessary to corroborate the findings.