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Ashry A, Abdelhamid AM, Ezzelarab S, Khamis MM. Effect of using scan body accessories and inter-implant distances on the accuracy of complete arch implant digital impressions: An in vitro study. J Prosthodont 2024. [PMID: 38594949 DOI: 10.1111/jopr.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE To introduce a novel design for scan body accessory parts that are reusable, easy to attach and detach without permanent change of the scan body, and can be used with different inter-implant distances to enhance the accuracy of complete arch implant scans. MATERIALS AND METHODS A maxillary polymethylmethacrylate (PMMA) model with a soft tissue replica was fabricated with four implant analogs located at tooth positions 17, 13, 22, and 27 with 18, 25, and 30 mm inter-implant distances. Four scan bodies (SBs) were attached to the implants. The model was scanned with a laboratory scanner to be used as a reference scan. A total of 40 scans were made with the same intraoral scanner and they were divided equally into two groups. Group A: Complete arch implant scans without scan body accessories (n = 20), and Group B: Complete arch implant scans with scan body accessories (n = 20). Intraoral scans were exported and superimposed on the reference scan using reverse engineering inspection software to be evaluated for 3D deviations, angular deviations, and linear deviations. Statistical analysis was performed with student t-test and analysis of variance (ANOVA) with repeated measures followed by post hoc adjusted Bonferroni test. The level of significance was set at P = 0.05. RESULTS The scan body accessories decreased both the 3D and linear deviations, with a statistically significant difference at SB4 for the 3D deviation (P = 0.043) and the linear inter-implant discrepancies between SB1-SB2 and SB3-SB4 (P = 0.029 and < 0.001), respectively. However, there was no statistically significant difference in angular deviation between the study groups. Implant positions had significant differences within each group. CONCLUSIONS A significant improvement in the accuracy of the complete arch implant digital impression was achieved by using the scan body accessories, particularly in reducing the 3D and linear deviations at the most distant implant positions.
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Affiliation(s)
- Amal Ashry
- Department of Prosthodontics, Faculty of Dentistry, Damanhour University, El-Behaira, Egypt
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed M Abdelhamid
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Salah Ezzelarab
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Moataz Khamis
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Anwar H, Azer A, AboElHassan RG. Influence of a specially designed geometric device and modified scan bodies on the accuracy of a maxillary complete arch digital implant scan: An in vitro study. J Prosthet Dent 2024; 131:683.e1-683.e7. [PMID: 38472074 DOI: 10.1016/j.prosdent.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
STATEMENT OF PROBLEM Capturing accurate complete arch digital implant scans remains a challenging process because of the lack of recognizable anatomic landmarks. The effect of modified scan bodies (SBs) on improving scanning accuracy is unclear. PURPOSE The purpose of this in vitro study was to evaluate and compare the accuracy of a maxillary complete arch digital implant scan when using a specially designed geometric device with the accuracy of modified scan bodies. MATERIAL AND METHODS Four implants were placed in an edentulous maxillary model made of porous bone material with polyurethane attached gingiva. Scan bodies were attached to the implants and then digitized with a high precision laboratory scanner to create the reference scan. Round depressions were made on the buccal and palatal surfaces of the scan bodies, and the model was scanned with an intraoral scanner using 4 different scenarios: the model with no geometric device or modified scan bodies (ND-NM), device only without modified scan bodies (D-NM), no device but with modified scan bodies (ND-M), and device with modified scan bodies (D-M). Each group was scanned 10 times for a total of 40 scans. Trueness and precision were evaluated using inspection software to measure the 3D surface deviation. Trueness was measured by superimposing each test scan on the reference scan, and precision was calculated by superimposing the test scans of the same group with each other. Data were analyzed using the GraphPad Prism version 8.0.0 software program. Two-way ANOVA was performed to assess the effect of the device and modifications on trueness and precision (α=.05). RESULTS Both the geometric device and SB modifications had a significantly significant effect on trueness and precision (P<.001). Regarding trueness, group D-M had the lowest mean and standard deviation (0.158 ±0.028 mm) in contrast with group ND-NM, which had the highest deviation (0.282 ±0.038 mm). In terms of precision, group D-M showed the lowest mean and standard deviation (0.134 ±0.013 mm), while group ND-NM revealed the highest deviation (0.222 ±0.031 mm). However, no statistically significant interaction was found between the device and modifications regarding either trueness or precision (P>.05). CONCLUSIONS Using a specially designed geometric device improved both the trueness and precision of complete arch digital implant scans. The modified SBs had a positive influence on the scanning trueness and precision, and the best accuracy was achieved when using the geometric device and the modified SBs simultaneously.
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Affiliation(s)
- Haidy Anwar
- Teaching Assistant, Fixed Prosthodontics Department, Faculty of Dentistry, Arab Academy for Science, Technology and Maritime Transport, El-Alamein, Egypt.
| | - Amir Azer
- Associate Professor, Fixed Prosthodontics, Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rewaa G AboElHassan
- Lecturer, Fixed Prosthodontics, Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Cai ZZ, Li X, Wu XY, Lai HC, Shi JY. Does intra-oral scan improve the impression accuracy of full-arch implant-supported prostheses: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024. [PMID: 38517307 DOI: 10.1111/cid.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/17/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES The present study aimed to systematically review the studies comparing the accuracy of intraoral scan (IOS) and conventional implant impressions (CI) in completely edentulous patients. MATERIALS AND METHODS Electronic searches were performed in PubMed, Embase and Cochrane CENTRAL up to December 1, 2023. Clinical studies and in vitro studies reporting the accuracy of digital full arch impressions were included. The primary outcome is the 3-dimensional deviations between the study reference models. A risk of bias assessment was performed for clinical studies. A stratified meta-analysis and a single-armed meta-analysis were conducted. RESULTS A total of 49 studies were included, with 8 clinical studies and 41 in vitro studies. For comparison between IOS and conventional impressions, studies were categorized into two groups based on the different measurement methods employed: RMS and CMM. In studies using RMS, the result favored the IOS in the unparalleled situation with the mean difference of -99.29 μm (95% CI: [-141.38, -57.19], I2 = 81%), while the result was opposite with the mean difference of 13.62 μm (95% CI: [10.97, 16.28], I2 = 26%) when implants were paralleled. For different brands of IOS, the accuracy ranged from 76.11 μm (95% CI: [42.36, 109.86]) to 158.63 μm (95% CI: [-14.68, 331.93]). CONCLUSIONS Accuracy of intraoral scan is clinically acceptable in edentulous arches, especially for unparalleled implants. More clinical studies are needed to verify the present finding.
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Affiliation(s)
- Zheng-Zhen Cai
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xin Li
- Department of Stomatology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xin-Yu Wu
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Hong-Chang Lai
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jun-Yu Shi
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Alonso Pérez-Barquero J, García-Sala Bonmatí F, de Fernández Estevan L, Guinot Barona C, Maneiro Lojo J, Revilla-León M. Virtual implant scan body switch by using computer-aided design programs avoiding the need of obtaining a new intraoral implant digital scan: A novel protocol. J ESTHET RESTOR DENT 2024; 36:278-283. [PMID: 37681471 DOI: 10.1111/jerd.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE The present manuscript describes a technique to virtually switch an implant scan body eliminating the need of obtaining a new intraoral implant digital scan. CLINICAL CONSIDERATIONS Implant scan bodies assist on transferring the 3-dimensional position of the implants into the virtual definitive implant cast. However, if a different implant part is desired during the designing procedures of the implant restoration such as selecting a different implant abutment of varying height, angulation, or manufacturer, a new intraoral implant digital scan with the specific implant scan body is required. CONCLUSIONS This novel protocol aims to reduce possible complications that require capturing a new intraoral implant digital scan, facilitate prostheses design modifications after the obtention of the definitive intraoral implant digital scan, and to ease the manufacturing procedures. CLINICAL SIGNIFICANCE The novel technique may provide a solution for virtually switch implant scan bodies for fabricating implant-supported single crowns or short-span prostheses. Additional studies are needed before its clinical implementation.
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Affiliation(s)
| | | | - Lucía de Fernández Estevan
- Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Clara Guinot Barona
- Department of Dental Orthodontics, Faculty of Medicine and Health Sciences, Universidad Católica de Valencia, Valencia, Spain
| | - Jesús Maneiro Lojo
- Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Faculty and Director of Research and Digital Dentistry, Kois Center, Seattle, Washington, USA
- Graduate Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
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Gómez-Polo M, Donmez MB, Çakmak G, Yilmaz B, Revilla-León M. Influence of implant scan body design (height, diameter, geometry, material, and retention system) on intraoral scanning accuracy: A systematic review. J Prosthodont 2023; 32:165-180. [PMID: 37771200 DOI: 10.1111/jopr.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To evaluate the influence of implant scan body (ISB) design (height, diameter, geometry, material, and retention system) on the accuracy of digital implant scans. MATERIAL AND METHODS A literature search was completed in five databases: PubMed/Medline, Scopus, Embase, World of Science, and Cochrane. A manual search was also conducted. Studies reporting the evaluation of ISB design on the accuracy of digital scans obtained by using IOSs were included. Two investigators evaluated the studies independently by applying the Joanna Briggs Institute critical appraisal. A third examiner was consulted to resolve any lack of consensus. Articles were classified based on the ISB features of height, geometry, material, and retention system. RESULTS Twenty articles were included. Among the reviewed studies, 11 investigations analyzed the influence of different ISB geometries, 1 study assessed the impact of ISB diameter, 4 studies investigated the effect of ISB splinting, 2 articles evaluated ISB height, and 2 studies focused on the effect of ISB material on scan accuracy. In addition, 8 studies involved ISBs fabricated with different materials (1- and 2-piece polyetheretherketone and 1-piece titanium ISBs), and all of the reviewed articles tested screw-retained ISBs, except for 3 in vitro studies. CONCLUSIONS The findings did not enable concrete conclusions regarding the optimal ISB design, whether there is a relationship between IOS technology and a specific ISB design, or the clinical condition that maximizes intraoral scanning accuracy. Research efforts are needed to identify the optimal ISB design and its possible relationship with the IOS selected for acquiring intraoral digital implant scans.
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Affiliation(s)
- Miguel Gómez-Polo
- Department of Prosthetic Dentistry, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Mustafa Borga Donmez
- Department of Prosthodontics, Faculty of Dentistry, Istinye Univeristy, İstanbul, Turkey
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Gülce Çakmak
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, University of Washington, Seattle, Washington, USA
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
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Revilla-León M, Lanis A, Yilmaz B, Kois JC, Gallucci GO. Intraoral digital implant scans: Parameters to improve accuracy. J Prosthodont 2023; 32:150-164. [PMID: 37586762 DOI: 10.1111/jopr.13749] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE To report the means to maximize the predictability and accuracy of intraoral digital implant scans through the evaluation of operator and patient-related factors. MATERIALS AND METHODS A search of published articles related to factors that can decrease the scanning accuracy of intraoral digital implant scans was completed in four data sources:MEDLINE, EMBASE, EBSCO, and Web of Science. All studies related to variables that can influence the accuracy of intraoral digital implant scans obtained by using intraoral scanners (IOSs) were considered. These variables included ambient lighting, scanning pattern, implant scan body (ISB) design, techniques for splinting ISBs, arch location, implant position, and inter-implant distance. RESULTS Among operator-related factors, ambient lighting conditions, scanning pattern, and ISB design (material, geometry, and retention design) can impact the accuracy of intraoral digital implant scans. The optimal ISB for maximizing IOS accuracy is unclear; however, polymer ISB can wear with multiple reuse and sterilization methods. Among patient-related factors, additional variables should be considered, namely arch (maxillary vs. mandibular arch), implant position in the arch, inter-implant distance, implant depth, and angulation. CONCLUSIONS Ambient lighting conditions should be established based on the IOS selected to optimize the accuracy of intraoral digital implant scans. The optimal scanning pattern may vary based on the IOS, clinical situation, and the number of implants. The optimal ISB design may vary depending on the IOS used. Metallic implant scan bodies are preferred over polymer ISB designs to minimize wear due to multiple use and sterilization distortion. Among patient-related factors, additional variables should be considered namely the arch scanned, implant position in the arch, inter-implant distance, implant depth, and angulation. The impact of these factors may vary depending on the IOS selected.
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Affiliation(s)
- Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Alejandro Lanis
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - John C Kois
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Private Practice, Seattle, Washington, USA
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Ashraf Y, Abo El Fadl A, Hamdy A, Ebeid K. Effect of different intraoral scanners and scanbody splinting on accuracy of scanning implant-supported full arch fixed prosthesis. J ESTHET RESTOR DENT 2023; 35:1257-1263. [PMID: 37310208 DOI: 10.1111/jerd.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study evaluated the accuracy of different intraoral scanners (IOS) for scanning of implant-supported full arch fixed prosthesis with different implant angulations with and without scanbodies splinting. MATERIALS AND METHODS Two maxillary models were designed and fabricated to receive an all-on-four implant retained. The models were divided into two groups according to the angulation of the posterior implant (Group 1; 30 and Group 2; 45). Each group was then divided into three subgroups according to the type of IOS used: Subgroup C; Primescan, subgroup T; Trios4, and subgroup M; Medit i600. Then each subgroup was divided into two divisions according to scanning technique; division S: splinted and division N: nonsplinted. Ten scans were made by each scanner for every division. Trueness and precision were analyzed using Geomagic controlX analysis software. RESULTS Angulation had no significant effect on both the trueness (p = 0.854) and precision (p = 0.347). Splinting had a significant effect on trueness and precision (p < 0.001). Scanner type had a significant effect on trueness (p < 0.001) and precision (p < 0.001). There was no significant difference between trueness of Trios 4 (112.15 ± 12.85) and Primescan (106.75 ± 22.58). However, there was a significant difference when compared to trueness of Medit i600 (158.50 ± 27.65). For the precision results Cerec Primescan showed the highest precision (95.45 ± 33.21). There was a significant difference between the three scanners, precision of Trios4 (109.72 ± 19.24) and Medit i600 (121.21 ± 17.26). CONCLUSION Cerec Primescan has higher trueness and precision than Trios 4 and Medit i600 in full arch implants scanning. Splinting the scanbodies improve the accuracy of full arch implants scanning. CLINICAL SIGNIFICANCE Cerec Primescan and 3Shape Trios 4 can be used for scanning of All-on-four implant supported prosthesis when scanbodies are splinted using a modular chain device.
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Affiliation(s)
- Yasmine Ashraf
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ahmad Abo El Fadl
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Amina Hamdy
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Kamal Ebeid
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Nuytens P, Vandeweghe S, D'haese R. Accuracy of a chairside reverse scanbody workflow for a complete arch implant-supported prosthesis using four intraoral scanners versus a desktop scanner. J Dent 2023; 138:104717. [PMID: 37739058 DOI: 10.1016/j.jdent.2023.104717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of a chairside reverse scanbody workflow for a complete arch implant-supported prosthesis using four intraoral scanners (IOSs) and a desktop scanner. MATERIAL AND METHODS A complete arch implant-supported interim prosthesis was designed and milled in polymethylmethacrylate. Six reverse scanbodies (ScAnalog) were connected to the implant-prosthetic connections and twenty scans were made extraorally using four IOS devices (TRIOS 3, TRIOS 5, Primescan v.5.2, Medit i700W) and one desktop scanner (E4 RED). A coordinate machine (ATOS Q GOM) was used to assess the milling distortion. The scanbody positions were compared to the reference CAD design using metrology software. Linear and angular measurements per implant-prosthetic connection were considered for trueness and precision. Data were analyzed using one-way ANOVA and Bonferroni test. RESULTS Trueness values were 118.14 ± 25.49 µm for TRIOS 3, 84.62 µm ±19.10 for TRIOS 5, 106.39 ± 27.58 µm for Primescan v.5.2, 120.25 ± 27.44 µm for Medit i700W and 65.36 ± 4.66 µm for E4 RED. Significant differences in mean trueness values were found among IOS and E4 RED. Precision values were 108 ± 55 µm for TRIOS 3, 86 ± 55 µm for TRIOS 5, 104 ± 55 µm for Primescan v.5.2, 90 ± 54 µm for Medit i700W and 18 ± 11 µm for E4 RED. Significant differences in precision were found between IOS and E4 RED. CONCLUSIONS A chairside reverse scanbody workflow with IOS remains less accurate compared to similar workflow with a desktop scanner. CLINICAL SIGNIFICANCE A chairside reverse scanbody workflow is a valuable alternative but the IOS device should be selected with caution because in the present study, only TRIOS5 was capable to achieve an accuracy below the clinical acceptable thresholds. The use of a desktop scanner remains the best choice for this clinical workflow. Additionally, the milling distortion of the interim prosthesis plays a major role in this reverse scanbody workflow and should be kept as low as possible.
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Affiliation(s)
- Philippe Nuytens
- Department of Reconstructive Dentistry, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent 9000, Belgium.
| | - Stefan Vandeweghe
- Department of Reconstructive Dentistry, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Rani D'haese
- Department of Reconstructive Dentistry, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent 9000, Belgium
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