Effect of scan substrates on accuracy of 7 intraoral digital impression systems using human maxilla model

Effect of substrate material and abutment geometry on the accuracy of intraoral scanning: An in vitro study

STATEMENT OF PROBLEM

Digital scanning is gradually replacing conventional impression making, but consensus on how tooth preparation influences the accuracy of intraoral scanning is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of substrate material and abutment geometry on the accuracy of digital casts obtained by intraoral scanning.

MATERIAL AND METHODS

The height and total occlusal convergence (TOC) angle were measured in 5 different groups that contained 5 specimens of different materials: natural tooth, cobalt chromium alloy, titanium, zirconium dioxide ceramic, and resin. The specimens were scanned with an industrial scanner to obtain reference data. Each specimen was placed in a maxillary standard dentition model that was assembled in a head simulator. Each dentition model was scanned 10 times with an intraoral scanner (IOS) under operatory lighting conditions to acquire intraoral scanning files for each specimen. All data were imported into a metrology software program and processed. A total of 10 trueness deviations, the mean superimposition results between IOS scanning data and reference data, and precision deviations, the mean superimposition results between IOS scanning data in pairs, were recorded. Two-way analysis of variance (ANOVA) and Tukey multiple comparison test were used to analyze the accuracy of intraoral scanning in relation to the height or TOC angle of the abutment (α=.05). The total means of each substrate material were compared with the Kruskal-Wallis test and Dunn test for multiple comparisons.

RESULTS

The accuracy of scanning images was related to material and abutment geometry (P<.05). Bias was larger as abutment height increased with most substrates. Larger TOC angles increased the accuracy of the digital scans. The trueness deviation of translucent materials and the precision deviation of reflective materials were generally larger.

CONCLUSIONS

Substrate material and abutment geometry influence the accuracy of intraoral scanning. The accuracy of IOS generally tended to improve with decreasing height and increasing TOC angle and was affected by different substrates.

Evaluation of the effect of different core substrates on the accuracy of intraoral scanners

BACKGROUND

The aim of this study was to determine if different types of core substrates have any effect on the trueness and precision of digital intraoral impressions.

MATERIAL AND METHODS

A customized typodont with four similar cores of natural dentine, composite, metal (Ni-Cr), and zirconia in the position of premolars was fabricated. The study model was scanned five times with two types of intraoral scanners (Carestream 3600 and 3Shape Trios 3), and a reference standard scan was obtained using a laboratory scanner (3shape D1000). A metrology software (Geomagic X) was used to align the data of experimental scans and the reference scan to determine deviation values (trueness). Precision values were calculated with random superimposition in each intraoral scanner group. The Kruskal-Wallis test was used to compare differences between different substrates, and the Mann-Whitney test was used to compare the average values between the two scanners.

RESULTS

Trios 3 was found to be significantly truer and more precise than Carestream 3600 (p value = .005, <0.001). There were no significant differences in the trueness of different substrates when they were scanned by Trios 3, while different materials showed significantly different trueness values in the Carestream 3600 group (p value = .003). Dentin showed the best trueness, and zirconia performed worse than other substrates. Regarding the precision of the scanners, neither of the scanners was affected by the type of scanning substrate.

CONCLUSION

For Carestream 3600, substrate type did impact the trueness of intraoral scans, with dentin and zirconia showing the highest and lowest accuracy, respectively, while Trios 3 was similarly accurate across all substrates. Trios 3 had both higher trueness and precision than Carestream 3600.

Influence of ambient light conditions on intraoral scanning: A systematic review

PURPOSE

To systematically assess the influence of ambient light on the accuracy and scanning time of intraoral scanning.

STUDY SELECTION

The present systematic review (CRD 42022346672) was registered at the International Prospective Register of Systematic Reviews (PROSPERO) and was performed based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Electronic searches were conducted using PubMed, Web of Science, and EMBASE, complemented by gray literature, references, and citations of the included studies. The primary outcome was accuracy, and the scanning time was a secondary outcome. Owing to the high heterogeneity, the pooled data were analyzed descriptively.

RESULTS

Six in vitro and two in vivo experiments were performed. Three in vitro studies reported both the accuracy and scanning time of the intraoral scans, whereas the remaining studies exclusively evaluated the accuracy. The studies mainly investigated the influence of illumination levels (0-11000 lux) on intraoral scanning. Intraoral scans revealed optimal accuracy at 1000-lux illumination for complete-arch dentition scans, whereas the influence of illumination levels on 4-unit or shorter scans was not clinically significant. The intraoral scans obtained using confocal microscopy were less affected by the illumination levels than those obtained using the active triangulation technique. Furthermore, the scanning time tended to increase with increasing illumination.

CONCLUSIONS

Evidently from the limited number of studies conducted, ambient light illumination had considerable influence on the accuracy and scanning time of intraoral scanning, which appeared to be related to the scanning range and imaging technology.

Trueness and precision of complete arch dentate digital models produced by intraoral and desktop scanners: An ex-vivo study

OBJECTIVES

The study aimed to compare the trueness and precision of five intraoral scanners (Emerald S, iTero Element 5D, Medit i700, Primescan, and Trios 4) and two indirect digitization techniques for both teeth and soft tissues on fresh mandibular and maxillary cadaver jaws.

METHODS

The maxilla and mandible of a fully dentate cadaver were scanned by the ATOS industrial scanner to create a master model. Then, the specimens were scanned eight times by each intraoral scanner (IOS). In addition, 8 polyvinylsiloxane (PVS) impressions were made and digitized with a Medit T710 desktop scanner. Stone models were then poured and again scanned with the desktop scanner. All IOS, PVS, and stone models were compared to the master model to calculate the mean absolute surface deviation for mandibular teeth, maxillary teeth, and palate.

RESULTS

For mandibular teeth, the PVS trueness was only significantly better than the Medit i700 (p < 0.001) and Primescan (p < 0.05). In maxillary teeth, the PVS trueness was significantly better than all IOSs (p < 0.05-0.001); the stone trueness was significantly better than Emerald S (p < 0.01), Medit i700 (p < 0.001) and Primescan (p < 0.01). In the palate, PVS and stone trueness were significantly lower than the iTero Element 5D (p < 0.01) and Trios 4 (p < p < 0.01). Stone trueness was significantly lower than the Medit i700 (p < 0.05). The precision in the palate was significantly lower for PVS and stone than for Emerald S (p < 0.01, p < 0.05), iTero Element 5D (p < 0.01, p < 0.01), Primescan (p < 0.001, p < 0.001), and Trios 4 (p < 0.001, p < 0.01). Significant differences in trueness between the IOSs were observed only in the mandibular teeth. The Medit i700 performed worse than Emerald S (p < 0.01) and iTero Element 5D (p < 0.01). For mandibular teeth, the Medit i700 was significantly more precise than Primescan (p < 0.01) and the Emerald S (p < 0.05). The Trios 4 was significantly less precise than Emerald S (p < 0.05). The precision of Medit i700 was significantly worse than iTero Element 5D (p < 0.01) for maxillary teeth, as well as the Primescan (p < 0.01) and Trios 4 (p < 0.05) for the palate.

CONCLUSIONS

In general, indirectly digitized models from PVS impressions had higher trueness than IOS for maxillary teeth; precision between the two methods was similar. IOS was more accurate for palatal tissues. The differences in trueness and precision for mandibular teeth between the various techniques were negligible.

CLINICAL SIGNIFICANCE

All investigated IOSs and indirect digitization could be used for complete arch scanning in mandibular and maxillary dentate arches. However, direct optical digitization is preferable for the palate due to the low accuracy of physical impression techniques for soft tissues.

Effect of substrate adjacent to the scan region on the trueness of four intraoral scanners: An in vitro study

OBJECTIVES

The purpose of this in vitro study was to evaluate the trueness of four commercially available intraoral scanners (IOSs) on scanning different substrates that existed in the adjacent proximal contact area.

METHODS

Four IOSs (TRIOS 4, TRIOS 3, Primescan, Omnicam) were used for scanning the intact enamel surface of a molar tooth, and six restorative materials (zirconia, lithium disilicate glass-ceramic, composite resin, hybrid ceramic, feldspathic ceramic, metal) that were located at the adjacent proximal contact area of the same tooth. Reference scans were obtained using an extraoral scanner (inEos X5). A 3-dimensional analyzing software (Geomagic Control X) was used to compare the reference and tested scans. The two-way analysis of variance (ANOVA) followed by Bonferroni correction was performed for statistical analyses (α=0.05).

RESULTS

TRIOS 3 and TRIOS 4 showed higher trueness than Primescan, and Primescan showed higher trueness than Omnicam (p<0.001), while there were no differences between TRIOS 3 and TRIOS 4. Metal showed significantly higher Root Mean Square values (0.273 ± 0.24 mm) than other substrates. No difference was found between the scanners' zirconia, lithium disilicate glass-ceramic, composite, and feldspathic ceramic scans (p > 0.05). For the metal, TRIOS 3 and TRIOS 4 showed higher trueness than Primescan and Omnicam, while Omnicam showed lower trueness among all scanners. For the hybrid ceramic, TRIOS 3 showed higher trueness than Omnicam (p<0.001). For the enamel, TRIOS 3 showed higher trueness than Primescan and Omnicam (p<0.001).

CONCLUSIONS

The trueness of IOSs can be affected by the substrates that exist in the proximal contact area. Amongst all, the metal substrate affected most the trueness of the IOSs.

CLINICAL SIGNIFICANCE

The clinician should decide on the impression system, taking into account that the IOS and the surfaces to be scanned affect the trueness of the digital data. The deviation of the digital impression would be high in the presence of a metal restoration on the adjacent proximal surface.

Effect of novel prefabricated auxiliary devices attaching to scan bodies on the accuracy of intraoral scanning of complete-arch with multiple implants: An in-vitro study

OBJECTIVES

To examine the effect of novel prefabricated auxiliary devices with different geometric features called Scan Body Clasp (SBC) at different levels on the accuracy of intraoral scanning of complete-arch with multiple implants.

METHODS

An edentulous maxilla 4-implant model and SBCs with different geometric features (flat or curved) were fabricated by a 3D printer (AccuFab-C1s, 3DShining, Hangzhou, China). Test scans were performed using an intraoral scanner (Aoralscan 3, 3DShining, Hangzhou, China) software version 1.0.0.3104 under different scenarios: group A (CO), without any SBCs; group B&C (LC&HC), with curved SBCs adjacent to and away from the mucosa; group D&E (LF&HF), with flat SBCs adjacent to and away from the mucosa. 20 scans were done for each group (CO, LC, HC, LF and HF). Reference Scans were obtained by digitizing the model in group A using a dental laboratory scanner (D2000, 3Shape, Copenhagen, Denmark). The related files were imported into inspection software for trueness and precision assessment. Statistical analysis was performed with One-way ANOVA, Independent-Sample T test for trueness values. Kruskal-Wallis test and Mann-Whitney test were used to assess the precision values. The level of significance was set at α=0.05.

RESULTS

Groups with SBCs demonstrated trueness enhancement, among which LF revealed the best trueness. Significant differences were also found between LF and HC (p < .01), LF and HF (p < .001), LC and HF (p < .01). LF and HF showed precision enhancement. The best precision was LF, which was found to be more precise than LC (p < .001) and HC (p < .001). HF was more precise than LC (p < .001) and HC (p < .001).

CONCLUSIONS

Attaching the scan bodies with SBCs at different levels significantly influenced the scanning accuracy. The SBCs near the mucosa result in superior trueness, while the flat morphology benefits the precision.

CLINICAL SIGNIFICANCE

The results demonstrated the feasibility of the SBCs in enhancing intraoral complete-arch implant scanning accuracy. Among the configurations tested in the present study, low-level and flat surfaces of the artificial landmarks may be the potential pivotal elements to optimizing long-span scanning accuracy.

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.

Effect of relative humidity on the accuracy, scanning time, and number of photograms of dentate complete arch intraoral digital scans

STATEMENT OF PROBLEM

Intraoral scanners (IOSs) have been used in dentistry for diagnostic and treatment purposes; however, the influence of environmental factors such as humidity or temperature on the accuracy of intraoral scanning is uncertain.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of relative humidity and ambient temperature on the accuracy, scanning time, and number of photograms of dentate complete arch intraoral digital scans.

MATERIAL AND METHODS

A completely dentate mandibular typodont was digitized by using a dental laboratory scanner. Four calibrated spheres were attached following the International Organization for Standardization (ISO) standard 20 896. A watertight box was designed to simulate 4 different relative humidity conditions (50%, 70%, 80%, and 90%) (n = 30). An IOS (TRIOS 3) was used to obtain a total of 120 complete arch digital scans (n = 120). Scanning time and number of photograms of each specimen were recorded. All the scans were exported and compared with the master cast by using a reverse engineering software program. The linear distances among the reference spheres were used to calculate trueness and precision. A unifactorial analysis of variance (ANOVA) and Levene tests followed by the post hoc Bonferroni test were used to analyze trueness and precision data, respectively. A unifactorial ANOVA followed by a post hoc Bonferroni test was also conducted to analyze scanning time and the number of photogram data.

RESULTS

Statistically significant differences were found in trueness, precision, number of photograms, and scanning time (P<.05). Regarding trueness and precision, significant differences were found between the 50% and 70% relative humidity groups and the 80% and 90% relative humidity groups (P<.01). Regarding scanning time and number of photograms, significant differences were obtained among all groups, except between the 80% and 90% relative humidity groups (P<.01).

CONCLUSIONS

The relative humidity conditions tested influenced accuracy, scanning time, and number of photograms in complete arch intraoral digital scans. High relative humidity conditions resulted in the decreased scanning accuracy, longer scanning time, and greater number of photograms of complete arch intraoral digital scans.

In Vitro Trueness and Precision of Intraoral Scanners in a Four-Implant Complete-Arch Model

(1) Background: New intraoral (IOS) and laboratory scanners appear in the market and their trueness and precision have not been compared. (2) Methods: Seven IOS and two laboratory scanners were used to scan a mandibular edentulous model with four parallel internal hexagon implant analogues and PEEK scan bodies. Digital models in Standard Tessellation Language (STL) were created. The master model with the scan bodies was scanned (×10) with a computerized numerical control 3D Coordinate Measuring Machine (CMM). The short (distances of adjacent scan posts) and long distances (distances of the scan posts with non-adjacent sites in the arch) among the centroids of the four analogues were calculated using CMM special software. Trueness (comparisons with the master model) and precision (intragroup comparisons) were statistically compared with ANOVA, chi-square and Tukey tests. (3) Results: Laboratory scanners had the best trueness and precision compared to all IOSs for long distances. Only iTero (Align Technologies Inc., Milpitas, CA, USA) had comparable trueness with one laboratory scanner in short and long distances. For short distances, CS3600 (Carestream Health, Inc., Rochester, NY, USA), Omnicam, Primescan (Sirona Dental Sys-tems GmbH, Bens-heim, Germany) and TRIOS 4 (3Shape A/S, Copen-hagen, Denmark) had similar trueness to one laboratory scanner. From those, only Omnicam and Primescan had similar precision as the same laboratory scanner. Most IOSs seem to work better for smaller distances and are less precise in cross-arch distances. (4) Conclusions: The laboratory scanners showed significantly higher trueness and precision than all IOSs tested for the long-distance group; for the short distance, some IOSs were not different in trueness and precision than the laboratory scanners.

Improving intraoral implant scanning with a novel auxiliary device: An in-vitro study

OBJECTIVES

To develop a novel auxiliary device for improving the accuracy of intraoral implant scanning in the complete-edentulous arch.

MATERIALS AND METHODS

A standard model of edentulous maxilla with six dummy implants was prepared. Scan bodies were attached to the model, which was scanned by a laboratory scanner. A simulated mucosa (Group 0), a resin base (Group 1), a resin base with a cuboidal reference block and 4 fiduciary spheres (Group 2) or artificial teeth (Group 3) in between the implants were mounted on the model, respectively. Each group were consecutively scanned using an intraoral scanner (n = 10). The scans were analysed for trueness and precision in inter-implant distances and angles by inspection software. Effects of the auxiliary device and different quadrants on the accuracy of complete-arch intraoral scanning were analysed by two-way ANOVA.

RESULTS

Significant effects of the auxiliary device and quadrant were found on both linear and angular accuracies. The lowest linear accuracy was found in group 0. Group 1 and group 3 showed the best linear accuracy in quadrant 1 and quadrant 2, respectively. Group 2 showed the least angular precision among the three groups.

CONCLUSIONS

The three designs of auxiliary devices significantly improved the accuracy of complete-arch intraoral implant scanning. The base-only design showed good scanning accuracy in a single quadrant, while the base with tooth-shaped landmarks design showed better accuracy in cross-arch. The fiduciary spheres might compromise the precision of scanning.

A Comparison of Accuracy of Different Dental Restorative Materials between Intraoral Scanning and Conventional Impression-Taking: An In Vitro Study

The properties of underlying substrates influence the quality of an intraoral scan, but few studies have compared the outcomes using common restorative materials. In this study, we aimed to compare the accuracy of digital and conventional impressions recorded for four different dental materials as the substrates. Experimental crowns were produced with a metallic surface (gold or cobalt-chromium alloy (Co-Cr)) or without a metallic surface (zirconia or PMMA (polymethyl methacrylate)). A conventional impression was made in the conventional group (CON group), and gypsum models were subsequently scanned with a tabletop scanner. An intraoral scanner was used to scan the crowns either after applying a powder spray to reduce the surface reflectivity (IOS-P group) or without the powder spray (IOS group). The scans were assessed in three dimensions for precision and trueness. The accuracy did not differ between the CON and IOS groups for the non-metallic crowns. However, it was statistically different for the Co-Cr metallic crown, reducing trueness observed between groups as CON > IOS > IOS-P. The study evidences the differences in outer surface accuracy observed with a change in the substrate material to be imaged using an oral scanner and with the impression method. These findings suggest that the restoration material present in the oral cavity should be considered when selecting an impression-taking method.

Evaluation of complete-arch implant scanning with 5 different intraoral scanners in terms of trueness and operator experience

STATEMENT OF PROBLEM

The intraoral scanning of the edentulous arch might be challenging for an inexperienced operator because of the large mucosal area and the use of scan bodies.

PURPOSE

The purpose of this ex vivo study was to compare the trueness of 5 intraoral scanners in replicating implant scan bodies and soft tissues in an edentulous maxilla and to investigate the effects of operator experience.

MATERIAL AND METHODS

The maxilla was resected from a fresh cadaver, 5 implants placed, and a reference scan made. Eight scans were made by experienced operators and 8 by an inexperienced operator with each scanner (iTero Element 2, Medit i500, Primescan, TRIOS 3, TRIOS 4). The implant platform deviation was measured after complete surface alignment and after scan body alignment. Deviation data were analyzed with a generalized linear mixed model (α=.05).

RESULTS

After complete surface alignment, the mean ±standard deviation implant platform deviation was higher for the inexperienced operator (421 ±25 μm) than for experienced ones (191 ±12 μm, P<.001) for all scanners. After scan body alignment, no significant differences were found between operators for Element 2, Primescan, and TRIOS 3. The experienced operators produced a lower deviation for TRIOS 4 (35 ±3.3 μm versus 54 ±3.1 μm, P<.001), but higher deviation for i500 (68 ±4.1 μm versus 57 ±3.6 μm, P<.05). The scanner ranking was Element 2 (63 ±4.1 μm), i500 (57 ±3.6 μm, P=.443), TRIOS 4 (54 ±3.1 μm, P=.591), TRIOS 3 (40 ±3.1 μm, P<.01), Primescan (27 ±1.6 μm, P<.001) for the inexperienced operator and i500 (68 ±4.1 μm), Element 2 (58 ±4.0 μm, P=.141), TRIOS 3 (41 ±2.8 μm, P<.001), TRIOS 4 (35 ±3.3 μm, P=.205), Primescan (28 ±1.8 μm, P=.141) for the experienced operators.

CONCLUSIONS

Mucosal alignment greatly overestimated the platform deviation. The intraoral scanners showed different trueness during the complete-arch implant scanning. The operator experience improved the trueness of the edentulous mucosa but not implant platform deviation.

Design of a Single-Tooth Model and Its Application in Oral Scan System Assessment

Intraoral scanners have been widely used in the application of dentistry. Accuracy includes trueness and precision; they have an important position in the assessment of intraoral scanners. The existing standard models are divided into the inlay and the crown, but the operation is relatively complicated. In this study, in order to simplify the current standard model, we designed a new integration model to compare the accuracy of two intraoral scanners (CEREC and TRIOS) and an extraoral scanner (SHINING). The coordinate measuring machine measured value is the gold standard. Values of the length and angle were analyzed by converting the scanned digital impressions into an STL (standard triangulation language) format to evaluate the accuracy of the intraoral scanner and to verify the feasibility of the designed model. The result shows that the integration model can be successfully scanned and imaged. In the case of the powder-free integration model, intraoral scanner precision, trueness, 3D fitting, and imaging are better than the extraoral scanner. It can be seen straightly from the measurement result and the 3D fitting result that the intraoral scanner can acquire the shape of the standard model integrally with good repeatability. Therefore, it can be concluded that TRIOS is superior to CEREC and SHINING in accuracy, and the integration model is feasible as a reference in the examination of intraoral scanners. The performance of the newly designed integration model that can be scanned is clinically significant, suggesting that this model can be used as a standard reference model.

Accuracy, Labor-Time and Patient-Reported Outcomes with Partially versus Fully Digital Workflow for Flapless Guided Dental Implants Insertion-A Randomized Clinical Trial with One-Year Follow-Up

(1) Background: Prosthetically-driven implant positioning is a prerequisite for long-term successful treatment. Transferring the planned implant position information to the clinical setting could be done using either static or dynamic guided techniques. The 3D model of the bone and surrounding structures is obtained via cone beam computed tomography (CBCT) and the patient's oral condition can be acquired conventionally and then digitalized using a desktop scanner, partially digital workflow (PDW) or digitally with the aid of an intraoral scanner (FDW). The aim of the present randomized clinical trial (RCT) was to compare the accuracy of flapless dental implants insertion in partially edentulous patients with a static surgical template obtained through PDW and FDW. Patient outcome and time spent from data collection to template manufacturing were also compared. (2) Methods: 66 partially edentulous sites (at 49 patients) were randomly assigned to a PDW or FDW for guided implant insertion. Planned and placed implants position were compared by assessing four deviation parameters: 3D error at the entry point, 3D error at the apex, angular deviation, and vertical deviation at entry point. (3) Results: A total of 111 implants were inserted. No implant loss during osseointegration or mechanical and technical complications occurred during the first-year post-implants loading. The mean error at the entry point was 0.44 mm (FDW) and 0.85 (PDW), p ≤ 0.00; at implant apex, 1.03 (FDW) and 1.48 (PDW), p ≤ 0.00; the mean angular deviation, 2.12° (FDW) and 2.48° (PDW), p = 0.03 and the mean depth deviation, 0.45 mm (FDW) and 0.68 mm (PDW), p ≤ 0.00; (4) Conclusions: Despite the statistically significant differences between the groups, and in the limits of the present study, full digital workflow as well as partially digital workflow are predictable methods for accurate prosthetically driven guided implants insertion.

Comparison of the Accuracy of 3D Images Obtained fromDifferent Types of Scanners: A Systematic Review

Introduction

The purpose of this systematic review was to compare the accuracy of the three-dimensional images among different scanners, scanning techniques, and substrates. Materials and methods. Electronic databases (PubMed and Elsevier) were searched until March 2020. The systematic search was performed to identify the most precise method of obtaining a 3D image of the dentition.

Results

Thirteen articles out of 221, considering the accuracy of 3D images, were selected. The main factors that are considered to have an influence on the precision are substrate type in the oral cavity, experience of the scanner's operator, direct vs. indirect scanning, and the reproducibility of the procedure.

Conclusion

Substrate type does have an impact on the overall accuracy of intraoral scans where dentin has the most and enamel the least accurately recorded dental structure. Experience of the operator has an influence on the accuracy, where more experienced operators and smaller scan sizes are made for more accurate scans. A conventional impression technique in a full-arch image provided the lowest deviation. The reproducibility of direct scanning was comparable to indirect scanning although a slight difference was noticeable (0.02 mm).

Marginal and internal fit of full ceramic crowns milled using CADCAM systems on cadaver full arch scans

Background

Chairside systems are becoming more popular for fabricating full-ceramic single restorations, but there is very little knowledge about the effect of the entire workflow process on restoration fit. Therefore, this study aimed to compare the absolute marginal discrepancy (AMD) and the full internal fit (FULL) of all-ceramic crowns made by two chairside systems, Planmeca FIT and CEREC, with detailed and standard mill settings.

Methods

One upper molar was prepared for an all-ceramic crown in human cadaver maxilla. Full-arch scans were made by Emerald or Omnicam four times each. Twenty-four e.max crowns were designed and milled by the Planmill 30s or 40s or CEREC MCXL mills with either detailed or standard settings. The cadaver tooth was extracted, and each crown was fixed on it and scanned by a high-resolution microCT scanner. The AMD and FULL were measured digitally in mesio-distal and bucco-lingual 2D slices. The actual and predicted times of the milling were also registered.

Results

No differences were observed between detailed or standard settings in either system. The AMD was significantly higher with CEREC (132 ± 12 μm) than with either Planmill 30s (71 ± 6.9 μm) or 40s (78 ± 7.7 μm). In standard mode, the FULL was significantly higher with CEREC (224 ± 9.6 μm) than with either Planmill 30s (169 ± 8.1 μm) or 40s (178 ± 8.5 μm). There was no difference between actual and predicted time with the two Planmeca models, but with CEREC, the actual time was significantly higher than the predicted time. The 30s had significantly higher actual and predicted times compared to all other models. Across all models, the average milling time was 7.2 min less in standard mode than in detailed mode.

Conclusions

All fit parameters were in an acceptable range. No differences in fit between Planmeca models suggest no effect of spindle number on accuracy. The detailed setting has no improvement in the marginal or internal fit of the restoration, yet it increases milling time.

Does ambient light affect the accuracy and scanning time of intraoral scans?

STATEMENT OF PROBLEM

Intraoral scanners (IOSs) are based on light-optical imaging methods. However, little is known about whether the ambient light in dental practices influences the accuracy and scanning time of the IOS.

PURPOSE

The purpose of this in vitro study was to investigate the influence of different illuminations on the accuracy of 4-unit and complete-arch scans of 6 IOSs. In addition, the required scanning time was evaluated.

MATERIAL AND METHODS

A reference structure was attached to the first premolars (P) and second molars (M) in both quadrants (L/R) of a maxillary model. The resulting measured distances were M1-P1, M2-P2, P1-P2, and M1-M2. The investigation included 6 IOSs: TRIOS 3 (TRI), Cerec Omnicam (OC), iTero Element (ITE), CS 3600 (CS), Planmeca Emerald (EME), and GC Aadva (AAD). With each IOS, 17 scans at different illuminances (100, 500, 1000, and 5000 lux) were performed (N = 408). The precision and trueness for all distances were determined, and the scanning time was recorded. For statistical analyses, the Levene tests (precision) and 1-way analysis of variance with the post hoc Tukey honestly significant difference and Games-Howell tests (trueness) were calculated.

RESULTS

Illuminance significantly influenced the trueness of 4-unit scans for OC, EME, and AAD. TRI, OC, ITE, and CS demonstrated comparable results. AAD (>96 ±22 μm; 1000 lux) and EME (>248 ±88 μm; 500 lux) revealed greater deviations. For complete-arch scans, illuminance did not influence TRI and AAD, but significant variations were detected for ITE, CS, EME, and AAD. The least deviations were achieved with TRI and OC. The scanning time was extended for all IOSs except ITE at more than 500 lux. The shortest scanning times with OC and EME were recorded at 100 lux; with TRI, CS, and AAD at 500 lux; and with ITE at both 100 and 5000 lux. At all illuminances, the fastest scans were obtained with TRI.

CONCLUSIONS

Ambient light was found to influence the accuracy and scanning time of IOSs. This influence varies depending on the device. For 4-unit scans, the effect was not clinically relevant, but for complete-arch scans, accuracy and scanning time can be improved with appropriate lighting.

Accuracy of intraoral scans in the mixed dentition: a prospective non-randomized comparative clinical trial

OBJECTIVE

In-vivo accuracy of intraoral scans of complete mixed dentitions of patients in active treatment have not yet been investigated. The aim was to test the hypothesis that dimensional differences between intraoral scans and conventional alginate impressions in the mixed dentition are clinically irrelevant.

METHODS

Trial design: Prospective non-randomized comparative clinical trial. Based on sample size calculation 44 evaluable mixed dentition jaws of patients in active orthodontic treatment were included. Each patient received an alginate impression following an intraoral scan (TRIOS® Ortho). Plaster cast was fabricated and scanned with an external scanner (ATOS-SO®). Both STL datasets were analyzed with the 3D inspection and mesh processing software GOM Inspect®. Statistical analysis comprised sample size calculation, t-test as well as nonparametric tests.

RESULTS

The absolute mean difference between digital plaster casts and intraoral scans is 0.022 mm ± 0.027 mm (median 0.015 mm). The obtained measurements are in the range of comparable studies on full arch permanent dentitions. Gender, the size of the jaw represented by the dentition stage and upper respectively lower jaw, as well the malocclusion have no effect on the total deviations between digital plaster casts and intraoral scans. Detectable impression errors were bubbles in fissures and marginal ridges as well as incomplete alginate flow and detachment from the tray. Detectable scanning errors were incomplete distal surface of the most distal molar.

CONCLUSION

Dimensional differences between intraoral scans and conventional alginate impressions in the mixed dentition are clinically irrelevant for orthodontic purposes. In all clinical situations of active treatment in the mixed dentition, the intraoral scans are more detailed and less error-prone.

Diagnosing tooth wear, a new taxonomy based on the revised version of the Tooth Wear Evaluation System (TWES 2.0)

Background

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Physiological tooth wear is a slow process that normally does not lead to any subjective symptoms. When the condition progresses, it can become pathological, and several signs and symptoms may occur. The Tooth Wear Evaluation System (TWES) was described to implement a systematic diagnostic and management approach. Recently, management guidelines were presented in a European Consensus Statement (ECS) as well.

Objectives

To evaluate the TWES in practice and to integrate the principles described in the ECS in order to compose a renewed TWES 2.0 and a new taxonomy.

Methods

The TWES and the recommendations of the ECS were used by dental clinicians, in order to test its applicability in practice.

Results

Agreement was reached that the TWES 2.0 will use a stepwise approach, with a straightforward Tooth Wear Screening part and a more detailed Tooth Wear Status part. Also, the assessment of pathology from the ECS is incorporated in the TWES 2.0 (both classification and taxonomy).

Conclusions

In the TWES 2.0 is described that tooth wear is pathological if moderate/severe/extreme tooth wear is present, in combination with one or several described signs and symptoms. Aetiology can be assessed by findings that indicate a chemical and/or a mechanical cause. The taxonomy may help to identify situations in which preventive (restorative) interventions in early stages of tooth wear can be indicated. The reliability and validity of the adapted parts must be proven.

Comparing the trueness of seven intraoral scanners and a physical impression on dentate human maxilla by a novel method

Backgrounds

Intraoral scanner (IOS) accuracy is commonly evaluated using full-arch surface comparison, which fails to take into consideration the starting position of the scanning (scan origin). Previously a novel method was developed, which takes into account the scan origin and calculates the deviation of predefined identical points between references and test models. This method may reveal the error caused by stitching individual images during intraoral scan. This study aimed to validate the novel method by comparing the trueness of seven IOSs (Element 1, Element 2, Emerald, Omnicam, Planscan, Trios 3, CS 3600) to a physical impression digitized by laboratory scanner which lacks linear stitching problems.

Methods

Digital test models of a dentate human cadaver maxilla were made by IOSs and by laboratory scanner after polyvinylsiloxane impression. All scans started on the occlusal surface of the tooth #15 (universal notation, scan origin) and finished at tooth #2. The reference model and test models were superimposed at the scan origin in GOM Inspect software. Deviations were measured between identical points on three different axes, and the complex 3D deviation was calculated. The effect of scanners, tooth, and axis was statistically analyzed by the generalized linear mixed model.

Results

The deviation gradually increased as the distance from scan origin increased for the IOSs but not for the physical impression. The highest deviation occurred mostly at the apico-coronal axis for the IOSs. The mean deviation of the physical impression (53 ± 2 μm) was not significantly different from the Trios 3 (156 ± 8 μm) and CS 3600 (365 ± 29 μm), but it was significantly lower than the values of Element 1 (531 ± 26 μm), Element 2 (246 ± 11 μm), Emerald (317 ± 13 μm), Omnicam (174 ± 11 μm), Planscan (903 ± 49 μm).

Conclusions

The physical impression was superior compared to the IOSs on dentate full-arch of human cadaver. The novel method could reveal the stitching error of IOSs, which may partly be caused by the difficulties in depth measurement.

A comparison of accuracy of 3 intraoral scanners: A single-blinded in vitro study

STATEMENT OF PROBLEM

Measuring both the trueness and precision of an intraoral scanner (IOS) will provide a thorough understanding of its accuracy.

PURPOSE

The purpose of this in vitro study was to measure the complete-arch trueness and precision of 3 commercially available intraoral scanners equipped with the latest software version and compare them by using a laboratory scanner as reference.

MATERIAL AND METHODS

Nineteen maxillary and 19 mandibular completely dentate stone casts previously acquired from 19 patients by using a polyvinyl siloxane (PVS) dual mix impression and stock trays were scanned with 3 intraoral scanners (TRIOS 3; 3Shape A/S, i500; Medit, and Emerald; Planmeca) using their latest software versions. The same casts were also scanned with a laboratory scanner (E3; 3Shape A/S) that served as the reference scanner. Files were exported in standard tessellation language (STL) format and inserted into a metrology 3D mesh comparison software program (CloudCompare).

RESULTS

In terms of trueness, a significant difference was found among the scanners (F (2.37)=239.7, P<.001). Planmeca Emerald had significantly lower trueness values than either the Medit i500 (P<.001) or the 3Shape A/S TRIOS 3 (P<.001). No significant difference in trueness was found between the Medit i500 and the 3Shape A/S TRIOS 3 scanner (P=.365). In terms of precision, a significant difference was found among the scanners (F (2.89)=301.2, P<.001). The 3Shape A/S TRIOS 3 scanner was significantly more precise than the other scanners (P<.001 for both the Medit i500 and Planmeca Emerald). The Planmeca scanner was significantly more precise than the Medit i500 scanner (P<.001). Concerning the ability of the scanners to reproduce the files of the reference scanner without overestimation or underestimation, the Medit i500 produced files that significantly underestimated the reference scanner's files (t (37)=-12.4, P<.001). The other scanners did not significantly either underestimate or overestimate the files of the standard (t (37)=-1.91, P=.062 for the TRIOS 3 and t (37)=1.64, P=.101 for the Planmeca) CONCLUSIONS: With regard to completely dentate arch trueness, the Planmeca Emerald IOS had statistically lower trueness. With regard to complete dentate arch precision, the 3Shape A/S TRIOS 3 IOS was the statistically more precise scanner. With regard to reference scanner file estimation, the Medit i500 IOS produced files that significantly underestimated the reference scanner files. All 3 tested scanners exhibited a completely dentate arch average accuracy below 100 μm in vitro.

The effect different substrates have on the trueness and precision of eight different intraoral scanners

OBJECTIVE

This in vitro study compares the newest generation of intraoral scanners to their older counterparts, and tests whether material substrates affect the trueness and precision of intraoral scanners (IOS).

MATERIAL AND METHODS

A custom model, used as the reference standard, was fabricated with teeth composed of different dental materials. The reference standard scan was obtained using a three-dimensional (3D) optical scanner, the ATOS III. Experimental scans were obtained using eight different IOS, operated by experienced clinicians, using the manufacturer's recommended scanning strategy. A comprehensive metrology program, Geomagic Control X, was used to compare the reference standard scan with the experimental scans.

RESULTS

For all scanners tested, except Trios3, the substrate does influence the trueness and precision of the scan. Furthermore, differences exist when comparing the same substrate across different scanners with some of the latest generation scanners clearly leaping ahead of the older generation regarding both trueness and precision.

CONCLUSIONS

Substrate type affects the trueness and precision of a scan. Active Triangulation scanners are more sensitive to substrate differences than their parallel confocal counterparts. Some scanners scan certain substrates better, but in general the new generation of scanners outperforms the old, across all substrates.

CLINICAL SIGNIFICANCE

The substrates being scanned play an import role in the trueness and precision of the 3D model. The new generation of scanners is remarkably accurate across all substrates and for complete-arch scanning.