Accuracy of digital impressions versus conventional impressions for 2 implants: an in vitro study evaluating the effect of implant angulation

Accuracy of conventional impressions and digital scans for implant-supported fixed prostheses in maxillary free-ended partial edentulism: An in vitro study

OBJECTIVES

To evaluate the accuracy of conventional polyether impressions and digital scans produced by five intra-oral scanners (IOSs) in maxillary free-ended partial edentulism for long-span implant-supported prostheses.

METHODS

This in vitro study involved the impression of a maxillary model with free-end partial edentulism, in which six implants were placed before digitization using a desktop scanner to generate a digital reference model. Conventional impressions (Impregum Penta Soft, 3M) and digital scans with five IOSs (Trios 3 and 4, 3Shape; Primescan, Dentsply-Sirona; CS 3600, Carestream Dental; and i-500, Medit) were obtained. Conventional impressions were digitized using the same desktop scanner. Each digital STL file of conventional or digital impressions was superimposed over the reference STL file to enable comparison. Trueness was assessed by calculating angles and distance deviations. For precision, dispersions of values around their means were also measured.

RESULTS

The mean distance deviation was significantly higher for conventional impressions (454.24 ± 334.70 µm) than for IOSs (ranging from 160.98 ± 204.48 µm to 255.56 ± 395.89 µm) (p < 0.001). The mean angular deviation was high with conventional impressions (1.82 ± 1.51°), intermediate with CS 3600 (1.38 ± 1.42°), Primescan (1.37 ± 2.54°) and Trios 4 (1.30 ± 0.64°) scanners, and lower with I500 (0.97 ± 0.75°) and Trios 3 (1.01 ± 0.85°) scanners (p < 0.001). The dispersion of distance values around their means was lowest with Trios 3 and i-500, followed by CS3600, Primescan, and Trios 4, respectively, and higher for conventional impressions (p < 0.001). The dispersion of angular values was smallest with i-500, Trios 3, and Trios 4 compared with other groups and was highest with Primescan (p < 0.001).

CONCLUSIONS

Within the limits of the current study, Trios 3 scanner exhibited the highest accuracy, followed by i-500, Trios 4, CS 3600, Primescan, and conventional impressions respectively. IOSs might be reliable for the fabrication of an implant-supported prosthesis. In vivo studies are required to confirm these findings.

CLINICAL SIGNIFICANCE

Passive adaptation of the implant-supported framework is a challenge when rehabilitating patients with maxillary free-end partial edentulism. While Conventional impressions remain a reliable and validated technique, but IOSs demonstrated higher accuracy, suitable for the fabrication of long-span implant-supported prostheses in partially edentulous arch.

Influence of Implant Adjacent Teeth on the Accuracy of Digital Impression

OBJECTIVE

 The aim of this study was to evaluate the effect of adjacent teeth patterns on the accuracy of digital scans of parallel and divergent implants for three-unit prostheses.

MATERIALS AND METHODS

 A maxillary typodont model with implants in the locations of the first premolars and first molars was used to develop three clinical scenarios for three-unit prostheses: (S1) Partially edentulous arch with missing first premolars and first molars only; (S2) partially edentulous arch with missing first premolars, second premolars and first molars; and (S3) partially edentulous arch with missing canines, first premolars, second premolars, first molars, and second molars. On one side, the implants were parallel, and for the other side, the implants had a 15-degree buccolingual angle. With the aid of scan bodies, 10 digital impressions were taken for each scenario and for each side. To evaluate the accuracy, a reverse engineering software was used to measure trueness, precision, and interimplant distance.

RESULTS

 The best trueness for parallel implants was observed for S2 (30.0 µm), followed by S3 (67.3 µm) and S1 (74.8 µm) (p < 0.001). Likewise, S2 had the best precision for parallel implants (31.3 µm) followed by S3 (38.0 µm) and S1 (70.3 µm) (p < 0.001). For the divergent implants, S2 exhibited the best trueness (23.1 µm), followed by S3 (48.2 µm) and S1 (59.4 µm) (p = 0.007). Similarly, the S2 had the best precision (12.3 µm) followed by S3 (62.1 µm) and S1 (66.9 µm) (p < 0.001). The S2 had the least interimplant distance deviation followed by S1 and S3. The difference was significant for parallel implants (p = 0.03), but insignificant for divergent implants (p = 0.15).

CONCLUSION

 Regardless of the presenting scenario, digital implant impressions for three-unit prostheses appear to be clinically accurate. A clear interimplant area between scan bodies enhanced the accuracy of digital impressions. This observation can be attributed to more accessible axial surface scanning of the scan body.

Influence of parallel pins on the angle deviation for placement of dental implants: an in vitro study

The aim of the present study was to analyze and compare the angle deviation of two, four and six adjacent dental implants placed with and without straight parallel pins.

MATERIALS AND METHODS

Two hundred and forty (240) dental implants were selected and randomly allocated into the following study groups: Two dental implants placed with straight parallel pins (Ref.: 144-100, BioHorizons, Birmingham, AL, USA) (n = 10) (2PP); Two dental implants placed without parallel pins (n = 10) (2withoutPP); Four dental implants placed with straight parallel pins hT(n = 10) (4PP); Four dental implants placed without parallel pins (n = 10) (4withoutPP); Six dental implants placed with straight parallel pins (n = 10) (6PP) and Six dental implants placed without parallel pins (n = 10) (6withoutPP). The dental implants randomly assigned to groups 2PP and 2withoutPP were placed into standardized polyurethane models of partially edentulous upper jaws in tooth positions 2.4 and 2.6, the dental implants randomly assigned to groups 4PP and 4withoutPP were placed into standardized polyurethane models of fully edentulous upper jaws in tooth positions 1.6, 1.4, 2.4 and 2.6, and the dental implants randomly assigned to groups 6PP and 6withoutPP were placed into standardized polyurethane models of fully edentulous upper jaws in tooth positions 1.6, 1.4, 1.2, 2.2, 2.4 and 2.6. Afterwards, postoperative CBCT scans and digital impressions were aligned in a 3D implant-planning software to compare the angle deviation (°) of two, four and six adjacent dental implants placed with and without straight parallel pins using the General Linear Model statistical analysis.

RESULTS

Statistically significant differences were found between the angle deviation of 2 dental implants placed with straight parallel pins (p < 0.0001) and between the angle deviation of 4 dental implants placed with straight parallel pins (p = 0.0024); however, no statistically significant differences were found in the angle deviation of 6 dental implants placed with straight parallel pins (p = 0.9967).

CONCLUSION

The use of a straight parallelization pin results in lower angle deviation between two and four adjacent dental implants; however, it is not effective for a larger number of dental implants.

Chairside 3-D printed impression trays: a new approach to increase the accuracy of conventional implant impression taking? An in vitro study

PURPOSE

A high transfer accuracy of the intraoral implant position to a model is required, to manufacture implant-supported restorations. However, clinically relevant deviations persist between the intraoral implant position and the model obtained, even for the benchmark conventional custom implant impressions with polyether. Thus, new approaches using 3-D printed impression trays may increase the transfer accuracy of implant impressions. The ability to adjust parameters such as the thickness of the layers and the influence of the openings in the impression tray could potentially affect accuracy.

METHODS

Four different types of impression trays (n = 10 for each group) for the conventional impression technique were investigated: conventional custom impression tray, customized foil tray, chairside 3-D printed impression tray with the SHERA system, and the Primeprint system using an implant master model with four implants in the posterior region and a reference cube. After plaster model casting, all models were measured using a coordinate measuring machine, and the deviation from the reference dataset was determined. A statistical ANOVA analysis was performed (p < 0.05).

RESULTS

Chairside 3-D printed impression trays showed the best results, followed by conventional custom impression trays. Implant impressions obtained using a customized foil tray exhibited the lowest accuracy. Statistically significant differences were observed between 3-D printed impression trays and conventional custom impression and customized foil trays (p < 0.05). Whereas, the implant position did not have any significant influence on accuracy (p > 0.05).

CONCLUSIONS

Chairside 3-D printed impression trays significantly increase the transfer accuracy for implant impression taking.

Effect of angulation on the 3D trueness of conventional and digital implant impressions for multi-unit restorations

PURPOSE

The study aimed to determine the influence of implant angulation on the trueness of multi-unit implant impressions taken through different techniques and strategies.

MATERIALS AND METHODS

As reference models, three partially edentulous mandibular models (Model 1: No angulation; Model 2: No angulation for #33, 15-degree distal angulation for #35 and #37; Model 3: No angulation for #33, 25-degree distal angulation for #35 and #37) were created by modifying the angulations of implant analogues. Using a lab scanner, these reference models were scanned. The obtained data were preserved and utilized as virtual references. Three intraoral scanning (IOS) strategies: IOS-Omnicam, ISO-Quadrant, and IOS-Consecutive, as well as two traaditional techniques: splinted open tray (OT) and closed tray (CT), were used to create impressions from each reference model. The best-fit alignment approach was used to sequentially superimpose the reference and test scan data. Computations and statistical analysis of angular (AD), linear (LD), and 3D deviations (RMS) were performed.

RESULTS

Model type, impression technique, as well as interaction factor, all demonstrated a significant influence on AD and LD values for all implant locations (P < .05). The Model 1 and SOT techniques displayed the lowest mean AD and LD values across all implant locations. When considering interaction factors, CT-Model 3 and SOT-Model 1 exhibited the highest and lowest mean AD and LD values, respectively. Model type, impression technique, and interaction factor all revealed significant effects on RMS values (P ≤ .001). CT-Model 3 and SOT-Model 1 presented the highest and lowest mean RMS values, respectively.

CONCLUSION

Splinted-OT and IOS-Omnicam are recommended for multi-unit implant impressions to enhance trueness, potentially benefiting subsequent manufacturing stages.

Influence of intraoral conditions on the accuracy of digital and conventional implant impression techniques for two-implant-supported fixed dental prostheses

PURPOSE

To compare the trueness and precision of different impression techniques for two-implant-supported fixed dental prostheses between extraoral and intraoral conditions at different locations.

METHODS

Six volunteers participated in this study. A resin block with two parallel analogs was fabricated as an implant site simulator (ISS). The ISS was bonded to a molded ethylene vinyl acetate sheet to create a reference model. For each participant, four reference models were prepared based on the locations of the ISSs: maxillary posterior/anterior region (MaxP/MaxA) and mandibular posterior/anterior region (ManP/ManA). Five impressions were taken extraorally using the open-tray (conventional implant impression technique, CIT) and intraoral scanning (digital implant impression technique, DIT) techniques. The reference models were positioned in the participants' mouths, and impressions were obtained intraorally using the CIT and DIT. The interanalog distance (d) and angulation (θ) were measured to calculate trueness (Δd, Δθ) and precision (dP, θP). Two-way ANOVA and t tests were performed (α=0.05).

RESULTS

For the DIT, under intraoral conditions, the Δd and Δθ in MaxP and Δθ in ManP were significantly higher than those under extraoral conditions. For the CIT, under intraoral conditions, the Δd and Δθ in ManA and ManP and Δθ in MaxP were significantly lower than those under extraoral conditions. No significant differences in the dP and θP of either DIT or CIT were observed between the two conditions.

CONCLUSIONS

Intraoral conditions affected the trueness of DIT and CIT in different regions but had no influence on precision.

Effect of inter-dental abutment distance on the impression accuracy of digital and conventional methods

This study aimed to examine the effect of inter-dental abutment distance on the accuracy of digital and conventional impression methods. Five maxillary and mandibular models were prepared with different inter-dental abutment distances. Digital scans were obtained using an extraoral laboratory scanner as reference data. Each group was scanned 8 times using the intra-oral scanner for the digital method. For the conventional impression method, 8 additional silicone impression material was used to generate the stone casts from each group. Then casts were scanned. In the next step, stereolithography (STL) data was exported from the scans. The STL files were super-imposed on the reference scans using 3shape dental designer software to make the measurement. Kolmogorov-Smirnoff was used to determine if the data were normally distributed. In the digital impression method, as the abutment distance increased, the accuracy decreased. Various inter-dental abutment distances in digital groups showed significant differences (p=0.016) in impression accuracy, while the difference among conventional groups was not statistically significant (p=0.822). In the digital method, the mean inter-dental abutment between the 4-5 and 3-7 groups, 4-6 and 3-7 groups had a significant difference (p<0.05). However, the conventional method revealed no significant differences (p>0.05) between groups. In conclusion, when the inter-dental abutment distance exists and is surrounded by soft tissue, the possibility of error in the digital impression method is higher than in the conventional impression method.

Digital assessment of the accuracy of implant impression techniques in free end saddle partially edentulous patients. A controlled clinical trial

Objectives

This in vivo study aims to assess the accuracy of the digital intraoral implant impression technique, the conventional closed-tray impression technique, and open-tray impression techniques in a standardized method of data segmentation along with the best-fit algorithm to overcome the inconsistency of results of previous studies regarding implant impression techniques.

Materials and methods

Sixteen implants were placed in eight patients. Each patient has undergone four impression techniques: direct intraoral scanning of the stock abutment, intraoral scanning using a scan body, conventional closed tray impression technique, and the conventional open tray impression technique. The conventional impressions were poured into stone casts with analogues and stock abutments and scanned using a desktop scanner. In intraoral scanning of the scan body, computer-aided design software was used for the replacement of the scan body with a custom-made abutment that is identical to the stock abutment, allowing comparison with the other impression techniques. The deviation in implant position between the groups was measured using special 3D inspection and metrology software. Statistical comparisons were carried out between the studied groups using a one-way analysis of variance (ANOVA) test.

Results

The total deviation between groups was compared to the reference group represented by the intraoral scanning of the abutment. The total deviation was statistically significantly different (P = 0.000) among the different studied groups. The mean deviation was recorded as 21.45 ± 3.3 μm, 40.04 ± 4.1 μm, and 47.79 ± 4.6 μm for the intraoral scanning of the scan body, the conventional closed, and open tray, respectively.

Conclusion

For implant impressions in partially edentulous patients, intraoral oral scanning using a scan body significantly improves scanning and overall accuracy. Regarding conventional impressions, the closed-tray impression techniques showed more accuracy than conventional open-tray impressions.

Clinical relevance

Intraoral digital implant impression using scan body offers more accuracy than conventional implant impression techniques for recording posterior implant position in free-end saddle partially edentulous patients.

Accuracy and precision of intraoral scanners for shade matching: A systematic review

STATEMENT OF PROBLEM

The use of intraoral scanners is rising in prosthetic dentistry; however, systematic analysis of their accuracy and precision for shade matching is scarce.

PURPOSE

The purpose of this systematic review was to evaluate the accuracy and precision of intraoral scanners for shade matching.

MATERIAL AND METHODS

In addition to a manual search, an electronic systematic search was conducted on MEDLINE/PubMed, EMBASE, Web of Science, Cochrane, and Scopus databases. English-language original studies published between January 1, 2010 and March 1, 2022 with intraoral or digital scanners were chosen based on the keywords of tooth color or shade selection or determination, color or shade matching, accuracy, validity, or trueness, and precision, repeatability, or reproducibility as inclusive criteria. Two reviewers independently performed the literature search, selected the studies, collected the data from the studies included, and evaluated the quality of the studies included using a quality assessment method and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. A third reviewer resolved disagreements.

RESULTS

A total of 17 articles concerning the shade matching accuracy and precision of intraoral scanners were selected and reviewed. Among them, 4 articles evaluated only accuracy, 4 articles assessed only precision, and 9 articles investigated both accuracy and precision. Ten articles reported low levels of shade matching accuracy for intraoral scanners, while 11 articles reported high levels of shade matching precision for intraoral scanners.

CONCLUSIONS

Based on the current literature, intraoral scanners show acceptable precision but unacceptable accuracy for shade matching.

Accuracy of different laboratory scanners for scanning of implant-supported full arch fixed prosthesis

OBJECTIVE

This study evaluated the accuracy of different laboratory scanners (LS) for scanning of implant-supported full arch fixed prosthesis with different implant angulations.

MATERIALS AND METHODS

Two maxillary models that are designed to receive an all-on-four implant retained prosthesis were fabricated then scanned using five different LS. 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 subdivided into five subgroups according to the type of LS, subgroup T; Medit T710, subgroup I; IneosX5, subgroup E; 3ShapeE4, subgroup A; Autoscan DS-Mix, and subgroup M; Ceramill Map600. An industrial 3D scanner was used as reference scanner, then each model was scanned with 5 LS 10 times. Trueness and precision were analyzed using Geomagic 3D analysis software.

RESULTS

Both scanner type and implant angle had a significant effect on the trueness (p < 0.001). Significant interaction was found between the scanner type and implant angle (p < 0.001). For scanner type tukeys post hoc test revealed highest trueness with the 3Shape E4 (21.3 ± 2.1) and the medit T710 (22.6 ± 2.1) and least trueness with the shining 3D autoscan ds-mix (33.8 ± 3.0). Significantly better trueness was observed with the 30° than the 45° angle. Regarding precision, two-way ANOVA revealed significant effect of the scanner type only (p < 0.001). There were no significant differences between the 3Shape E4, medit T710, Ineos X5, and the Ceramill map600. However, all showed significantly higher precision values when compared to shining 3D autoscan ds-mix.

CONCLUSIONS

All tested scanners showed results within the clinically acceptable range with 3ShapeE4 and Medit T710 showing the highest accuracy.

CLINICAL SIGNIFICANCE

Tested scanners can be used for scanning of All-on-four implant supported prosthesis.

Accuracy of Digital Dental Implants Impression Taking with Intraoral Scanners Compared with Conventional Impression Techniques: A Systematic Review of In Vitro Studies

The aim of this systematic review was to evaluate the in vitro accuracy of dental implants impressions taken with intraoral scanner compared with impressions taken with conventional techniques. Two independent reviewers conducted a systematic electronic search in the PubMed, Web of Science and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "dental implants", "impression accuracy", "digital impression" and "conventional impression". Publication dates ranged from the earliest article available until 31 July 2021. A total of 26 articles fulfilled the inclusion criteria: 14 studies simulated complete edentation (CE), nine partial edentation (PE) and only two simulated a single implant (SI); One study simulated both CE and SI. In cases of PE and SI, most of the studies analyzed found greater accuracy with conventional impression (CI), although digital impression (DI) was also considered adequate. For CE the findings were inconclusive as six studies found greater accuracy with DI, five found better accuracy with CI and four found no differences. According to the results of this systematic review, DI is a valid alternative to CI for implants in PE and SI, although CI appear to be more accurate. For CE the findings were inconclusive, so more studies are needed before DI can be recommended for all implant-supported restorations.

Trueness of digital implant impressions based on implant angulation and scan body materials

Effects of implant angulation on digital implant impression accuracy remain controversial. Therefore, this in vitro study aimed to compare the digital implant impression trueness among models with different implant angulations and scan body materials. Six partially edentulous mandibular models with dental implants on the right second premolar and second molar areas were categorized according to the implant angulation of the distal implant (parallel, or 15° mesially or lingually tilted compared to the mesial implant) and scan body materials (polyetheretherketone or titanium). After scanning each model with intraoral scanners, the root mean square and within-tolerance values were calculated with respect to the reference, and nonparametric statistical tests were performed (α = .05). Scan data from models with the mesially tilted distal implant showed better trueness than the corresponding parallel and lingually tilted groups in terms of root mean square values (p < .017). The root mean square value in the titanium scan body group was lower than that in the polyetheretherketone scan body group (p < .001). However, the percentage within a tolerance of ± .1 mm was higher in the polyetheretherketone scan body group than in the titanium scan body group (p = .001). Intraoral scan data of models where the terminal implant was mesially tilted showed better trueness.