Accuracy of digital and conventional dental implant impressions for fixed partial dentures: A comparative clinical study

Effect of 3D printer, implant analog system, and implant angulation on the accuracy of analog position in implant casts

OBJECTIVES

To evaluate the accumulative effect of 3D printer, implant analog systems, and implant angulation on the accuracy of analog position in implant casts.

METHODS

A reference cast, presenting a case of a three-unit implant-supported prosthesis, was scanned with a coordinate measurement machine, producing the first reference data set (CMM, n = 1). The second reference data set (n = 10) was prepared using an intraoral scanner (IOS) (Trios4). Test quadrant casts were produced using three DLP type 3D printers, Max (MAX UV385), Pro (PRO 4K65 UV), and Nex (NextDent 5100), and three implant analog systems, El (Elos), Nt (Nt-trading), and St (Straumann) (n = 90). Stone casts were also produced via analog impressions (Stone, n = 10). After digitization, the accuracy of 3D distance, local angulation (angle between implants) and global angulation (angle between the implant center axis and an axis perpendicular to the global plane) was evaluated by comparing the reference (CMM, IOS), test (3D print), and control (Stone) groups using metrology software. Data were statistically analyzed using three-way ANOVA and Tukey`s tests (α=0.05).

RESULTS

IOS was truer in 3D implant distance and more precise in capturing local angulation than Stone (p ≤ 0.05). Other measurements were similar between both groups (p > 0.05). The amount of error introduced in the workflow by IOS and 3D printing was mostly similar (p > 0.05). 3D printed casts had similar or even higher accuracy than Stone group (p > 0.05). In most cases, higher trueness was achieved when using PRO 4K65 UV 3D printer and Elos implant analog system (p ≤ 0.05).

CONCLUSION

3D printer, implant analog system, and implant angulation have a significant effect on the accuracy of analog position in implant casts. Limited-span implant-supported cases could be reproduced digitally with similar accuracy as conventional methods.

CLINICAL SIGNIFICANCE

A fully digital workflow with a carefully selected 3D printer and implant analog system can increase the accuracy of digitally produced implant casts with comparable accuracy to conventional workflow.

Comparative Accuracy of Intraoral and Extraoral Digital Workflows for Short Span Implant Supported Fixed Partial Denture Fabrication: An In Vitro Study

BACKGROUND The advent of digital impressions using computer-aided design and manufacturing technology (CAD/CAM) has simplified and improved the fabrication of implant prostheses in dentistry. The conventional impression has several drawbacks, including tray selection, material type, impression technique, impression disinfection, and cast model storage. The inaccuracies caused by distortion and contraction of impression material can be minimized with digital impressions. This study aimed to compare digital dental impressions of 10 working casts made using the Pindex laser removable die system to fabricate parallel drill channels vs 10 working casts made using the Di-Lok plastic tray removable die system. MATERIAL AND METHODS An implant master die with 2 dental implant analogs was fabricated. Ten working casts using the Pindex laser removable die system with parallel drill channels and 10 working casts using the Di-Lok plastic tray removable die system were fabricated. The working casts were scanned using an extra-oral laboratory scanner and the implant master model was scanned with an intra-oral scanner. RESULTS The properties of the casts made using the 2 systems were evaluated and analyzed with ANOVA and post hoc Tukey test. The mean horizontal linear distances between A1B1 (P<0.021), A2B2 (P<0.018), C1D1 (P<0.026), C2D2 (P<0.03), B1C1 (P<0.01), and mean vertical distances between B1A2 (P<0.015), C1D2 (P<0.001), B1B2 (P<0.028), and C1C2 (P<0.001) were significantly different between the Pindex system and Di-Lok tray system as compared to intra-oral scans. CONCLUSIONS Complete digital workflow with intra-oral scans were more than the partial digital workflow with extra-oral scans for the Pindex system and Di-Lok tray systems.

Accuracy of intraoral scanners in different complete arch scan patterns

STATEMENT OF PROBLEM

The accuracy (trueness and precision) of intraoral scanners and complete arch scans remains controversial.

PURPOSE

The purpose of this in vitro study was to compare the trueness and precision of 3 intraoral scanners with various scan patterns.

MATERIAL AND METHODS

Four standard metal spheres were installed on a dental maxillary cast according to American National Standard/American Dental Association (ANSI/ADA) specification no. 132. Six distances among the center of spheres were measured with a coordinate measuring machine and used as references. Four different scanning patterns were assigned: zigzag, occlusal-palatal-buccal, occlusal-buccal-palatal, and molar-to-canine. Dental Wings and TRIOS 3 applied to the first 3 scan patterns, while True Definition applied to all patterns (n=30). Six distances in the scan files were also measured and calculated for relative errors of trueness and precision. A ratio less than 0.0025 was considered acceptable and used for binary outcome analysis. Differences among scanners and scan patterns in terms of trueness and precision were analyzed with the chi-squared test, Fisher exact test, and logistic regression (α=.05).

RESULTS

The zigzag scan pattern from TRIOS 3 and the occlusal-buccal-palatal pattern from True Definition exhibited 100% acceptable precision. TRIOS 3 revealed the highest number of acceptable trueness values in the occlusal-palatal-buccal scan (88.3%). The scan patterns from Dental Wings and TRIOS 3 were related to the trueness. TRIOS 3 and True Definition were 12.8 and 6.4 times more likely to obtain acceptable trueness than Dental Wings (P<.001). The zigzag scan pattern had the highest chance of obtaining acceptable trueness.

CONCLUSIONS

The scan patterns influenced the trueness and precision of the intraoral scanners in different ways. For the best trueness, TRIOS 3 should be applied with an occlusal-palatal-buccal scan pattern, Dental Wings should be applied with a zigzag scan pattern, while True Definition can be used with any scan pattern.

Influence of implant angulation and clinical implant scan body height on the accuracy of complete arch intraoral digital scans

STATEMENT OF PROBLEM

The accuracy of digital implant scans can be affected by the implant angulation, implant depth, or interimplant distance. However, studies analyzing intraoral scanning accuracy with different implant angulations and different scan body heights are scarce.

PURPOSE

The purpose of this in vitro study was to determine the influence of the implant angulation and clinical implant scan body height on the accuracy of complete arch scans.

MATERIAL AND METHODS

Two definitive implant casts with 6 implant analogs (Zimmer Biomet) were obtained: 1 cast had all the implant analogs parallel (GP group), and 1 cast had the implant analogs with divergence of up to 30 degrees (GD group). A coordinate measurement machine (Global Evo 09.15.08) was used to measure the positions of the implant analogs. Each group was divided into 3 subgroups depending on the clinical implant scan body height: 10, 6, and 3 mm. An implant scan body (Elos Accurate Scan Body Brånemark system) was positioned on each implant analog. A total of 10 scans of each subgroup were recorded by using an intraoral scanner (TRIOS 3). Each STL file obtained was imported into a reverse engineering software program (Geomagic), and linear and angular Euclidean measurements were obtained. The Euclidean calculations between the implant analog positions of the definitive implant casts were used as a reference to calculate the discrepancies among the corresponding subgroups. The Kolmogorov-Smirnov test revealed that the lineal measurements were not normally distributed, so the Kruskal-Wallis and pairwise comparison Dunn tests were used (α=.05). The Kolmogorov-Smirnov test revealed that the angular measurements were normally distributed. Therefore, the 2-way ANOVA and pairwise comparison Tukey tests were used (α=.05).

RESULTS

The Kruskal-Wallis test revealed significant differences in the linear Euclidean medians between the GP and GD groups with different clinical implant scan body heights (H(5)=23.18, P<.001). Significant differences in the linear Euclidean medians were computed between the GP-6 and GD-10 subgroups (P=.009), GD-3 and GD-6 subgroups (P=.029), and GD-3 and GD-10 subgroups (P=.001). Two-way ANOVA revealed that the implant angulation (F(1, 3.3437)=28.93, P<.001) and clinical implant scan body height (F(2, 0.4358)=3.77, P=.029) were significant predictors of discrepancies in the angular measurement.

CONCLUSIONS

Implant angulation and clinical scan body height influenced scanning accuracy. The lowest clinical implant scan body height tested had the lowest accuracy in both parallel and angled implants, but statistically significant differences were found only in the angled group.

Accuracy of digital implant impressions obtained using intraoral scanners: a systematic review and meta-analysis of in vivo studies

PURPOSE

This systematic review aimed to investigate the accuracy of intraoral scan (IOS) impressions of implant-supported restorations in in vivo studies.

METHODS

A systematic electronic search and review of studies on the accuracy of IOS implant impressions were conducted to analyze the peer-reviewed literature published between 1989 and August 2023. The bias analysis was performed by two reviewers. Data on the study characteristics, accuracy outcomes, and related variables were extracted. A meta-analysis of randomized control trials was performed to investigate the impact of IOS on peri-implant crestal bone loss and the time involved in the impression procedure.

RESULTS

Ten in vivo studies were included in this systematic review for final analysis. Six studies investigated the trueness of IOS impressions, but did not reach the same conclusions. One study assessed the precision of IOS impressions for a single implant. Four clinical studies examined the accuracy of IOS implant impressions with a follow-up of 1-2 years. In full arches, IOS impression procedure needed significantly less time than conventional one (mean difference for procedure time was 8.59 min [6.78, 10.40 min], P < 0.001), prosthetic survival rate was 100%, and marginal bone levels of all participants could be stably maintained (mean difference in marginal bone loss at 12 months was 0.03 mm [-0.08, 0.14 mm], P = 0.55).

CONCLUSIONS

The accuracy of IOS impressions of implant-supported restorations varied greatly depending on the scanning strategy. The trueness and precision of IOS in the partial and complete arches remain unclear and require further assessment. Based on follow-up clinical studies, IOS impressions were accurate in clinical practice. However, these results should be interpreted with caution, as some evidences are obtained from the same research group.

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.

Intraoral Scan Accuracy and Time Efficiency in Implant-Supported Fixed Partial Dentures: A Systematic Review

The digital implant impression technique (DIT) and conventional implant impression technique (CIT) workflows in implant-supported fixed partial dentures (FPDs) have not been extensively compared in prior studies. Moreover, there is no agreement on the more accurate method that entails less time in the laboratory and during the clinical phases of fabrication and delivery of the prosthesis, respectively. This review aimed to assess the precision of the imaging procedure and overall fabrication time of the DIT and CIT for the implant-supported FPDs. An electronic search was performed using PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases through EBSCO for relevant studies from January 2014 to April 2023. Following the preliminary screening, the studies that met the inclusion criteria underwent full-text review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Collaboration risk of bias appraisal tool and Newcastle-Ottawa scale were applied to assess the quality of randomized controlled trials (RCTs) and non-randomized prospective clinical studies, respectively. The initial search yielded 332 studies, and after excluding duplicates, 241 papers were available for screening. Titles and abstracts were reviewed, and 97 articles were chosen for full-text review by two authors independently. Furthermore, 89 articles were excluded in compliance with the PICOS question, and eight studies were chosen for qualitative analysis. Hence, the review comprised two RCTs and six prospective clinical studies. The time efficiency of the implant-supported FPDs was examined in four investigations, three of which used the Trios 3 scanner and one used the Intero scanner. The three-dimensional accuracy of DIT and CIT was compared in six clinical comparative studies. One of the RCTs was rated to have a high risk of bias and the other with a moderate quality of evidence. The six prospective studies were rated to have high-quality of evidence. The findings of this review indicate the prospective applicability of future intraoral scanning systems. The DIT was reported to be outstanding in terms of patient preferences and total fabrication time efficiency. Additional in vivo studies are needed to establish the therapeutic usefulness and time efficiency of integrating DIT in more comprehensive settings.

Comparative Verification of the Accuracy of Implant Models Made of PLA, Resin, and Silicone

Polylactic acid (PLA) has gained considerable attention as an alternative to petroleum-based materials due to environmental concerns. We fabricated implant models with fused filament fabrication (FFF) 3D printers using PLA, and the accuracies of these PLA models were compared with those of plaster models made from silicone impressions and resin models made with digital light processing (DLP). A base model was obtained from an impact-training model. The scan body was mounted on the plaster, resin, and PLA models obtained from the base model, and the obtained information was converted to stereolithography (STL) data by the 3D scanner. The base model was then used as a reference, and its data were superimposed onto the STL data of each model using Geomagic control. The horizontal and vertical accuracies of PLA models, as calculated using the Tukey-Kramer method, were 97.2 ± 48.4 and 115.5 ± 15.1 μm, respectively, which suggests that the PLA model is the least accurate among the three models. In both cases, significant differences were found between PLA and gypsum and between the PLA and resin models. However, considering that the misfit of screw-retained implant frames should be ≤150 µm, PLA can be effectively used for fabricating implant models.

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

Aim

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

Setting and Design

In-Vitro study.

Material and Methods

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

Statistical Analysis

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

Results

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

Conclusion

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

Fully Digital versus Conventional Workflows for Fabricating Posterior Three-Unit Implant-Supported Reconstructions: A Prospective Crossover Clinical Trial

This study assessed the clinical variables influencing the success of three-unit implant-supported fixed dental prostheses (ISFDPs) fabricated using either fully digital or conventional workflows. The clinical trial evaluated 10 patients requiring three-unit ISFDPs in the posterior mandible. Maxillomandibular relation records, and digital and conventional impressions were obtained from each patient using an intraoral scanner (IoS) and polyvinylsiloxane (PVS), and the frameworks were fabricated using zirconia and cobalt-chromium, respectively. A 2 µm accuracy scanner scanned the conventional master casts and standard reference models. The stereolithography (STL) files of the digital and conventional impressions were superimposed on the standard model file, and the accuracy was calculated with the best-fit algorithm. The framework adaptation and passivity were assessed using the one-screw and screw resistance tests. The time required for occlusal adjustment of both types of reconstructions, including the duration of the whole treatment, was recorded. The aesthetic appearance of ISFDPs was rated by each patient and clinician using a self-administered visual analogue scale questionnaire and the FDI World Dental Federation aesthetic parameters, respectively. The sample size was based on the power calculation, and alpha was set at 0.05 for the statistical analyses. The impression accuracy, framework adaptation and passivity, and reconstructions aesthetics did not significantly differ between the digital and conventional approaches. The total fabrication time was significantly shorter using the digital workflow. Within the limitations of this clinical study, the fully digital workflow can be used for the fabrication of ISFDPs with a clinical outcome comparable to that of the conventional workflow.

The effect of different implant impression splinting techniques and time on the dimensional accuracy: An in vitro study

Splinting of impression copings is generally recommended for more complex implant-supported restorations. It can also be used in the digital workflow when the control model is needed to improve the fit of the prosthesis. However, there is a lack of knowledge on how dimensional accuracy is affected by different splinting techniques and time factors.

OBJECTIVES

To evaluate the time factor on the dimensional stability of different implant impression splinting strategies used in the conventional and digital workflow.

MATERIALS AND METHODS

Ten pairs of implant analogs were fixed to a stainless steel bar. Modified impression copings were connected to the analogs and eight splinting strategies evaluated (n=10): 1) type I impression plaster (PLA), 2) autopolymerizing acrylic resin, cut and rejoin technique (PTR), 3) light-cured acrylic resin, cut and rejoin technique (ILC), 4) light-cured acrylic resin, no cutting and rejoining (ILN), 5) VPS bite registration material (SBR), 6) bis-acryl bite registration material (LXB), 7) bis-acryl composite resin (PTP), 8) 3D printed splint (3DP). In each group, the position of modified impression copings was scanned with an accurate laboratory scanner at different time points: 1) unsplinted impression copings (baseline), 2) 2 hours after splinting, 3) 24 hours after splinting. Modified impression coping design allowed using metrology software to measure and compare distance, vertical, angle and rotational deviations between impression copings.

RESULTS

All types of splints showed dimensional deviations. After 2 hours of splinting, the lowest distance deviation was recorded in PTR (15.4±6.15µm), vertical deviation - in ILC (19.2±27.37µm), angle deviation - in ILC (0.08±0.1°), rotation - in LXB (0.2±0.24°) groups. Comparing results 2 and 24 hours after connection of impression copings, statistically significant deviations in the distance were recorded in groups PLA (-5.6±5.95 µm), PTR (5.5±7.01µm), ILN (19.2±14.26µm), PTP (23.8±12.55µm).

CONCLUSION

The best dimensional accuracy was observed in the ILC group, followed by PTR and 3DP groups.

CLINICAL SIGNIFICANCE

Proper selection of splinting technique and polymerization time can increase the accuracy of conventional or digital impressions. Splinting techniques with rigid materials, proper polymerization and compensating for material shrinkage produce the best results.

Effect of full arch two scanning techniques on the accuracy of overdenture conventional and CAD/CAM Co-Cr bars

This work evaluates the internal and marginal adaptation of implant-assisted overdenture cobalt–chromium (Co–Cr) bars manufactured using conventional as well as CAD/CAM subtractive and selective laser melting (SLM) utilizing two scanning techniques. Methods: An edentulous study model containing four dental implants placed at teeth sites 36, 33, 43, and 46 was used. The study cast was scanned and compared to the virtual casts developed from two scanning techniques, straight and zigzag motion, using the in silico superimposition process. Then, conventional techniques were used to produce full-arch bars that were compared to the bars fabricated using the two scanning techniques and CAD/CAM subtractive and additive techniques. Results: The conventional impression and casting techniques had the smallest marginal gap among the groups (P-value < 0.05). The CAD/CAM subtractive milling techniques in groups II and III had significantly smaller marginal gaps than SLM technique used in groups IV and V (P-value < 0.05). The analysis of the internal gap within each group showed statistically significant differences between different implant sites in all groups (P-value < 0.001), except when using the conventional impression and casting techniques in group I (P-value = 0.20). Conclusion: The conventional impression and fabrication techniques were better than the digital impression and CAD/CAM subtractive and additive techniques for the fabrication of full-arch bars. However, both straight and zigzag scanning techniques and the CAD/CAM subtractive technique had marginal and internal gaps that were within clinically accepted ranges, and the SLM was found to be unsuitable for long-span framework fabrication with either scanning technique used.

Digital Workflow for Prosthetically Driven Implants Placement and Digital Cross Mounting: A Retrospective Case Series

Fully digital workflow in implant dentistry is ever increasing. Treatment of partial edentulous cases is well-documented; nevertheless, complete edentulous cases are still a challenge. To present several innovations in the treatment of complete edentulous patients using digital solutions, both for implant placement and restoration delivery, was the objective of this study. It was designed as a retrospective case series study, aimed to tune further research with larger sample size, and a longer follow-up. Patients requiring complete, implant-supported restoration were asked to participate in this study. Enrolled patients were treated with four implants, immediate loading and a definitive complete arch restoration. Patients were treated using computer-assisted, template-based surgery. Multi-piece surgical templates were used to accurately place the implants, to manage the bone if needed and to make immediate loading procedure quicker and easier. After osseointegration period, definitive, extra-oral, digital impressions were taken using newly developed scan analogs, connected in the patient mouth using temporary cylinders and stabilized by means of the low-shrinkage, flowable, resin composite. Outcomes were implant and prosthesis survival rate, complications, accuracy, and patient satisfaction. Radiographic evaluation performed with a preliminary, radiopaque aluminum try-in, was used to test the accuracy of the digital impressions. Overall, 20 implants were placed in five patients. All the implants osseointegrated without complications. One impression was taken a second time due to inaccuracy of the aluminum tray-in. Finally, all of the patients were completely satisfied with both surgical and prosthetic procedures. Within the limitations of this case series, multi-piece surgical templates showed promising results improving the clinician’s confidence in the case of bone reduction, post-extractive implants and immediate loading. The prosthetic template increased the trueness of the digital impression for complete edentulous patients. Finally, even if an impression was performed again, the scan-analog used for extra-oral chair-side digital impressions seemed to be a promising tool. Continuous improvements and further study are needed to confirm these preliminary results.

Accuracy of digital implant impressions in clinical studies: A systematic review

OBJECTIVES

The use of intraoral scanners (IOSs) for digital implant impressions in daily clinical practice is increasing. However, no structured literature review on the accuracy of digital implant impressions in clinical studies has been described to date. Therefore, this systematic review aimed to answer the PICO question: Which accuracy is described for digital implant impressions in clinical studies?

MATERIAL AND METHODS

An electronic database search was conducted in December 2021 using MeSH terms and free-text search. English-language studies addressing the accuracy of digital implant impressions in clinical studies involving at least 10 patients were included. All clinical indications were considered.

RESULTS

Eight publications between 2014 and 2021 matched the review criteria. However, the study designs showed considerable differences. The number of implants within the studies ranged from 1 to 6, and the number of patients ranged from 10 to 39. The oldest study (2014) revealed the highest deviation for linear distances at 1000±650 µm, whereas the other studies reported data in the range of 360±46 µm to 40±20 µm. In one study, no numerical data were reported and all studies compared digital and conventional implant impressions.

CONCLUSIONS

The number of clinical studies on the accuracy of digital implant impressions is low. Thus, the impact of different factors, such as the scanpath or scanbody, could not be identified. However, the accuracy of recent IOSs for digital implant impressions in patients was shown to be clinically acceptable. Nevertheless, the transfer error still needs to be considered when fabrication implant-supported restorations.

Error propagation from intraoral scanning to additive manufacturing of complete-arch dentate models: an in vitro study

OBJECTIVES

. To evaluate deviation propagation from data acquisition with an intraoral scanner to additive manufacturing of complete-arch dentate models.

METHODS

. A reference (Ref) mandibular dentate model having 5 precision spheres was scanned with a coordinate measurement machine equipped with a laser scanning head (ALTERA; Nikon) producing a Ni reference data set (n=1). Digital impressions were taken of the Ref model with intraoral scanner (IOS) (Trios4; 3Shape) with Insane (T4_Imo) and Classic (T4_Cmo) scanning modes (each n=10). T4_Imo scans were used as a second reference data set and to produce test models with two additive manufacturing (AM) devices (each n=10): MAX UV385 (Asiga) and NextDent 5100 (3DSystems). As for the control group, dual viscosity vinyl polysiloxane impressions were taken of the Ref model and poured with Type IV dental stone (n=10). All AM and stone models were scanned with a laboratory scanner (E4; 3Shape). Trueness and precision of linear (intermolar and intercanine width, arch length) and surface deviations were measured between reference (Ni, T4_Imo), test (T4_Cmo, AM), and control (stone) groups using best-fit alignments (Geomagic Control X; 3D Systems). The normality of data and differences between the groups were analyzed using Shapiro-Wilk, Levene's, Mann-Whitney U, Welch's t-test statistical analysis (p<0.05).

RESULTS

. The accuracy of the IOS impression was not significantly affected by the scanning mode (p>0.05). Stone models showed significantly better trueness than IOS impressions (p<0.05). AM models had higher trueness than IOS Imo digital impressions (p<0.05). The precision of AM models was comparable (linear, p>0.05) or lower (surface, p<0.05) than of IOS Imo digital impressions. Trueness was insignificantly different among the stone and AM models (p>0.05). Higher trueness was achieved by Max UV385 than with Nextdent 5100 (p<0.05). The majority of linear and all surface deviations of IOS impressions and AM models were below 200 μm.

CONCLUSIONS

. Within the limitations of this in vitro study, digital IOS impressions and AM models using the aforementioned equipment have acceptable accuracy for orthodontic and prosthodontic applications when complete-arch dentate records are used.

CLINICAL SIGNIFICANCE

. IOS and AM devices can have a significant influence on error propagation when applying digital workflow with complete-arch dentate models.

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.

Three-dimensional Change of Elastomeric Impression Materials During the First 24 Hours: A Pilot Study

OBJECTIVES

To evaluate the three-dimensional (3D) changes of three elastomeric impression materials using a novel measurement method for the first 24 hours after preparation.

METHODS AND MATERIALS

Three impression materials consisting of a low-viscosity polyvinyl siloxane (PVS) (Aquasil LV, Dentsply Sirona, Charlotte, NC, USA) and two vinyl polyether silicone (VPES) materials consisting of a light body (EXA'lence LB, GC America, Alsip, IL, USA) and monophase (EXA'lence Monophase, GC America) materials were used in this study. All materials were prepared following manufacturer's recommendations with approximately 1-2 millimeters of material placed on the measurement pedestal of a calibrated noncontact, video imaging based, volumetric change measuring device (AcuVol ver 2.5.9, Bisco, Schaumburg, IL, USA). Data collection was initiated immediately, with measurements made every 30 seconds for 24 hours. Each material was evaluated 10 times (n=10). Evaluated parameters included were 24-hour mean shrinkage, mean shrinkage at time of recommended first pour, mean shrinkage between recommended first pour and 24 hours, mean maximum shrinkage, and the time of maximum shrinkage. Mean data, both within and between each group, was evaluated using Kruskal-Wallis/Dunn's tests at a 95% level of confidence (α=0.05).

RESULTS

All three materials were found to have significant differences (p<0.001) in volumetric shrinkage over 24 hours. Aquasil LV and EXA'lence LB polymerization shrinkage rates were statistically similar all through the 24-hour evaluation (p=0.92). All three materials demonstrated similar (p=0.19) shrinkage between 10 and 15 minutes after preparation, while between 5 and 16 hours both EXA'lence Monophase and low-viscosity materials demonstrated similar polymerization shrinkage values (p=0.22). EXA'lence Monophase demonstrated significantly greater 24-hour mean shrinkage (p<0.008) as well as shrinkage between recommended first pour time and 24 hours (p=0.003) than Aquasil LV and EXA'lence LB. EXA'lence Monophase demonstrated significantly greater (p=0.002) shrinkage at the recommended time of first pour as compared to Aquasil LV and EXA'lence LB that displayed similar shrinkage (p=0.89). Furthermore, all materials demonstrated increasing polymerization shrinkage values that reached a maximum between 16 for Aquasil LV and 20 hours for EXA'lence LB, after which some relaxation behavior was observed. However, EXA'lence Monophase did not display any relaxation behavior over the 24-hour evaluation.

CONCLUSIONS

Under the conditions of this study, volumetric polymerization shrinkage was observed for one polyvinyl siloxane (PVS) and two vinyl polyether silicone (VPES) materials for up to 24 hours. All impression materials exhibited fast early volumetric shrinkage that continued past the manufacturer's recommended removal time. Dimensional change behavior was not uniform within or between groups; resultant volume change between the manufacturer recommended pouring time and 24 hours might represent up to from 20% to 30% of the total material shrinkage. It may be prudent to pour elastomeric impressions at the earliest time possible following the manufacturer's recommendations.

Comparison of digital and silicone impressions for single-tooth implants and two- and three-unit implants for a free-end edentulous saddle

Background

The use of intraoral scanners (IOS) has facilitated the use of digital workflows for the fabrication of implant-supported prostheses not only for single missing teeth, but also for multiple missing teeth. However, the clinical application of IOS and computer-aided design/manufacturing (CAD/CAM) in implant-supported prosthodontics remains unclear. This study aimed to compare the accuracy of digital and silicone impressions for single-tooth implants for bounded edentulous spaces and two-unit and three-unit implant-supported fixed dental prostheses for free-end edentulous spaces.

Methods

This study enrolled 30 patients (n = 10 for each of the three groups) with an average age of 61.9 years. Conventional silicone-based and digital IOS-based impressions were made for all patients, and the implant superstructures were fabricated. We measured the scan-body misfit and compared the accuracy of the impressions for single-unit, two-unit, and three-unit implant prostheses with a bounded edentulous space by superimposing the standard triangulated language (STL) data obtained from IOS over the STL data of the plaster model used for final prosthesis fabrication. The scan bodies of the superimposed single-molar implant, two-unit implant prosthesis without teeth on the mesial side, two-unit implant prosthesis without teeth on the distal side, three-unit implant prosthesis without teeth on the mesial side, and three-unit implant prosthesis without teeth on the distal side were designated as A, B1, B2, C1, and C2, respectively. The misfit for each scan body was calculated and the accuracies were compared using the Tukey–Kramer method.

Results

The average scan-body misfit for conditions A, B1, B2, C1, and C2 was 40.5 ± 18.9, 45.4 ± 13.4, 56.5 ± 9.6, 50.7 ± 14.9, and 80.3 ± 12.4 μm, respectively. Significant differences were observed between the accuracies of A and B2, A and C2, and C1 and C2 (P < 0.001).

Conclusions

IOS and CAD/CAM can find clinical applications for implant-supported prostheses of up to three units for a bounded edentulous saddle. The use of IOS could render implant treatment easier, benefiting both the surgeons and patients. Prosthesis maladjustment may lead to peri-implantitis and prosthetic fracture. Therefore, further validation of the accuracy of IOS impressions is required in patients with multiple missing teeth in long-span implant prostheses.

In vitro and in vivo accuracy of full-arch digital implant impressions

OBJECTIVES

The main objective of the study was to compare the accuracy of full-arch digital implant impressions for fixed dental prosthesis under in vitro and in vivo conditions.

MATERIALS AND METHODS

Eight patients (five women and three men) with at least one edentulous arch and with 4-6 osseointegrated implants participated in this study. For each edentulous arch (n = 10), experimental screw-retained titanium bar with attached four scan bodies was fabricated. The bar containing four scan bodies was screw-retained intraorally on implants and scanned with Trios 3 intraoral scanner eight times (IOS group, in vivo). Then, the bar was attached to the master cast and scanned eight times again with the same intraoral scanner (MIOS group, in vitro). Finally, the bar with scan bodies was scanned 8 times with a laboratory scanner (reference). Precision and trueness were calculated for 3 distances and 3 angles between the scan bodies (1-2, 1-3, and 1-4) in IOS and MIOS groups.

RESULTS

Precision and trueness for the largest distance (1-4) were found to be 44 ± 18 µm and 32 ± 19 µm for the IOS group and 31 ± 16 µm and 30 ± 14 µm for MIOS group, respectively. Precision and trueness for the angle between the most distant scan bodies (1-4) were 0.22 ± 0.14° and 0.18 ± 0.10° for the IOS group and 0.16 ± 0.11° and 0.07 ± 0.05° for MIOS group, respectively.

CONCLUSIONS

Intraoral conditions moderately affected the precision and trueness of Trios 3 (3Shape) intraoral scanner. Results of in vitro accuracy studies cannot be directly transferred to the clinical field.

Effect of different arch widths on the accuracy of three intraoral scanners

PURPOSE

The purpose of this study was to compare the accuracy of three intraoral scanner (IOS) systems with three different dental arch widths.

MATERIALS AND METHODS

Three dental models with different intermolar widths (small, medium, and large) were attached to metal bars of different lengths (30, 40, and 50 mm). The bars were measured with a coordinate measuring machine and used as references. Three IOSs were compared: TRIOS 3 (TRI), True Definition (TD), and Dental Wings (DW). The relative length and angular deviation of both ends of the metal bars from the scan data set (n = 15) were calculated and analyzed.

RESULTS

Comparing among scanners in terms of trueness, the relative length deviation of DW in the small (1.28%) and medium (1.08%) arches were significantly higher than TRI (0.46% and 0.48%) and TD (0.33% and 0.18%). The angular deviation of DW in the small (1.75°) and medium (1.83°) arches were also significantly greater than TRI (0.63° and 0.40°) and TD (0.55° and 0.89°). Comparing within scanner, the large arch of DW showed better accuracy than other arch sizes (P < .05). On the other hand, the larger arch of TD presented a greater tendency of angular deviation in terms of trueness. No significant differences were found in terms of trueness between the arch widths of TRI group.

CONCLUSION

The different widths of the dental arches can affect the accuracy of some intraoral scanners in full arch scan.

The Influence of Hard- and Software Improvement of Intraoral Scanners on the Implant Transfer Accuracy from 2012 to 2021: An In Vitro Study

This study aimed to investigate the transfer accuracy (trueness and precision) of three different intraoral scanning families using different hardware and software versions over the last decade from 2012 to 2021, compared to a conventional impression. Therefore, an implant master model with a reference cube was digitized and served as a reference dataset. Digital impressions of all three scanning families (True definition, TRIOS, CEREC) were recorded (n = 10 per group), and conventional implant impressions were taken (n = 10). The conventional models were digitized, and all models (conventional and digital) were measured. Therefore, it was possible to obtain the deviations between the master model and the scans or conventional models in terms of absolute three-dimensional (3D) deviations, deviations in rotation, and angulation. The results for deviations between the older and newer scanning systems were analyzed using pairwise comparisons (p < 0.05; SPSS 26). The absolute 3D deviations increased with increasing scan path length, particularly for the older hardware and software versions (old vs. new (MW ± SD) True Definition: 355 ± 62 µm vs. 483 ± 110 µm; TRIOS: 574 ± 274 µm vs. 258 ± 100 µm; and CEREC: 1356 ± 1023 µm vs. 110 ± 49 µm). This was also true for deviations in rotation and angulation. The conventional impression showed an advantage only regarding the absolute 3D deviation compared to the older systems. Based on the data of the present study, the accuracy of intraoral scanners is decisively related to hardware and software; though, newer systems or software do not necessarily warrant improvement. Nevertheless, to achieve high transfer accuracy, regular updating of digital systems is recommended. The challenge of increasing errors with increasing scan paths is overcome in the most recent systems. The combination of two different scanning principles in a single device seems to be beneficial.

The question about the numerical value and quantitative data transfer of implant prosthodontics-orom experience guidance to digital guidance

The correct implant site design and placement are the basic clinical techniques that must be known for implant restoration. For a long time, most implants have been placed by free hands, and the choice of site is mostly dependent on the accumulation of long-term experience of the surgeon. The selection of implant site guided by this experience analogy logic is often based on the surgeon's level of experience,which often makes it very easy to produce complications related to the implant restoration of the incorrect site. In contrast, a clinical program using digital guidance and real-time measurable verification has emerged based on the restoration-oriented implantation concept, which marks the formation of an accurate, measurable and verifiable whole-process digital implant prototype. Furthermore, from the perspective of surveying, the numerical requirements that digital implant restoration relies on are actually incomplete to the four elements of measurement, which leading to the doubts about its authenticity. This article will question the numbers in implant restoration, and conduct a preliminary demonstration, and propose a new reliable actual measurement and verification method of the correct location and the numerical requirements of the restoration space and a new clinical program that relies on numbers from the perspective of the evolution of digital restoration, guided implantology and actual measurement technology. And this article further discusses the current mainstream implant restoration technology based on experience analogy which cannot effectively support the whole process of digital implant restoration and provides a new logical cognitive basis for the final realization of the entire process of digital implant restoration.

Comparison of the accuracy of intraoral digital impression system and conventional impression techniques for multiple implants in the full-arch edentulous mandible

Background

Several impression techniques, especially in combination with computer-aided design and computer-aided manufacturing (CAD/CAM), are used in increasing the accuracy of dental implantology and decreasing patient discomfort. The study was designed to examine the accuracy of the digital impression (DI) of multiple implants with an intraoral scanner (IOS) and compared with that of a conventional impression (CI).

Material and Methods

Four dental implants were placed in teeth area #33, #36, #43 and 46# of the mandibular full-arch model. The implanted model was replicated by IOS and CI after fitting of scannable abutments over the implant screws. Then, a small hole was made on the scan region (as a reference point). Two types of CI techniques were used; dual-phase (DP) and monophase (MP). Stone casts were produced through a conventional close tray impression technique using die stone. The casts were scanned with a laboratory scanner. DI was attained by scanning the implanted model with the IOS. The control sample was accomplished by scanning the implanted model directly with a laboratory scanner. Dimensional accuracy was calculated by measuring the distances between the reference points of four measuring parameters as follows; A-B, B-C, C-D, and A-D using CAD software.

Results

The mean values and standard deviation between the four parameters of different impression techniques (CI and DI) and the control group showed convergent value. One-way ANOVA test showed all CI techniques, except IOS, showed a significant differences from the control group.

Conclusions

Compared with CI, the IOS was more accurate because no differences were observed between its measurements and those of the control model. CI is simple and reduces patient discomfort when used in fabricating multiple implants and allowing communication with dental technicians.

Key words:Dimension accuracy, conventional impressions, digital impressions, multiple implants.

Accuracy of impressions for multiple implants: A comparative study of digital and conventional techniques

STATEMENT OF PROBLEM

Intraoral scanning has benefits over conventional impression making, but whether scanning is sufficiently accurate for multiple implants is unclear.

PURPOSE

The purpose of this in vitro study was to compare the trueness of digital scans acquired by using intraoral scanners from a small range to a complete arch with the conventional impression technique and to determine the influence of 2 different evaluation methods (best-fit algorithm versus absolute linear deviation) on the outcomes of accuracy assessment.

MATERIAL AND METHODS

A mandibular model with 8 implants (A-H) around an edentulous arch was used as the master model. Open-format standard tessellation language (STL) data sets (1 reference file from a highly accurate dental laboratory scanner, 10 files from an intraoral scanner, and 10 files from digitized conventional impressions at room temperature) were imported to a metrology software program, and 5 groups of scanning ranges (AB, FGH, CDEF, BCDEFG, and ABCDEFGH) were identified simulating different clinical situations. Two evaluation methods-root mean square values calculated from the best-fit algorithm and average value of linear discrepancies from absolute linear deviation-were used to describe the trueness values. The impacts of different scanning or impression methods, ranges, and evaluation methods were tested by using a 3-way ANOVA. The effect of the scanning range on accuracy was further identified with 1-way ANOVA. The paired-sample t test was used to determine the differences of trueness values between the 2 methods in different groups.

RESULTS

The trueness values of the implant impressions were significantly affected by different scanning or impression methods (P<.001), evaluation methods (P<.001), and scanning ranges (P<.001) as independent variables. With use of the best-fit algorithm, deviations from the digital scans were significantly greater than those from the conventional impressions in cross-arch situations (groups CDEF, BCDEFG, and ABCDEFGH). With use of the absolute linear deviation method, statistically significant lower accuracy was found when larger areas were encountered (groups BCDEFG and ABCDEFGH). Use of the absolute linear deviation method resulted in a higher mean score of inaccuracy than that from the best-fit algorithm method in most situations.

CONCLUSIONS

Scanning or impression methods, ranges, and evaluation methods affected the dimensional accuracy (trueness) of scans or impressions with multiple implants. Digital scans had worse trueness values compared with those made with the conventional splinting open-tray technique when cross-arch implant impressions were acquired.

A comparative clinical study on the transfer accuracy of conventional and digital implant impressions using a new reference key-based method

OBJECTIVES

The objective of this study was to systematically compare the transfer accuracy of conventional and digital implant impressions in patients using a new reference key-based method.

MATERIAL AND METHODS

Thirty-nine cases were included in the study (upper jaw 22 edentulous, 8 partially edentulous, average distance between implants 30.15 ± 11.18 mm; lower jaw 6 cases edentulous, 3 cases partially edentulous, average distance between implants 33.19 ± 14.85 mm). Individual reference keys were manufactured and reversibly fixed on implants. A conventional (CVI) and a digital (DI) implant impression was made. The implant positions (center points) of conventional and digital models were measured (coordinate-measuring machine/three-dimensional analysis software) and superimposed with the positions of the reference keys to compare the deviations of the conventional and digital models. For statistical analysis, ANOVA with MIXED procedure was applied (p < .05).

RESULTS

Mean deviation ranged from 0.040±0.029 mm (DI/upper jaw) to 0.079 ± 0.050 mm (DI/lower jaw). There were significant differences between the CVI and DI impressions in the lower jaw (p < .05). No significant differences in transfer accuracy were found between partially and completely edentulous patients for the impression methods.

CONCLUSIONS

Within the limits of the present study, it can be concluded that full-arch digital implant impressions of the upper jaw in partially or completely edentulous patients showed comparable results to conventional implant impressions. However, with regard to the implant position transfer accuracy, there are still limitations for digital impression in the lower jaw.

Digital Impressions in Implant Dentistry: A Literature Review

Introduction. Digital impressions in implant dentistry rely on many variables, and their accuracy, particularly in complete edentulous patients, is not well understood. Aim. The purpose of this literature review was to determine which factors may influence the accuracy of digital impressions in implant dentistry. Emphasized attention was given to the design of the intra-oral scan body (ISB) and scanning techniques. Materials and methods. A Medline, PubMed and EBSCO Host databases search, complemented by a hand search, was performed in order to select relevant reports regarding the appliance of digital impressions in implant dentistry. The search subject included but was not limited to accuracy of digital impressions in implant dentistry, digital scanning techniques, the design and material of the ISBs, and the depth and angulation of the implant. The related titles and abstracts were screened, and the remaining articles that fulfilled the inclusion criteria were selected for full-text readings. Results. The literature search conducted for this review initially resulted in 108 articles, among which only 21 articles fulfilled the criteria for inclusion. Studies were evaluated according to five subjects: accuracy of digital impressions in implant dentistry; the design and material of the intra-oral scan bodies; scanning technique; the influence of implants depth/angulations on the digital impression and accuracy of different intra-oral scanner devices. Conclusions. The accuracy of digital impressions in implant dentistry depends on several aspects. The depth/angulation of the implant, the experience of the operator, the intra-oral scanner used, and environmental conditions may influence the accuracy of digital impressions in implant dentistry. However, it seems that ISBs’ design and material, as well as scanning technique, have a major impact on the trueness and precision of digital impressions in implant dentistry. Future research is suggested for the better understanding of this subject, focusing on the optimization of the ISB design and scanning protocols.

Accuracy of Five Intraoral Scanners and Two Laboratory Scanners for a Complete Arch: A Comparative In Vitro Study

This study aims to evaluate the accuracy of five different intraoral scanners and two different laboratory scanners for a complete arch. A computer-aided design (CAD) reference model (CRM) was obtained using industrial scanners. A CAD test model (CTM) was obtained using five types of intraoral scanners (CS3500, CS3600, Trios2, Trios3, and i500) and two types of laboratory scanners (3shape E1 and DOF) (N = 20). In addition, the CRM and CTM were superimposed using a 3D inspection software (Geomagic control X; 3D Systems) and 3D analysis was performed. In the 3D analysis, the accuracy was measured by the type of tooth, the anterior and posterior region, and the overall region. As for the statistical analysis of the accuracy, the differences were confirmed using the Kruskal–Wallis H test (α = 0.05). Also, the differences between the groups were analyzed by post-hoc tests including Mann–Whitney U-test and Bonferroni correction method (α = 0.0017). There was a significant difference in the scanning accuracy of the complete arch according to the type of scanner (P < 0.001). The i500 Group showed the lowest accuracy (143 ± 69.6 µm), while the 3Shape E1 Group was the most accurate (14.3 ± 0.3 µm). Also, the accuracy was lower in the posterior region than in the anterior region in all types of scanners (P < 0.001). Scanning accuracy of the complete arch differed depending on the type of scanner. While three types of intraoral scanners (CS3500, CS3600, Trios3) can be recommended for scanning of a complete arch, the two remaining types of intraoral scanners (Trios2 and i500) cannot be recommended.