Influence of crown shade, translucency, and scan powder application on the trueness of intraoral scanners

OBJECTIVES

Natural teeth and dental restorations present with various shades and levels of translucency. This study aimed to determine whether these variations in ceramic crowns and scan powder application affect the trueness of intraoral scanners.

METHODS

Eight identical premade resin typodonts, each prepared for a crown on the maxillary right second molar, were used. Eight lithium disilicate crowns, distinguished by two levels of translucency (high and low) and four shades (BL1, A2, A3, and A4), were fabricated to an identical design and cemented onto each typodont, providing eight distinct experimental groups (2 levels of translucency × 4 shades). Reference scans were acquired using a desktop scanner. Test scans were performed ten times for each experimental group using two different intraoral scanners (Medit i700 and CEREC Primescan AC), with and without the application of scan powder (n = 10). Three-dimensional metrology software was used to assess the trueness of the intraoral scan datasets. Statistical analysis involved the Kruskal-Wallis H test, Mann-Whitney U test, and independent t-test (α=0.05).

RESULTS

For powder-free intraoral scan datasets, the crown shade did not significantly affect trueness within each translucency group (P = 1.000). For both intraoral scanners, compared with low translucency groups, higher marked deviations were exhibited by high translucency groups (P<.001). Scan powder use largely mitigated these differences (P>.05) and enhanced the trueness of the intraoral scan (P<.01).

CONCLUSIONS

Shade did not significantly influence the trueness of intraoral scans. High-translucency crowns were scanned with less accuracy than were low-translucency crowns.

CLINICAL SIGNIFICANCE

Unlike tooth shade, translucency significantly affected the accuracy of intraoral scans. Therefore, considering the use of scan powder when scanning objects with high translucency may be beneficial.

Influence of augmented reality technique on the accuracy of autotransplanted teeth in surgically created sockets

BACKGROUND

The objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth.

MATERIALS AND METHODS

Forty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student's t-test and Mann-Whitney non-parametric statistical analysis were used to analyze the results.

RESULTS

No statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different.

CONCLUSION

The augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Auxiliary occlusal devices for IO scanning in a complete digital workflow of implant-supported crowns: a randomized controlled trial

OBJECTIVES

To compare the crown accuracy and time efficiency of a complete digital workflow, utilizing an auxiliary occlusal device and IO scanning, with a conventional workflow, for multiple implant-supported single crowns.

MATERIALS AND METHODS

24 patients with two adjacent posterior implants were included. 12 patients were randomly assigned to digital workflow group, involving intra-oral scanning with an auxiliary occlusal device and manufacture of customized abutments and zirconia single crowns (test group). The other 12 were assigned to the conventional workflow (control group), involving conventional impression and CAD-CAM crowns based on stone casts. Crown scanning was done before and after clinical adjustment using an intraoral scanner. Two 3D digital models were overlapped to assess dimension changes. Chair-side and laboratory times for the entire workflow were recorded and a linear mixed model and Independent-sample t tests were used for the statistical analysis.

RESULTS

The maximum occlusal deviation was 279.67 ± 112.17 μm and 479.59 ± 203.63 μm in the test and control group, respectively (p < 0.001). The sizes of the occlusion adjustment areas were 12.12 ± 10.51 mm2 and 25.12 ± 14.14 mm2 in the test and control groups, respectively (p = 0.013). The mean laboratory time was 46.08 ± 5.45 and 105.92 ± 6.10 min in the test and control groups, respectively (p < 0.001).The proximal contact adjustment and mean chair-side time showed no statistically significant difference between two groups.

CONCLUSIONS

A digital workflow for two implants-supported single crowns using an auxiliary device required fewer occlusal crown adjustments, and less laboratory time compared to conventional workflow.

CLINICAL RELEVANCE

The use of auxiliary occlusal devices in IOS enhances the accuracy of virtual maxillomandibular relationship in extended edentulous spans. Consequently, employing a digital workflow for multiple implants-supported crowns using IO scanning and an auxiliary occlusal device proves to be a feasible, accurate and efficient approach.

Impact of scanning distance on the accuracy of a photogrammetry system

PURPOSE

To measure the impact of the scanning distance on the accuracy of complete-arch implant scans acquired by using a photogrammetry (PG) system.

MATERIAL AND METHODS

An edentulous cast with 6 implant abutment analogs was obtained. A brand new implant scan body was positioned on each implant abutment and digitized using an extraoral scanner (T710; Medit) and the reference file was obtained. Three groups were created based on the scanning distance used to acquire complete-arch implant scans by using a PG (PIC System; PIC Dental): 20 (20 group), 30 (30 group), and 35 cm (35 group). An optical marker (PIC Transfer, HC MUA Metal; PIC Dental) was placed on each implant abutment and a total of thirty scans per group were acquired. Euclidean linear and angular measurements were obtained on the reference file was obtained and used to compare the discrepancies with the same measurements obtained on each experimental scan. One-way ANOVA and Tukey tests were used to analyze trueness. The Levene test was used to analyze the precision values (α = 0.05).

RESULTS

Significant linear (P < .001) and angular trueness (P < .001) discrepancies were found among the groups. For linear trueness, Tukey test showed that the 20 and 30 groups (P < .001) and 30 and 35 groups were different (P < .001). For angular trueness, the Tukey test revealed that 20 and 30 groups (P = .003), 20 and 35 (P < .001), and 30 and 35 groups were different (P < .001) The Levene test showed no significant linear precision (P = .197) and angular discrepancies (P = .229) among the groups.

CONCLUSIONS

The scanning distance influenced the trueness of complete-arch implant scans obtained with the PG method tested. The maximum linear trueness mean discrepancy among the groups tested was 10 µm and the maximum angular trueness mean discrepancy among the groups tested was 0.02 .

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Influence of the scanning path on the accuracy of intraoral scanners in the implanted edentulous patient: an in vitro study

AIM

The aim of this in vitro study was to investigate the influence of scan paths on the accuracy (trueness and precision) of intra-oral scanning of an implant impression on an edentulous patient.

MATERIAL AND METHODS

An epoxy resin maxillary model was made with 6 bone level implants (NobelParallel Conical Connection RP, NobelBiocare®). The implants were placed at the spot of the first incisor, the canine and the first molar. The trans gingival component (Multi-unit, NobelBiocare®) was screwed onto the implants. The scanbodies (IO 2C-A, Elos Accurate®) were then screwed onto the multi-units. The model was run through a coordinate measurement machine to obtain a control cast. Then, five different scanning paths, respectively the zigzag technique (ZZT), the zigzag technique with palatal (ZZTP), the wrap technique (WT), the wrap technique with palatal (WTP), and the big zigzag technique (BZZT), were applied by a single operator. Finally, each scan was compared to the control model. Results were assessed by one-way ANOVA and linear mixed effects models at P<0.05.

RESULTS

The study showed that scan paths ZZT and ZZTP had significantly lower absolute positioning errors and residual mean square errors than the others (P<0.0001). For distances between consecutive implant axes and for absolute vertical errors, their superiority was borderline (P<0.10). Overall, techniques ZZT and ZZTP were equally performant and proved to be the most accurate.

CONCLUSIONS

This in vitro experimental study demonstrates that the scan path can have an influence on the accuracy of the optical impression for full arch rehabilitation on implants.

Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement

OBJECTIVE

This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology.

METHODS

Digital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology.

RESULTS

A completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less.

CONCLUSIONS

This study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints.

CLINICAL SIGNIFICANCE

The proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.

Accuracy of intraoral optical scan versus stereophotogrammetry for complete-arch digital implant impression: An in vitro study

PURPOSE

To assess and compare the accuracies of intraoral scanners (IOS) and stereophotogrammetry (SPG) devices for complete-arch digital implant impressions.

METHODS

A 4-analog model was digitized using a desk scanner to obtain a reference file. Thirty test scans were conducted using the investigated IOS device, while an additional 30 scans were performed using the SPG device. Using the best-fit algorithm, the resulting 60 test files were aligned with the reference file. Linear (ΔX, ΔY, and ΔZ-axis) and angular deviations (ΔANGLE) were evaluated. Three-dimensional (3D) deviation was calculated based on the Euclidean distance (ΔEUC). The analysis was stratified according to the scanning device and implant position. Fisher's F and t-tests were used to compare the variances and expected values of the two scanning systems.

RESULTS

IOS expressed a higher 3D (ΔEUC) mean deviation than SPG (52.8 µm vs. 33.4 µm, P < 0.0001), with extreme measurements up to 181.9 µm. A significantly higher standard deviation (SD) was associated with IOS (37.1 µm vs. 17.7 µm, P < 0.0001). Considering angular deviations, the IOS showed slightly higher angular mean deviations (ΔANGLE) than the SPG (0.28° vs. 0.24°, P = 0.0022), with extreme measurements of up to 0.73°. The SPG SD values were significantly lower than the IOS SD values (0.14° vs. 0.04°, P < 0.0001).

CONCLUSIONS

The SPG showed significantly higher 3D and angular accuracies for complete arch implant impressions, with consistent repeatability. IOS scanning revealed significantly higher extreme deviations exceeding the acceptable threshold value. Despite study limitations, SPG appears more feasible than IOS for complete-arch digital implant impressions.

Effect of prefabricated auxiliary devices and scanning patterns on the accuracy of complete-arch implant digital impressions

OBJECTIVES

This study aimed to evaluate the impact of prefabricated auxiliary devices (PAD) and scanning patterns on the accuracy of complete-arch implant digital impressions.

METHODS

An edentulous maxillary model was inserted with four parallel implant analogs and four PAD. The model was scanned with D2000 dental laboratory scanner as the reference scans. Test scans were obtained by 8 different scanning patterns (SP), which including SPA, SPB, SPC, SPD, SPE, SPF, SPG and SPH, with (test group) or without (control group) using the PAD by an intraoral scanner (Aoralscan 3, 3DShining). SPA was the scanning pattern recommended by the manufacturer. Each scanning time was recorded. The related files were imported into inspection software for assessment. Aligned Ranks Transformation ANOVA, Kruskal-Wallis and Mann-Whitney tests were used to evaluate the values. The level of significance was set at α = 0.05.

RESULTS

The scanning patterns significantly influenced the linear accuracy in the test group and the scanning time for both groups. Lower linear trueness in the test group was found in SPF (p<0.05) and SPG (p<0.05). Longer scanning time was found in SPB and SPG for both groups. The test group demonstrated linear accuracy enhancement in all the scanning patterns; angular trueness enhancement was seen in SPA (p<0.05), SPC (p<0.01) and SPH (p<0.01). Significant longer scanning time was found in SPB (p<0.05), SPF (p<0.05), SPG (p<0.05) and SPH (p<0.05) when using PAD.

CONCLUSION

The scanning patterns impact the accuracy differently depending on the PAD's existence. The scanning time can be significantly influenced by the scanning patterns and the PAD.

CLINICAL SIGNIFICANCE

In daily clinical practice, selecting a suitable scanning pattern is significant in achieving accurate digital impressions. The PAD demonstrated effective linear accuracy enhancement in all the scanning patterns tested.

Accuracy of digitally coded healing abutments: A systematic review

The aim of this systematic review was to evaluate the in vitro accuracy of dental implant impressions taken using digitally coded healing abutments (CHAs) compared with impressions taken with conventional techniques (CI) and/or within the CHA group at varying degrees of angulations for multiple implant units. Two independent reviewers conducted a systematic electronic search in the MedLine, PubMed, Google Scholar, Cochrane Library, Web of Science, and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "digitally coded healing abutments", "encode healing abutment", "dental implants", "impression accuracy", "digital impression", and "conventional impression". Publication dates ranged from January 2010 to November 2022. A total of 7 articles fulfilled the inclusion criteria: 6 studies compared the accuracy of CHA with conventional pick-up impression techniques, and one study only used CHAs at different angulations and heights to compare accuracy within the group. The results were divided into Group A (elastomeric impression of CHA) and Group B (CHA + Intraoral scanner). According to the results of this systematic review, elastomeric impression of CHA performed poorly when compared to CI for multiple implants, although an intraoral scan of CHA appears to be more accurate. Within the CHA group, the angulation and visible height of CHA play a significant role in impression accuracy. However, more studies are needed before CHA can be recommended for all non-parallel multiple implant-supported restorations.

Effect of scanning strategies on the accuracy of digital intraoral scanners: a meta-analysis of in vitro studies

PURPOSE

This study aimed to investigate whether the accuracy of intraoral scanners is influenced by different scanning strategies in an in vitro setting, through a systematic review and meta-analysis.

MATERIALS AND METHODS

This review was conducted in accordance with the PRISMA 2020 standard. The following PICOS approach was used: population, tooth impressions; intervention, the use of intraoral scanners with scanning strategies different from the manufacturer's instructions; control, the use of intraoral scanners following the manufacturers' requirements; outcome, accuracy of intraoral scanners; type of studies, in vitro. A comprehensive literature search was conducted across various databases including Embase, SciELO, PubMed, Scopus, and Web of Science. The inclusion criteria were based on in vitro studies that reported the accuracy of digital impressions using intraoral scanners. Analysis was performed using Review Manager software (version 5.3.5; Cochrane Collaboration, Copenhagen, Denmark). Global comparisons were made using a standardized mean difference based on random-effect models, with a significance level of α = 0.05.

RESULTS

The meta-analysis included 15 articles. Digital impression accuracy significantly improved under dry conditions (P < 0.001). Moreover, trueness and precision were enhanced when artificial landmarks were used (P ≤ 0.02) and when an S-shaped pattern was followed (P ≤ 0.01). However, the type of light used did not have a significant impact on the accuracy of the digital intraoral scanners (P ≥ 0.16).

CONCLUSION

The accuracy of digital intraoral scanners can be enhanced by employing scanning processes using artificial landmarks and digital impressions under dry conditions.

Evaluating the Impact of Scan Body Angulation and Geometric Attachments on the Accuracy of Complete-Arch Digital Implant Impressions: A Comparison of Two Intraoral Scanners

PURPOSE

To investigate the effects of scan body (SB) angulation and geometric attachments on the deviations of complete-arch digital implant impressions obtained using intraoral scanners (IOSs), in relation to the gold-standard desktop scanner.

MATERIAL AND METHODS

Two intraoral scanners (iTero and Omnicam), two scan body angulations (0 degrees and 30 degrees), and geometric attachments (GAs) for the SBs were investigated. SBs were attached to an edentulous maxillary cast with the following implant analogs: parallel 0-degree at positions #13, #23, and #26, and 30-degree posteriorly tilted at position #16. The cast was digitized using a reference desktop scanner, followed by ten consecutive digital scans using each IOS (five scans with GAs and five without GAs, n = 20). Meshes obtained from the IOS scans were superimposed on the master reference mesh. Linear distance and 3D surface deviations from the reference mesh were calculated. A three-way multivariate analysis of variance (MANOVA) was employed to assess the effects of angulation, IOS type, and GAs on the combined dependent variables (α = 0.05).

RESULTS

No significant three-way interaction was observed between IOS type, SB angulation, and GAs for combined deviations from the reference scan (p = 0.56). Simple main effect analysis revealed that iTero exhibited significantly lower mean 3D surface and linear deviations than Omnicam (p<0.05). Additionally, the use of GAs significantly reduced deviations (p<0.001), with mean deviation reductions for both scanners ranging from 26-33 micrometers (μm) for 3D deviations and 15-21μm for linear distance deviations. No differences were found between angled and parallel SBs regarding 3D surface and linear distance deviations (p≥0.05).

CONCLUSIONS

iTero demonstrated significantly smaller deviations, and the use of GAs led to significantly reduced distance and 3D surface deviations. SB angulations did not impact scan deviations. This article is protected by copyright. All rights reserved.

Accuracy of single-implant digital impression with various scanbody exposure levels at anterior and posterior regions

OBJECTIVES

This in vitro study aimed to evaluate the effect of the exposure heights of the scanbody on the accuracy of digital implant impressions at different positions.

METHODS

Four maxillary master models with one analog at the anterior and posterior region were fabricated by a 3-dimensional (3D) printer. The analogs were submerged from the gingival margin to ensure four exposure heights of the scanbody: 10, 8, 6, and 4 mm. . The master models were then scanned with D2000 dental laboratory scanner as the reference models. An intraoral scanner obtained ten test models for each group. After aligning the scanbody library file, the related files were imported into inspection software for superimposition by a local fit algorithm based on the adjacent teeth.

RESULTS

3D trueness was significantly decreased at 6 and 4 mm scanbody exposure at the anterior region. In comparison, a significant decrease was only seen at 4 mm scanbody exposure at the posterior region. 3D precision was significantly decreased at 4 mm scanbody exposure at both anterior and posterior regions.

CONCLUSION

The exposure height of the scanbody influenced the accuracy of the digital implant impression, according to the implant positions. Scanbody exposure of less than 6 mm at the anterior region and 4 mm scanbody exposure at the posterior region could lead to increased deviations, but still in the tolerance range.

CLINICAL SIGNIFICANCE

The scanbody exposure height less than 6 mm at the anterior region and 4 mm scanbody exposure height at the posterior region could lead to significantly increased deviations. Though these deviations may be still in the clinically acceptable range, caution should be taken.

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.

Retrospective clinical study of 1472-unit monolithic zirconia restorations with feather-edge margins realized with digital workflow

OBJECTIVES

To evaluate the clinical performance of monolithic zirconia restorations with feather-edge margins fabricated by digital impressions.

MATERIALS AND METHODS

All participants that present monolithic zirconia restorations with feather-edge margins realized with digital workflow were evaluated during scheduled periodontal maintenance between February and September 2022 according to predetermined inclusion criteria. Clinical performance was assessed using the modified USPHS and periodontal parameters. Overall survival was calculated for monolithic zirconia restorations. Technical and biologic complications were reported. Descriptive statistical analysis and life-table analyses were performed for all data.

RESULTS

A total of 1472 monolithic zirconia FDPs (1279 on abutments and 193 on pontics) placed in 1189 patients (982 males and 490 females) from February 2017 to September 2020 were analyzed. The mean follow-up was 44 months (range 36-61 months), and the overall survival rate was 98.5%. There were 931 single crowns, 96 were 3-unit FDPs, 33 were 4-unit FDPs, 11 were 5-unit FDPs, and 6-unit FDPs. Three single crowns had irreparable cracks, and 6 single crowns and one 4-unit FDP were fractured. One 3-unit FDP failed due to tooth fracture and 5 single crowns failed due to endodontic failure. The loss of retention was noted in 25 monolithic zirconia FDPs and hypersensitivity in 44 single crowns. Biologic complications were uncommon.

CONCLUSIONS

Based on the results and its limitations, the monolithic zirconia FPDs and digital impressions represent a favorable prosthetic treatment similar to that reported with other margin designs CLINICAL RELEVANCE: Monolithic zirconia restorations on vertical-margin abutments fabricated using a digital workflow demonstrate excellent clinical performance. The digital clinical workflow without the use of a cast means a reduction in costs, steps, and operating time.

Novel model-less fully digital workflow for implant superstructures in an esthetic zone: A technical report

PURPOSE

This report introduces a fully digital workflow for the fabrication of implant superstructures in an esthetic zone using an intraoral scanner (IOS), computer-aided design/computer-aided manufacturing (CAD/CAM) technology, and monolithic multilayer zirconia.

METHODS

Digital impressions of scan bodies and occlusal registration were made in the esthetic zone using an IOS. The provisional restoration in the oral cavity was scanned, and the provisional restoration with an optimized surface morphology of the subgingival contour was scanned outside the oral cavity. These morphological data were integrated into the CAD software to generate a digital cast. The morphology of the final superstructure was generated based on morphological data of the provisional restoration. The final superstructure was fabricated from monolithic multilayer zirconia using a CAM machine, sintered, colored with a stain material, and subsequently bonded to a titanium base using resin cement.

CONCLUSIONS

The superstructure was successfully fabricated using a model-less, fully digital workflow, and delivered to the patient. No clinical complications were reported. Thus, within the limitations of this report, the novel developed superstructure fabrication techniques can change the clinical and laboratory workflows from analog to digital in the esthetic zone.

Effect of abutment tooth location on the accuracy of digital impressions obtained using an intraoral scanner for removable partial dentures

PURPOSE

To verify the effect of abutment tooth location on the accuracy of digital impressions obtained using an intraoral scanner (IOS) for removable partial dentures (RPDs).

METHODS

The target abutment teeth included the left first premolar (#34), second molar (#37), and right second premolar (#45) in a mandibular Kennedy class II model and the left and right second molars (#37, #47) in a class III model. Only #37 was isolated from the remaining teeth by the mucosal area in both models. Digital impressions were obtained using a desktop scanner (reference data) and an IOS (IOS data; scanning origin #37; n=10). The general trueness based on the entire model superimposition (TG), local trueness (TL) of an individual tooth, and dimensional accuracy (coordinate and linear accuracy) of the IOS data of the target abutment teeth were compared (α=0.05).

RESULTS

In both models, #37 showed significantly inferior TG (P<0.01), superior TL (P<0.01), and mesial coordinate displacement (P<0.01 and P<0.05 in class II and III models, respectively). Intra-model comparisons showed that #45 in the class II model and #47 in the class III model had significantly inferior linear accuracy (P<0.05 and P<0.01, respectively) and buccal coordinate displacement (P<0.05 and P<0.01, respectively) compared with the other target teeth.

CONCLUSIONS

In digital impressions of RPDs, isolation of abutment teeth by mucosal areas can reduce general trueness based on the entire dental arch and mesial tooth displacement, whereas increased distance from the scanning origin can adversely affect local trueness and dimensional accuracy.

Influence of the implant scan body modifications on trueness of digital impressions

Background/purpose

Effects of implant angulation on digital impression accuracy remain controversial. The purpose of this study was to assess the relationship between the alteration of implant scan bodies and the trueness of digital impressions.

Materials and methods

A maxillary typodont without the right premolars and first molar was scanned with a laboratory scanner and saved as a standard triangular language (STL) file. A model from the STL file was fabricated with a 3-dimensional printer. Two implants were placed into the first premolar and first molar sites of the model, followed by the insertion of two scan bodies onto the implants. These scan bodies were divided into four test groups, based on the surface modifications. A digital impression of each typodont was made with three different intraoral scanners. An abutment was digitally seated on each implant. 120 STL files (30 for each group) of the typodont with two implants and two corresponding abutments were used for statistical analysis.

Results

A total of 240 values (two implants for each typodont) were obtained after each sample (4 groups) was scanned 10 times by utilizing three intraoral scanners. The overall linear and angular discrepancies were analyzed. Group 1 showed the lowest linear discrepancy of 14.9 ± 5.4 μm while Group 4 reported the highest linear discrepancy of 137.5 ± 41.7 μm, yielding a statistical significance (P < 0.05).

Conclusion

It has been concluded that the more adjustments made to the scan bodies, the greater the linear and angular deviations occur, compromising the trueness of the digital implant impression.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Application of three-dimensional reconstruction technology in dentistry: a narrative review

BACKGROUND

Three-dimensional(3D) reconstruction technology is a method of transforming real goals into mathematical models consistent with computer logic expressions and has been widely used in dentistry, but the lack of review and summary leads to confusion and misinterpretation of information. The purpose of this review is to provide the first comprehensive link and scientific analysis of 3D reconstruction technology and dentistry to bridge the information bias between these two disciplines.

METHODS

The IEEE Xplore and PubMed databases were used for rigorous searches based on specific inclusion and exclusion criteria, supplemented by Google Academic as a complementary tool to retrieve all literature up to February 2023. We conducted a narrative review focusing on the empirical findings of the application of 3D reconstruction technology to dentistry.

RESULTS

We classify the technologies applied to dentistry according to their principles and summarize the different characteristics of each category, as well as the different application scenarios determined by these characteristics of each technique. In addition, we indicate their development prospects and worthy research directions in the field of dentistry, from individual techniques to the overall discipline of 3D reconstruction technology, respectively.

CONCLUSIONS

Researchers and clinicians should make different decisions on the choice of 3D reconstruction technology based on different objectives. The main trend in the future development of 3D reconstruction technology is the joint application of technology.

INTRAORAL SCANNING AND CONVENTIONAL IMPRESSION MAY HAVE SIMILAR TIME EFFICIENCY FOR COMPLETE COVERAGE CROWNS AND THREE-UNIT FIXED TOOTH-SUPPORTED PROSTHESES

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Bandiaky ON, Le Bars P, Gaudin A, Hardouin JB, Cheraud-Carpentier M, Mbodj EB, Soueidan A. Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: A systematic review and meta-analysis. J Prosthet Dent. 2022 Jan;127(1):71-79. doi: 10.1016/j.prosdent.2020.09.017. Epub 2020 Nov 2. PMID: 33,143,901.

SOURCE OF FUNDING

Information not available TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Clinical aspects of digital three-dimensional intraoral scanning in orthodontics - A systematic review

Objective

This systematic review aimed to investigate the accuracy, reproducibility, scanning time, patient comfort, and operator experience of various commercially available intraoral scanners (IOS) in orthodontics.

Methods

An elaborate and extensive search of literature in the PubMed, Scopus, Google Scholar, Embase, Web of Science, and Cochrane Central databases was performed using various relevant keywords.

Results

A total of 3256 articles were obtained from all the databases, 35 studies were included. The accuracy of IOS was controversial compared to that of conventional impression techniques. Digital scanning demonstrated satisfactory to excellent reproducibility, shorter scanning time, and improved patient comfort compared with conventional techniques.

Conclusion

IOS are time-efficient, comfortable for patients, and simple to use with a learning curve for the operator. These methods are sufficiently accurate for treatment planning and aligner fabrication in orthodontics.

Accuracy assessment (trueness and precision) of a confocal based intraoral scanner under twelve different ambient lighting conditions

OBJECTIVES

. The ambient lighting condition has been identified as an important factor that influences the accuracy of intraoral scanners (IOSs). The purpose of this study was to evaluate the influence of 12 different ambient lighting conditions on the accuracy of a confocal based IOS (PrimeScan).

MATERIALS AND METHODS

. A typodont was digitized using a laboratory scanner (L2i) to obtain a reference standard tessellation language (STL_r) file. A restorative dentist recorded the scans using an IOS (PrimeScan) under 12 different ambient lighting conditions where the luminosity was measured using a light meter (LX1330B Light Meter). Twelve groups were created, namely 0-, 500-, 1000-, 2000-, 3000-, 4000-, 5000-, 6000-, 7000-, 8000-, 9000-, and 10 000-lux groups. Ten STL files were recorded per group. The STL_r file was used as a reference with which to compare the distortion of the 120 STL files obtained using a software program (Meshlab). The normality Shapiro-Wilk test indicated that the distributions were not normal. Therefore, the nonparametric Kruskal-Wallis and pairwise multicomparison tests were used to analyze the data (α = 0.05).

RESULTS

. The group with the 1000-lux lighting condition obtained the smallest median ±interquartile range (IQR) with scanning distortion values of 69.5 ±97.4 µm, followed by the 8000-lux group with a median ±IQR of 166.5 ±318.1 µm. The 0-lux group presented the highest distortion values with a mean ±IQR of 355.5 ±488.0 µm (p < 0.05).

CONCLUSIONS

. Ambient lighting conditions influenced the accuracy of the IOS tested. The highest accuracy values were obtained with 1000 lux. The lowest scanning accuracy was obtained with 0 lux.

Influence of type of restorative materials and surface wetness conditions on intraoral scanning accuracy

OBJECTIVES

To assess the influence of different restorative materials and surface wetness on intraoral scanning accuracy.

METHODS

Reference casts with an extracted second premolar and first and second molar were digitized (L2). Four groups were established according to the material of the first molar: natural tooth (control), zirconia (Z), lithium disilicate (LD), and nanoceramic resin crown (NC). Four subgroups were developed: dry, low-, mild-, and high-wetness subgroups (n=15). All the scans were completed by using an intraoral scanner (TRIOS 3). In the control-dry subgroup, the reference cast was dry. In the control-low subgroup, artificial saliva was sprayed with a 1 mL/min volumetric flow for 4 seconds. In the control-mild and control-high subgroups, the same procedures as in the control-low subgroup were performed, but with a volumetric flow of 4 and of 8 mL/min, respectively. In the Z, LD and NC groups, each crown was fabricated with its respective material. Trueness was analyzed using 2-way ANOVA and Bonferroni tests. The Levene and Bonferroni tests were used to assess precision (α=.05).

RESULTS

Material (P<.001) and wetness (P<.001) significantly influenced trueness and precision. The mild and high subgroups revealed lower trueness and precision compared with the dry and low subgroups. The control, Z, and LD groups under dry and low wetness conditions showed better trueness compared with the NC group, but the materials tested had no significant precision discrepancies. Under mild wetness conditions, all the materials showed no significant trueness discrepancies. Under high wetness conditions, the LD group demonstrated the best trueness and precision.

CONCLUSIONS

The restorative materials and surface wetness tested influenced scanning trueness and precision of the IOS assessed.

CLINICAL SIGNIFICANCE

Dried surfaces are recommended to maximize the scanning accuracy values of the IOS tested. Overall, the presence of saliva can reduce the performance of the IOS tested.

The effect of different tooth preparation finishing procedures and immediate dentin sealing on the scanning accuracy of different intraoral scanners

PURPOSE

To measure the effect of different tooth preparation finishing procedures (super-coarse grit, fine grit, and air-particle abrasion) and immediate dentin sealing (IDS) on the scanning accuracy of 4 intraoral scanners (IOSs).

MATERIAL AND METHODS

A tooth preparation for a full-coverage restoration was performed on an extracted mandibular molar using super-coarse diamond burs. Four groups were created depending on the tooth preparation finishing procedure: super-coarse grit (bur with a grit size of 150 µm) (SCG group), fine grit (bur with a grit size of 30 µm) (FG), air-particle abrasion with 27-µm aluminum oxide particles (APA group), and IDS (IDS group). Each group was divided into 5 subgroups according to the scanning system used to digitize the tooth preparation: laboratory scanner (control subgroup) (T710; Medit), Trios 4 (Trios subgroup), CS 3800 (CS subgroup), i700 wireless (i700 subgroup), and iTero Element 5D Plus (iTero subgroup) (n=20). For each subgroup, the control file was aligned with each experimental scan using the best-fit algorithm and an engineering program (Geomagic Control X). The discrepancy between the control and experimental files of each subgroup was computed by measuring the root mean square (RMS) error. Two-way ANOVA and Tukey tests were used to analyze the data (α=.05).

RESULTS

Tooth preparation finishing procedures (P<.001) and the IOS assessed (P<.001) were significant predictors of the trueness and precision values obtained. The highest trueness and precision values were measured in the APA group, while the IDS group had the lowest trueness and precision. Additionally, the i700 subgroup obtained the highest trueness and precision values, while the CS and Trios subgroups had the lowest trueness and precision values.

CONCLUSIONS

The different tooth preparations finishing procedures tested influenced on the scanning accuracy of the 4 IOSs considered. The air-particle abrasion procedure obtained the best accuracy values. The trueness discrepancies measured among all the subgroups was 19µm and the precision discrepancies measured among all the subgroups was 4.69 µm.

CLINICAL SIGNIFICANCE

The tooth preparation finishing procedure used can reduce the intraoral scanning accuracy of any of the intraoral scanners tested. The air-particle abrasion finishing procedure might be recommended for maximizing the scanning accuracy of the IOSs tested.

A modified scan technique for multiple abutment teeth using the trim and lock function

OBJECTIVES

To describe a new protocol for digital scanning of multiple abutment teeth using the trim and lock software tools.

METHODS

A reverse workflow technique was used. Scanning was performed with the interim restoration in position. The abutment teeth were then trimmed from the scan. The retraction cord or interim restoration from either the first mesial or distal abutment tooth was removed and only that tooth was scanned, allowing the dentist to easily manage gingival displacement and keep the tooth dry from crevicular fluid and saliva. Consequently, the preparation margin remained visible and uncontaminated during the scan. The adjacent abutment teeth detected in the scan were deleted from it, and the scan was then locked using a tool of the scanning software. Next, the retraction cord or interim restoration of the next abutment tooth was removed, and only that tooth was scanned. The procedure was repeated until all prepared teeth were individually scanned.

RESULTS

The technique presented here facilitated the scanning of multiple abutment teeth in a simple and predictable way by utilizing the trim and lock surface tools of the scanning software and helped in avoiding closure of the gingival crevice.

CONCLUSIONS

Splitting the scan for a complex case with multiple abutment teeth allows reliable 3D acquisition of the finish line of each abutment tooth. Therefore, this technique simplifies the full-arch intraoral scanning process and can improve treatment efficiency.

CLINICAL SIGNIFICANCE

The trim and lock tool allows scanning of each prepared abutment tooth separately, transforming a full-arch impression into multiple single scans. This technique helps to easily manage gingival displacement and maintain an uncontaminated and dry preparation margin during the scan.

Performance of high-translucent zirconia CAD/CAM fixed dental prostheses using a digital workflow: A clinical study up to 6 years

Background/purpose

Zirconia has recently become a popular material for fixed restorations. The purpose of this study was to use a digital workflow to fabricate monolithic zirconia fixed dental prostheses (FDPs) and assess the connection between variable connector sizes compared to their clinical performance.

Materials and methods

Clinicians evaluated monolithic zirconia FDPs in 58 patients. After definitive impressions were made, stone casts were obtained. The stone casts were scanned to a standard triangle language (STL) file. A digital wax up was fabricated, and corresponding provisional restorations were milled. Final FDPs were fabricated from a high-translucent zirconia material. During digital fabrication, the connector area of each FDP was recorded while meticulous attention was paid to ensure that the connector cross-sectional area was ≥9 mm² for the 3-unit restorations (pontic to retainer) and ≥12 mm² for the 4-unit restorations (pontic to pontic). Biological an technical outcomes of the FDPs were performed at 1 week, 6 months and then annually for 6 consecutive years.

Results

A total of 23 men and 35 women received a total of 63 full-contour zirconia FDPs in the posterior regions and were observed for a time period ranging between 50 and 70 months. No decementation occurred and no caries were detected during the observation period, however signs of gingivitis were detected in 4 patients. The dimension of the connector areas was 12 mm² in the two broken 4-unit FDPs.

Conclusion

The results of this study suggest that the use of digital scanning and milling to fabricate monolithic zirconia FDPs of posterior regions may be an acceptable alternative restorative approach to traditional metal-ceramic restorations.

Accuracy of 14 intraoral scanners for the All-on-4 treatment concept: a comparative in vitro study

PURPOSE

This in vitro study aimed to evaluate the accuracy of 14 different intraoral scanners for the All-on-4 treatment concept.

MATERIALS AND METHODS

Four implants were placed in regions 13, 16, 23, and 26 of an edentulous maxillary model that was poured with scannable Type 4 gypsum to imitate the All-on-4 concept. The cast was scanned 10 times for each of 14 intraoral scanners (Primescan, iTero 2, iTero 5D, Virtuo Vivo, Trios 3, Trios 4, CS3600, CS3700, Emerald, Emerald S, Medit i500, BenQ BIS-I, Heron IOS, and Aadva IOS 100P) after the polyether ether ketone scanbody was placed. For the control group, the gypsum model was scanned 10 times with an industrial scanner. The first of the 10 virtual models obtained from the industrial model was chosen as the reference model. For trueness, the data of the 14 dental scanners were superimposed with the reference model; for precision, the data of all 14 scanners were superimposed within the groups. Statistical analyses were performed using the Kolmogorov-Smirnov, Shapiro-Wilks, and Dunn's tests.

RESULTS

Primescan showed the highest trueness and precision values (P < .005), followed by the iTero 5D scanner (P < .005).

CONCLUSION

Some of these digital scanners can be used to make impressions within the All-on-4 concept. However, the possibility of data loss due to artifacts, reflections, and the inability to combine the data should be considered.

Influence of the surface humidity, implant angulation, and interimplant distance on the accuracy and scanning time of complete-arch implant scans

OBJECTIVES

To assess the influence of implant angulation, humidity, and interimplant distance on the accuracy and scanning time of complete-arch implant scans.

METHODS

A definitive cast with 4 parallel implant abutment analogs (P group), and another cast with 4 angulated (up to 30 degrees) implant abutment analogs (NP group) were digitized by using a scanner (7Series) (reference scans). Two subgroups were created: dry (D subgroup) and wet (W subgroup). For the D subgroup, the casts were digitized without altering the surface humidity by using an intraoral scanner (IOS) (TRIOS 3). For the W subgroup, the cast surface was humidified with artificial saliva and digitized by using the same IOS. The interimplant distance discrepancies were assessed by computing linear and angular measurements. Trueness data was analyzed using 3-way ANOVA followed by the pairwise comparison Tukey tests. The Bartlett test, followed by the pairwise comparison tests, was used to assess the precision (α=.05).

RESULTS

Regarding the trueness, implant angulation (P<.001) and inter-implant distance measurement (P<.001) influenced the linear discrepancies. Implant angulation (P=.002), humidity conditions (P<.001), and inter-implant distance (P=.001) influenced the angular discrepancies. Regarding the precision, significant differences in the variance of linear and angular measurements and inter-implant distances were found. Humidity conditions (P<.001) influenced the scanning time.

CONCLUSIONS

Implant angulation, humidity, and interimplant distance influenced the accuracy and scanning time of complete-arch implant scans. Parallel implants resulted in higher trueness and precision values. Dry conditions resulted in slightly higher scanning trueness and precision and shorter scanning time.

CLINICAL SIGNIFICANCE

Drying the surface being scanned increases intraoral scanning accuracy and decreases intraoral scanning time.

The trueness of an intraoral scanner in scanning different post space depths

OBJECTIVES

The purpose of this in vitro study was to evaluate the trueness of scanning the post space up to 20 mm with an intraoral scanner (IOS).

METHODS

We captured 20-, 18-, 16-, 14-, 12-, and 10-mm length post space scans using an IOS (Primescan) eight times each by shortening the apical 2 mm end of the same mandibular canine tooth. The reference impressions of each length group were taken using a light-body polyvinyl siloxane impression material and were scanned with an extraoral scanner. The recorded standard tessellation language (STL) data of all impressions were uploaded to a 3D matching program for the trueness evaluation via the root mean square (RMS) calculation. For the statistical analysis, the Kruskal-Wallis and post-hoc Mann-Whitney U nonparametric tests were performed to compare the differences among the groups (α=0.05).

RESULTS

The median RMS values increased in direct proportion to the length of the post space from 10 mm (357.1 µm) to 20 mm (897.5 µm). We noted a significant difference among groups (p< 0.001). In the pairwise comparisons, there were no significant differences between the 14 mm and 16 mm groups (p=0.431) or between the 18 mm and 20 mm groups (p=0.036), while other paired groups showed significant differences (p=0.001).

CONCLUSIONS

The scanned space depth affected the trueness of the IOS (Primescan). If the post depth was below 14 mm, and the minimum diameter was 2.2 mm, Primescan could be used for impressions of the post-core structure, simplifying the impression procedure.

CLINICAL SIGNIFICANCE

IOS seems to be a promising technology for taking digital impressions of post spaces, but cannot be recommended as a routine procedure at its present stage, as final results are highly dependent on the clinical situation. Further studies with different IOS systems are needed to gain sound evidence.

Comparison of accuracy between digital and conventional implant impressions: two and three dimensional evaluations

PURPOSE

The present study compared the accuracy between digital and conventional implant impressions.

MATERIALS AND METHODS

The experimental models were divided into six groups depending on the implant location and the scanning span. Digital impressions were captured using the intraoral optical scanner TRIOS (3Shape, Copenhagen, Denmark). Conventional impressions were taken with the monophase impression material based on addition-cured silicones, Honigum-Mono (DMG, Hamburg, Germany). A high-precision laboratory scanner D900 (3Shape, Copenhagen, Denmark) was used to obtain digital data of resin models and stone casts. Surface tessellation language (STL) datasets from scanner were imported into the analysis software Geomagic Qualify 14 (3D Systems, Rock Hill, SC, USA), and scan body deviations were determined through two-dimensional and three-dimensional analyses. Each scan body was measured five times. The Sidak t test was used to analyze the experimental data.

RESULTS

Implant position and scanning distance affected the impression accuracy. For a unilateral arch implant and the mandible models with two implants, no significant difference was observed in the accuracy between the digital and conventional implant impressions on scan bodies; however, the corresponding differences for trans-arch implants and mandible with six implants were extremely significant (P<.001).

CONCLUSION

For short-span scanning, the accuracy of digital and conventional implant impressions did not differ significantly. For long-span scanning, the precision of digital impressions was significantly inferior to that of the traditional impressions.

In vitro scanning accuracy using different aids for multiple implants in the edentulous arch

OBJECTIVES

Optical impressions of implants in the edentulous arch are challenged by the absence of distinct surface morphology between multiple implant scan bodies. The purpose of this in vitro study was to evaluate a newly developed scan aid in various designs and colors to improve the accuracy of multi-implant scans.

MATERIAL AND METHODS

A universal scan aid in three different designs (circular, square, irregular) and three different materials (colors: beige, gray, white) was applied to the implant scan bodies of a master model of 6 implants in an edentulous maxilla. Ten scans using an intra-oral scanner of each scan aid were acquired. Reference scanning was performed using a desktop optical scanner. Alignment of scans was performed at the first scan body in a three-dimensional modeling and inspection software and deviations for trueness and precision were calculated using the signed nearest neighbor method and then statistically analyzed (α=.05).

RESULTS

Overall, the beige irregular scan aid had the highest trueness and showed significant differences compared to unsplinted scans. The precision showed more heterogenous results and decreased when using the scan aid. Ease of use was observed with the irregular gray scan aid due to its increased elongation at break.

CONCLUSIONS

The evaluated scan aid led to improved trueness when compared to unsplinted scans. Even though the irregular design in beige color showed highest trueness, the poor fracture strength of the tested material requires further improvement.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

New Method of Dental Personal Identification of Disaster Victims Using Oral Scanner

Dentistry plays an important role in the identification of victims in large-scale disasters. The current poor status of and problems with victim identification work were highlighted in the aftermath of the Great East Japan Earthquake of March 11, 2011, in which some 10,000 people lost their lives. The techniques of dental identification therefore need to be improved if they are to cope with the problems associated with identification that will accompany the predicted Tokai earthquake and other unexpected large-scale disasters in the future. The purpose of this study was to determine the effectiveness of applying a digital impression-taking device employed in regular dental care to dental personal identification. The Trophy 3DI pro (Yoshida Dental) was applied to a total of 150 dental models. The diagnosis was accurate in 2,096 teeth from a sample of 2,100 comprising 1,240 non-treated teeth, 670 treated teeth, and 190 missing teeth, yielding a 99.8% level of statistical precision. These results suggest that the level of accuracy offered by this impression-taking device indicates that it would be a useful tool in establishing personal identification in disaster victims.

Assessment of the readiness of restorations manufactured by CAD/CAM in terms of marginal fit (Part I)

Background

The master cast is the gold standard for the control and eventual adjustment of restorations produced by conventional procedures. Some digital workflow bypasses the master cast and relies completely on the precision of the CAD/CAM restoration.

Aim

To examine the reproducibility of the margins of CAD/CAM restorations generated from a single digital scan. Also, to check the readiness of these restorations for delivery directly after fabrication without adjustment on a master cast and thereby eliminate the need for the master cast.

Methods

A total of 18 metal substructures made from cobalt chrome alloy were fabricated utilizing a single STL file. The circumference was divided into eight zones. The vertical marginal discrepancy (VMD) was measured at each zone of each metal substructure, with optical microscopy at ×200 magnification.

Results

Measurements of vertical marginal discrepancy were in a range of (-94: 300) with a mean of 62 ± 60 μm. A one-way ANOVA test revealed that the mean VMD is significantly different among the 18 substructures (F17, 1,134 = 63.948, p < 0.001).

Conclusion

Although all the received substructures were fabricated from the same scan file, they were not identical and varied widely, and they were going outside the acceptable range in some zones. Within the limitations of this study, the marginal fit can be improved by extraoral adjustments on the master cast. Thus, skipping the master cast deprives the dentist of delivering a restoration of higher quality.

Influence of the implant scan body geometry bevel feature position, implant angulation, and position on intraoral scanning accuracy: An in vitro study

PURPOSE

To assess the influence of the scan body geometry bevel position and implant angulation and position of complete-arch implant digital scans.

MATERIAL AND METHODS

Two definitive casts with 4 implant analogs placed parallel (P group) or angulated up to 30 degrees (NP group) were fabricated. Five subgroups were created based on the scan body geometry bevel position: facial, mesial, distal, lingual, or random (F, M, D, L, and R subgroup). Casts were digitized using a laboratory scanner (reference) (7Series Desktop Scanner) and an intraoral scanner (TRIOS 3). The implant position discrepancies between the reference and experimental scans were calculated. Data was analyzed using 3-way ANOVA and Tukey tests (α=.05).

RESULTS

The scan body geometry bevel position (P<.001) and the inter-implant distance (P<.001) were shown as significant predictors of the linear discrepancies obtained. The L subgroup had a significantly lower discrepancy compared with the other subgroups. Implant angulation (P<.001), the scan body geometry bevel position (P<.001), and the inter-implant distance (P<.001) were all significant predictors on the angular discrepancies obtained.

CONCLUSIONS

The scan body geometry bevel feature position and implant angulation and position influenced the accuracy of the IOS tested. The lingual orientation obtained significantly better accuracy values compared with the other positions. The parallel implant analog position obtained better accuracy than the angulated positions. Lastly, the implant positioned in the dental arch where the intraoral digital scan was started obtained significantly higher distortion than the contralateral implant.

A digital technique to manage restoration of severely tilted adjacent implants: A dental technique

Implant placement in close proximity with adverse angulations may result in difficulty with impression making. With the lock surface function provided by intraoral scanning software programs, the severely tilted adjacent implants can be digitized one by one without interfering with the accuracy of digital cast. This article presents a straightforward digital impression technique for severely mesiodistally tilted adjacent implants in a clinical case. This article is protected by copyright. All rights reserved.

Analysis of the relationship between the surface topography of prepared tooth surfaces and data quality of digital impressions from an intraoral scanner

Background/purpose

With the rise of digitalization in dentistry, intraoral scanners and digital impressions have recently been adopted by many clinicians. The aim of this study was to investigate surface topography of prepared teeth and the accuracy of digital impressions.

Materials and methods

Twenty mandibular typodonts, containing left first premolar and left first molar abutment teeth manufactured by using CAD/CAM, were used in this study. An intraoral scanner was used to scan each typodont, and each STL file generated was exported in high resolution (Group H), moderate resolution (Group M), and low resolution (Group L). All 60 files were inspected in a 3-D mesh processing software. For each file, the number of triangulation points in the meshwork were obtained for both abutment teeth.

Results

The measurements obtained from the 3-D mesh processing software revealed that the mean number of triangulation points on the 3-D surface of the abutment teeth (20 premolars + 20 M) were 790,625 ± 98,890 dots in Group H, 592,283 ± 74,881 dots in Group M, and 198,067 ± 19,328 dots in Group L. Significant differences were found between Group H and M (p < 0.05), Group H and L (p < 0.001), and Group M and L (p < 0.01).

Conclusion

The outcomes of this study reveal that there are strong correlations between the data quality of digital impressions and surface topography of prepared teeth. Therefore, the utilization of STL files in high resolution format is the recommended choice for clinicians engaging in a digital workflow process.

Comparison of marginal and internal fit of 5-unit zirconia fixed dental prostheses fabricated with CAD/CAM technology using direct and indirect digital scans

BACKGROUND/PURPOSE

Advancements in digital dentistry and the development of intraoral scanners (IOS) have provided clinicians with an accurate and efficient alternative to analog impressions. The aim of this study was to assess the accuracy of the marginal and internal fit of 5-unit monolithic zirconia fixed dental prostheses (FDPs) fabricated with CAD/CAM technology using direct and indirect digitalization methods.

MATERIAL AND METHODS

Three teeth in a maxillary typodont model were prepared to receive a 5-unit zirconia FDP. Six different groups were created according to the type of scanner (intraoral and extraoral) and the type of workflow. For direct workflow, the typodont was scanned with two different IOS (3Shape Trios 3 [3S-IOS] and Cerec Omnicam [C-IOS]). For indirect workflow, after conventional impressions were obtained, the impressions (IMP) were scanned with two different laboratory scanners (3S-IMP and C-IMP). After the impressions were poured, the stone (STN) casts were scanned with the same laboratory scanners (3S-STN and C-STN). Sixty 5-unit monolithic zirconia FDPs (10 in each group) were designed and milled. The marginal and internal fit was assessed.

RESULTS

The mean marginal gap values were 78.2±9 μm in the IOS group, 82.6± 9 μm in the IMP group, and 82.6±9 μm in the STN group, indicating no statistically significant differences among groups (p > 0.05). The mean axial gap values were 77.7 ± 10 μm in IOS group, 83.61 ± 15 μm in the IMP group, and 84.5±9 μm in the STN group, indicating no statistically significant differences among groups (p > 0.05).

CONCLUSION

The marginal and internal fit of 5-unit monolithic zirconia FDPs fabricated with direct and indirect digital scans were similar. The smallest gap values were observed at the marginal region while the greatest gap values were detected at the occlusal region.

Five-to-five clear aligner therapy: predictable orthodontic movement for general dentist to achieve minimally invasive dentistry

Background

Esthetic dentistry has become a very important aspect of every dental treatment from the patient perspective, whether it is orthodontics or implant therapy. The aim of this article is to describe the advantages of a newly developed branch of five-to-five clear aligner therapy (CAT) (Invisalign Go, Align Technology, San Jose, Calif) in interdisciplinary treatments especially in terms of minimally invasive interventions.

Case presentation

Two case reports are presented together with a comprehensive analysis using the SAFE (Safety, Assessment, Function, Ethics) assessment. This paper aims to introduce a new systematic in CAT. Invisalign Go (Align Technology, Santa Clara, California, USA) allows orthodontic treatment from second premolar and second premolar in both arches. It is specially designed for general practitioners devoted to restorative dentistry for a better planning of a multidisciplinary and mini-invasive treatment plan.

Discussion and conclusion

The clinical results demonstrate how CAT is extremely useful in multidisciplinary treatment plan in order to straighten teeth especially in a pre-restorative phase to allow minimally invasive and adhesive restorations.

Effect of assistive devices on the precision of digital impressions for implants placed in edentulous maxilla: an in vitro study

PURPOSE

To examine the effect of assistive devices on the precision of digital impression for multiple implants placed in the edentulous maxilla.

METHODS

A reference model representing an edentulous maxilla with four implants was developed. The digital impression group included three settings: Type 0, without an assistive device; Type 1, with an assistive device connecting only neighboring implants; and Type 2, with an assistive device connecting not only neighboring implants but also the two posterior implants, with perpendicular branches from this bar towards the anterior implants. Digital impressions were made five times for each type using three intraoral scanners (IOSs). For conventional method, silicone impressions and verification jigs were prepared; fabricated plaster models were scanned using a laboratory scanner/industrial 3D scanner. In analysis 1, two-way ANOVA analyzed the effect of IOSs and assistive devices on the precision of digital impressions. In analysis 2, one-way ANOVA compared the silicone impressions, the verification jigs, and the most precise group of digital impressions from analysis 1.

RESULTS

In analysis 1, the IOS and assistive device type (F = 25.22, p < .0001) effects and the interaction between these two factors (F = 5.64, p = .0005) were statistically significant. In analysis 2, CON, VJ, and digital impression with Type 2 devices (most precise devices in analysis 1) were compared; better precision was obtained by digital impression with Type 2 device than by CON and VJ (F = 30.08, p < .0001).

CONCLUSIONS

For implants placed in an edentulous maxilla, digital impressions with assistive devices can provide better precision compared to silicone impressions and verification jigs.

In-vitro accuracy of complete arch scans of the fully dentate and the partially edentulous maxilla

PURPOSE

This in-vitro study aimed to compare the accuracy of complete arch scans (CAS) of a fully dentate (FD) and a partially edentulous (PE) maxillary model. Three intraoral scanning systems were used: Omnicam AC (OC), TRIOS 4 (TR), and Primescan (PS).

METHODS

Each intraoral scanner was used to take 30 scans each of two clinical scenarios (FD and PE) simulated by a reference model. The PE model simulated a maxilla with six prepared teeth to accommodate a jaw-spanning fixed partial denture (FPD). The missing teeth were then added to create an FD model. Five ceramic precision balls (ball centers P₁-P₅) mounted on metal pins were welded to the metal base on the buccal side of the dental arch. These were later used to determine dimensional (given by each 2 ball centers) and angular changes (given by each 3 or 4 ball centers) between the reference model (digitized with high precision before the tests) and the intraoral scans. Data were statistically analyzed using a type II ANOVA.

RESULTS

The maximum mean absolute distance deviations were as follows. OC: 147 µm (FD) and 139 µm (PE). TR: 133 µm (FD) and 136 µm (PE). PS: 87 µm (FD) and 80 µm (PE). The scanning system used had a significant effect on distance deviations (p < 0.027) and CAS scanning time (p < 0.001). Dental status had no clear effect on distance deviations but did significantly affect angular changes (p < 0.001) and scanning time (p < 0.001).

CONCLUSION

The manufacture of jaw-spanning FPDs based on a CAS cannot yet be recommended.

Improved accuracy of digital implant impressions with newly designed scan bodies: an in vivo evaluation in beagle dogs

Background

The accuracy of digital impressions for fully edentulous cases is currently insufficient for routinely clinical application. To overcome the challenge, a modified scan body was introduced, which demonstrated satisfactory accuracy in vitro. The aim of this study was to evaluate the accuracy of digital impressions using the modified scan bodies with extensional structure versus scan bodies without extensional structure in mandible with two implants in beagle dogs.

Methods

The unilateral mandibular second premolar to second molar were extracted in four beagle dogs. Twelve weeks later, two implants were placed. Five repeated digital impressions were performed with an intraoral scanner on each dog using each of the two different scan bodies: Group I—scan body without extensional structure (SB); Group II—scan body with extensional structure (SBE). The scans were exported to Standard Tessellation Language (STL) files to serve as test data. The dogs were sacrificed and the dissected mandibles were digitalized with a lab scanner to provide reference data. Linear and angular deviations were calculated in an inspection software for accuracy assessment. Statistical analysis was performed with two-way ANOVA. The level of significance was set at α = 0.05.

Results

For trueness assessment, the mean of absolute linear/angular deviations were 119.53 μm/0.75 degrees in Group I and 68.89 μm/0.36 degrees in Group II. SBE was more accurate than SB regarding both linear (p = 0.008) and angular (p = 0.049) deviations. For precision assessment, the mean of absolute linear/angular deviations were 63.01 μm/0.47 degrees in Group I and 38.38 μm/0.24 degrees in Group II. No significant difference was found.

Conclusions

The application of SBE significantly improved the trueness of digital impressions in mandible with two implants compared to SB. No significant difference was found in terms of precision.

Intraoral scanning reduces procedure time and improves patient comfort in fixed prosthodontics and implant dentistry: a systematic review

OBJECTIVES

The primary aim of this systematic review was to evaluate whether intraoral scanning (IOS) is able to reduce working time and improve patient-reported outcome measures (PROMs) compared to conventional impression (CI) techniques, taking into account the size of the scanned area. The secondary aim was to verify the effectiveness of IOS procedures based on available prosthodontic outcomes.

MATERIALS AND METHODS

Electronic and manual literature searches were performed to collect evidence concerning the outcomes of IOS and CI performed during the treatment of partially and complete edentulous patients for tooth- or implant-supported restorations. Qualitative analysis was conducted to evaluate the time efficiency and PROMs produced by the two different techniques. Clinical prosthodontic outcomes were analyzed among the included studies when available.

RESULTS

Seventeen studies (9 randomized controlled trials and 8 prospective clinical studies) were selected for qualitative synthesis. The 17 included studies provided data from 430 IOS and 370 CI performed in 437 patients. A total of 7 different IOS systems and their various updated versions were used for digital impressions. The results demonstrated that IOS was overall faster than CI independent of whether quadrant or complete-arch scanning was utilized, regardless of the nature of the restoration (tooth or implant supported). IOS was generally preferred over CI regardless of the size of the scanned area and nature of the restoration (tooth- or implant-supported). Similar prosthodontic outcomes were reported for workflows implementing CI and IOS.

CONCLUSIONS

Within the limitations of this systematic review, IOS is faster than CI, independent of whether a quadrant or complete arch scan is conducted. IOS can improve the patient experience measured by overall preference and comfort and is able to provide reliable prosthodontic outcomes.

CLINICAL RELEVANCE

Reduced procedure working time associated with the use of IOS can improve clinical efficiency and the patient experience during impression procedures. Patient-reported outcome measures (PROMs) are an essential component of evidence-based dental practice as they allow the evaluation of therapeutic modalities from the perspective of the patient. IOS is generally preferred by patients over conventional impressions.

Trueness of full-arch IO scans estimated based on 3D translational and rotational deviations of single teeth-an in vitro study

Objectives

To three-dimensionally evaluate deviations of full-arch intraoral (IO) scans from reference desktop scans in terms of translations and rotations of individual teeth and different types of (mal)occlusion.

Materials and methods

Three resin model pairs reflecting different tooth (mal)positions were mounted in the phantom head of a dental simulation unit and scanned by three dentists and three non-graduate investigators using a confocal laser IO scanner (Trios 3®). The tooth-crown surfaces of the IO scans and reference scans were superimposed by means of best-fit alignment. A novel method comprising the measurement of individual tooth positions was used to determine the deviations of each tooth in the six degrees of freedom, i.e., in terms of 3D translation and rotation. Deviations between IO and reference scans, among tooth-(mal)position models, and between dentists and non-graduate investigators were analyzed using linear mixed-effects models.

Results

The overall translational deviations of individual teeth on the IO scans were 76, 32, and 58 µm in the lingual, mesial, and intrusive directions, respectively, resulting in a total displacement of 114 µm. Corresponding rotational deviations were 0.58° buccal tipping, 0.04° mesial tipping, and 0.14° distorotation leading to a combined rotation of 0.78°. These deviations were the smallest for the dental arches with anterior crowding, followed by those with spacing and those with good alignment (p < 0.05). Results were independent of the operator’s level of education.

Conclusions

Compared to reference desktop scans, individual teeth on full-arch IO scans showed high trueness with total translational and rotational deviations < 115 µm and < 0.80°, respectively.

Clinical relevance

Available confocal laser IO scanners appear sufficiently accurate for diagnostic and therapeutic orthodontic applications. Results indicate that full-arch IO scanning can be delegated to non-graduate dental staff members.

Digital impressions' accuracy through "cut-out-rescan" and "data exchange by over scanning" techniques in complete arches of two intraoral scanners and CAD/CAM software

PURPOSE

This technical procedure describes the accuracy of "cut-out-rescan" and "data exchange by over scanning" on cast areas using computer-aided design and computer-aided manufacturing software and two intraoral scanners (IOSs).

METHODS

A customized cast was used as a reference standard and scanned using an ATOS Triple Scan digitizer. Two IOS setups were used in three scanning groups, namely, the control, cut-out-rescan, and data exchange by over scanning groups. Sixty digital files (n = 10 per group) were obtained and converted into the standard tessellation language format. A metrology program was used to evaluate the difference in accuracy between the control group and the other groups using Welch's unequal variances t-test.

CONCLUSION

For trueness and precision of complete arch scans, the present technique provides statistical evidence that using data exchange by over scanning and a Primescan IOS results in higher accuracy scans compared to using cut-outrescan and a Primescan IOS. The cut-out-rescan procedure provides scans with higher accuracy when using an Omnicam IOS. This technique is simple and saves time in workflows using a Primescan IOS.

Accuracy of intraoral scans of edentulous jaws with different generations of intraoral scanners compared to laboratory scans

PURPOSE

Purpose of this in vitro study was to determine the accuracy of different intraoral scans versus laboratory scans of impressions and casts for the digitization of an edentulous maxilla.

MATERIALS AND METHODS

A PEEK model of an edentulous maxilla, featuring four hemispheres on the alveolar ridges in region 13, 17, 23 and 27, was industrially digitized to obtain a reference dataset (REF). Intraoral scans using Cerec Primescan AC (PRI) and Cerec AC Omnicam (OMN), as well as conventional impressions (scannable polyvinyl siloxane) were carried out (n = 25). Conventional impressions (E5I) and referring plaster casts were scanned with the inEOS X5 (E5M). All datasets were exported in STL and analyzed (Geomagic Qualify). Linear and angular differences were evaluated by virtually constructed measurement points in the centers of the hemispheres (P13, P17, P23, P27) and lines between the points (P17–P13, P17–P23, P17–P27). Kolmogorov-Smirnov test and Shapiro-Wilk test were performed to test for normal distribution, Kruskal-Wallis-H test, and Mann-Whitney-U test to detect significant differences in trueness, followed by 2-sample Kolmogorov-Smirnov test to detect significant differences in precision (P < .008).

RESULTS

Group PRI showed the highest trueness in linear and angular parameters (P < .001), while group E5I showed the highest precision (P < .001).

CONCLUSION

Intraoral scan data obtained using Primescan showed the highest trueness while the indirect digitization of impressions showed the highest precision. To enhance the workflow, indirect digitization of the impression itself appears to be a reasonable technique, as it combines fast access to the digital workflow with the possibility of functional impression of mucosal areas.