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.

Clinical evaluation of the precision of interocclusal registration by using digital and conventional techniques.

STATEMENT OF PROBLEM: Although studies have evaluated the accuracy of data obtained by intraoral scanners (IOSs), studies on the precision of interocclusal registrations made with IOSs are lacking. PURPOSE: The purpose of this clinical study was to compare the precision of IOS interocclusal registration with that of conventional methods with a silicone impression material and a gypsum cast. MATERIAL AND METHODS: Eight participants with complete natural dentitions were enrolled. Images of their maxillary and mandibular quadrant arches and their interocclusal relationship were scanned with 2 IOSs: the 3M True Definition Scanner and the TRIOS Scanner 3. In the conventional method, impressions of complete-arch dentition and quadrant-arch dentition were made with a silicone impression material, and gypsum casts were fabricated, mounted on a dental articulator related with a silicone interocclusal record, and scanned with a 3D laboratory scanner. These procedures were repeated 4 times, and 4 sets of interocclusal registration data in standard tessellation language (STL) format were generated for each condition. Interocclusal registration precision was evaluated by determining the discrepancy of the STL data between repeated measurements by using the best-fit-algorithm method. RESULTS: The average discrepancies for all participants were 25 ±12 µm for the True Definition, 31 ±7 µm for the TRIOS 3, 154 ±59 µm for the complete arch, and 128 ±33 µm for the quadrant arch. The Kruskal-Wallis test revealed that the effect of the impression methods on the discrepancy was statistically significant (P<.001). The Steel-Dwass test showed that both digital scan methods exhibited significantly smaller discrepancies than the 2 conventional methods (P=.005). CONCLUSIONS: These results suggest that the intermaxillary relationship captured by the digital scan method by using IOSs had better precision than that obtained by the conventional method.