Accuracy of implant abutment level digital impressions using stereophotogrammetry in edentulous jaws: an in vitro pilot study.

BACKGROUND: In edentulous jaws, factors such as the number of implants, cross-arch distribution, and the angle among implants may affect the accuracy of the implant impression. This study explored factors influencing the accuracy of implant abutment-level digital impressions using stereophotogrammetry in edentulous jaws. METHODS: Two standard all-on-4 and all-on-6 models of edentulous jaws were constructed in vitro. In the stereophotogrammetry group (PG), the implant digital impression was made using stereophotogrammetry and saved as an STL file. In the conventional group (CNV), the impression was made using the open-tray splint impression technique. An electronic and optical 3D measuring instrument was used to scan the standard model and the conventional plaster model to obtain STL files. Using 3D data processing software (GOM Inspect Pro, Zeiss), the distance and angle between the abutments in the CNV impression and the PG impression were measured and compared with the data from the standard model. RESULTS: The distance deviation in the PG and the CNV was 145 ± 196 µm and 96 ± 150 µm, respectively, with a significant difference (P < 0.001). The angle deviation in the PG and the CNV was 0.82 ± 0.88° and 0.74 ± 0.62°, respectively, with no significant difference (P = 0.267). In the PG, the distance deviation was negatively correlated with the distance between implants (r = -0.145, P = 0.028) and positively correlated with the angle of implants (r = 0.205, P = 0.002). The angle deviation was negatively correlated with the distance between implants (r = -0.198, P = 0.003) and positively correlated with the angle of implants (r = 0.172, P = 0.009). In the CNV, the effect of inter-implant distance on impression accuracy was also shown by Spearman correlation analysis: r = 0.347 (P < 0.001) for distance deviation and r = -0.012 (P = 0.859) for angle deviation. The effect of inter-implant angulation on impression accuracy deviation was r = -0.026 (P = 0.698) for distance deviation and r = 0.056 (P = 0.399) for angle deviation. CONCLUSIONS: The CNV method is closer to the real value of the original model. The distance between implants and the distribution angle had a weak correlation with the accuracy of digital impressions but no significant correlation with the accuracy of traditional impressions.

Effect of soft tissue thickness on accuracy of conventional and digital implant impression techniques.

BACKGROUND: Placing implants deep sub-gingivally may affect the accuracy of implant impression techniques and the fit of final restoration. PURPOSE: The aim of this in-vitro study was to evaluate the effect of soft tissue thickness on accuracy of conventional and digital implant impression techniques. METHODS: Four parallel implant analogues (A, B, C, D) placed in each of two epoxy resin models representing edentulous mandible covered by flexible polyurethane material with two different thickness two mm and four mm. A total of sixty impressions performed, thirty impressions for each model divided into four groups (n = 15 per group) GI (C2mm) open tray impression with two mm implant depth, GII (C4mm) open tray impression with four mm implant depth, GIII (D2mm) digital impression with two mm implant depth, GIV (D 4 mm) digital impression with four mm implant depth. Impressions from open tray technique were poured to get stone casts while impressions from digital scanning technique were printed as three-dimensional printed casts. The six inter-implant distances between analogues were measured using Co-ordinate measuring machine, deviations compared to reference models were calculated. Data was collected, tabulated and statistically analyzed using One-way ANOVA test to detect significances between groups. RESULTS: For conventional impressions there was significant difference between C2mm/C4mm (P < 0.001) regarding interimplant distance, while in digital impressions there was no significant difference between D2mm/D4mm AB(p = 0.110), BC(p = 0.066), CD(p = 0.710), AD(p = 0.084), AC(p = 0.067) and BD(p = 0.072). There was significant difference between conventional and digital impression techniques C2mm/D2mm, C4mm/D4mm (P < 0.001). CONCLUSION: Within the limitations of this in-vitro study digital impressions provide more accurate outcomes with implants placed deeper subgingivally than conventional impressions. TRIAL REGISTRATION: Retrospectively registered.

Intraoral optical impression versus conventional impression for fully edentulous maxilla: an in vivo comparative study.

AIM: The aim of the present in vivo study was to compare the clinical trueness of primary mucostatic impressions obtained either by a classical alginate or an optical intraoral scanner technique in patients with a fully edentulous maxilla. MATERIALS AND METHODS: A total of 30 patients with a fully edentulous maxilla were included in the study and underwent both conventional impressions and intraoral optical impressions (Trios 3). The conventional impressions were casted and the resulting plaster casts were digitized using a desktop scanner (Imetric D104i). These digitized impressions were superimposed over the optical impressions to compare the differences between the two data sets. Statistical analyses were performed to identify relevant deviations. RESULTS: For the 30 intraoral impressions, 80.88% of the surface areas were below the tolerance threshold of 25 µm and were thus considered similar to the areas scanned with the desktop scanner from the reference plaster cast. Interestingly, the differences (19.12% of the surface areas) were localized in depressible areas such as the vestibule, soft palate, incisive papilla, and flabby ridges. These locations were consistent with the mean of positive differences of +22.8 µm, indicating deformation or less compression with the use of the intraoral scanner. CONCLUSIONS: The digital primary impression of the fully edentulous maxilla can be considered similar to the conventional alginate impression except in the depressible areas. Considering the mucostatic objective of such a primary impression, one may consider the optical impression to be more accurate than the conventional one.

Evaluation of the trueness and precision of conventional impressions versus digital scans for the all-on-four treatment in the maxillary arch: An in vitro study.

PURPOSE: To compare the accuracy of digitizing conventional impressions to intraoral surface scans for all-on-four treatment in the maxillary arch. MATERIALS AND METHODS: An edentulous maxillary arch model with four implants placed in an all-on-four design was fabricated. Intraoral surface scans (n = 10) were obtained using an intraoral scanner after scan body insertion. For conventional polyvinylsiloxane impressions of the model, implant copings were inserted into the implant fixation for implant level, opened tray impressions (n = 10). The model and conventional impressions were digitized to obtain digital files. A reference file was created using a laboratory-scanned conventional standard tessellation language (STL) file with analog to scan the body using exocad software. STL datasets from the two digital and conventional impression groups were superimposed with reference files to assess the 3D deviations. Two-way ANOVA and paired-samples t-test was performed to assess the difference in trueness and examine the effects of impression technique and implant angulation on the deviation amount. RESULTS: No significant differences were found between the conventional impression and intraoral surface scan groups F(1, 76) = 2.705, p = 0.104. No significant differences were found between conventional straight and digital straight implants and between conventional and digital tilted implants F(1, 76) = .041, p = 0.841. No significant differences were found between conventional straight and conventional tilted implants p = 0.07 and between digital straight and digital tilted implants p = 0.08. CONCLUSION: Digital scans were more accurate than conventional impressions. The digital straight implants were more accurate than the conventional straight implants, and the digital tilted implants were more accurate than the conventional tilted implants, with higher accuracy for digital straight implants.

Non-invasive oral implant position assessment: An ex vivo study using a 3D industrial scan as the reference model to mimic the clinical situation.

AIM: To introduce an objective method to evaluate the accuracy of implant position assessment in partially edentulous patients by comparing different techniques (conventional impression, intraoral scan, CBCT) to a reference 3D model obtained with an industrial scanner, the latter mimicking the clinical situation. MATERIALS AND METHODS: Twenty-nine implants were placed in four human cadaver heads using a fully guided flapless protocol. Implant position was assessed using (a) a conventional impression, (b) an intraoral scan, and (c) CBCT and compared to an industrial scan. Three-dimensional models of intraoral scan body and implant were registered to the arch models and the deviation at implant shoulder, apex, and the angle of deviation were compared to each other as well as to the reference model. RESULTS: The three assessment techniques showed statistically significant deviations (p < .01) from the industrial scan, for all measurements, with no difference between the techniques. The maximum deviation at the implant shoulder was 0.16 mm. At the implant apex this increased to 0.38 mm. The intraoral scan deviated significantly more than the CBCT (0.12 mm, p < .01) and the conventional impression (0.10 mm, p = .02). The maximum implant angle deviation was 1.0°. The intraoral scan deviated more than the conventional impression (0.3°, p = .02). CONCLUSION: All assessment techniques deviated from the reference industrial scan, but the differences were relatively small. Intraoral scans were slightly less accurate than both conventional impressions and CBCT. Depending on the application, however, this inaccuracy may not be clinically relevant.

Clinical evaluation of marginal fit of uncemented CAD-CAM monolithic zirconia three-unit restorations in anterior areas, using scannable and conventional polyvinyl siloxane impression materials.

BACKGROUND: The accuracy of impression techniques determines the marginal fit of fixed prostheses. Marginal accuracy plays a main role in the success and failure of treatments. This in-vivo study evaluated the marginal fit of anterior three-unit monolithic zirconia fixed partial dentures (FPDs) using conventional and scannable polyvinyl siloxane impression materials. METHODS: Ten patients were selected to replace the lateral teeth with a three-unit monolithic zirconia bridge. For each patient, in the first group, an impression was made with a two-step putty-wash technique using scannable polyvinyl siloxane material (BONASCAN; DMP, Greece). In the identical session, as the second group, an impression of conventional putty-wash polyvinyl siloxane was taken (BONASIL A+ Putty; DMP, Greece). The marginal discrepancy was measured through the replicas, which were cut perpendicularly within the buccolingual and mesiodistal directions. An Independent t-test was employed for data analyses (P < 0.05). RESULTS: The marginal discrepancy in a conventional method for central abutment in mid-buccal, mid-lingual, mid-mesial, and mid-distal was higher than in the scannable method but it was not significant (P > 0.05). Also, the marginal discrepancy for canine abutment in the conventional method was higher than in the scannable method, but it was not significant, either (P > 0.05). CONCLUSIONS: FPDs fabricated from both scannable and conventional impression materials were not superior to each other in marginal fit for both central and canine abutments by evaluation using the replica technique.

Effect of Different Definitive Impression Techniques for Resorbed Mandibular Ridge on Retention of a Lower Complete Denture.

AIM: This study aimed to evaluate the effect of different definitive impression techniques for the resorbed mandibular ridge on the retention of lower complete dentures. MATERIALS AND METHODS: Ten completely edentulous male patients with severe atrophic mandibular ridge were selected from the Prosthodontic Department's outpatient clinic, Faculty of Dentistry, Sinai University (Kantara branch). Each patient received four dentures. Dentures were divided into four groups according to the type of final impression, Group I: Conventional impression techniques (open mouth technique), Group II: Cocktail impression techniques, Group III: Modified functional impression technique, and Group IV: Wire impression technique. Each denture was used for one month and at the end of the month the retention test was carried out and the results were tabulated and statistically analyzed. RESULTS: There is a statistically significant difference between the groups. The results also showed that the highest mean value was in group IV, whereas the lowest mean value of retention was in group I. CONCLUSION: Wire impressions produce lower dentures with higher retention, whereas conventional impressions produce lower dentures with the lowest retention, so it is considered to be more advantageous. CLINICAL SIGNIFICANCE: The wire impression technique is superior in the management of resorbed ridges as compared with other techniques.

EPA Consensus Project Paper: Accuracy of Conventional and Digital Workflows in Partially Edentulous Cases Restored with FPDs over Implants. A Systematic Review

PURPOSE: To compare conventional and digital workflows in terms of accuracy in partially edentulous cases restored with implant-supported restorations. METHODS: An electronic search in the databases PubMed, Scopus, Web Of Science, and CENTRAL was conducted to identify relevant publications, comparing digital and conventional workflows in partially edentulous cases restored with implant-supported prostheses. RESULTS: 18 articles were included in the systematic review. Ten of the studies were in-vitro, and eight were clinical. Sample sizes varied considerably from 20 to 100. In three studies, three implants were investigated, whereas, in all other instances, accuracy was evaluated on two implants. Substantial heterogeneity in the methodology of the selected studies is evident, which prevents summarising the accuracy outcomes. CONCLUSIONS: Digital impressions showed similar results in terms of accuracy compared to the conventional approach. There is a lack of uniform criteria for the tolerable misfit, which hampers the ability to transfer in-vitro results to clinical situations. A need for a standardised approach in the evaluation of impression and workflow accuracy is warranted to enable the systematisation and analysis of results from different studies.

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.

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.

Evaluation of the Accuracy of Digital Impressions Obtained from Intraoral and Extraoral Dental Scanners with Different CAD/CAM Scanning Technologies: An In Vitro Study.

PURPOSE: To compare the accuracy of intraoral and extraoral scanners (IOSs and EOSs) with different scanning technologies. MATERIAL AND METHODS: A phantom cast was used to simulate the patient's mouth. Polyether impression was made of the phantom cast and poured to fabricate stone casts. The stone casts were scanned by two IOSs (3shape Trios 3, 3S and Dental Wings, DW) and two EOSs (S600 Arti Zirkonzahn, ZK and Ceramill map 600 Amann Girrbach, AG) to obtain digital casts. Reference teeth (canines, premolar, and molars) dimensions were measured on the digital casts by Geomagic software and compared to measurements of the stone cast done by stereomicroscope. The dimensions were occluso-cervical mesio-distal, and bucco-lingual and their average was calculated. Differences between digital and stereoscopic measurements were assessed using paired t-test. Discrepancies between these measurements were calculated as differences and were compared among the four scanners using ANOVA. RESULTS: The differences among the discrepancies of the four scanners were not significant overall (p = 0.969), in premolars (p = 0.932) or molars (p = 0.069) but significant in canines (p = 0.025). The discrepancies of the EOSs were ≤0.01 mm in canines and molars. DW had the greatest discrepancy in canines and molars. CONCLUSIONS: The IOSs and EOSs had similar accuracy except in canines where EOSs performed better. The accuracy of scanning is affected by the smoothness and regularity of the teeth surfaces as in case of the canine.

Accuracy of photogrammetry, intraoral scanning, and conventional impression techniques for complete-arch implant rehabilitation: an in vitro comparative study.

BACKGROUND: To compare the accuracy of photogrammetry, intraoral scanning and conventional impression techniques for complete-arch implant rehabilitation. METHODS: A master cast containing 6 implant abutment replicas was fabricated. Group PG: digital impressions were taken 10 times using a photogrammetry system; Group IOS: intraoral scanning was performed to fabricate 10 digital impressions; Group CNV: splinted open-tray impression technique was used to fabricate 10 definitive casts. The master cast and conventional definitive casts were digitized with a laboratory reference scanner. For all STL files obtained, scan bodies were converted to implant abutment replicas using a digital library. The accuracy of a digitizer was defined by 2 main parameters, trueness and precision. "Trueness" was used to describe the deviation between test files and reference file, and "precision" was used to describe the closeness between test files. Then, the trueness and precision of three impression techniques were evaluated and statistically compared (α = 0.05). RESULTS: The median trueness was 24.45, 43.45 and 28.70 µm for group PG, IOS and CNV; Group PG gave more accurate trueness than group IOS (P < 0.001) and group CNV (P = 0.033), group CNV showed more accurate trueness than group IOS (P = 0.033). The median precision was 2.00, 36.00 and 29.40 µm for group PG, IOS and CNV; Group PG gave more accurate precision than group IOS (P < 0.001) and group CNV (P < 0.001), group CNV showed more accurate precision than IOS (P = 0.002). CONCLUSIONS: For complete-arch implant rehabilitation, the photogrammetry system showed the best accuracy of all the impression techniques evaluated, followed by the conventional impression technique, and the intraoral scanner provided the least accuracy.

Comparison of Intaglio Surface Adjustment in the Oral Cavity for Lithium Disilicate Crowns Fabricated Using Different Scanners.

PURPOSE: A clinical study to evaluate the intraoral adjustment of crowns fabricated using different scanners. MATERIALS AND METHODS: A total of 15 patients requiring single ceramic crowns were recruited. Impressions were made according to four protocols: a conventional approach and using three intraoral scanners (IOSs) (CS3600 (Carestream Dental, Atlanta, GA), i500 (Medit, Seoul, Republic of Korea), and EZIS PO (DDS, Seoul, Republic of Korea)). Four crowns per patient were fabricated using lithium disilicate ceramic. An experienced dentist performed the internal adjustment in the oral cavity. Three-dimensional analysis was conducted using an inspection software program (Geomagic Control X; 3D Systems, Rock Hill, SC). Statistical analysis was conducted using one-way analysis of variance and Tukey's honest significance difference tests (α = 0.05). RESULTS: A significant difference was observed in the intraoral adjustment among the conventional approach and the three IOSs (F = 213.7, p < 0.001). Crowns fabricated by conventional impressions (20.1 ± 1.4 µm) displayed better three-dimensional conformity before and after intraoral adjustment than IOS groups (29.6 ± 4.3 µm) (p < 0.001). CONCLUSIONS: Crowns fabricated using conventional impressions required fewer intraoral adjustments of the intaglio surface than those fabricated using IOSs.

Clinical efficiency and patient preference of digital and conventional workflow for single implant crowns using immediate and regular digital impression: A meta-analysis.

OBJECTIVE: To assess whether digital workflow gives better results than the conventional one in the single implant crowns, when analyzing the impression time, patient preference, time efficiency, and adjustment time. MATERIAL AND METHODS: MEDLINE, Embase, and Cochrane were searched and supplemented via hand search up to June 19, 2019. Only clinical trials assessing conventional versus digital workflows for single implant crowns were included. Impression time was evaluated using random effects meta-analysis, while patient preference, adjustment time, and time efficiency were reported descriptively. RESULTS: Among 1,334 publications identified, ten studies were included. The random effects models revealed statistically significant reduction in time in the digital impression group when compared to the conventional group by the mean meta-analysis (MD: 8.22 [95% CI: 5.48, 10.96]). Analysis from immediate digital impression versus conventional (MD: 3.84 [95% CI: 3.30, 4.39]) and regular digital impression versus conventional (MD:10.67 [95% CI: 5.70, 15.65]) showed statistically significant reduction in time on using the digital impression. Impression time in the digital process ranged between 6 min 39 s and 20 min, whereas for conventional, it was between 11.7 and 28.47 min. Patients showed greater preference for digital impression. Adjustment time in the digital process ranged between 1.96 and 14 min, whereas for conventional, it was between 3.02 and 12 min. Time efficiency in the digital process ranged between 36.8 and 185.4 min, whereas for conventional, it was between 55.6 and 332 min. CONCLUSION: The digital workflow has demonstrated better clinical efficiency considering impression time, patient preference, and time efficiency. According to the adjustment time, different results were presented.

Evaluation of the Adaptation of Complete Dentures Fabricated Using Intraoral Scanning and Conventional Techniques.

AIM AND OBJECTIVE: This study aimed to digitally analyze the 3-dimensional variations existing between conventional impressions and intraoral scans made in edentulous maxillae. MATERIALS AND METHODS: Ten (n = 10) edentulous maxillae of patients seeking a maxillary complete denture were scanned using an intraoral scanner. The same participants were subject to the conventional impression procedure for the fabrication of maxillary complete dentures. The dentures' intaglio surfaces were scanned and superimposed over their corresponding IOS files with a 2-base best-fit alignment. Deviation analyses were calculated using the digital subtraction technique. Four anatomical regions were preselected to evaluate the deviations at these sites (posterior palatal seal, anterior border seal, the crest of the ridge and palate). RESULTS: Based on the results and color maps of all selected regions, the overall difference between the two scans [IOS and denture intaglio surface scanning (DISS)] was not significant. The IOS technique allowed for predictable outcomes of treatment compared to those observed with conventional impression. The palatal area seems to be the region with the least deviation, while the highest incidence of discrepancy was reported in the anterior border seal. CONCLUSION: Within the limitations of this study, the IOS technique allowed the capturing of intraoral tissues and their immediate interpretation and transfer to a designing software making the impression procedure faster and easier. CLINICAL SIGNIFICANCE: The computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies can help overcome many limitations related to conventional impressions and therefore should be well investigated to improve the edentulous patient's quality of life.

Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro.

OBJECTIVE: Intraoral scanners (IOSs) are widely used for obtaining digital dental models directly from the patient. Additionally, improvements in IOSs are made from generation to generation. The aim of this study was to evaluate the accuracy of new and actual IOS devices for complete- and partial-arch dental impressions in an in vitro setup. MATERIALS AND METHODS: A custom maxillary complete-arch cast with teeth made from feldspar ceramic material was used as the reference cast and digitized with a reference scanner (ATOS III Triple Scan MV60). One conventional impression technique using polyvinylsiloxane (PVS) material (President) served as the control (CO), and eight different IOS devices comprising different hardware and software configurations (TRn: Trios 3; TRi: Trios 3 insane; CS: Carestream Dental CS 3600; MD: Medit i500; iT: iTero Element 2; OC4: Cerec Omnicam 4.6.1; OC5: Cerec Omnicam 5.0.0; PS: Primescan) were used to take complete-arch impressions from the reference cast. The impressions were repeated 10 times (n = 10) for each group. Conventional impressions were poured with type IV gypsum and digitized with a laboratory scanner (inEos X5). All datasets were obtained in standard tessellation language (STL) file format and cut to either complete-arch, anterior segment, or posterior segment areas for respective analysis. Values for trueness and precision for the respective areas were evaluated using a three-dimensional (3D) superimposition method with special 3D difference analysis software (GOM Inspect) using (90-10)/2 percentile values. Statistical analysis was performed using either one-way analysis of variance (ANOVA) or Kruskal-Wallis test (α = 0.05). Results are given as median and interquartile range [IQR] values in µm. RESULTS: Statistically significant differences were found between test groups for complete- and partial-arch impression methods in vitro (p < 0.05). Values ranged from 16.3 [2.8] µm (CO) up to 89.8 [26.1] µm (OC4) for in vitro trueness, and from 10.6 [3.8] µm (CO) up to 58.6 [38.4] µm (iT) for in vitro precision for the complete-arch methods. The best values for trueness of partial-arch impressions were found for the posterior segment, with 9.7 [1.2] µm for the conventional impression method (CO), and 21.9 [1.5] µm (PS) for the digital impression method. CONCLUSION: Within the limitations of this study, digital impressions obtained from specific IOSs are a valid alternative to conventional impressions for partial-arch segments. Complete-arch impressions are still challenging for IOS devices; however, certain devices were shown to be well within the required range for clinical quality. Further in vivo studies are needed to support these results.

A novel in vivo method to evaluate trueness of digital impressions.

BACKGROUND: Intraoral scanners are devices for capturing digital impressions in dentistry. Until now, several in vitro studies have assessed the trueness of digital impressions, but in vivo studies are missing. Therefore, the purpose of this study was to introduce a new method to assess trueness of intraoral scanners and digital impressions in an in vivo clinical set-up. METHODS: A digital impression using an intraoral scanner (Trios® 3 Cart wired, 3Shape, Copenhagen, Denmark) and a conventional alginate impression (Cavex Impressional®, Cavex, Haarlem, the Netherlands) as clinical reference were made for two patients assigned for full mouth extraction. A total of 30 teeth were collected upon surgery after impressions making. The gypsum model created from conventional impression and extracted teeth were then scanned in a lab scanner (Activity 885®, SmartOptics, Bochum, Germany). Digital model of the intraoral scanner (DM), digital model of the conventional gypsum cast (CM) and those of the extracted natural teeth (NT) were imported to a reverse engineering software (3-matic®, Materialise, Leuven, Belgium) in which the three models were registered then DM and CM were compared to their corresponding teeth in NT by distance map calculations. RESULTS: DM had statistically insignificant better trueness when compared to CM for total dataset (p = 0.15), statistically insignificant better trueness for CM when mandibular arches analyzed alone (p = 0.56), while a significantly better DM trueness (p = 0.013) was found when only maxillary arches were compared. CONCLUSIONS: Our results show that digital impression technique is clinically as good as or better than the current reference standard for study models of orthognathic surgery patients.

Digital Versus Conventional Impressions in Fixed Prosthodontics: A Review.

PURPOSE: To conduct a systematic review to evaluate the evidence of possible benefits and accuracy of digital impression techniques vs. conventional impression techniques. MATERIALS AND METHODS: Reports of digital impression techniques versus conventional impression techniques were systematically searched for in the following databases: Cochrane Central Register of Controlled Trials, PubMed, and Web of Science. A combination of controlled vocabulary, free-text words, and well-defined inclusion and exclusion criteria guided the search. RESULTS: Digital impression accuracy is at the same level as conventional impression methods in fabrication of crowns and short fixed dental prostheses (FDPs). For fabrication of implant-supported crowns and FDPs, digital impression accuracy is clinically acceptable. In full-arch impressions, conventional impression methods resulted in better accuracy compared to digital impressions. CONCLUSIONS: Digital impression techniques are a clinically acceptable alternative to conventional impression methods in fabrication of crowns and short FDPs. For fabrication of implant-supported crowns and FDPs, digital impression systems also result in clinically acceptable fit. Digital impression techniques are faster and can shorten the operation time. Based on this study, the conventional impression technique is still recommended for full-arch impressions.

Comparison of digital scanning and polyvinyl siloxane impression techniques by dental students: instructional efficiency and attitudes towards technology.

INTRODUCTION: With increasing use of digital scanning with restorative procedures in the dental office, it becomes necessary that educational institutions adopt instructional methodology for introducing this technology together with conventional impression techniques. OBJECTIVE: To compare the time differences between instructing dental students on digital scanning (DS) (LAVA C.O.S. digital impression system) and a conventional impression technique (CI) (polyvinyl siloxane), and to compare students' attitudes and beliefs towards both techniques. MATERIALS AND METHODS: Volunteer sophomore dental students (n = 25) with no prior experience in clinical impressions were recruited and IRB consent obtained. Participants responded to a pre-and post-exposure questionnaire. Participants were instructed on the use of both DS and CI for a single tooth full coverage crown restoration using a consecutive sequence of video lecture, investigator-led demonstration and independent impression exercise. The time necessary for each step (minutes) was recorded. Statistical significance was calculated using dependent t-tests (time measurements) and 2-sample Mann-Whitney (questionnaire responses). RESULTS: The time spent teaching students was greater for DS than CI for video lecture (15.95 and 10.07 min, P = 0.0000), demonstration time (9.06 and 4.70 min, P = 0.0000) and impression time (18.17 and 8.59 min, P = 0.0000). Prior to the instruction and practice, students considered themselves more familiar with CI (3.96) than DS (1.96) (P = 0.0000). After the instruction and practice, participants reported CI technique proved significantly easier than expected (pre-instruction: 3.52 and post-instruction: 4.08, P = 0.002). However, overall participants' perception of ease of use for DS was not influenced by this instruction and practice experience (pre-instruction: 3.84 and post-instruction: 3.56, P = 0.106). Despite the results, 96% of participants expressed an expectation that DS will become their predominant impression technique during their careers. CONCLUSIONS: Dental students with no clinical experience have high expectations for digital scanning, and despite their initial difficulty, expect it to become their primary impression technique during their professional futures. The instructional time necessary for introducing DS into the curriculum is significantly greater than CI in both classroom (lecture) and clinical simulation settings (investigator-led demonstration).

Evaluation of fit and efficiency of CAD/CAM fabricated all-ceramic restorations based on direct and indirect digitalization: a double-blinded, randomized clinical trial.

OBJECTIVES: The aim of this clinical trial was to evaluate the marginal and internal fit of CAD/CAM fabricated zirconia crowns and three-unit fixed dental prostheses (FDPs) resulting from direct versus indirect digitalization. The efficiency of both methods was analyzed. MATERIALS AND METHODS: In 25 patients, 17 single crowns and eight three-unit FDPs were fabricated with all-ceramic zirconia using CAD/CAM technology. Each patient underwent two different impression methods; a computer-aided impression with Lava C.O.S. (CAI) and a conventional polyether impression with Impregum pent soft (CI). The working time for each group was recorded. Before insertion, the marginal and internal fit was recorded using silicone replicas of the frameworks. Each sample was cut into four sections and evaluated at four sites (marginal gap, mid-axial wall, axio-occlusal transition, centro-occlusal site) under ×64 magnification. The Mann-Whitney U test was used to detect significant differences between the two groups in terms of marginal and internal fit (α = 0.05). RESULTS: The mean for the marginal gap was 61.08 µm (±24.77 µm) for CAI compared with 70.40 µm (±28.87 µm) for CI, which was a statistically significant difference. The other mean values for CAI and CI, respectively, were as follows in micrometers (± standard deviation): 88.27 (±41.49) and 92.13 (±49.87) at the mid-axial wall; 144.78 (±46.23) and 155.60 (±55.77) at the axio-occlusal transition; and 155.57 (49.85) and 171.51 (±60.98) at the centro-occlusal site. The CAI group showed significantly lower values of internal fit at the centro-occlusal site. A quadrant scan with a computer-aided impression was 5 min 6 s more time efficient when compared with a conventional impression, and a full-arch scan was 1 min 34 s more efficient. CONCLUSIONS: Although both direct and indirect digitalization facilitate the fabrication of single crowns and three-unit FDPs with clinically acceptable marginal fit, a significantly better marginal fit was noted with direct digitalization. Digital impressions are also less time-consuming for the dental practitioner and the patient. CLINICAL RELEVANCE: The results show that a direct, intraoral, digitalized impression technique is more accurate and efficient when compared with conventional impressions in fabricating single crowns and three-unit FDPs.