Influence of intraoral conditions on the accuracy of full-arch scans by Cerec Primescan AC: an in vitro and in vivo comparison.

AIM: To determine the effect of intraoral conditions on the accuracy of digital full-arch scans. MATERIALS AND METHODS: A reference bar was used for the in vivo and in vitro parts of the present study. For the in vitro part (PAT-vitro), the bar was fixed to connect the maxillary second molars on the patient's resin model. The same reference bar was fixed in a similar position intraorally for the in vivo testing (PAT-vivo). Model and patient were digitized using an intraoral scanner (Cerec Primescan AC, N = 40, n [PAT-vitro] = 20, n [PAT-vivo] = 20). Datasets were exported and metrically analyzed (Geomagic Control 2015) to determine the 3D linear and angular distortions in all three coordinate axes of the datasets with reference to the bar. Normality of the data distribution was tested using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Homogeneity of the variances was tested using the Levené test. Statistically significant differences for all measured parameters in view of trueness were determined using the two-sample t test, and in view of precision using the two-sample Kolmogorov-Smirnov test. RESULTS: The PAT-vivo group showed significantly higher trueness for most of the measured linear and angular distortion parameters than the PAT-vitro group. Regarding precision, the PAT-vitro group showed significantly better values for most of the measured linear and angular distortion parameters than the PAT-vivo group. CONCLUSIONS: Within the limitations of the present study, Cerec Primescan AC leads to comparable accuracy parameters when applied in vivo and in vitro. The reproducibility (precision) was higher when scans were performed in vitro. Due to the high trueness, the system seems to be a valid tool to obtain digital full-arch datasets in vivo with comparable accuracy to in vitro tests. coronalaxial.

Accuracy of full-arch digitalization for partially edentulous jaws - a laboratory study on basis of coordinate-based data analysis.

OBJECTIVES: To compare the accuracy (trueness and precision) of direct digitization of four different dental gap situation with two IOS (intraoral scanner). MATERIALS AND METHODS: Four partially edentulous polyurethane mandible models were used: (1) A (46, 45, 44 missing), (2) B (45, 44, 34, 35 missing), (3) C (42, 41, 31, 32 missing), and (4) D (full dentition). On each model, the same reference object was fixed between the second molars of both quadrants. A dataset (REF) of the reference object was generated by a coordinate measuring machine. Each model situation was scanned by (1) OMN (Cerec AC Omnicam) and (2) PRI (Cerec Primescan AC) (n = 30). Datasets of all 8 test groups (N = 240) were analyzed using inspection software to determine the linear aberrations in the X-, Y-, Z-axes and angular deviations. Mann-Whitney U and two-sample Kolmogorov-Smirnov tests were used to detect differences for trueness and precision. RESULTS: PRI revealed higher trueness and precision in most of the measured parameters ([Formula: see text] 120.95 to 175.01 µm, [Formula: see text](x) - 58.50 to - 9.40 µm, [Formula: see text] (z) - 70.35 to 63.50 µm), while OMN showed higher trueness for [Formula: see text] (y) regardless of model situation (- 104.90 to 34.55 µm). Model D revealed the highest trueness and precision in most of the measured parameters regardless of IOS ([Formula: see text] 120.95 to 195.74 µm, [Formula: see text] (x) - 9.40 to 66.75 µm,[Formula: see text] (y) - 14.55 to 51.50 µm, [Formula: see text] (z) 63.50 to 120.75 µm). CONCLUSIONS: PRI demonstrated higher accuracy in the X- and Z-axes, while OMN depicted higher trueness in the Y-axis. For PRI, Model A revealed the highest distortion, while for OMN, Model B produced the largest aberrations in most parameters. Clinical relevance Current results suggest that both investigated IOS are sufficiently accurate for the manufacturing of tooth-borne restorations and orthodontic appliances. However, both hardware specifications of IOS and the presence of edentulous gaps in the dental model have an influence on the accuracy of the virtual model dataset.

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.

Time and costs related to computer-assisted versus non-computer-assisted implant planning and surgery. A systematic review.

AIM: To study the time and costs involved with computer-assisted versus non-computer-assisted implant planning and placement. MATERIAL AND METHODS: Based on the PICO question, "In patients receiving dental implants, is computer-assisted implant planning and surgery (CAIPS) compared to non-computer-assisted implant planning and surgery (non-CAIPS) beneficial in terms of treatment related costs and time involved?", a search path was created to perform an electronic search in the databases PubMed, PubMed Central, EMBASE, and Cochrane. The publication period of eligible publications extended from 01.01.2005 to 04.05.2020. Four independent reviewers reviewed the literature to identify studies that met the eligibility inclusion criteria. A further manual search of articles was performed, and gray literature was excluded. Corresponding authors of potentially eligible manuscripts were contacted for further information. RESULTS: Of the 1354 retrieved titles after the search were screened. Thirty-one articles have been identified to read the full text, resulting in four articles to be analyzed for the present review all of which were RCTs. In total, 182 partially and completely edentulous patients were treated with 416 implants following either non-computer-assisted or computer-assisted implant planning and surgery to determine the duration of the single working steps and the financial aspects of the different procedures. CONCLUSIONS: When evaluating the time and costs involved with the diagnostic and planning procedures in computer-assisted implant planning and surgery workflow protocols, one can summarize that these are higher than in the non-computer-assisted workflow protocols. The time involved with the procedures appears to be the driving factor when it comes to economic considerations. On the basis of the conclusions, also the time for the prosthetic restoration should be taken into account.

In-vivo-wear in composite and ceramic full mouth rehabilitations over 3 years.

The aim of this study was to quantify and to compare the wear rates of premolar (PM) and molar (M) restorations of lithium disilicate ceramic (LS2) and an experimental CAD/CAM polymer (COMP) in cases of complex rehabilitations with changes in vertical dimension of occlusion (VDO). Twelve patients with severe tooth wear underwent prosthetic rehabilitation, restoring the VDO with antagonistic occlusal coverage restorations either out of LS2 (n = 6 patients, n = 16 posterior restorations/patient; N = 96 restorations/year) or COMP (n = 6 patients; n = 16 posterior restorations/patient; N = 96 restorations/year). Data was obtained by digitalization of plaster casts with a laboratory scanner at annual recalls (350 ± 86 days; 755 ± 92 days; 1102 ± 97 days). Each annual recall dataset of premolar and molar restorations (N = 192) was overlaid individually with the corresponding baseline dataset using an iterative best-fit method. Mean vertical loss of the occlusal contact areas (OCAs) was calculated for each restoration and recall time. For LS2 restorations, the mean wear rate per month over 1 year was 7.5 ± 3.4 µm (PM), 7.8 ± 2.0 µm (M), over 2 years 3.8 ± 1.6 µm (PM), 4.4 ± 1.5 µm (M), over 3 years 2.8 ± 1.3 µm (PM), 3.4 ± 1.7 µm (M). For COMP restorations, the mean wear rate per month over 1 year was 15.5 ± 8.9 µm (PM), 28.5 ± 20.2 µm (M), over 2 years 9.2 ± 5.9 µm (PM), 16.7 ± 14.9 µm (M), over 3 years 8.6 ± 5.3 µm (PM), 9.5 ± 8.0 µm (M). Three COMP restorations fractured after two years and therefore were not considered in the 3-year results. The wear rates in the LS2 group showed significant differences between premolars and molars restorations (p = 0.041; p = 0.023; p = 0.045). The wear rates in COMP group differed significantly between premolars and molars only in the first two years (p < 0.0001; p = 0.007). COMP restorations show much higher wear rates compared to LS2. The presented results suggest that with increasing time in situ, the monthly wear rates for both materials decreased over time. On the basis of this limited dataset, both LS2 and COMP restorations show reasonable clinical wear rates after 3 years follow-up. Wear of COMP restorations was higher, however prosthodontic treatment was less invasive. LS2 showed less wear, yet tooth preparation was necessary. Clinicians should balance well between necessary preparation invasiveness and long-term occlusal stability in patients with worn dentitions.

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.

Accuracy of data obtained from impression scans and cast scans using different impression materials.

AIM: Despite the expanding implementation of intraoral scanning (IOS) devices, indirect digitization of conventional impressions or casts still represents the primary access to CAD/CAM. The aim of this study was to evaluate the accuracy of data acquired from impression scans and cast scans with respect to impression material and type of cast used. MATERIALS AND METHODS: A standardized titanium model for a four-unit fixed dental prosthesis (FDP) served as a testing model. Industrial computed tomography (CT) was applied, generating a reference data set. Four different impression materials were utilized (n = 12 per material): 1) Impregum Penta (polyether/group PE); 2) Imprint 4 Penta Super Quick Heavy + Super Quick Light (polyvinyl siloxane (PVS)/group PVS-I); 3) Dimension Penta H Quick + L (PVS/group PVS-D); and 4) Imprint 4 Preliminary Penta Super Quick (PVS/group PVS-P). Data were obtained from three different model situations, ie, impressions (group IMP), unsectioned plaster casts (group UNSEC), and sectioned casts (group SEC). The surfaces were digitized three times each using a laboratory scanner. The resulting test data were superposed with the reference data using a best-fit algorithm to evaluate accuracy. Statistical analysis was conducted using the Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney tests (level of significance: P < 0.050). RESULTS: Imprint 4 Penta presented the highest overall accuracy, while Imprint 4 Preliminary Penta Super Quick displayed the poorest results. Regarding the model situation (impression scan vs cast scan), impression scans from Impregum Penta and Imprint 4 Penta showed superior results. CONCLUSION: Impression scans in combination with high-precision impression material results in the most accurate data.

In vivo wear of CAD-CAM composite versus lithium disilicate full coverage first-molar restorations: a pilot study over 2 years.

OBJECTIVES: To present a digital approach to measure and compare material wear behavior of antagonistic first molar restorations made of an experimental CAD/CAM composite (COMP) and lithium disilicate ceramic (LS2) in patients with reconstructed vertical dimension of occlusion (VDO) after generalized hard tissue loss. METHODS: A total of 12 patients underwent complete full jaw rehabilitation with full occlusal coverage restorations made either of COMP or LS2. The first molar restorations (n = 48) were chosen for wear examination. At annual recall appointments, polyether impressions were taken, and resulting plaster casts were digitalized using a laboratory scanner. Mean observation period was 371 days for first and 769 days for second year. The resulting 96 datasets were analyzed by superimposition of 3-D datasets using an iterative best-fit method. Based on the superimposition data, the wear rates of the occlusal contact areas (OCAs) were calculated. RESULTS: For antagonistic restorations made of COMP, the average wear rate was 24.8 ± 13.3 µm/month, while for LS2, it was 9.5 ± 4.3 µm/month in first year, with significant differences (p < 0.0001) between the materials. In second year, monthly wear rates decreased significantly for both materials: COMP (16.2 ± 10.7 µm/month) and LS2 (5.5 ± 3.3 µm/month). Statistical comparison between wear time showed significant differences for both materials: COMP p < 0.037 and LS2 p < 0.001. A logarithmic fit (COMP R2 = 0.081; LS2 R2 = 0.038) of the data was calculated to estimate the wear progression. SIGNIFICANCE: In patients with reconstructed VDO, restorations made of LS2 show a more stable wear behavior than ones out of experimental CAD/CAM composite. In cases of complete rehabilitation, load bearing CAD/CAM-composite restorations should be critically considered for application due to their occlusal wear behavior. However, when choosing a restorative material, not only the functional occlusal stability should be taken into account but also the prospect of minimally invasive treatment with maximum preservation of natural tooth structures.

Impact of fabrication procedures on residual monomer elution of conventional polymethyl methacrylate (PMMA)-a measurement approach by UV/Vis spectrophotometry.

OBJECTIVES: To analyse the residual monomer (MMA) elution of polymethyl methacrylate (PMMA) in distilled water after diverse fabrication methods and aging procedures. MATERIALS AND METHODS: PMMA specimens (N = 192, PalaXpress; Kulzer, Hanau, Germany) were manufactured (pouring, n = 96/injection, n = 96) and polymerized in water (55°C) without pressure (n = 48) and with 2 bar pressure (n = 48). Specimens were grinded (n = 24) or polished (n = 24) and aged for 12 h in distilled water/37°C (n = 12) or at air/20°C (n = 12) and stored afterwards in distilled water at 37°C. MMA elution was evaluated after 1, 2, 3, 4, 5, 6, 7, 10, 15 days (UV/Vis spectrophotometry). Data were analysed with Kolmogorov-Smirnov, Mann-Whitney-U and Cohen-d test using SPSS (α < 0.5). RESULTS: The pouring procedure resulted in significantly higher MMA elution than the injection procedure up to 5 days. Polymerization with a pressure of 2 bar reduced the MMA elution significantly for poured specimens. Polishing reduced the MMA elution in comparison to grinding. CONCLUSIONS: The fabrication procedure (pouring/injection) showed the strongest correlation to the MMA elution (r = 0.500), followed by polishing (r = 0.243), the pressure during polymerization (r = 0.109) and the storage medium (r = 0.053). CLINICAL RELEVANCE: Higher MMA elution may increase the risk of chemical irritations, allergic reactions and hypersensitivities of the oral mucosa. Technicians and dentists should be aware about the elution differences dependent on the fabrication procedure.

Digital impressions in dentistry-accuracy of impression digitalisation by desktop scanners.

OBJECTIVES: To test if the partially digital workflow by digitalisation of the impression reveals a comparable accuracy as the indirect digitalisation of the gypsum cast for 4-unit fixed dental prostheses (FDPs). MATERIALS AND METHODS: A titanium model with a tapered full veneer preparation of a molar and premolar was used as analysis model. To receive a virtual three-dimensional reference dataset (REF), it was digitised by industrial computed tomography. Three impression materials were used with individual impression trays (N = 36, n/material = 12): (1) PE (Impregum Penta), (2) PVS-I (Imprint 4 Penta: Super Quick Heavy plus Super Quick Light), and (3) PVS-D (Dimension Penta: H Quick plus L). For partially digital workflow (group IMP), two desktop scanners were used: (1) D810 (3Shape D810) and (2) ZZ (Zirkonzahn S600ARTI). For indirect digitalisation (group CAST), gypsum master casts were manufactured and digitalised using the same desktop scanners. Virtual datasets were superimposed by best fit algorithm, and accuracy was analysed by calculating the Euclidean distances (ED) to the REF (Geomagic Qualify). Statistic was determined (Kruskal-Wallis H test, Mann-Whitney U post hoc analysis, two-sample Kolmogorov-Smirnov test, p < 0.05). RESULTS: ZZ showed for positive deviations superior accuracy for IMP than for CAST. PE and PVS-I showed superior accuracy than PVS-D. D810 showed partially significant better performance with PVS-I and PVS-D than ZZ. CONCLUSIONS: The partially digital workflow by digitalisation of the impression can be used for clinical indications of small-span fixed dental prostheses. However, for this indication, the impression material and the desktop scanner are more decisive for the accuracy of virtual model datasets. CLINICAL RELEVANCE: Despite the rapid advancement of the computer-aided technology for dental therapy purposes, the implementation of this technique is not as fast as the technical development. In order to combine the well-established procedure to use elastomeric materials for a conventional impression and to avoid the drawbacks of casting it by gypsum, the digitalisation of the impression itself by a desktop scanner may be a logical procedure as an access point to the digital workflow. However, there is only limited information about the accuracy of this partially digital workflow by the digitalisation of modern impression materials in comparison to the well-known process of indirect digitalisation of gypsum casts.

Residual monomer elution from different conventional and CAD/CAM dental polymers during artificial aging.

OBJECTIVES: Analyze and quantify the residual monomer elution of nine conventional and CAD/CAM (computer-aided design/computer-aided manufacturing) dental polymers during artificial aging. MATERIALS AND METHODS: A total of 360 square-shaped specimens (14 × 12 × 2 ± 0.05 mm) were fabricated from eight CAD/CAM polymer blanks (n = 40): Avadent Base material, Avadent Teeth material, PMMA Multi blank, PMMA Mono blank, Temp Premium, Telio CAD, Ceramill Temp, Shofu Block HC, and conventional polymer PalaXpress. Specimens were aged in distilled water for 60 days at 37 °C and the evaluation of the residual monomer elution was made through UV spectrophotometry. Statistical analysis was carried out in the SPSS software. One-way ANOVA and Scheffé post hoc test were applied (α < 0.05). RESULTS: Aging time significantly changed the elution in all groups, except for PalaXpress. Statistically significant differences of elution were found between the materials. Shofu Block HC presented the highest, whereas PMMA Multi blank A3 and Mono blank A1 presented the lowest elution after the 60th day of aging. CONCLUSIONS: CAD/CAM dental polymers as well as the conventional polymer PalaXpress eluted residual monomer within aging time. The differences in elution were material-dependent; still, the maximum elution found is below the specified threshold of ISO standard 20795-1. CLINICAL RELEVANCE: With the evolution of CAD/CAM technology, material's manufacturers have invested in the development of polymeric materials with higher resistance and stability to produce indirect restorations using CAD/CAM. It is expected that these materials present lower elution of residual monomer than conventional polymers.

Influence of speed sintering on the fit and fracture strength of 3-unit monolithic zirconia fixed partial dentures.

STATEMENT OF PROBLEM: Speed sintering has been introduced to enable single-visit monolithic zirconia prostheses. However, the fit and fracture load of zirconia 3-unit monolithic fixed partial dentures (FPDs) after speed sintering are unknown. PURPOSE: The purpose of this in vitro study was to test the properties of zirconia 3-unit monolithic FPDs after speed sintering and to compare the properties with conventional sintering. MATERIAL AND METHODS: A calibrated operator digitized an in vitro model with a complete coverage preparation of a maxillary right second premolar and second molar (n=12) by using the CEREC AC Omnicam (Dentsply Sirona) scanner. Twelve zirconia FPDs were designed (CEREC SW 4.1.1), and for each data set (n=12), 1 FPD was designed and milled 4 times (MCXL Premium; CEREC Zirconia; Dentsply Sirona), resulting in 4 identical monolithic FPDs (N=48). The FPDs were divided into 2 groups according to the sintering procedure (n=24): speed sintering (group S) by using the SpeedFire (Dentsply Sirona) and the conventional sintering (group C) by using the inFire HTC speed (Dentsply Sirona). All the FPDs were glazed by using glaze-spray and fired according to the sintering group. The SpeedFire (Dentsply Sirona) was used for group S, and the VACUMAT 6000M (VITA Zahnfabrik) was used for group C. The fit of the FPDs was evaluated with the replica technique by using polyvinyl siloxane and analyzed according to the measurement areas: marginal gap, chamfer area, axial wall, and occlusal area. Subsequently, groups S and C were further subdivided, and 12 specimens per group underwent artificial aging by thermomechanical loading in a mastication machine (50 N for 1.2×106 times at a frequency of 1.7 Hz and a thermal change in distilled water from 5 °C to 50 °C every 120 seconds), resulting in additional subgroups: group SA and group CA. For all the FPDs (groups S, C, SA, and CA), a fracture load measurement was conducted. The Kolmogorov-Smirnov test was used to examine the values of the fit and fracture load for normal distribution. The Mann-Whitney U test for the fit and a 2-way ANOVA for the fracture load were used to detect the differences among the groups (α=.05). RESULTS: Group S showed a better marginal (P=.018) and occlusal (P<.001) fit than group C. For the fracture load values, no significant difference was found because of the sintering procedure (P=.070) or the interaction of the sintering procedure and artificial aging (P=.484). Artificial aging showed an impact (P=.024) with significantly lower values after aging. CONCLUSIONS: Speed-sintered FPDs had equal and better values for the fit and fracture load than conventional sintering.

Accuracy of full-arch digital impressions: an in vitro and in vivo comparison.

OBJECTIVES: Comparison of full-arch digital impressions to conventional impressions in vitro and in vivo. MATERIALS AND METHODS: A straight metal bar was fixed between the second upper molars as a reference structure in the mouth of a voluntary patient and a corresponding polymer model. The following digitalization methods were applied: (1) the maxilla was digitized in vivo 12 times with the iTero Element (P-SCAN); (2) the maxilla was captured in vivo 12 times by conventional impression and the impression was digitized by a desktop scanner (P-IMP); (3) the impressions were poured and the 12 referring gypsum master-casts were scanned with the same desktop scanner (P-CAST); (4) the polymer model was digitized in vitro 12 times with the iTero Element (M-SCAN); (5) the polymer model was captured in vitro 12 times by conventional impression and the impression was digitized by a desktop scanner (M-IMP); (6) the impressions were poured and the 12 referring gypsum master-casts were scanned with the same desktop scanner (M-CAST). Datasets were exported and metrically analyzed (Geomagic Control X) to determine three-dimensional length aberration and angular distortion versus the reference structure. Mann-Whitney U test was implemented to detect differences (p < 0.05). RESULTS: For multiple accuracy parameters, P-SCAN and M-SCAN showed similar or superior results compared to the other digitalization methods. The following length deviations were found: M-SCAN (- 55 to 80 µm), M-IMP (110 to 329 µm), M-CAST (88 to 178 µm), P-SCAN (- 67 to 76 µm), P-IMP (125-320 µm), and P-CAST (92-285 µm). CONCLUSIONS: Within the limitations of this study, the iTero-scan seems to be a valid alternative to conventional impressions for full arches. CLINICAL RELEVANCE: Intraoral scanners are more and more used in daily routine; however, little is known about their accuracy when it comes to full-arch scans. Under optimum conditions, the direct digitalization using the iTero Element intraoral scanning device results in the same and for single parameters (arch width and arch distortion) even in higher accuracy than the indirect digitalization of the impression or the gypsum cast using a desktop scanner.

Can lithium disilicate ceramic crowns be fabricated on the basis of CBCT data?

OBJECTIVES: Evaluating the fit of CAD/CAM lithium disilicate ceramic crowns fabricated on basis of direct and indirect digitalization of impressions by CBCT or of dental casts. MATERIAL AND METHODS: A metal model with a molar chamfer preparation was digitized (n = 12 per group) in four ways: IOS-direct digitalization using an Intra-Oral scanner (CS3600), cone-beam computed tomography scan (CBCT 1)-indirect digitalization of impression (CBCT-CS9300), CBCT 2-indirect digitalization of impression (CBCT-CS8100), and Extra-Oral scanner (EOS)-indirect digitalization of gypsum-cast (CeramillMap400). Accuracy of 3D datasets was evaluated in relation to a reference dataset by best-fit superimposition. Marginal fit of lithium disilicate crowns after grinding was evaluated by replica technique. Significant differences were detected for 3D accuracy by Mann-Whitney U and for fit of crowns by One-way ANOVA followed by Scheffe's post hoc (p = 0.05). RESULTS: 3D analysis revealed mean positive and negative deviations for the groups IOS (- 0.011 ± 0.007 mm/0.010 ± 0.003 mm), CBCT 1 (- 0.046 ± 0.008 mm/0.093 ± 0.004 mm), CBCT 2 (- 0.049 ± 0.030 mm/0.072 ± 0.015 mm), and EOS (- 0.023 ± 0.007 mm/0.028 ± 0.007 mm). Marginal fit presented the results IOS (0.056 ± 0.022 mm), CBCT 1 (0.096 ± 0.034 mm), CBCT 2 (0.068 ± 0,026 mm), and EOS (0.051 ± 0.017 mm). CONCLUSIONS: The marginal fit of EOS and IOS, IOS and CBCT 2, and CBCT 2 and CBCT 1 showed statistical differences. The marginal fit of CBCT 1 and CBCT 2 is within the range of clinical acceptance; however, it is significant inferior to EOS and IOS. CLINICAL RELEVANCE: The use of a CBCT enables clinicians to digitize conventional impressions. Despite presenting results within clinical acceptable levels, the CBCT base method seems to be inferior to Intra-Oral scans or to scanning gypsum models regarding the resulting accuracy and fit.

Accuracy of five intraoral scanners compared to indirect digitalization.

OBJECTIVES: Direct and indirect digitalization offer two options for computer-aided design (CAD)/ computer-aided manufacturing (CAM)-generated restorations. The aim of this study was to evaluate the accuracy of different intraoral scanners and compare them to the process of indirect digitalization. MATERIAL AND METHOD: A titanium testing model was directly digitized 12 times with each intraoral scanner: (1) CS 3500 (CS), (2) Zfx Intrascan (ZFX), (3) CEREC AC Bluecam (BLU), (4) CEREC AC Omnicam (OC) and (5) True Definition (TD). As control, 12 polyether impressions were taken and the referring plaster casts were digitized indirectly with the D-810 laboratory scanner (CON). The accuracy (trueness/precision) of the datasets was evaluated by an analysing software (Geomagic Qualify 12.1) using a "best fit alignment" of the datasets with a highly accurate reference dataset of the testing model, received from industrial computed tomography. RESULTS: Direct digitalization using the TD showed the significant highest overall "trueness", followed by CS. Both performed better than CON. BLU, ZFX and OC showed higher differences from the reference dataset than CON. Regarding the overall "precision", the CS 3500 intraoral scanner and the True Definition showed the best performance. CON, BLU and OC resulted in significantly higher precision than ZFX did. CONCLUSIONS: Within the limitations of this in vitro study, the accuracy of the ascertained datasets was dependent on the scanning system. The direct digitalization was not superior to indirect digitalization for all tested systems. CLINICAL RELEVANCE: Regarding the accuracy, all tested intraoral scanning technologies seem to be able to reproduce a single quadrant within clinical acceptable accuracy. However, differences were detected between the tested systems.

Artificial Neural Networks as a powerful numerical tool to classify specific features of a tooth based on 3D scan data.

Chairside manufacturing based on digital image acquisition is gainingincreasing importance in dentistry. For the standardized application of these methods, it is paramount to have highly automated digital workflows that can process acquired 3D image data of dental surfaces. Artificial Neural Networks (ANNs) arenumerical methods primarily used to mimic the complex networks of neural connections in the natural brain. Our hypothesis is that an ANNcan be developed that is capable of classifying dental cusps with sufficient accuracy. This bears enormous potential for an application in chairside manufacturing workflows in the dental field, as it closes the gap between digital acquisition of dental geometries and modern computer-aided manufacturing techniques.Three-dimensional surface scans of dental casts representing natural full dental arches were transformed to range image data. These data were processed using an automated algorithm to detect candidates for tooth cusps according to salient geometrical features. These candidates were classified following common dental terminology and used as training data for a tailored ANN.For the actual cusp feature description, two different approaches were developed and applied to the available data: The first uses the relative location of the detected cusps as input data and the second method directly takes the image information given in the range images. In addition, a combination of both was implemented and investigated.Both approaches showed high performance with correct classifications of 93.3% and 93.5%, respectively, with improvements by the combination shown to be minor.This article presents for the first time a fully automated method for the classification of teeththat could be confirmed to work with sufficient precision to exhibit the potential for its use in clinical practice,which is a prerequisite for automated computer-aided planning of prosthetic treatments with subsequent automated chairside manufacturing.

Glass Fiber Post/Composite Core Systems Bonded to Human Dentin: Analysis of Tensile Load vs Calculated Tensile Strength of Various Systems Using Pull-out Tests.

PURPOSE: Pull-out testing was used to determine the tensile load (TL) and tensile strength (TS) of five different fiber post systems bonded to human intracanal dentin. MATERIALS AND METHODS: 120 caries-free premolars, canines, and maxillary central incisors were divided into 5 different groups for 5 fiber post systems (n = 24): 1. RelyX Fiber Post 3D (RX3D); 2. RelyX Fiber Post (RX); 3. Luxa- Post (LP); 4. FibreKleer 4X Tapered Post (FK); 5. ParaPost Taper Lux (PP). The teeth were prepared and posts inserted. Core buildups were performed with the corresponding product's resin composite. All specimens were stored in water for 24 h at 37°C. TL and TS were tested on half of the specimens (n = 12/group). The remaining samples were thermocycled (10,000 x 5°C/55°C) before testing. TL was directly measured and TS was calculated using the bonding surface. Failure modes were identified using a stereomicroscope. Data were analyzed using twoway ANOVA with the post-hoc Scheffé test, as well as the chi-squared test (p < 0.05). RESULTS: FK and LP resulted in the lowest mean TL but were not significantly different from those of RX and RX3D. The highest mean TL and TS were observed for PP. Nevertheless, PP fell within the same statistical subset as RX3D and RX. Thermocycling showed no impact on the results. RX3D predominantly showed debonding of the post plus core buildup from the tooth; all other systems mainly demonstrated detachment of the core from the posts. CONCLUSION: PP, RX, and RX3D together with an adhesive core buildup yielded the highest bond strength to human dentin. Parameters TL and TS showed the same tendencies and statistical evidence.

A new method for the evaluation of the accuracy of full-arch digital impressions in vitro.

OBJECTIVES: Introducing a new approach to evaluate the accuracy of digital impression methods for full-arch scans, avoiding "best-fit alignment." MATERIALS AND METHODS: A lower jaw model with a straight metal bar between the second molars of both quadrants was directly digitized using an intraoral scanner (True Definition, TRD, n = 12) and indirectly digitized (D810, CON, n = 12) after impression and plaster cast. A dataset of the bar from a coordinate measuring machine served as reference (REF). Datasets obtained from test groups were analyzed using inspection software to determine the aberration of the bar length, the linear shift (in X-, Y-, Z-axis) and the angle deviation (α overall, α coronal, α horizontal) caused by the digitalization method. Mann-Whitney U and unpaired two-sample Student's t test were implemented to detect differences. The level of significance was set at 5 %. RESULTS: Concerning the bar length, no significant differences were found between groups. In view of the linear shift, CON showed significantly higher values than TRD in Y-axis (p = 0.003) and in Z-axis (p = 0.040). Regarding the angle measurement, TRD showed significant smaller values than CON for α overall (p = 0.006) and for α coronal (p = 0.005). CONCLUSIONS: This in vitro study shows that intraoral scanning systems seem to show the same or even higher accuracy than the conventional impression with subsequent indirect digitalization. CLINICAL RELEVANCE: Intraoral scanners have proven excellent accuracy for single teeth or small spans. However, insufficient data is available about their accuracy for full-arch scans. The presented new approach seems to be suitable to precisely analyze differences in the accuracy of different digitalization methods without using best-fit alignment.

Bonding between CAD/CAM resin and resin composite cements dependent on bonding agents: three different in vitro test methods.

OBJECTIVES: The aim of this study was to assess the bonding properties between CAD/CAM resin and three resin composite cements combined with different bonding agents using three test methods. MATERIALS AND METHODS: Four hundred twenty CAD/CAM resin substrates were fabricated and divided into three test methods (shear bond strength (SBS, n = 180), tensile bond strength (TBS, n = 180) and work of adhesion (WA, n = 60)), further into four pretreatment methods (VP connect (VP), visio.link (VL), Clearfil Ceramic Primer (CP) and no pretreatment (CG)) and three cements (RelyX ARC, Variolink II and Clearfil SA Cement). Each subgroup contained 15 specimens. SBS and TBS were measured after 24 h H2O/37 °C + 5000 thermal-cycles (5/55 °C) and failure types were assessed. WA was determined for pretreated CAD/CAM resin and non-polymerized resin composite cements. Data were analysed with Mann-Whitney U, Kruskal-Wallis H, Chi(2) and Spearman's Rho tests. RESULTS: Within SBS and TBS tests, CGs and groups pretreated with CP (regardless of resin composite cements), and VP pretreated with Clearfil SA Cement showed no bond. However, CG combined with RelyX ARC showed a TBS of 5.6 ± 1.3 MPa. In general, highest bond strength was observed for groups treated with VL. CG and groups pretreated using VL showed lower WA than the groups treated with VP or CP. CONCLUSIONS: Measured TBS values were higher than SBS ones. In general, SBS and TBS showed similar trends for the ranges of the values for the groups. WA results were not comparable with SBS/TBS results and admitted, therefore, no conclusions on it. CLINICAL RELEVANCE: For a clinical use of XHIP-CAD/CAM resin, the bond surface should be additionally pretreated with visio.link as bonding agent.