Trueness and precision of complete arch dentate digital models produced by intraoral and desktop scanners: An ex-vivo study.

OBJECTIVES: The study aimed to compare the trueness and precision of five intraoral scanners (Emerald S, iTero Element 5D, Medit i700, Primescan, and Trios 4) and two indirect digitization techniques for both teeth and soft tissues on fresh mandibular and maxillary cadaver jaws. METHODS: The maxilla and mandible of a fully dentate cadaver were scanned by the ATOS industrial scanner to create a master model. Then, the specimens were scanned eight times by each intraoral scanner (IOS). In addition, 8 polyvinylsiloxane (PVS) impressions were made and digitized with a Medit T710 desktop scanner. Stone models were then poured and again scanned with the desktop scanner. All IOS, PVS, and stone models were compared to the master model to calculate the mean absolute surface deviation for mandibular teeth, maxillary teeth, and palate. RESULTS: For mandibular teeth, the PVS trueness was only significantly better than the Medit i700 (p < 0.001) and Primescan (p < 0.05). In maxillary teeth, the PVS trueness was significantly better than all IOSs (p < 0.05-0.001); the stone trueness was significantly better than Emerald S (p < 0.01), Medit i700 (p < 0.001) and Primescan (p < 0.01). In the palate, PVS and stone trueness were significantly lower than the iTero Element 5D (p < 0.01) and Trios 4 (p < p < 0.01). Stone trueness was significantly lower than the Medit i700 (p < 0.05). The precision in the palate was significantly lower for PVS and stone than for Emerald S (p < 0.01, p < 0.05), iTero Element 5D (p < 0.01, p < 0.01), Primescan (p < 0.001, p < 0.001), and Trios 4 (p < 0.001, p < 0.01). Significant differences in trueness between the IOSs were observed only in the mandibular teeth. The Medit i700 performed worse than Emerald S (p < 0.01) and iTero Element 5D (p < 0.01). For mandibular teeth, the Medit i700 was significantly more precise than Primescan (p < 0.01) and the Emerald S (p < 0.05). The Trios 4 was significantly less precise than Emerald S (p < 0.05). The precision of Medit i700 was significantly worse than iTero Element 5D (p < 0.01) for maxillary teeth, as well as the Primescan (p < 0.01) and Trios 4 (p < 0.05) for the palate. CONCLUSIONS: In general, indirectly digitized models from PVS impressions had higher trueness than IOS for maxillary teeth; precision between the two methods was similar. IOS was more accurate for palatal tissues. The differences in trueness and precision for mandibular teeth between the various techniques were negligible. CLINICAL SIGNIFICANCE: All investigated IOSs and indirect digitization could be used for complete arch scanning in mandibular and maxillary dentate arches. However, direct optical digitization is preferable for the palate due to the low accuracy of physical impression techniques for soft tissues.

Assessing the Antimicrobial Properties of Copper-Iodide Doped Adhesives in an In vitro Caries Model: A Pilot Study.

Context: Recurrent caries are the leading cause of composite resin failure. Aims: The purpose of this pilot study was to test the efficacy of a novel copper iodide (CuI) containing dental adhesive in an in vitro caries model. Subjects and Methods: Streptococcus mutans and Lactobacillus acidophilus were grown individually on the complex medium for 48 h at 37°C. The pH of the mixed medium was 7.0 initially and tested every 24 h. 40 extracted teeth were prepared with standardized cavity preparations and coated with control or experimental CuI adhesives and imaged using a micro-computed tomography (microCT). Four study groups were evaluated: (1) control (2) 0.5 µg/ml CuI (3) 1.0 µg/ml CuI, 4) 5.0 µg/ml CuI. After incubation, the teeth were re-imaged using the microCT. Utilizing AnalyzePro software the three-dimensional data sets were overlaid and demineralization was measured and statistics were run. Statistics: Stratified ANOVA models were run to determine if there were differences between the control and experimental adhesive groups. Similarly, pH and bacterial concentrations were evaluated to ensure the viability of polymicrobial specimen. Results and Conclusions: Significant differences were found between the control group and the 1.0 and 5.0 CuI adhesive groups. No differences in pH were noted between the groups. Overlaid changes in demineralization were recorded as volume loss. CuI adhesives with 5 mg/ml or higher have the potential to limit tooth demineralization after bacterial penetration of a dental restoration in an in vitro caries model. Further testing is needed.

Evaluation of complete-arch implant scanning with 5 different intraoral scanners in terms of trueness and operator experience.

STATEMENT OF PROBLEM: The intraoral scanning of the edentulous arch might be challenging for an inexperienced operator because of the large mucosal area and the use of scan bodies. PURPOSE: The purpose of this ex vivo study was to compare the trueness of 5 intraoral scanners in replicating implant scan bodies and soft tissues in an edentulous maxilla and to investigate the effects of operator experience. MATERIAL AND METHODS: The maxilla was resected from a fresh cadaver, 5 implants placed, and a reference scan made. Eight scans were made by experienced operators and 8 by an inexperienced operator with each scanner (iTero Element 2, Medit i500, Primescan, TRIOS 3, TRIOS 4). The implant platform deviation was measured after complete surface alignment and after scan body alignment. Deviation data were analyzed with a generalized linear mixed model (α=.05). RESULTS: After complete surface alignment, the mean ±standard deviation implant platform deviation was higher for the inexperienced operator (421 ±25 µm) than for experienced ones (191 ±12 µm, P<.001) for all scanners. After scan body alignment, no significant differences were found between operators for Element 2, Primescan, and TRIOS 3. The experienced operators produced a lower deviation for TRIOS 4 (35 ±3.3 µm versus 54 ±3.1 µm, P<.001), but higher deviation for i500 (68 ±4.1 µm versus 57 ±3.6 µm, P<.05). The scanner ranking was Element 2 (63 ±4.1 µm), i500 (57 ±3.6 µm, P=.443), TRIOS 4 (54 ±3.1 µm, P=.591), TRIOS 3 (40 ±3.1 µm, P<.01), Primescan (27 ±1.6 µm, P<.001) for the inexperienced operator and i500 (68 ±4.1 µm), Element 2 (58 ±4.0 µm, P=.141), TRIOS 3 (41 ±2.8 µm, P<.001), TRIOS 4 (35 ±3.3 µm, P=.205), Primescan (28 ±1.8 µm, P=.141) for the experienced operators. CONCLUSIONS: Mucosal alignment greatly overestimated the platform deviation. The intraoral scanners showed different trueness during the complete-arch implant scanning. The operator experience improved the trueness of the edentulous mucosa but not implant platform deviation.

Evaluation of the accuracy of multiple digital impression systems on a fully edentulous maxilla.

OBJECTIVE: This study aimed to compare the accuracy performance of five different intraoral scanning systems for a full-arch scan on an edentulous cadaver maxilla. METHOD AND MATERIALS: Five digital intraoral impression systems were used to scan a fully edentulous cadaver maxilla. A master scan obtained with an ATOS Capsule industrial grade scanner provided the point of comparison. Experimental scans were compared to the master scan using a metrology software that allows images to be overlayed on one another and deviations interpreted. Once aligned, three comparisons were made between the experimental scans and the reference: the entire maxilla, the ridge area only, and the palate area only. RESULTS: Trueness deviations between the experimental scans and the master digital model were up to 0.1 mm in the 75th percentile. For the whole maxilla, only the Medit scanner had statistically significantly inferior trueness compared to other scanners. When only the palate was considered, Medit was significantly different from Element (P = .0025) and Trios 4 (P = .0040), with no differences found between other scanners. For the ridge region the results replicate the trend observed for the whole maxilla. In regard to precision, differences were found only in the whole maxilla and the ridge area. In both areas, only Medit's precision was significantly different compared to other scanners, with the exception of Element. However, Element performance was similar to all other scanners. CONCLUSION: Most intraoral scanners exhibited similar performance. Although several statistically significant differences were identified, the clinical impact of these variances is probably not meaningful. (Quintessence Int 2021;52:488-495; doi: 10.3290/j.qi.b1244373).

The effect of software updates on the trueness and precision of intraoral scanners.

OBJECTIVES: The goal of the study was to determine the effects of software updates on the trueness and precision of digital impressions obtained with a variety of intraoral scanner (IOS) systems. METHOD AND MATERIALS: Seven IOS systems were investigated. Each system was tested using two versions of software, with the second version being the latest at the time of conducting the study. Scans were performed on a custom mandibular typodont model with natural teeth that were either unrestored or restored with amalgam, composite, lithium disilicate, zirconia, and gold. Eight scans were obtained for each software version on any of the tested IOS systems. Experimental IOS scans were compared against an industry-standard master scan of the typodont obtained with an ATOS Capsule scanner proven to have a trueness of 3 µm and a precision of 2 µm. Isolation of each substrate material on the digital experimental and master scans was achieved using the Geomagic metrology software for subsequent analysis of the substrate influence on accuracy. A generalized linear mixed model was used to determine the influence of the software version on the trueness and precision of the impression scan. RESULTS: For some IOS systems, scans made with older software versions differ in accuracy compared with those obtained with the most recent software versions. Trueness was improved for most scanners following the software update, although the Element2 IOS performance deteriorated. Software updates had lesser effects on precision and showed variable trends among different systems. Software updates also influence different substrate materials scans' accuracy, although the results show variability among IOS systems. When comparisons were done among IOS systems updated with the latest software version, best performers for complete arch trueness were the Emerald S, Trios 3, and Primescan systems. CONCLUSION: Software updates have a statistically significant effect on the trueness and precision of different IOS systems. These updates can have both positive and negative effects on scan accuracy, although it appears that these variations are within the clinical acceptability levels.

Comparing the trueness of seven intraoral scanners and a physical impression on dentate human maxilla by a novel method.

BACKGROUNDS: Intraoral scanner (IOS) accuracy is commonly evaluated using full-arch surface comparison, which fails to take into consideration the starting position of the scanning (scan origin). Previously a novel method was developed, which takes into account the scan origin and calculates the deviation of predefined identical points between references and test models. This method may reveal the error caused by stitching individual images during intraoral scan. This study aimed to validate the novel method by comparing the trueness of seven IOSs (Element 1, Element 2, Emerald, Omnicam, Planscan, Trios 3, CS 3600) to a physical impression digitized by laboratory scanner which lacks linear stitching problems. METHODS: Digital test models of a dentate human cadaver maxilla were made by IOSs and by laboratory scanner after polyvinylsiloxane impression. All scans started on the occlusal surface of the tooth #15 (universal notation, scan origin) and finished at tooth #2. The reference model and test models were superimposed at the scan origin in GOM Inspect software. Deviations were measured between identical points on three different axes, and the complex 3D deviation was calculated. The effect of scanners, tooth, and axis was statistically analyzed by the generalized linear mixed model. RESULTS: The deviation gradually increased as the distance from scan origin increased for the IOSs but not for the physical impression. The highest deviation occurred mostly at the apico-coronal axis for the IOSs. The mean deviation of the physical impression (53 ± 2 µm) was not significantly different from the Trios 3 (156 ± 8 µm) and CS 3600 (365 ± 29 µm), but it was significantly lower than the values of Element 1 (531 ± 26 µm), Element 2 (246 ± 11 µm), Emerald (317 ± 13 µm), Omnicam (174 ± 11 µm), Planscan (903 ± 49 µm). CONCLUSIONS: The physical impression was superior compared to the IOSs on dentate full-arch of human cadaver. The novel method could reveal the stitching error of IOSs, which may partly be caused by the difficulties in depth measurement.

Effect of scan pattern on complete-arch scans with 4 digital scanners.

STATEMENT OF PROBLEM: Complete-arch digital scans are becoming popular as digital dentistry is adopted for expanded clinical situations such as complete-arch prostheses, removable prostheses, extensive implant-supported treatment, and orthodontic aligners. Whether the scan pattern technique affects the trueness and precision of complete-arch scans and whether differences in accuracy exist among different scanners remain unclear. Furthermore, each manufacturer recommends a different scan pattern, but evidence of the superiority of the manufacturer's recommended pattern is lacking. PURPOSE: The purpose of this in vitro study was to determine whether the scan pattern affects the trueness, precision, and speed of complete-arch digital scans performed by using 4 different digital scanning systems. MATERIAL AND METHODS: A custom model used as the reference standard was fabricated with teeth having the same refractive index as dentin and enamel to simulate the natural dentition. The scan of the custom typodont was obtained by using an ATOS III Triple Scan 3D optical scanner. This study evaluated the CEREC Omnicam, Planmeca Emerald, Align iTero Element, and 3Shape TRIOS 3. Experimental scans were obtained from each of the 4 different digital scanning systems by using 4 unique scan patterns by experienced clinicians. Four experimental scans were acquired from each of the scanners by using 4 distinct scan patterns for a total of 16 scans for each scanner. Scan patterns 1 to 4 were based on the operator manuals for each different scanner. The scan time was recorded for each scan. All experimental scans were converted to standard tessellation language (STL) format, and a comprehensive metrology program, Geomagic Control X, was used to compare the reference standard scan with the experimental scans. RESULTS: For trueness, the scanner (P<.001), scan pattern (P=.001), and their interaction (P<.001) were found to be significant. Overall, scan pattern 2 showed the highest average trueness and precision. Likewise, for overall scan pattern precision, the scanner, scan pattern, and their interaction were found to be significant (P<.001). CONCLUSIONS: Scan pattern affected trueness and precision for some scanners, but not for others. Differences exist in the complete-arch scan speed, trueness, and precision of individual scanners. Scan pattern can play an important role in the success of digital scanning.

The effect different substrates have on the trueness and precision of eight different intraoral scanners.

OBJECTIVE: This in vitro study compares the newest generation of intraoral scanners to their older counterparts, and tests whether material substrates affect the trueness and precision of intraoral scanners (IOS). MATERIAL AND METHODS: A custom model, used as the reference standard, was fabricated with teeth composed of different dental materials. The reference standard scan was obtained using a three-dimensional (3D) optical scanner, the ATOS III. Experimental scans were obtained using eight different IOS, operated by experienced clinicians, using the manufacturer's recommended scanning strategy. A comprehensive metrology program, Geomagic Control X, was used to compare the reference standard scan with the experimental scans. RESULTS: For all scanners tested, except Trios3, the substrate does influence the trueness and precision of the scan. Furthermore, differences exist when comparing the same substrate across different scanners with some of the latest generation scanners clearly leaping ahead of the older generation regarding both trueness and precision. CONCLUSIONS: Substrate type affects the trueness and precision of a scan. Active Triangulation scanners are more sensitive to substrate differences than their parallel confocal counterparts. Some scanners scan certain substrates better, but in general the new generation of scanners outperforms the old, across all substrates. CLINICAL SIGNIFICANCE: The substrates being scanned play an import role in the trueness and precision of the 3D model. The new generation of scanners is remarkably accurate across all substrates and for complete-arch scanning.

A novel method for complex three-dimensional evaluation of intraoral scanner accuracy.

AIMS: The aim of this study was to compare two existing methods and one novel method for measuring the distortion of three-dimensional (3D) models created with complete-arch digital impressions, and to assess the accuracy of different scan patterns using these methods. MATERIALS AND METHODS: Maxillary and mandibular models were imaged with the PlanScan intraoral scanner using four different scan patterns. Accuracy and distortion were assessed by comparing the master scans with the intraoral scans using the following three methods: 1) Mean surface deviation was measured after complete arch superimposition; 2) 28 points were selected identically on the experimental and on the master reference models, and the deviation between identical points was assessed after superimposition over the complete arch; 3) In the case of the novel technique, the superimposition was made only at the scanning origin, and after that the 28 points were compared. RESULTS: Significant differences were found between the three different methods, regardless of the arch and pattern. The overall mean deviation between identical points when the models were aligned at the scanning origin was the highest, and the mean deviation between the non-identical values was the lowest. The novel method revealed local tooth-wise differences between the scan patterns as well as a pattern of amplified model error extending away from the scan origin. CONCLUSIONS: The novel method better detects the cumulative deviation of stitching errors in complete arch intraoral scans and is suitable to investigate the effect of scanning pattern in a very sensitive manner.

Elucidating the Geometric Substitution of Petroporphyrins by Spectroscopic Analysis and Atomic Force Microscopy Molecular Imaging.

Determination of the molecular structures of petroporphyrins has been crucial to understand the diagenetic pathways and maturation of petroleum. However, these studies have been hampered by their structural complexity and the challenges associated with their isolation. In comparison to the skeletal macrocyclic structures, much less is known about the substitutions, which are more sensitive to the maturation and diagenesis pathways. While these isolated vanadyl petroporphyrins largely consist of etioporphyrin and deoxophylloerythroetioporphyrin as expected, surprisingly, we find evidence that one or a few ß hydrogens are present in petroporphyrins of low carbon numbers using a combination of ultraviolet-visible spectroscopy, Fourier transform ion cyclotron resonance mass spectrometry, and non-contact atomic force microscopy. Petroporphyrins with ß hydrogens were not anticipated on the basis of their biological precursors. The data support dealkylation under catagenesis but not transalkylation or random alkylation of the ß and meso positions, despite the fact that more complex porphyrin structures are formed.

Evaluation of the trueness and precision of complete arch digital impressions on a human maxilla using seven different intraoral digital impression systems and a laboratory scanner.

OBJECTIVES: An impression accuracy study using a cadaver maxilla was performed using both prepared and intact teeth as well as palatal tissue. MATERIALS AND METHODS: Three crown preparations were performed on a cadaver maxilla. Seven different digital impression systems along with polyvinylsiloxane impressions were used to create digital models of the maxilla. Three-dimensional (3D) files of the experimental models were compared to a master model. The 3D files were overlaid and analyzed using a comparison software to create color coded figures that were measured for deviations between the master and experimental models. RESULTS: For scanning tooth structure, only the Planscan was significantly less accurate than the rest of impression techniques. No significant differences in accuracy were found between models created using digital impressions and those created from traditional vinyl polysiloxane impressions with cross arch deviations ranging from 18 to 39 µm for each. CONCLUSIONS: Impressions taken using all digital impression systems, save for the Planscan, were able to accurately replicate the tissues of a complete arch human maxilla. CLINICAL SIGNIFICANCE: Studies examining accuracy of digital impression systems have generally been performed on materials other than dental tissues. Optically, materials such as plastic and metal have properties different from enamel and dentin. This study evaluates accuracy of digital impression systems on human dentin, enamel, and soft tissues.

Effect of scan substrates on accuracy of 7 intraoral digital impression systems using human maxilla model.

OBJECTIVE: This study aimed to determine how the accuracy of digital impressions was affected by four common dental substrates using seven prevalent IOS systems to scan the complete arch of a human maxilla. SETTING AND SAMPLE POPULATION: The Department of Oral Rehabilitation at the Medical University of South Carolina. A single cadaver maxilla. MATERIALS AND METHODS: Seven digital intraoral impression systems were used to scan a freshly harvested human maxilla. The maxilla contained several teeth restored with amalgam and composite, as well as unrestored teeth characterized by enamel. Also, three teeth were prepared for full coverage restorations to expose natural dentin. An industrial grade metrology software program that allowed 3D overlay and dimensional computation compared deviations of the complete arch and its substrates on the test model from the reference model. RESULTS: Substrates were significantly different from each other when considering scan data as a whole, as well as when comparing IOS devices individually. Only PlanScan failed to reveal trueness differences between the different substrates, while only Emerald revealed precision differences between the substrates. CONCLUSIONS: Substrate type does impact the overall accuracy of intraoral scans with dentin being the most accurate and enamel being the least accurate. The four substrates scanned impacted the trueness of all IOS devices.

Evaluation of the effect scan pattern has on the trueness and precision of six intraoral digital impression systems.

OBJECTIVE: Clinicians have been slow to adopt digital impression technologies due possibly to perceived technique sensitivities involved in data acquisition. This research has two aims: determine whether scan pattern and sequence affects the accuracy of the three-dimensional (3D) model created from this digital impression and to compare the 5 imaging systems with regards to their scanning accuracy for sextant impressions. MATERIALS AND METHODS: Six digital intraoral impression systems were used to scan a typodont sextant with optical properties similar to natural teeth. The impressions were taken using five different scan patterns and the resulting digital models were overlayed on a master digital model to determine the accuracy of each scanner performing each scan pattern. Furthermore, regardless of scan pattern, each digital impression system was evaluated for accuracy to the other systems in this same manner. RESULTS: No differences of significance were noted in the accuracy of 3D models created using six distinct scan patterns with one exception involving the CEREC Omnicam. Planmeca Planscan was determined to be the truest scanner while 3Shape Trios was determined to be the most precise for sextant impression making. CONCLUSIONS: Scan pattern does not significantly affect the accuracy of the resulting digital model for sextant scanning. CLINICAL SIGNIFICANCE: Companies who make digital impression systems often recommend a scan pattern specific for their system. However, every clinical scanning scenario is different and may require a different approach. Knowing how important scan pattern is with regards to accuracy would be helpful for guiding a growing number of practitioners who are utilizing this technology.

Anatomic Customization of Root-Analog Dental Implants With Cone-Beam CT and CAD/CAM Fabrication: A Cadaver-Based Pilot Evaluation.

Existing root-analog dental implant systems have no standardized protocols regarding retentive design, surface manipulation, or prosthetic attachment design relative to the site's unique anatomy. Historically, existing systems made those design choices arbitrarily. For this report, strategies were developed that deliberately reference the adjacent anatomy, implant and restorable path of draw, and bone density for implant and retentive design. For proof of concept, dentate arches from human cadavers were scanned using cone-beam computed tomography and then digitally modeled. Teeth of interest were virtually extracted and manipulated via computer-aided design to generate root-analog implants from zirconium. We created a stepwise protocol for analyzing and developing the implant sites, implant design and retention, and prosthetic emergence and connection all from the pre-op cone-beam data. Root-analog implants were placed at the time of extraction and examined radiographically and mechanically concerning ideal fit and stability. This study provides proof of concept that retentive root-analog implants can be produced from cone-beam data while improving fit, retention, safety, esthetics, and restorability when compared to the existing protocols. These advancements may provide the critical steps necessary for clinical relevance and success of immediately placed root-analog implants. Additional studies are necessary to validate the model prior to clinical trial.

A novel technique for reference point generation to aid in intraoral scan alignment.

OBJECTIVE: When using a completely digital workflow on larger prosthetic cases it is often difficult to communicate to the laboratory or chairside Computer Aided Design and Computer Aided Manufacturing system the provisional prosthetic information. The problem arises when common hard tissue data points are limited or non-existent such as in complete arch cases in which the 3D model of the complete arch provisional restorations must be aligned perfectly with the 3D model of the complete arch preparations. In these instances, soft tissue is not enough to ensure an accurate automatic or manual alignment due to a lack of well-defined reference points. A new technique is proposed for the proper digital alignment of the 3D virtual model of the provisional prosthetic to the 3D virtual model of the prepared teeth in cases where common and coincident hard tissue data points are limited. Clinical considerations: A technique is described in which fiducial composite resin dots are temporarily placed on the intraoral keratinized tissue in strategic locations prior to final impressions. These fiducial dots provide coincident and clear 3D data points that when scanned into a digital impression allow superimposition of the 3D models. CONCLUSIONS: Composite resin dots on keratinized tissue were successful at allowing accurate merging of provisional restoration and post-preparation 3D models for the purpose of using the provisional restorations as a guide for final CLINICAL SIGNIFICANCE: Composite resin dots placed temporarily on attached tissue were successful at allowing accurate merging of the provisional restoration 3D models to the preparation 3D models for the purposes of using the provisional restorations as a guide for final restoration design and manufacturing. In this case, they allowed precise superimposition of the 3D models made in the absence of any other hard tissue reference points, resulting in the fabrication of ideal final restorations.

Evaluation of the accuracy of 7 digital scanners: An in vitro analysis based on 3-dimensional comparisons.

STATEMENT OF PROBLEM: As digital impressions become more common and more digital impression systems are released onto the market, it is essential to systematically and objectively evaluate their accuracy. PURPOSE: The purpose of this in vitro study was to evaluate and compare the trueness and precision of 6 intraoral scanners and 1 laboratory scanner in both sextant and complete-arch scenarios. Furthermore, time of scanning was evaluated and correlated with trueness and precision. MATERIAL AND METHODS: A custom complete-arch model was fabricated with a refractive index similar to that of tooth structure. Seven digital impression systems were used to scan the custom model for both posterior sextant and complete arch scenarios. Analysis was performed using 3-dimensional metrology software to measure discrepancies between the master model and experimental casts. RESULTS: Of the intraoral scanners, the Planscan was found to have the best trueness and precision while the 3Shape Trios was found to have the poorest for sextant scanning (P<.001). The order of trueness for complete arch scanning was as follows: 3Shape D800 >iTero >3Shape TRIOS 3 >Carestream 3500 >Planscan >CEREC Omnicam >CEREC Bluecam. The order of precision for complete-arch scanning was as follows: CS3500 >iTero >3Shape D800 >3Shape TRIOS 3 >CEREC Omnicam >Planscan >CEREC Bluecam. For the secondary outcome evaluating the effect time has on trueness and precision, the complete- arch scan time was highly correlated with both trueness (r=0.771) and precision (r=0.771). CONCLUSIONS: For sextant scanning, the Planscan was found to be the most precise and true scanner. For complete-arch scanning, the 3Shape Trios was found to have the best balance of speed and accuracy.

Antibacterial properties of copper iodide-doped glass ionomer-based materials and effect of copper iodide nanoparticles on collagen degradation.

OBJECTIVES: This study investigated the antibacterial properties and micro-hardness of polyacrylic acid (PAA)-coated copper iodide (CuI) nanoparticles incorporated into glass ionomer-based materials, and the effect of PAA-CuI on collagen degradation. MATERIALS AND METHODS: PAA-CuI nanoparticles were incorporated into glass ionomer (GI), Ionofil Molar AC, and resin-modified glass ionomer (RMGI), Vitrebond, at 0.263 wt%. The antibacterial properties against Streptococcus mutans (n = 6/group) and surface micro-hardness (n = 5/group) were evaluated. Twenty dentin beams were completely demineralized in 10 wt% phosphoric acid and equally divided in two groups (n = 10/group) for incubation in simulated body fluid (SBF) or SBF containing 1 mg/ml PAA-CuI. The amount of dry mass loss and hydroxyproline (HYP) released were quantified. Kruskal-Wallis, Student's t test, two-way ANOVA, and Mann-Whitney were used to analyze the antibacterial, micro-hardness, dry mass, and HYP release data, respectively (p < 0.05). RESULTS: Addition of PAA-CuI nanoparticles into the glass ionomer matrix yielded significant reduction (99.999 %) in the concentration of bacteria relative to the control groups. While micro-hardness values of PAA-CuI-doped GI were no different from its control, PAA-CuI-doped RMGI demonstrated significantly higher values than its control. A significant decrease in dry mass weight was shown only for the control beams (10.53 %, p = 0.04). Significantly less HYP was released from beams incubated in PAA-CuI relative to the control beams (p < 0.001). CONCLUSIONS: PAA-CuI nanoparticles are an effective additive to glass ionomer-based materials as they greatly enhance their antibacterial properties and reduce collagen degradation without an adverse effect on their mechanical properties. CLINICAL RELEVANCE: The use of copper-doped glass ionomer-based materials under composite restorations may contribute to an increased longevity of adhesive restorations, because of their enhanced antibacterial properties and reduced collagen degradation.

Evaluation of the Marginal Fit of CAD/CAM Crowns Fabricated Using Two Different Chairside CAD/CAM Systems on Preparations of Varying Quality.

PURPOSE: This study evaluated the marginal gap of crowns fabricated using two new chairside computer-aided design/computer-aided manufacturing systems on preparations completed by clinicians with varying levels of expertise to identify whether common preparation errors affect marginal fit. The null hypothesis is that there is no difference in the mean marginal gaps of restorations of varying qualities and no difference in the mean marginal gap size between restorations fabricated using the PlanScan (D4D, Richardson, TX, USA) and the CEREC Omnicam (Sirona, Bensheim, Germany). MATERIAL AND METHODS: The fit of 80 lithium disilicate crowns fabricated with the E4D PlanScan or CEREC Omnicam systems on preparations of varying quality were examined for marginal fit by using the replica technique. These same preparations were then visually examined against common criteria for anterior all-ceramic restorations and placed in one of four categories: excellent, good, fair, and poor. Linear mixed modeling was used to evaluate associations between marginal gap, tooth preparation rating, and fabrication machine. RESULTS: The fit was not significantly different between both systems across all qualities of preparation. The average fit was 104 µm for poor-quality preparations, 87.6 µm for fair preparations, 67.2 µm for good preparations, and 36.6 µm for excellent preparations. CONCLUSION: The null hypothesis is rejected. It can be concluded that preparation quality has a significant impact on marginal gap regardless of which system is used. However, no significant difference was found when comparing the systems to each other. CLINICAL SIGNIFICANCE: Within the limitations of this in vitro study, it can be concluded that crown preparation quality has a significant effect on marginal gap of the restoration when the clinician uses either CEREC Omnicam or E4D PlansScan.

Utilizing self-assessment software to evaluate student wax-ups in dental morphology.

Traditionally, evaluating student work in preclinical courses has relied on the judgment of experienced clinicians utilizing visual inspection. However, research has shown significant disagreement between different evaluators (interrater reliability) and between results from the same evaluator at different times (intrarater reliability). This study evaluated a new experimental software (E4D Compare) to compare 66 student-produced tooth wax-ups at one U.S. dental school to an ideal standard after both had been digitally scanned. Using 3D surface-mapping technology, a numerical evaluation was generated by calculating the surface area of the student's work that was within a set range of the ideal. The aims of the study were to compare the reliability of faculty and software grades and to determine the ideal tolerance value for the software. The investigators hypothesized that the software would provide more consistent feedback than visual grading and that a tolerance value could be determined that closely correlated with the faculty grade. The results showed that a tolerance level of 450 µm provided 96% agreement of grades compared with only 53% agreement for faculty. The results suggest that this software could be used by faculty members as a mechanism to evaluate student work and for students to use as a self-assessment tool.

Incorporation of bactericidal poly-acrylic acid modified copper iodide particles into adhesive resins.

OBJECTIVES: This study aimed to investigate incorporation of polyacrylic acid (PAA) coated copper iodide (CuI) nanoparticles into dental adhesives, and to evaluate for the first time, their antibacterial properties, bond strength and cytotoxicity. METHODS: PAA-CuI nanoparticles were synthesized and incorporated into commercially available adhesives Optibond XTR (1.0mg/ml) and XP Bond (0.5 and 1.0mg/ml). The antibacterial properties of experimental and control specimens were evaluated (n=8), after ageing for 18h or 1 year, against Streptococcus mutans (1×10(8)cells/ml). Bond strength to human dentine of the control and experimental adhesives was evaluated by shear bond strength (n=10). For cytotoxicity evaluation, HGF cells were cultured with gingival fibroblast media and exposed to control and experimental adhesive blends (n=3). An MTT cell viability assay was used to assess cell metabolic function. A one-way analysis of variance followed by Tukey's test was used for data analysis. RESULTS: Significantly greater antibacterial properties were demonstrated for PAA-CuI containing adhesives after ageing for 18h or 1 year relative to all control groups. A reduction in Streptococcus mutans viable cell count of 99.99%, 99.99% and 79.65% was shown for XP Bond - 0.5mg/ml, XP Bond - 1.0mg/ml and Optibond XTR - 1.0mg/ml PAA-CuI after ageing for 18h, and 99.99% for both XP Bond - 0.5mg/ml and XP Bond - 1.0mg/ml PAA-CuI after ageing for 1 year. No significant variations in shear bond strength or cytotoxicity were detected between the experimental resins and their corresponding controls. CONCLUSIONS: PAA-CuI nanoparticles are an effective additive to adhesive blends as it renders them antibacterial without adversely affecting their bond strength or cytotoxicity. CLINICAL SIGNIFICANCE: The incorporation of PAA-coated copper iodide particles into adhesive resins renders the adhesive antibacterial to S. mutans for at least 1 year in vitro. This may prevent or delay bacterial invasion and the consequent development of caries lesions if the adhesive interface becomes defective.