Radiographic Appearance of Interocclusal Record Materials for Cone Beam Computed Tomography-Guided Implant Surgeries.

PURPOSE: To select an ideal interocclusal record material for cone beam computed tomography (CBCT)-guided implant surgery based on the material's radiodensity on the scan. MATERIALS AND METHODS: Twelve commonly used interocclusal record materials were used for this investigation: two were waxes, one was polyether, and nine were polyvinyl-siloxane-type materials. A scan template was fabricated by duplicating existing dentures in Ortho-Jet acrylic resin mixed with 30% barium powder for the teeth and 10% barium powder for the denture base between the teeth and the tissue. An interocclusal record was fabricated with each material, and the same template was used to obtain a CBCT scan with an ICAT machine (Imaging Sciences International) at 0.3 voxel and 14-bit depth settings. Twelve CBCT scans were obtained and analyzed. The radiopacity of the barium teeth was used as a control and was compared with the opacity of the 12 materials using a paired t test. A post hoc analysis of variance (ANOVA) test was used to compare the densities of the various materials with each other. RESULTS: There was a statistically significant difference between the radiopacity of barium teeth (gray value: 1,959.475) and that of Modelling Wax (gray value: 750; P = .0026), Aluwax (gray value: 795.22; P = .0022), Blu-Bite CT (gray value: 1,105; P = .005), Ramitec (gray value: 1,105.3; P = .08), Memosil 2 (gray value: 1,202; P = .01) followed by Reprosil (gray value: 1,407.73; P = .01). Compared with the barium teeth, there was no statistically significant difference between the densities of Futar D (gray value: 1,866.5; P = .51), Jet Bite (gray value: 1,660.04; P = .08), Lab-Putty (gray value: 1,402.14; P = .19), and Memoreg 2 (gray value: 1,754.72; P = .1). The highest radiodensity was seen with Blu-Mousse (gray value: 2,949; P = .007) and Take 1 (gray value: 2,229.85; P = .025), which were also significantly different from the density of the barium teeth but in the opposite direction, making them more opaque. CONCLUSION: Within the limitations of this in vitro study, the most radiolucent appearance of Modelling Wax, Aluwax, Memosil 2, Blu-Bite CT, and Ramitec made them the suitable materials of choice of those tested, as the interocclusal registration record during CBCT scanning allowed clear visualization of barium teeth.

Diagnostic accuracy and measurement sensitivity of digital models for orthodontic purposes: A systematic review.

INTRODUCTION: Our objective was to assess the accuracy, validity, and reliability of measurements obtained from virtual dental study models compared with those obtained from plaster models. METHODS: PubMed, PubMed Central, National Library of Medicine Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to November 2014. A grading system described by the Swedish Council on Technology Assessment in Health Care and the Cochrane tool for risk of bias assessment were used to rate the methodologic quality of the articles. RESULTS: Thirty-five relevant articles were selected. The methodologic quality was high. No significant differences were observed for most of the studies in all the measured parameters, with the exception of the American Board of Orthodontics Objective Grading System. CONCLUSIONS: Digital models are as reliable as traditional plaster models, with high accuracy, reliability, and reproducibility. Landmark identification, rather than the measuring device or the software, appears to be the greatest limitation. Furthermore, with their advantages in terms of cost, time, and space required, digital models could be considered the new gold standard in current practice.

Dimensional accuracy of digital dental models from cone-beam computed tomography scans of alginate impressions according to time elapsed after the impressions.

INTRODUCTION: Our objective was to investigate the dimensional accuracy of digital dental models obtained from the cone-beam computed tomography (CBCT) scans of alginate impressions according to the time elapsed after the impressions were taken. METHODS: Alginate impressions were obtained of 20 adults using 2 alginate materials: Alginoplast (Heraeus Kulzer, Hanau, Germany) and Cavex (Cavex Holland, Haarlem, The Netherlands). These impressions were stored in wet conditions and scanned by CBCT immediately after impression-taking and after storage times of 12, 24, 36, 48, 60, and 72 hours. After reconstruction of the 3-dimensional digital dental models, the models were measured, and the data were analyzed to determine the dimensional changes according to the time elapsed. The changes within the measurement error were regarded as clinically acceptable in this study. RESULTS: The measurement errors ranged from 0.27 to 0.29 mm in the digital dental models obtained from CBCT scans of the alginate impressions. All measurements showed decreasing accuracy with greater elapsed time after the impressions were taken. Changes above the measurement error occurred at 24 and 36 hours for Cavex and Alginoplast, respectively. CONCLUSIONS: Digital dental models can be obtained from CBCT scans of alginate impressions without sending them to a remote laboratory. However, the impressions need to be scanned within 24 hours; otherwise, dimensional changes lead to errors that exceed the error of measurement.

How orthodontic records can influence torque choice decisions?

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Influência do agente cimentante e desajuste interno na adaptação marginal de coroas em resina nanocerâmica / Influence of the cement agent and internal mismatch in the marginal adaptation of nanoceramic resins crowns

A adaptação marginal é um dos requisitos fundamentais para a longevidade e o sucesso das restaurações. O objetivo desse estudo foi avaliar a influência do desajuste interno associado à diferentes agentes cimentantes na desadaptação marginal de coroas em resina nanocerâmica (Lava Ultimate 3M ESPE) confeccionadas pelo sistema CAD-CAM. A partir do escaneamento de um preparo de coroa total em um pré-molar, foram obtidos 36 modelos em metal. Esses foram divididos em seis grupos de acordo com o desajuste interno (70 µm ou 100 µm) e o cimento (Fosfato de zinco- SS White, Cimento de ionômero de vidro- Ketac Cem 3M/ESPE e Cimento resinoso- Relyx Ultimate 3M/ESPE). Após escaneamento de todos os modelos as coroas foram confeccionadas a partir da fresagem de blocos de resina nanocerâmica (Lava Ultimate 3M/ESPE). Com auxílio de microscópio óptico comparador (40X) foram medidas as desadaptações marginais prévia e posteriormente à cimentação, sendo considerados 8 pontos ao longo do término em todas as faces do corpo de prova. Os valores obtidos após serem submetidos aos testes two-way anova e teste t, demonstraram que as coroas confeccionadas com desajuste interno de 70 µm apresentam desadaptação marginal inferior estatisticamente significante às coroas com desajuste interno de 100 µm. Para o desajuste interno de 70 µm o grupo do cimento fosfato de zinco apresentou o menor gap marginal, sendo que este valor não foi estatisticamente diferente em relação ao grupo do Ketac Cem. Ainda com esse desajuste, o grupo do Ketac Cem não apresentou diferença estatística significante em relação ao grupo do Relyx Ultimate, no entanto esse último promoveu "gap" marginal estatisticamente maior em relação ao grupo do cimento fosfato de zinco. Para o desajuste interno de 100 µm não houve diferença estatisticamente significante no "gap" marginal entre os três cimentos avaliados. O presente estudo demonstrou através da metodologia utilizada, que a menor desadaptação marginal observada nas restaurações de Lava Ultimate, foi proveniente do desajuste interno de 70 µm. Neste grupo os cimentos de fosfato de zinco e de ionômero de vidro demonstraram melhor comportamento comparado ao cimento resinoso, embora o cimento de ionômero de vidro numericamente, mas não estatisticamente tenha apresentado resultado inferior ao do fosfato de zinco

The marginal adaptation is one of the basic requirements for the longevity and success of restorations. The aim of this study was to evaluate the influence of the internal imbalances associated with different luting agents on marginal leakage of crowns Nanoceramic resin ( Lava Ultimate 3M ESPE) made by CAD-CAM system. From the scanning of a full crown preparation in a pre molar were obtained 36 metal models. These were divided into six groups according to the internal imbalances ( 70 or 100 micrometres) and cement (SS White Zinc phosphate, glass ionomer cemet Ketac Cem 3M/ Espe and resinous cement Relyx Ultimate 3M / Espe). After scanning all models crowns were made from milling Nanoceramic resin blocks (Lava Ultimate 3M / Espe). With the aid of optical comparator microscope (40X) were measured prior marginal mismatches and after the cementation, being considered 8 points along the end in all specimen faces. The values were submitted to ANOVA two-way test and t test. Results showded that crowns made with internal imbalances of 70 uM show statistically significant lower marginal leakage to the crows with internal imbalances of 100 micrometres. For the internal imbalances 70 uM zinc phosphate cement group showed the lowest "gap" marginal, and this figure does not show a statistically significant difference compared to Ketac Cem gropu. Even with this misfit, Ketac Cem group showed no statistically significant difference in relation to Relyx Ultimate group, though the latter showed a statistically significant difference compared to zinc phosphate cement group. For the internal imbalances of 100 micrometres there was no statistically significant difference in the "gap" marginal among the three cements. This study demostrated through the methodology used, the lower marginal leakage oberved in Lava Ultimate restorations, was from the inner misfit 70 micrometers...

Biomecânica da união dente-implante com plataforma restauradora reduzida, sistema de retenção tipo cone morse e roscas quadradas: uma análise por elementos finitos / Biomechanics of tooth-implant union with restorative platform reduced, restraint system morse cone type and square threads: a finite element analysis

Objetivou-se, a partir do Método dos Elementos Finitos, avaliar a biomecânica da união dente-implante e implante-implante, além de estabelecer uma análise qualitativa com achados fotoelásticos prévios. Foram planejados quatro modelos tridimensionais: dois Modelos Teste (dentes unidos a implantes) e dois Modelos Controle (a mesma condição, porém implanto suportada). Os implantes (ANKYLOS® - Dentsply) apresentaram conexão cônica, roscas quadradas e pilares Switching. Suas dimensões, ângulos externos e pilares protéticos foram obtidos a partir de um projetor de perfil. Já, dentes e próteses, a partir da visão direta, tiveram suas formas externas construídas em plataforma CAD (SOLIDSWORKS). O suporte alveolar foi configurado como um retângulo (68/30/15 mm). Todos os pilares foram posicionados no suporte alveolar, conforme os modelos físicos pré-existentes, gerando modelos sólidos. O ligamento periodontal consistiu de uma camada de 0,25 mm de espessura em poliéter (Impregum Soft, 3M Espe). Os modelos de dentes foram produzidos em dentina, pilares e implantes em titânio puro, próteses em liga Níquel-Cromo (Ni-Cr), e o suporte alveolar em resina fotoelástica (Araldite® - Produtos Químicos Ciba S/A do Brasil). As propriedades da resina foram obtidas por meio de ensaio de tração. Carga pontual, vertical e estática, de 150 N, foi aplicada. Os resultados destes ensaios evidenciaram menor concentração de tensão no aspecto cervical de implantes do grupo teste. Ao se confrontar tais achados com os fotoelásticos anteriormente obtidos, foi possível estabelecer uma relação direta entre as áreas mais solicitadas para os modelos de prótese fixa (PF) de três elementos. Concluiu-se que, para as condições estudadas ¿ conexão cônica, roscas quadradas e restauração com Plataforma Switching ¿, unir dentes a implantes parece ser uma terapia clínica viável, sugerindo, inclusive, ser mais favorável que a união de implantes entre si. Além disso, a partir da afinidade positiva entre os achados das duas técnicas, pôde-se considerar validados os modelos matemáticos de prótese fixa de três elementos

The goal of this study was to evaluate, from the Finite Element Method, the biomechanics of implant-tooth union and implant-implant and to establish a qualitative analysis with previous photoelastic findings. Four three-dimensional models were planned: two Test Models (teeth attached to implants) and two Control Models (the same condition, however implant supported). The implants (ANKYLOS® - Dentsply) showed conical connection, square threads and Switching pillars. Their dimensions, external angles and abutments were obtained from a profile projector. Already, teeth and dentures, from direct view, had their external forms built in CAD platform (SOLIDSWORKS). Alveolar support wasconfigured as a rectangle (68/30/15 mm). All the pillars were placed in the alveolar support, as the pre-existing physical models, generating solid models. The periodontal ligament consists of a layer of 0.25 mm thick in polyether (Impregum Soft, 3M Espe). The models of teeth trumped up of dentin, abutments and implants of pure titanium, prosthetics of Nickel-Chrome (Ni-Cr) alloy and alveolar support in photoelastic resin (Araldite® - Chemicals Ciba S/A of Brazil). The resin properties were obtained by traction tests. Punctual and vertical static load of 150 N was applied. The results of these tests showed lower concentration of tension in the cervical aspect of the test group implants. When comparing these findings with the photoelastic previously found, it was possible to establish a direct relation between the areas most requested for fixed prosthesis (FP) models of three elements. It was concluded that, for the studied conditions tapered connection, square threads and Platform Switching restoration , joining teeth implants seems to be a viable clinical therapy, suggesting, inclusive, to be more favorable than to join implants each other. Moreover, from the positive affinity between the findings of the two techniques, it was possible to consider validated the mathematical models of fixed prosthesis of three elements

Comparison of 5 types of interocclusal recording materials on the accuracy of articulation of digital models.

INTRODUCTION: One method of articulating digital models is to use a digitized interocclusal record. However, the accuracy of different interocclusal record materials to articulate digital models has yet to be evaluated. METHODS: A plastic typodont was modified with reference points for interarch measurements and articulated in maximum intercuspal position on a semiadjustable hinge articulator. Twenty-five interocclusal records of each of the 5 experimental materials (Regisil Rigid, Dentsply, York, Pa; Futar Scan, Kettenbach, Huntington Beach, Calif; Byte Right, Motion View Software, Chattanooga, Tenn; Aluwax, Aluwax Dental Products, Allendale, Mich; and Beauty Pink wax, Miltex, York, Pa) were made on the mounted typodont and digitized using an Ortho Insight 3D laser surface scanner (Motion View Software). Motion View Software was used to articulate the digital models by matching points from the models to the digitized interocclusal records. The distances between corresponding interarch markers were measured and compared with the measurements taken on the physical typodont (gold standard). RESULTS: Polyvinyl siloxane materials were significantly more likely to lead to successful articulation than were the other interocclusal record materials. Statistical analysis showed a significant effect of the bite registration material on the probability of success of the articulation (P <0.005). CONCLUSIONS: Polyvinyl siloxane is a more accurate interocclusal recording material when articulating digital models according to the process described in this study. Using a bite registration to articulate digital models should be considered the first step in the articulation process, with a likely residual need to manipulate the models manually.

Influence of standardization on the precision (reproducibility) of dental cast analysis with virtual 3-dimensional models.

INTRODUCTION: Virtual 3-dimensional (3D) models obtained by scanning of physical casts have become an alternative to conventional dental cast analysis in orthodontic treatment. If the precision (reproducibility) of virtual 3D model analysis can be further improved, digital orthodontics could be even more widely accepted. The purpose of this study was to clarify the influence of "standardization" of the target points for dental cast analysis using virtual 3D models. Physical plaster models were also measured to obtain additional information. METHODS: Five sets of dental casts were used. The dental casts were scanned with R700 (3Shape, Copenhagen, Denmark) and REXCAN DS2 3D (Solutionix, Seoul, Korea) scanners. In this study, 3 system and software packages were used: SureSmile (OraMetrix, Richardson, Tex), Rapidform (Inus, Seoul, Korea), and I-DEAS (SDRC, Milford, Conn). RESULTS: Without standardization, the maximum differences were observed between the SureSmile software and the Rapidform software (0.39 mm ± 0.07). With standardization, the maximum differences were observed between the SureSmile software and measurements with a digital caliper (0.099 mm ± 0.01), and this difference was significantly greater (P <0.05) than the 2 other mean difference values. Furthermore, the results of this study showed that the mean differences "WITH" standardization were significantly lower than those "WITHOUT" standardization for all systems, software packages, or methods. CONCLUSIONS: The results showed that elimination of the influence of usability or habituation is important for improving the reproducibility of dental cast analysis.

Comparison of clinical bracket point registration with 3D laser scanner and coordinate measuring machine.

OBJECTIVE: The aim of the present study was to assess the diagnostic value of a laser scanner developed to determine the coordinates of clinical bracket points and to compare with the results of a coordinate measuring machine (CMM). METHODS: This diagnostic experimental study was conducted on maxillary and mandibular orthodontic study casts of 18 adults with normal Class I occlusion. First, the coordinates of the bracket points were measured on all casts by a CMM. Then, the three-dimensional coordinates (X, Y, Z) of the bracket points were measured on the same casts by a 3D laser scanner designed at Shahid Beheshti University, Tehran, Iran. The validity and reliability of each system were assessed by means of intraclass correlation coefficient (ICC) and Dahlberg's formula. RESULTS: The difference between the mean dimension and the actual value for the CMM was 0.0066 mm. (95% CI: 69.98340, 69.99140). The mean difference for the laser scanner was 0.107 ± 0.133 mm (95% CI: -0.002, 0.24). In each method, differences were not significant. The ICC comparing the two methods was 0.998 for the X coordinate, and 0.996 for the Y coordinate; the mean difference for coordinates recorded in the entire arch and for each tooth was 0.616 mm. CONCLUSION: The accuracy of clinical bracket point coordinates measured by the laser scanner was equal to that of CMM. The mean difference in measurements was within the range of operator errors.

Hypodontia and supernumerary and impacted teeth in children with various types of clefts.

INTRODUCTION: The purpose of this study was to determine the prevalence of hypodontia, hyperdontia, and impacted teeth in children with various types of clefts. METHODS: This study sample consisted of 201 cleft patients including 131 male subjects with a mean age of 12.3 ± 4 years and 70 female subjects with a mean age of 12.6 ± 3.9 years. Charts, models, radiographs, and intraoral photographs were used for the study. t tests, chi-square tests, and binomial tests were used for assessment of the data. RESULTS AND CONCLUSIONS: Hypodontia was found in 129 subjects (64.1%). The chi-square test showed no statistically significant difference between the type of cleft and hypodontia (P <0.319). The binomial test showed that the frequencies of subjects with hypodontia were significantly higher in both unilateral and bilateral cleft lip and palate patients (P <0.015 and P <0.001, respectively). Hyperdontia and impacted teeth were also found to occur mostly in the maxillary arch, and maxillary canines were the most commonly impacted teeth in both unilateral and bilateral cleft lip and palate patients.

Reliability of linear and angular dental measurements with the OrthoMechanics Sequential Analyzer.

INTRODUCTION: The aim of this study was to evaluate the reliability of newly developed software in the assessment of orthodontic tooth movement 3 dimensionally. METHODS: The sample consisted of pretreatment and posttreatment computed tomography scans and plaster dental models of 20 orthodontic patients treated with a hyrax palatal expander as a part of their comprehensive orthodontic treatment. Dental-arch measurements, including arch widths, tooth inclinations, and angulation parameters, were measured on the scans using InvivoDental 3D imaging software (version 5.1; Motionview, Hixson, Tenn). The plaster dental models were laser scanned and superimposed, and measurements were obtained digitally using the new software. Agreement between the digital models and the computed tomography measurements was evaluated with intraclass correlation coefficients, paired t tests, and Bland-Altman plots. A P value of ≤0.05 was considered statistically significant. RESULTS: High agreement, a nonsignificant paired t test, and no indication of agreement discrepancies were observed for most of the measured parameters. CONCLUSIONS: The results confirmed that the new software program offers a reliable tool for dental-arch measurements obtained from 3-dimensional laser-scanned models.

Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review.

A systematic review was undertaken to evaluate the validity of intra-arch dimensional measurements made from laser-scanned digital dental models in comparison with measurements directly obtained from the original plaster casts (gold standard). Finally included articles were only those reporting studies that compared measurements from digital models produced from laser scanning against their plaster models. Measurements from the original plaster models should have been made using a manual or digital caliper (gold standard). Articles that used scans from impressions or digital photographs were discarded. Detailed individual search strategies for Cochrane, EMBASE, MEDLINE, PubMed, and LILACS were developed. The references cited in the selected articles were also checked for any references that could have been missed in the electronic database searches. A partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item quality assessment tool for diagnostic accuracy studies (QUADAS). Only 16 studies were finally included for the qualitative/quantitative synthesis. The selected studies consistently agree that the validity of measurements obtained after using a laser scanner from plaster models is similar to direct measurements. Any stated differences would be unlikely clinically relevant. There is consistent scientific evidence to support the validity of measurements from digital dental models in comparison with intra-arch dimensional measurements directly obtained from them.

Comparison of the accuracy of a 3-dimensional virtual method and the conventional method for transferring the maxillary cast to a virtual articulator.

STATEMENT OF PROBLEM: The currently available virtual articulators fail to locate the digitized maxillary cast at the exact position in the virtual environment. Some locate the casts on a mechanical articulator with a facebow, and this position is then digitized for the virtual environment. PURPOSE: The purpose of this study was to compare the location of the maxillary cast on an articulator by using 2 different procedures: the conventional method and a virtual method. MATERIAL AND METHODS: With the conventional procedure, the kinematic axis of the participant was determined with an axiograph. The location of the maxillary cast in reference to this axis was then physically transferred to a Panadent mechanical articulator. By a virtual procedure, the same kinematic axis and the maxillary cast were transferred directly from the participant to the Panadent virtual articulator by means of reverse engineering devices. The locations obtained with both procedures were compared in a virtual environment with an optical scanner. By calculating the deviation at every point of the occlusal surface, the results obtained with this procedure were then compared with those of the conventional method. RESULTS: The mean deviation on the occlusal surface was 0.752 mm, and the standard deviation was 0.456 mm. CONCLUSIONS: The deviation between the procedures was sufficiently small to allow the methodology for orthodontic purposes. However, the accuracy of the virtual procedure should be improved so as to extend its use to other fields, such as orthognathic surgery or dental restorations, in which the clinical technique requires an articulator.

Application of three-dimensional digital models for the morphometric analysis of predentition plasters: accuracy and precision.

AIM: This study aimed to test the accuracy and precision of measurements of three-dimensional (3D) digital models from the pre-dentition period using a noncontact 3D measurement system (3D scanner) versus the gold standard method of direct measurements using a digital caliper on plaster models. MATERIALS AND METHODS: Ten pairs of plaster models were obtained from children during the predentition period. Linear measurements were performed using both methods. Three operators were trained in the use of both methods for this study. Measurements were performed with a minimum 2-week interval between measurements in a randomly chosen order. RESULTS: The mean difference between the measured values using the two methods was <0.2 mm for each measurement. There was no linearity in the measurements using pre-dentition digital models. An ANOVA Gage R&R analysis revealed that there was no significant operator difference (P < 0.307). The rate of variation of the 3D scanner over the total variation was 2.8%. The ICC was 0.982 (P< 0.001), suggesting excellent interoperator agreement. CONCLUSION: The results suggest that measurements of digital 3D pre-dentition models are highly accurate and precise, and also comparable to measurements using the gold standard method.

Clinical use of a direct chairside oral scanner: an assessment of accuracy, time, and patient acceptance.

INTRODUCTION: Chairside oral scanners allow direct digital acquisition of the intraoral situation and can eliminate the need for conventional impressions. In this study, we aimed to assess accuracy, scan time, and patient acceptance of a chairside oral scanner when used for full-arch scans; these are critical factors for acceptance of this technology in the orthodontic setting. METHODS: Fifteen patients had digital models made from both intraoral scans (Lava COS; 3M ESPE, St Paul, Minn) and alginate impressions. Each procedure was timed, and patient preference was assessed with a survey. In addition, digital models were made from 5 plaster model pairs using the intraoral scanner and an orthodontic model scanner. Model pairs were digitally superimposed, and differences between models were quantified. Accuracy was assessed using the Bland-Altman method. Time differences were tested for statistical significance with the Student t test. RESULTS: Digital models made using the chairside oral scanner and either impressions or the orthodontic model scanner did not differ significantly. The chair time required to take impressions was significantly shorter than the time required for the intraoral scans. When processing time was included, the time requirement did not differ significantly between methods. Although 73.3% of the patients preferred impressions because they were "easier" or "faster," 26.7% preferred the scan because it was "more comfortable." CONCLUSIONS: Despite the high accuracy of chairside oral scanners, alginate impressions are still the preferred model acquisition method with respect to chair time and patient acceptance. As digital technology continues to progress, intraoral scanning may become more accepted for use in orthodontics.

Interexaminer and intraexaminer reliabilities of 3-dimensional orthodontic digital setups.

INTRODUCTION: The use of digital orthodontic setups has grown quickly. The purpose of this study was to test the interexaminer and intraexaminer reliabilities of 3-dimensional orthodontic digital setups in OrthoCAD (Align Technology, San Jose, Calif). METHODS: Six clinicians made digital orthodontic setups on 6 digital models twice, with a minimum interval of 2 weeks and a maximum interval of 4 weeks. OrthoCAD software was used, and treatment goals were all set the same according to the American Board of Orthodontics Objective Grading System (ABO-OGS). Differences between the 72 setups were measured with the ABO-OGS scores. RESULTS: In comparing setups 1 and 2, the intraexaminer mean absolute differences in total ABO-OGS scores varied statistically significantly between 2.17 and 6.00 points. Interexaminer mean absolute differences varied statistically significantly between 4.77 and 5.56 points. All but 1 intraclass correlation coefficient (ICC) value showed significant excellent agreement (ICC, >0.8) for intraexaminer reliability. One ICC value was insignificant and showed moderate (ICC, 0.4-0.6) agreement. Interexaminer reliability showed significant good (ICC, 0.6-0.8) agreement. CONCLUSIONS: There is a significant difference in ABO-OGS score when using OrthoCAD. Although this difference was low, it could be clinically significant. Interexaminer and intraexaminer reliabilities are not redundant for general use of the 3-dimensional orthodontic digital setup in OrthoCAD.

The reliability of Little's Irregularity Index for the upper dental arch using three dimensional (3D) digital models.

AIM: To investigate the inter-examiner variability of contact point displacement measurements (used to calculate the overall Little's Irregularity Index (LII) score) from digital models of the maxillary arch by four independent examiners. METHODS: Maxillary orthodontic pre-treatment study models of ten patients were scanned using the Lava(tm) Chairside Oral Scanner (LCOS) and 3D digital models were created using Creo(®) computer aided design (CAD) software. Four independent examiners measured the contact point displacements of the anterior maxillary teeth using the software. Measurements were recorded randomly on three separate occasions by the examiners and the measurements (n=600) obtained were analysed using correlation analyses and analyses of variance (ANOVA). RESULTS: LII contact point displacement measurements for the maxillary arch were reproducible for inter-examiner assessment when using the digital method and were highly correlated between examiner pairs for contact point displacement measurements >2mm. The digital measurement technique showed poor correlation for smaller contact point displacement measurements (<2mm) for repeated measurements. The coefficient of variation (CoV) of the digital contact point displacement measurements highlighted 348 of the 600 measurements differed by more than 20% of the mean compared with 516 of 600 for the same measurements performed using the conventional LII measurement technique. CONCLUSIONS: Although the inter-examiner variability of LII contact point displacement measurements on the maxillary arch was reduced using the digital compared with the conventional LII measurement methodology, neither method was considered appropriate for orthodontic research purposes particularly when measuring small contact point displacements.

Accuracy, reproducibility, and time efficiency of dental measurements using different technologies.

INTRODUCTION: Historically, orthodontists have taken dental measurements on plaster models. Technological advances now allow orthodontists to take these measurements on digital models. In this study, we aimed to assess the accuracy, reproducibility, and time efficiency of dental measurements taken on 3 types of digital models. METHODS: emodels (GeoDigm, Falcon Heights, Minn), SureSmile models (OraMetrix, Richardson, Tex), and AnatoModels (Anatomage, San Jose, Calif) were made for 30 patients. Mesiodistal tooth-width measurements taken on these digital models were timed and compared with those on the corresponding plaster models, which were used as the gold standard. Accuracy and reproducibility were assessed using the Bland-Altman method. Differences in time efficiency were tested for statistical significance with 1-way analysis of variance. RESULTS: Measurements on SureSmile models were the most accurate, followed by those on emodels and AnatoModels. Measurements taken on SureSmile models were also the most reproducible. Measurements taken on SureSmile models and emodels were significantly faster than those taken on AnatoModels and plaster models. CONCLUSIONS: Tooth-width measurements on digital models can be as accurate as, and might be more reproducible and significantly faster than, those taken on plaster models. Of the models studied, the SureSmile models provided the best combination of accuracy, reproducibility, and time efficiency of measurement.