An in vitro analysis of the accuracy of static and robot-assisted implant surgery.

OBJECTIVES: Robot-assisted implant surgery (RAIS) is purported to improve the accuracy of implant placement. The objective of this study was to compare RAIS with static computer-assisted implant surgery (sCAIS) in a controlled environment. MATERIALS AND METHODS: A total of n = 102 implants were placed in the same modified typodont (n = 17 repeated simulated implant surgeries with each n = 3 implants per group) using robot-assisted or static computer-assisted implant surgery. The final implant positions were digitized utilizing cone-beam tomography and compared with the planned position. The angular deviation was the primary outcome parameter. 3D deviations at the implant platform level and the apex were secondary outcome parameters. Accuracy in terms of trueness and precision were assessed. Means, standard deviation, and 95%-confidence intervals were analyzed statistically. RESULTS: The overall angular deviation was 2.66 ± 1.83° for the robotic system and 0.68 ± 0.38° for guided surgery using static guides (p < .001), the 3D-deviation of the implant platform at crest level was for sCAIS 0.79 ± 0.28 mm and RAIS 1.51 ± 0.53 mm (p < .001) and at the apex for sCAIS 0.82 ± 0.26 mm and for RAIS 1.97 ± 0.79 mm (p < .001), respectively. CONCLUSIONS: Robotically guided implant surgery was less accurate in terms of trueness (planned vs. actual position) and precision (deviations among implants) than traditional static computer-assisted implant surgery in this in vitro study.

Influence of scanning protocol on the accuracy of complete-arch digital implant scans: An in vitro study.

OBJECTIVE: This in-vitro study assessed the influence of two intraoral scanning (IOS) protocols on the accuracy (trueness and precision) of digital scans performed in edentulous arches. METHODS: Twenty-two abutment-level master casts of edentulous arches with at least four implants were scanned repeatedly five times, each with two different scanning protocols. Protocol A (IOS-A) consisted of scanning the edentulous arch before inserting the implant scan bodies, followed by their insertion and its subsequent digital acquisition. Protocol B (IOS-B) consisted of scanning the edentulous arch with the scan bodies inserted from the outset. A reference scan from each edentulous cast was obtained using a laboratory scanner. Trueness and precision were calculated using the spatial fit analysis, cross-arch distance, and virtual Sheffield test. Statistical analysis was performed using generalized estimating equations (GEEs). Statistical significance was set at α = .05. RESULTS: In the spatial fit test, the precision of average 3D distances was 45 µm (±23 µm) with protocol IOS-A and 25 µm (±10 µm) for IOS-B (p < .001), and the trueness of average 3D distances was 44 µm (±24 µm) with protocol IOS-A and 24 µm (±7 µm) for IOS-B (p < .001). Cross-arch distance precision was 59 µm (±53 µm) for IOS-A and 41 µm (±43 µm) for IOS-B (p = .0035), and trueness was 64 µm (±47 µm) for IOS-A and 50 µm (±40 µm) for IOS-B (p = .0021). Virtual Sheffield precision was 286 µm (±198 µm) for IOS-A and 146 µm (±92 µm) for IOS-B (p < .001), and trueness was 228 µm (±171 µm) for IOS-A and 139 µm (±92 µm) for IOS-B (p < .001). CONCLUSIONS: The IOS-B protocol demonstrated significantly superior accuracy. Placement of scan bodies before scanning the edentulous arch is recommended to improve the accuracy of complete-arch intraoral scanning.

Accuracy of edentulous full-arch implant impression: An in vitro comparison between conventional impression, intraoral scan with and without splinting, and photogrammetry.

OBJECTIVES: The purpose of this in vitro study was to compare the trueness and precision of complete arch implant impressions using conventional impression, intraoral scanning with and without splinting, and stereophotogrammetry. MATERIALS AND METHODS: An edentulous model with six implants was used in this study. Four implant impression techniques were compared: the conventional impression (CI), intraoral scanning (IOS) without splinting, intraoral scanning with splinting (MIOS), and stereophotogrammetry (SPG). An industrial blue light scanner was used to generate the baseline scan from the model. The CI was captured with a laboratory scanner. The reference best-fit method was then applied in the computer-aided design (CAD) software to compute the three-dimensional, angular, and linear discrepancies among the four impression techniques. The root mean square (RMS) 3D discrepancies in trueness and precision between the four impression groups were analyzed with a Kruskal-Wallis test. Trueness and precision between single analogs were assessed using generalized estimating equations. RESULTS: Significant differences in the overall trueness (p = .017) and precision (p < .001) were observed across four impression groups. The SPG group exhibited significantly smaller RMS 3D deviations than the CI, IOS, and MIOS groups (p < .05), with no significant difference detected among the latter three groups (p > .05). CONCLUSIONS: Stereophotogrammetry showed superior trueness and precision, meeting misfit thresholds for implant-supported complete arch prostheses. Intraoral scanning, while accurate like conventional impressions, exhibited cross-arch angular and linear deviations. Adding a splint to the scan body did not improve intraoral scanning accuracy.

Accuracy of open-sleeved vs. closed-sleeved static computer-assisted implant systems in immediate maxillary molar implant placement: An in vitro study.

OBJECTIVES: The objective of this study is (1) to compare the accuracy of an open-sleeved static computer-assisted implant system (sCAIS) with a closed-sleeve sCAIS and free-hand approach in immediate implant placement (IIP) of maxillary molar sites and (2) to investigate the influence of socket morphology on these approaches. MATERIALS AND METHODS: Ninety partially edentulous duplicated maxillary models simulating three different molar sockets (type A, B, and C based on Smith and Tarnow's classification) were investigated. Three modalities, including sCAIS with open-sleeves, sCAIS with closed-sleeves, and free-hand approach, were applied separately to 30 models with 120 sockets. A customized Python script automatically measured the deviations between the virtual and actual implant positions for all 360 implants. RESULTS: The 3D deviations of sCAIS were significantly influenced by the socket and sleeve types. Both guided groups exhibited significantly less deviation than the free-hand approach. Type A and C sockets resulted in better implant positions than type B socket sites. In type B sockets, the open-sleeve group achieved significantly less deviation compared to the closed-sleeve group, with respect to apical global (1.34 ± 0.53 vs. 1.84 ± 0.59 mm), coronal horizontal (0.68 ± 0.36 vs. 0.93 ± 0.34 mm), apical horizontal (1.21 ± 0.59 vs. 1.74 ± 0.63 mm), and angular (3.30 ± 1.41 vs. 4.41 ± 1.96°) deviations. CONCLUSIONS: Guided implant surgery significantly reduces deviations during molar IIP compared to free-hand procedures. Furthermore, the use of open-sleeve sCAIS appears to be more effective in minimizing deviations in type B sockets when compared with the closed-sleeve guided system.

Comparative Accuracy of Intraoral and Extraoral Digital Workflows for Short Span Implant Supported Fixed Partial Denture Fabrication: An In Vitro Study.

BACKGROUND The advent of digital impressions using computer-aided design and manufacturing technology (CAD/CAM) has simplified and improved the fabrication of implant prostheses in dentistry. The conventional impression has several drawbacks, including tray selection, material type, impression technique, impression disinfection, and cast model storage. The inaccuracies caused by distortion and contraction of impression material can be minimized with digital impressions. This study aimed to compare digital dental impressions of 10 working casts made using the Pindex laser removable die system to fabricate parallel drill channels vs 10 working casts made using the Di-Lok plastic tray removable die system. MATERIAL AND METHODS An implant master die with 2 dental implant analogs was fabricated. Ten working casts using the Pindex laser removable die system with parallel drill channels and 10 working casts using the Di-Lok plastic tray removable die system were fabricated. The working casts were scanned using an extra-oral laboratory scanner and the implant master model was scanned with an intra-oral scanner. RESULTS The properties of the casts made using the 2 systems were evaluated and analyzed with ANOVA and post hoc Tukey test. The mean horizontal linear distances between A1B1 (P<0.021), A2B2 (P<0.018), C1D1 (P<0.026), C2D2 (P<0.03), B1C1 (P<0.01), and mean vertical distances between B1A2 (P<0.015), C1D2 (P<0.001), B1B2 (P<0.028), and C1C2 (P<0.001) were significantly different between the Pindex system and Di-Lok tray system as compared to intra-oral scans. CONCLUSIONS Complete digital workflow with intra-oral scans were more than the partial digital workflow with extra-oral scans for the Pindex system and Di-Lok tray systems.

Clinical comparative study on the accuracy of palatal rugae in models obtained by different impression materials and intraoral scanning.

OBJECTIVE: Palatal rugae are frequently used in the evaluation of tooth movement after treatment in orthodontics and as a stable region in superimposition. It is important to note that the impression method and material used to record the rugae region affect the accuracy of the impression. The aim of this study is to compare the accuracy of palatal rugae, in three-dimensional (3D) by employing both conventional and digital impression methods. MATERIALS AND METHODS: In this study, 22 patients (12 females, 10 males) mean age of 13.5 ± 1.7 years old were selected with complete permanent dentition. Three different impressions were taken from the maxillae of the patients: conventional impression using silicone rubber impression material, conventional impression using alginate impression material, and optical impression using an intraoral scanner. The impressions' digital data were analyzed by the GOM Inspect (Version 2018, Braunschweig, Germany), a 3D analysis software. The Root Mean Square (RMS) values of the total ruga region were evaluated in this software. The data were statistically analyzed using the Jamovi program. The Kruskal-Wallis test and Mann-Whitney U test were performed due to the non-normal distribution of the data. RESULTS: There is no statistically significant difference between the comparison points of the right and left rugae's medial and lateral points and total rugae regions' RMS values. Although there was no statistically significant difference, the total RMS values of alginate and digital scan measurements showed closer results than the RMS values of silicone and digital scan measurements. CONCLUSION: The study found that there was no statistically significant difference in the total RMS values of the ruga region between traditional and digital impression methods. CLINICAL RELEVANCE: The treatment period in orthodontics is long. Different impression materials and methods can be used for diagnostic, mid-treatment, and final impressions. For superimpositions and treatment and post-treatment palatal ruga evaluations, traditional and digital impression methods are clinically acceptable and can be used as alternatives to each other.

Evaluation of the accuracy of direct intraoral scanner impressions for digital post and core in various post lengths: An in-vitro study.

STATEMENT OF PROBLEM: Despite the growing utilization of direct intraoral scanners (IOSs) in dentistry, there is a scarcity of research investigating their accuracy, specifically in post and core. Few studies have conducted comprehensive three-dimensional assessments and comparisons of IOSs with the conventional impression technique, particularly in different post space lengths. PURPOSE: The purpose of this in vitro study was to digitally assess the accuracy of direct intraoral scanner (IOS) impressions for different post space lengths, specifically 6, 8, and 10 mm. MATERIALS AND METHODS: A total of 45 typodont teeth (maxillary central incisors) were selected for this study. The teeth underwent endodontic treatment and were divided into three subgroups, each with 15 teeth, based on the desired post space lengths: 6, 8, and 10 mm. Intraoral scans of all specimens were acquired directly using the CEREC Primescan intraoral scanners by two trained examiners. The obtained scan data were compared with conventional impressions obtained using light and heavy bodies of polyvinyl siloxane (PVS). As a control, the conventional impressions were subsequently scanned using an inEos X5a lab scanner. The accuracy of the digital scans was evaluated in the coronal, middle, and apical thirds using the Geomagic Control X software. Statistical analysis was performed using Bonferroni Post-hoc and One-way ANOVA tests to analyze the data. RESULTS: The overall mean root mean square (RMS) deviations for the different post lengths across the three thirds groups were 58, 81, and 101 µm for the 6, 8, and 10 mm subgroups, respectively. There were no statistically significant differences in the accuracy of the coronal and middle thirds among all subgroups (p > 0.5). However, in the apical third, the 10 mm subgroup exhibited a significantly lower accuracy (163 µm) compared to the 6 mm (96 µm) and 8 mm (131 µm) subgroups (p < 0.05). These results suggest that while the accuracy of intraoral scans using direct IOS impressions was consistent in the coronal and middle thirds regardless of the post length, there was a noticeable decrease in accuracy in the apical third, particularly with longer post lengths. CONCLUSION: Considering the limitations of this in vitro study, chairside direct IOS impressions offer a viable and clinically acceptable alternative to the conventional impression technique for post space lengths of 6 and 8 mm. However, as the post space length preparation increases, the accuracy of IOS decreases. CLINICAL SIGNIFICANCE: The Chairside direct IOS enables expedited and efficient digital impression capture within the root canal, ensuring acceptable accuracy for intracanal post length preparation of up to 8 mm.

In vitro comparison of accuracy between conventional and digital impression using elastomeric materials and two intra-oral scanning devices.

AIM: The aim of this study was to compare the accuracy of full-arch conventional implant impressions using two different materials (A-silicone and polyether) to full-arch digital implant impressions produced from two intraoral scanning devices. MATERIALS AND METHODS: A master model was fabricated representing an edentulous mandible with four implants with internal connection placed at the sites of canines and first molars. The anterior implants were parallel to the residual ridge, while the two posterior implants had an angulation of 15° to the distal and 15° to the lingual respectively. The conventional technique was performed with open-tray of non-splinted impression copings. Two different impression materials were used, A-silicone and polyether at monophase medium body consistencies. The digital impressions were obtained with the use of two different intraoral scanners, after the connection of scan bodies. A total of 10 impressions were produced for each of the four experimental groups. The conventional models as well as the master model were digitized using a high-resolution laboratory scanner. The STL files of the models and of the intraoral impressions were imported in a powerful superimposition software, for the conduction of measurements in pairs of files. The software calculated the 3D deviations, as well as the linear and angular displacements among scan bodies at the digital files. For "trueness" measurements every STL file of each experimental group was superimposed to the digital master model, while for "precision" measurements all STL files of each experimental group were superimposed to each other. RESULTS AND CONCLUSIONS: The accuracy of full arch mandibular implant impressions was influenced both by the impression technique used (conventional vs. digital) and the impression material used (A-silicone vs. polyether) or the intraoral scanner used (Trios vs. Heron). In terms of "trueness," A-silicone showed the highest impression accuracy with the lowest deviation values, followed by polyether and Trios, but the differences between the three groups were in the majority not statistically significant. Heron showed statistically lower accuracy results in all measurements compared to the other groups. In terms of "precision", conventional impressions with the use of A-Silicone or polyether were statistically significantly superior to digital impressions with either scanner. A-Silicone and polyether showed no statistically significant difference between them.

A guide for selecting the intraoral scan extension when fabricating tooth- and implant-supported fixed dental prostheses.

OBJECTIVES: To describe a new classification for intraoral scans based on the scan extension and to introduce a decision guideline to choose the scan extension for fabricating tooth- and implant-supported fixed dental prostheses (FDPs). OVERVIEW: Multiple operator- and patient-related factors have been identified that can decrease the scanning accuracy of intraoral scanners (IOSs), including scan extension. However, the decision criteria for selecting scan extension for fabricating tooth- and implant-supported restorations is unclear. Based on the extension of the intraoral digital scans, three types of scans can be defined: half-arch (anterior or posterior), extended half-arch, and complete-arch scan. Variables to consider when choosing the scan extension include the number and location of units being restored, as well as the extension and location of edentulous areas. Additionally, the accuracy of the virtual definitive cast and the accuracy of the maxillomandibular relationship captured by using IOSs should be differentiated. CONCLUSIONS: A decision tree for selecting the scan extension is presented. The decision is based on the number and location of units being restored, and the extension and location of edentulous areas. Intraoral scans with reduced scan extension are indicated when fabricating tooth- and implant-supported crowns or short-span fixed prostheses, when the patient does not have more than one missing tooth in the area of the dental arch included in the scan. For the remaining clinical conditions, complete-arch intraoral scans are recommended. CLINICAL SIGNIFICANCE: Scan extension is a clinician's decision that should be based on the number and location of units being restored and the extension and location of edentulous areas. Intraoral scans with a reduced scan extension is recommended, when possible.

Comparative analysis of the trueness of linear measurements using direct and indirect scanning protocols compared to actual clinical measurements.

OBJECTIVES: To assess the trueness of digital measurements using direct and indirect scanning approaches compared to the actual clinical measurements. MATERIALS AND METHODS: The crown length, width, and width/length ratio were measured in 36 anterior maxillary teeth using three different methods. The first was clinically using a digital caliper, the second was by scanning the teeth using a digital scanner and the third was by making an impression of the teeth, constructing a stone cast in the lab, and scanning it to obtain digital measurements. Bland-Altman test and intraclass correlation were used to assess the data and make comparisons. RESULTS: Measurements taken using both approaches were highly reliable, with intraclass correlations ranging from 0.934 to 0.977 (p ≤ 0.000). Bland-Altman plot reflected a minimal mean difference between measurements especially in crown width measurements. Crown width/crown length measurement displayed the highest mean difference. CONCLUSIONS: Both direct and indirect optical surface scans showed similar high trueness in linear measurements of teeth. A higher discrepancy was detected in the crown width/length ratio. CLINICAL SIGNIFICANCE: Digital dentistry is the new era in patient management. The use of conventional impression techniques and physical dental casts is associated with several disadvantages. Scanning dental casts to convert physical records into digital ones has multiple advantages. Optical surface scans (digital models) of the dentition are currently being more broadly used and advocated in the different dental disciplines including the construction of surgical guides for esthetic crown lengthening procedures. The trueness and reliability of linear measurements are of paramount importance to allow for proper fit and predictable outcomes. In this study, the trueness of these linear measurements obtained using direct and indirect methods was compared to the actual clinical measurements.

Digital application of three-dimensional diagnosis and treatment with a virtual articulator.

OBJECTIVE: The purpose of this article was to introduce a method for the digital application of three-dimensional (3D) diagnosis and treatment with a virtual articulator and 3D data. CLINICAL CONSIDERATION: With the use of cone-beam computed tomography (CBCT) and intraoral and facial scans, we can create a virtual articulator and evaluate the mandibular position in maximum intercuspation and centric-related occlusion for the patient with an unstable occlusion and temporomandibular disorders (TMD). Based on this, we treated a case using a digital mandibular position indicator (MPI) and fabricated a stabilization splint using a 3D printer. This approach eliminates the traditional impression or model mounting process and the analog face bow transfer. Furthermore, the design of the stabilization splint is accomplished using software. CONCLUSIONS: The approach outlined in this article offers the potential for a digital diagnosis and treatment process by seamlessly integrating CBCT, intraoral scans, and facial scans with a high degree of accuracy. This may enhance precision in diagnosis and treatment planning, especially for patients with complicated TMD, in addition to facilitating effective communication with orthodontic patients who require thorough attention. CLINICAL SIGNIFICANCE: Utilizing a virtual articulator and digital MPI for the occlusal evaluation of patients with TMD and unstable occlusion makes it possible to diagnose and analyze the occlusal condition accurately. This approach also allows for precision and efficiency in treatment.

Effect of storage temperature on the dimensional stability of DLP printed casts.

STATEMENT OF PROBLEM: Despite studies focusing on the accuracy and dimensional stability of additive manufacturing, research on the impact of storage conditions on these properties of 3-dimensional (3D) printed objects is lacking. PURPOSE: The purpose of this in vitro study was to investigate the influence of storage temperature on the dimensional stability of digital light processing (DLP) printed casts and to determine how different locations in printed casts react differently. MATERIAL AND METHODS: A completely dentate maxillary typodont model was digitized with a desktop laser scanner. The typodont was subsequently modified with a software program by adding cuboids with a side length of 3 mm on both maxillary central incisors, first molars, and second molars. The file was saved in the standard tessellation language (STL) format. The modified digitized typodont was then processed through the DLP technology printing process with a desktop DLP printer and photopolymerizing resin. The casts were printed 32 times and stored in sealed plastic bags, shielded from light, and subjected to 4 different temperature conditions (-20 °C, 4 °C, 20 °C, and 37 °C, n=8 each). The cuboids on the central incisors were labeled as the P1 group, first molars as the P2 group, and second molars as the P3 group. The distance between the cuboids was measured 5 times, with results recorded immediately after cast production and at 1, 2, 3, 5, 7, 14, and 28 days after. Repeated analysis of variance (ANOVA) and the Tukey honestly significant difference (HSD) test were used to compare the recorded values among the groups (α=.05). RESULTS: In the P1 group, the casts stored at -20 °C exhibited the smallest overall size change, with a mean ±standard deviation volume of 99.42 ±0.04% compared with the original casts after 28 days of storage. This was followed by the casts stored at 4 °C, 20 °C, and 37 °C, with remaining volumes of 99.39 ±0.06% (P=.139), 99.14 ±0.08% (P<.001), and 98.96 ±0.03% (P<.001), respectively. For the P2 and P3 groups, casts stored at 4 °C retained the most volume at 99.82 ±0.01%, whereas those stored at -20 °C, 20 °C, and 37 °C underwent greater changes, with remaining volumes of 99.66 ±0.03%, 100.32 ±0.02%, and 100.44 ±0.02%, respectively (P<.001). The P3 group exhibited a similar trend to that of the P2 group, with the casts stored at 4 °C remaining closest to the original dimensions at 99.86 ±0.02%, while casts stored at -20 °C showed 99.73 ±0.03% of the original volume and those stored at 20 °C and 37 °C expanded with volumes of 100.37 ±0.03% and 100.48 ±0.03%, respectively (P<.001). CONCLUSIONS: DLP printed casts stored at 4 °C exhibited the greatest overall dimensional stability, followed sequentially by those stored at -20 °C, 20 °C, and 37 °C. Additionally, the study confirmed that the posterior and anterior teeth regions of DLP printed casts respond differently to different storage temperatures.

Influence of intraoral scanner and finish line location on the fabrication trueness and margin quality of additively manufactured laminate veneers fabricated with a completely digital workflow.

STATEMENT OF PROBLEM: Knowledge of the fabrication trueness and margin quality of additively manufactured (AM) laminate veneers (LVs) when different intraoral scanners (IOSs) and finish line locations are used is limited. PURPOSE: The purpose of this in vitro study was to evaluate the fabrication trueness and margin quality of AM LVs with different finish line locations digitized by using different IOSs. MATERIAL AND METHODS: An LV preparation with a subgingival (sub), equigingival (equi), or supragingival (supra) finish line was performed on 3 identical maxillary right central incisor typodont teeth. Each preparation was digitized by using 2 IOSs, (CEREC Primescan [PS] and TRIOS 3 [TS]), and a reference LV for each finish line-IOS pair (n=6) was designed. A total of 90 LVs were fabricated by using these files and urethane acrylate-based definitive resin (Tera Harz TC-80DP) (n=15). Each LV was then digitized by using PS to evaluate fabrication trueness (overall, external, intaglio, and marginal surfaces). Each LV was also qualitatively evaluated under a stereomicroscope (×60), and the cervical and incisal margin quality was graded. Fabrication trueness and cervical margin quality were evaluated by using 2-way analysis of variance, while Kruskal-Wallis and Mann Whitney-U tests were used to evaluate incisal margin quality (α=.05). RESULTS: The interaction between the IOS type and the finish line location affected measured deviations at each surface (P≤.020). PS-sub and TS-supra had higher overall trueness than their counterparts. and the subgingival finish line resulted in the lowest trueness (P≤.005). PS and the subgingival finish line led to the lowest trueness of the external surface (P≤.001). TS-sub had the lowest intaglio surface trueness among the TS subgroups, and PS-sub had higher trueness than TS-sub (P<.001). PS-sub and PS-supra had higher marginal surface trueness than their TS counterparts (P<.001). TS resulted in higher cervical margin quality (P=.001). CONCLUSIONS: Regardless of the IOS tested, subgingival finish lines resulted in the lowest trueness. The effect of IOS on the measured deviations varied according to the surface evaluated and finish line location. The cervical margin quality of AM LVs was higher when TS was used.

Exploring the impact of the extent of the partially edentulous area on the accuracy of two intraoral scanners.

STATEMENT OF PROBLEM: The accuracy of intraoral scans, particularly in edentulous areas, remains a concern despite the increasing use of digital technology, especially intraoral scanners. PURPOSE: The purpose of this in vitro study was to assess the impact of the extent of an edentulous area on the accuracy (trueness and precision) of intraoral scans from 2 intraoral scanners. MATERIAL AND METHODS: A KaVo dentoform with epoxy resin teeth was used to generate 9 groups with different numbers of teeth removed. A laboratory scanner served as the reference dataset, and 2 intraoral scanners (TRIOS 3 and Primescan AC) were evaluated. A single operator performed all scans following standardized protocols and calibration. Trueness and precision were assessed by using root mean square (RMS) values. Analysis of variance was used to compare trueness and precision values obtained from the 2 scanners and different partially edentulous conditions (α=.05). RESULTS: A significant difference was found in the trueness of intraoral scans of the 2 scanners and under different partially edentulous extensions. Primescan AC exhibited significantly lower trueness than TRIOS 3 (P<.001). For the individual edentulous conditions, Primescan had a significantly higher RMS mean than TRIOS 3 for G0, G3, G4, G6, G7, and G8 (P<.001) and a significantly lower RMS mean than TRIOS 3 for G1 and G4 (P<.001), while no significant difference in RMS mean was found between the 2 scanners for G2 (P=.999). For precision, no significant difference was found between the 2 scanners or different edentulous conditions [(F 8, 90)=1.82, P=.085]. CONCLUSIONS: The accuracy of intraoral scans was influenced by the length of edentulous areas and the scanner used. Primescan AC demonstrated lower trueness than TRIOS 3 for most partially edentulous conditions, while the scanners were similar in precision. These findings highlight the need for careful scanner selection in specific clinical situations, as scanning accuracy may vary depending on the scanner and edentulous condition.

Evaluation and comparison of the accuracy of three intraoral scanners for replicating a complete denture.

STATEMENT OF PROBLEM: Technological advances in digital acquisition tools have increased the scope of intraoral scanners (IOSs), including scanning a removable complete denture (RCD) to replicate it. However, studies assessing the accuracy of IOSs for replicating a maxillary or mandibular RCD are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the accuracy (trueness and precision) of 3 IOSs while replicating a maxillary and mandibular RCD. MATERIAL AND METHODS: One maxillary and 1 mandibular RCD were scanned with a desktop scanner (D2000) to obtain the reference model. Two operators scanned each RCD 5 times with 3 different IOSs (TRIOS 4, Primescan, and IS3800), following a predefined acquisition protocol. The 60 study models obtained were compared with the reference model using the Geomagic software program. For each comparison, the mean and standard deviation of discrepancy were calculated. Distances were measured on both the reference and the study model, and differences were calculated to assess whether sagittal or transverse deformations were present. The tolerance percentage of the volume of the digital model compared with the volume of the reference model was determined (difference tolerance was set at 0.1 mm). A univariate analysis of variance followed by a post hoc analysis using the Student-Newman-Keuls (α=.05) test was performed to determine the truest and the most precise IOS. RESULTS: The TRIOS 4 and Primescan IOSs had comparable trueness, with mean dimensional variations of 47 ±27 µm and 57 ±8 µm respectively compared with the reference model. The IS3800 had a lower trueness (98 ±35 µm). Primescan was significantly more precise with a mean standard deviation of 64 ±15 µm (P<.05). The TRIOS 4 (141 ±48 µm) and IS3800 (129 ±24 µm) had comparable precision. Primescan showed the least sagittal and transverse deformation. CONCLUSIONS: This study determined that an RCD can be replicated using an IOS, although all IOSs did not have equal accuracy. An in vivo study needs to assess whether this procedure is clinically acceptable.

Influence of a specially designed geometric device and modified scan bodies on the accuracy of a maxillary complete arch digital implant scan: An in vitro study.

STATEMENT OF PROBLEM: Capturing accurate complete arch digital implant scans remains a challenging process because of the lack of recognizable anatomic landmarks. The effect of modified scan bodies (SBs) on improving scanning accuracy is unclear. PURPOSE: The purpose of this in vitro study was to evaluate and compare the accuracy of a maxillary complete arch digital implant scan when using a specially designed geometric device with the accuracy of modified scan bodies. MATERIAL AND METHODS: Four implants were placed in an edentulous maxillary model made of porous bone material with polyurethane attached gingiva. Scan bodies were attached to the implants and then digitized with a high precision laboratory scanner to create the reference scan. Round depressions were made on the buccal and palatal surfaces of the scan bodies, and the model was scanned with an intraoral scanner using 4 different scenarios: the model with no geometric device or modified scan bodies (ND-NM), device only without modified scan bodies (D-NM), no device but with modified scan bodies (ND-M), and device with modified scan bodies (D-M). Each group was scanned 10 times for a total of 40 scans. Trueness and precision were evaluated using inspection software to measure the 3D surface deviation. Trueness was measured by superimposing each test scan on the reference scan, and precision was calculated by superimposing the test scans of the same group with each other. Data were analyzed using the GraphPad Prism version 8.0.0 software program. Two-way ANOVA was performed to assess the effect of the device and modifications on trueness and precision (α=.05). RESULTS: Both the geometric device and SB modifications had a significantly significant effect on trueness and precision (P<.001). Regarding trueness, group D-M had the lowest mean and standard deviation (0.158 ±0.028 mm) in contrast with group ND-NM, which had the highest deviation (0.282 ±0.038 mm). In terms of precision, group D-M showed the lowest mean and standard deviation (0.134 ±0.013 mm), while group ND-NM revealed the highest deviation (0.222 ±0.031 mm). However, no statistically significant interaction was found between the device and modifications regarding either trueness or precision (P>.05). CONCLUSIONS: Using a specially designed geometric device improved both the trueness and precision of complete arch digital implant scans. The modified SBs had a positive influence on the scanning trueness and precision, and the best accuracy was achieved when using the geometric device and the modified SBs simultaneously.

Comparing the trueness of 3D printing and conventional casting for the fabrication of removable partial denture metal frameworks for patients with different palatal vault depths: An in vitro study.

STATEMENT OF PROBLEM: The success of a removable partial denture depends on its fit, and, with conventional casting, the framework is more distorted in patients with a deep palatal vault. Questions remain about whether the three-dimensional (3D) printing technique for fabricating a framework can improve the accuracy of fit for these patients. PURPOSE: The purpose of this in vitro study was to compare the trueness of metal frameworks fabricated by selective laser melting, 3D printing pattern casting, and conventional casting for different palatal vault depths. MATERIAL AND METHODS: A total of 30 partially edentulous maxillary casts were custom-made in 15 medium and 15 deep palatal vaults. All stone casts were scanned as reference models in digital files. For the medium palatal vault casts, Co-Cr frameworks of the conventional casting (CON) group (n=5) were fabricated with the lost wax technique. For the 3D printing pattern casting (PPC) group (n=5), wax patterns of the framework were printed, followed by metal casting. The frameworks created for the selective laser melting (SLM) group (n=5) were printed directly by using the SLM machine. The same procedures were followed for the deep palatal vault group. All the metal frameworks were scanned and superimposed with the reference casts by using the Geomagic Control X software program. Discrepancies were measured as mean ±standard deviation (trueness), and the data were statistically analyzed with a 2-way ANOVA test to evaluate the interaction of 2 independent factors (fabrication techniques and palatal vault depths) on a trueness outcome (α=.05). RESULTS: The lowest mean ±standard deviation value was 0.092 ±0.023 mm, found from the SLM framework with deep palatal vault group, while the highest value was 0.194 ±0.017 mm, found from the CON framework with deep palatal vault group. Different fabrication techniques interacted with different palatal vault depths in terms of trueness (P<.05); however, no significant differences were observed in the medium palatal vault groups (P>.05). Additionally, color mapping demonstrated the gaps of metal frameworks among the 6 groups. CONCLUSIONS: With the conventional casting technique, the accuracy of the metal framework was affected by the depth of the palate. For medium palatal vaults, all fabricated frameworks had clinically acceptable fit. For deep palatal vaults, the SLM frameworks showed the lowest discrepancy. As a result, the SLM technique is advised for fabricating a better-fitting metal framework for patients with a deep palatal vault.

Effect of substrate material and abutment geometry on the accuracy of intraoral scanning: An in vitro study.

STATEMENT OF PROBLEM: Digital scanning is gradually replacing conventional impression making, but consensus on how tooth preparation influences the accuracy of intraoral scanning is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of substrate material and abutment geometry on the accuracy of digital casts obtained by intraoral scanning. MATERIAL AND METHODS: The height and total occlusal convergence (TOC) angle were measured in 5 different groups that contained 5 specimens of different materials: natural tooth, cobalt chromium alloy, titanium, zirconium dioxide ceramic, and resin. The specimens were scanned with an industrial scanner to obtain reference data. Each specimen was placed in a maxillary standard dentition model that was assembled in a head simulator. Each dentition model was scanned 10 times with an intraoral scanner (IOS) under operatory lighting conditions to acquire intraoral scanning files for each specimen. All data were imported into a metrology software program and processed. A total of 10 trueness deviations, the mean superimposition results between IOS scanning data and reference data, and precision deviations, the mean superimposition results between IOS scanning data in pairs, were recorded. Two-way analysis of variance (ANOVA) and Tukey multiple comparison test were used to analyze the accuracy of intraoral scanning in relation to the height or TOC angle of the abutment (α=.05). The total means of each substrate material were compared with the Kruskal-Wallis test and Dunn test for multiple comparisons. RESULTS: The accuracy of scanning images was related to material and abutment geometry (P<.05). Bias was larger as abutment height increased with most substrates. Larger TOC angles increased the accuracy of the digital scans. The trueness deviation of translucent materials and the precision deviation of reflective materials were generally larger. CONCLUSIONS: Substrate material and abutment geometry influence the accuracy of intraoral scanning. The accuracy of IOS generally tended to improve with decreasing height and increasing TOC angle and was affected by different substrates.

Influence of base designs on the manufacturing accuracy of vat-polymerized diagnostic casts using two different technologies.

STATEMENT OF PROBLEM: Diagnostic casts can incorporate different base designs and be manufactured using different vat-polymerization technologies. However, the influence of the interrelation between the base design and the 3D printing technology on the casts' final accuracy remains unclear. PURPOSE: The purpose of this in vitro study was to assess the influence of different base designs of 3D printed casts on the accuracy of 2 vat-polymerization technologies. MATERIAL AND METHODS: A digital maxillary cast was obtained and used to generate 3 different base designs: solid (S group), honeycombed (HC group), and hollow (H group). The HC and H groups were subdivided based on the wall thickness of the cast design, resulting in 2 subgroups with thicknesses of 1 mm (HC1 and H1) and 2 mm (HC2 and H2) (N=100, n=10). Eleven reference cubes were added to each specimen for subsequent measurements. Specimens were manufactured by using 2 vat-polymerization 3D printers: Nextdent 5100 (ND group) and Sonic Mini 4K (SM4K group) and a resin material suitable for both 3D printers (Nextdent Model 2.0). A coordinate measuring machine quantified the linear and 3-dimensional discrepancies between the digital cast and each reference specimen. Trueness was defined as the average absolute dimensional discrepancy between the virtual cast and the specimens produced through additive manufacturing (AM), while precision was delineated as the standard deviation in dimensional discrepancies between the digital cast and the AM specimens. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U pairwise comparison tests (α=.05). RESULTS: For the NextDent group the trueness ranged from 21.83 µm to 28.35 µm, and the precision ranged from 17.82 µm to 37.70 µm. For the Phrozen group, the trueness ranged from 45.15 µm to 64.51 µm, and the precision ranged from 33.51 µm to 48.92 µm. The Kruskal-Wallis test showed significant differences on the x-, y-, and z-axes and in the 3D discrepancy (all P<.001). On the x-axis, the Mann-Whitney U test showed significant differences for the Phrozen group between the H-2 and H-1 groups (P=.001), H-2 and S groups (P<.001), and HC-2 and S groups (P=.012). On the y-axis, significant differences were found in the Phrozen group between the H-2 and H-1 groups (P=.001), the H-2 and S, H-1 and HC-1, and HC-1 and S groups (P<.001), the H-1 and HC-2 groups (P=.007), and the HC-2 and S groups (P=.009). The NextDent group exhibited significant differences, particularly among the HC-1 and H-2 groups (P=.004), H-1 (P=.020), and HC-2 (P=.001) groups; and on the z-axis significant differences were found in the Phrozen group between the H-2 and H-1 and S groups and the HC-2 group and H-1 and S groups (both P<.001). In the NextDent group, significant differences were found between the H-2 and HC-2 (P=.047) and HC-1 (P=.028) groups. For the 3D discrepancy analysis, significant differences were found in the Phrozen group between the H-2 and H-1 and S groups (P<.001), the H-1 and HC-2 groups (P=.001), the S and HC-1 and HC-2 groups (P<.001), and the H-1 and HC-1 groups (P=.002). In the NextDent group, significant differences were observed between the H-2 and HC-1 groups (P=.012). CONCLUSIONS: The accuracy of digital casts depends on the manufacturing trinomial and base design of the casts. The honeycomb and hollow based designs provided the highest accuracy in the NextDent and Phrozen groups respectively for the material polymer tested. All specimens fell in the clinically acceptable range.

Impact of the superimposition reference area on intraoral scanning accuracy in a partially dentate maxilla.

STATEMENT OF PROBLEM: The alignment of 3-dimensional (3D) files involves selecting a reference area before performing a local best fit alignment during the digital scan superimposition and is essential for comparing digital scans. Scan alignment relies on both reference area location and the alignment algorithm. However, a consensus on the impact of different reference areas on intraoral scanning accuracy is lacking. PURPOSE: The purpose of this in vitro study was to assess the impact of 3 superimposition reference areas on the accuracy of 3 intraoral scanners for a partially dentate maxilla. MATERIAL AND METHODS: A Kennedy class II resin cast was scanned using 3 intraoral scanners (Primescan, TRIOS 3, and Emerald) outputting 30 digital scans (10 per scanner). Test scans from intraoral scanners were subsequently compared with a reference digital standard tessellation language file generated by a laboratory scanner with validated accuracy. The files were superimposed using best fit alignment for each intraoral scanner using 3 different superimposition reference areas (whole region of interest, palate, and all teeth). Accuracy was assessed by using a 3D analysis program (Geomagic Control X; 3D systems) for each scanner at 4 preselected areas. Test and reference scan differences were depicted on color maps and quantified via root mean square deviations. Differences were analyzed using regression analysis with the post hoc student t test and Bonferroni correction (α=.05). RESULTS: The TRIOS 3 and Emerald produced positive deviations in the palatal color maps, whereas Primescan produced more uniform color maps, regardless of the superimposition strategy used. Primescan exhibited the best accuracy (trueness and precision) in both palatal and bounded edentulous areas, regardless of the superimposition reference area. The TRIOS 3 recorded the highest distal extension trueness (ranging from 42.9±7.7 µm to 65 ±19.5 µm), and Primescan achieved the highest precision (ranging from 28.5 ±9.8 µm to 48.9 ±16.9 µm), regardless of the superimposition area. Emerald demonstrated the highest teeth trueness (ranging from 31.6 ±6.8 µm to 69.6 ±11.5 µm), while Primescan produced the highest precision (ranging from 17.9 ±6.1 µm to 30.7 ±9.2 µm), regardless of the reference area used. CONCLUSIONS: The chosen reference area for best fit alignment significantly influenced digital scan accuracy (P<.001). Primescan displayed the highest palatal and bounded edentulous area accuracy, with TRIOS 3 recording the highest distal extension trueness. Emerald recorded the highest teeth trueness and Primescan recorded the highest distal extension and tooth precision. All conclusions were independent of the superimposition strategy used.