Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency.

OBJECTIVE: Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW: This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION: The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE: Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.

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.

A new technique to transfer the upper maxillary arch position using a facebow, a transfer table, and a reference block with a CAD application.

This paper presents a method for the digital transfer of the upper maxillary arch position using a facebow, a transfer table, and a reference block with a CAD application without requiring physical casts mounted with articulating gypsum. This technique facilitates the prosthetic digital workflow when the impression is made via intraoral scanning, to obtain the placement of the maxillary arch in the anatomical reference planes and in relation to the axes of rotation of the mandibular movements.

Intraoral scanner-based virtual facebow transferring: A chairside dental technique.

Accurately mounting dental casts on an articulator is an essential step in prosthetic treatments. In digital dentistry, virtual articulator mounting procedures rely on virtual facebow records. However, virtual facebow records usually require devices like face scanners or jaw motion tracking systems that are not commonly available in most dental practices. The present technique report describes a straightforward intraoral scanner-based virtual facebow transfer approach. In this technique, a reference facebow joint support was first scanned and aligned with a virtual articulator. Then, a patient's facebow joint support and bite fork assembly were scanned chairside with an intraoral scanner and aligned with the virtual articulator by matching common features with the reference facebow joint support. After aligning the patient's intraoral scans with the patient's bite fork scan that was already superimposed on the virtual articulator, a virtual mounting process was achieved. Once the corresponding reference facebow joint supports have been generated, this technique can be easily implemented with most facebow systems and be seamlessly integrated into daily clinical practice as only an intraoral scanner and a conventional facebow were required.

Comparison of the performance of various virtual articulator mounting procedures: a self-controlled clinical study.

OBJECTIVES: This clinical study aimed to compare the performance of various virtual articulator (VA) mounting procedures in the participants' natural head position (NHP). MATERIALS AND METHODS: Fourteen participants with acceptable dentitions and jaw relationships were recruited in this study registered in the Clinical Trials Registry (#NCT05512455; August 2022). A virtual facebow was designed for virtual mounting and hinge axis measurement. Intraoral scans were obtained, and landmarks were placed on each participant's face to register the horizontal plane in NHP. Six virtual mounting procedures were performed for each participant. The average facebow group (AFG) used an indirect digital procedure by using the average facebow record. The average mounting group (AMG) aligned virtual arch models to VA's average occlusal plane. The smartphone facial scan group (SFG) and professional facial scan group (PFG) used facial scan images with Beyron points and horizontal landmarks, respectively. The cone-beam computed tomography (CBCT) scan group (CTG) used the condyle medial pole, and horizontal landmarks were applied. The kinematic facebow group (KFG) served as the control group, and a direct digital procedure was applied using a kinematic digital facebow and the 3D skull model. Deviations of the reference plane and the hinge axis between the KFG and other groups were calculated. The inter-observer variability in virtual mounting software operation was then evaluated using the interclass correlation coefficient (ICC) test. RESULTS: In virtual condylar center deviations, the CTG had the lowest condylar deviations. The AFG showed larger condylar deviations than PFG, SFG, and CTG. There was no statistically significant difference between the AFG and the AMG and between the PFG and the SFG. In reference plane deviations, the AMG showed the largest angular deviation (8.23 ± 3.29°), and the AFG was 3.89 ± 2.25°. The angular deviations of PFG, SFG, and CTG were very small (means of each group < 1.00°), and there was no significant difference among them. There was no significant difference between the researchers, and the ICC test showed moderate to excellent reliability for the virtual condylar center and good to excellent reliability for the reference plane in the operation of the virtual mounting software. CONCLUSIONS: CBCT scan provided the lowest hinge axis deviation in virtual mounting compared to average mounting, facebow record, and facial scans. The performance of the smartphone facial scanner in virtual mounting was similar to that of the professional facial scanner. Direct virtual mounting procedures using horizontal landmarks in NHP accurately recorded the horizontal plane. CLINICAL RELEVANCE: Direct digital procedures can be reliably used for virtual articulator mounting. The use of a smartphone facial scanner provides a suitable and radiation-free option for clinicians.

Influence of the Number of Teeth and Location of the Virtual Occlusal Record on the Accuracy of the Maxillo-Mandibular Relationship Obtained by Using An Intraoral Scanner.

PURPOSE: To assess the influence of the number of teeth (2, 3, or 4) and location (molars, molar and premolar, or premolars and canines) of the bilateral virtual occlusal record on the accuracy of the virtual maxillo-mandibular relationship acquired by an intraoral scanner (IOS). MATERIAL AND METHODS: Diagnostic casts mounted on a semi-adjustable articulator were obtained. Four markers were adhered on the facial surfaces of the first molars and canines. The mounted casts were digitized using an extraoral scanner. Maxillary and mandibular intraoral digital scans were obtained using an intraoral scanner (TRIOS 4). The maxillary and mandibular digital scans were duplicated 105 times and divided into 7 groups based on the number of teeth (2, 3, or 4) and location (molar, molar and premolar, or premolars and canines) of the bilateral virtual occlusal records (n = 15). The alignment of the scans was automatically performed after the acquisition of the corresponding occlusal records by the IOS program. Eight linear distances between the gauge balls were computed on the reference scan and on the 105 digital scans. The distances obtained on the reference scan were used to calculate the discrepancies with the distances obtained on each experimental scan. The Shapiro-Wilk test showed that the data was normally distributed. The trueness and precision data were analyzed using 2-way ANOVA followed by pairwise comparison Tukey tests (α = 0.05). RESULTS: Two-way ANOVA showed that the number of teeth (p < 0.001) and the position of the virtual occlusal record (p < 0.001) were significant factors on the accuracy of the maxillo-mandibular relationship. Tukey test showed significant overall mean differences between the different groups tested: the 4-teeth group obtained the highest trueness, and the 2-teeth group showed the lowest trueness values (p < 0.001). Tukey test showed significant trueness differences between the virtual occlusal record locations. The 2-teeth record located more posteriorly obtained the lowest trueness. Significant differences in precision values were found among the subgroups tested (p < 0.001). The 2-teeth group obtained significantly more precision values than the 3- and 4-teeth groups. Additionally, there was a significant difference in precision values between the subgroup tested in which the first molar and second premolar location had the highest precision, while the first and second premolar's location obtained the lowest precision. CONCLUSIONS: The number of teeth and the location of the bilateral virtual occlusal record influenced the accuracy of the virtual maxillo-mandibular relationship obtained by the intraoral scanner tested. The more teeth included in the bilateral virtual occlusal record, the higher the accuracy of the maxillo-mandibular relationship. Additionally, the more anteriorly located the virtual bilateral occlusal record involving 2 or 3 teeth was, the higher the accuracy mean value.

EPA Consensus Project Paper: Shifting from the "Analogic Virtual Patient" to the "Digital Virtual Patient" in Prosthodontics. A Scoping Review.

AIMS: To determine whether the use of single or combined mechanical and virtual articulators, as well as facebows, jaw motion trackers, face scanners, and related devices, actually improve the efficacy of the prosthesis obtained in terms of lifespan and patient-related outcomes. To coin the terms Analogic and Digital Virtual Patients (AVP and DVP) as an attempt to analyze, clarify and synthesize terminology and workflows related to previously so-called devices. MATERIALS AND METHODS: A scoping review was accomplished involving different databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) checklist and JBI guidance were followed to extract data regarding the Population, Context and Concept established. RESULTS: Available literature on the efficacy of using devices and techniques related to both AVP and DVP workflows showed arguable study designs, great heterogeneity, and questionable quality. CONCLUSIONS: The terms AVP and DVP have been coined as a first step to clarify and simplify concepts and workflows related to the use of both mechanical and virtual articulators, as well as facebows, or facial and intraoral scanners, among others. This scoping review cannot claim that an AVP approach leads to more effective and efficient prosthetic restorations.

First steps of a digital workflow to build up a virtual articulator using open-source Autodesk Meshmixer software.

Virtual planning has become part and parcel of digital dentistry to ensure more precise planning, better treatment outcomes, and more effective communication between dental practitioners, dental technicians, and patients. In dentistry, CAD software programs are one way to achieve virtual treatment planning. Among the most crucial and critical steps in treatment planning and execution are virtual articulation and occlusal analysis of the maxillary and mandibular arches. These steps have a great influence on the success of the final outcome. The present article proposes a detailed method for constructing a novel virtual articulator that can also be used for educational purposes to enable occlusal analysis and adjustment for a virtual tooth mock-up by simulating a virtual dynamic occlusion through the use of open-source Autodesk Meshmixer software.

An Indirect Digital Technique to Transfer 3D Printed Casts to a Mechanical Articulator With Individual Sagittal Condylar Inclination Settings Using CBCT and Intraoral Scans.

With the widespread application of digital impression techniques in prosthetic dentistry, accurate intraoral scan mounting, and virtual articulator parameters setting as per patients' anatomic structures are essential for treatment planning and restoration fabrication, especially for complex rehabilitation cases; meanwhile, marginal fit checking, occlusal adjustment, and porcelain layering of restorations are also crucial procedures in all cases in which the analog procedure to mount maxillary arches on a mechanical articulator is still required. This technique article presents an indirect digital approach that can first achieve virtual intraoral scan mounting and sagittal condylar inclination value setting of an Artex virtual articulator based on bony structures provided by a single cone beam computed tomography scan. It then facilitates the transfer of virtually mounted intraoral scans from the virtual articulator to the matched Artex mechanical articulator by relating a digitally scanned mounting plate of the Artex mechanical articulator to the virtual articulator, printing the intraoral scan and mounting plate scan assembly, and then mounting the printed casts on the mechanical articulator based on the printed mounting plate. This technique eliminates the conventional facebow transfer and protrusive bite registration procedures and offers a straightforward approach for the seamless integration of virtual environments and analog workflows into clinical practice. It aids in the design of restorations that are harmonious with the mandibular movements and reduces chairside adjustment time.

Trueness and Precision of Economical Smartphone-Based Virtual Facebow Records.

PURPOSE: To investigate the trueness and precision of virtual facebow records using a smartphone as a three-dimensional (3D) face scanner. MATERIAL AND METHODS: Twenty repeated virtual facebow records were performed on two subjects using a smartphone as a 3D face scanner. For each subject, a virtual facebow was attached to his/her maxillary arch, and face scans were performed using a smartphone with a 3D scan application. The subject's maxillary arch intraoral scan was aligned to the face scan by the virtual facebow fork. This procedure was repeated 10 times for each subject. To investigate if the maxillary scan is located at the right position to the face, these virtual facebow records were superimposed to a cone-beam computed tomography (CBCT) head scan from the same subject by matching the face scan to the 3D face reconstruction from CBCT images. The location of maxillary arch in virtual facebow records was compared with its position in CBCT. The "trueness" of the proposed procedure is defined as the deviation between maxilla arch position in virtual facebow records and the CBCT images. The "precision" is defined as the deviation between each virtual facebow record. The linear deviation at left central incisor (#9), left first molar (#14), and right first molar (#3), as well as angular deviation of occlusal plane were analyzed with descriptive statistics. Differences between two objects were also explored with Mann Whitney U test. RESULTS: The 20 virtual facebow records using the smartphone 3D scanner deviated from the CBCT measurements (trueness) by 1.14 ± 0.40 mm at #9, 1.20 ± 0.50 mm at #14, 1.12 ± 0.51 mm at the #3, and 1.48 ± 0.56° in the occlusal plane. The VFTs deviated from each other by 1.06 ± 0.50 mm at #9, 1.09 ± 0.49 mm at #14, 1.11 ± 0.58 mm at #3, and 0.81 ± 0.58° in the occlusal plane. When all sites combined, the trueness was 1.14 ± 0.40 mm, and the precision was 1.08 ± 0.52 mm. Out of eight measurements, three measurements were significantly different between subjects. Nevertheless, the mean difference was small. CONCLUSIONS: Virtual facebow records made using smartphone-based face scan can capture the maxilla position with high trueness and precision. The deviation can be anticipated as around 1 mm in linear distance and 1° in angulation.

A Novel Technique to Align the Intraoral Scans to the Virtual Articulator and Set the Patient-Specific Sagittal Condylar Inclination.

Customized cast orientations and parameter settings of the virtual articulator according to the patient's condyles are indispensable parts of today's digital workflows in prosthodontics. This article describes a digital technique to align the intraoral scans to a virtual articulator by using a facial scanner to locate the patient's cutaneous landmarks of the arbitrary hinge axis and the reference plane, and to customize the sagittal condylar inclination of the virtual articulator through a digital protrusive interocclusal record and a dental computer-aided design software program. It enables individual cast orientations and virtual articulator parameter settings without conventional facebow transferring and bite registration procedures and can be easily integrated with most virtual articulator systems on the market to allow clinicians and technicians to work in a complete digital workflow and facilitate customized treatment planning and dental prosthesis fabrication.

The Accuracy of Transferring Casts in Maximal Intercuspal Position to a Virtual Articulator.

PURPOSE: To analyze the accuracy of transferring casts in maximal intercuspal position to a virtual articulator by using transfer plates in the laboratory scanner before and after occlusal optimization. MATERIAL AND METHODS: Five sets of standard dental casts were mounted on a mechanical articulator in maximal intercuspal position. The number and position of occlusal contacts were determined with 12-µm articulating foil. After a calibration process according to the manufacturer's instructions, the mountings were transferred to a virtual articulator using the transfer plates in a laboratory scanner. The occlusion of the digital casts was determined before and after the occlusal optimization process. Then, the sensitivity and positive predictive value were determined by comparing the occlusal contact points in the virtual articulator with those in the mechanical articulator. To evaluate trueness, the occlusal surface of the maxillary teeth in the mechanical articulator was recorded by polyvinyl siloxane occlusal record in maximal intercuspal position and retained on the mandibular arch. The trueness was calculated as the deviation between the occlusal surface of the maxillary teeth in the mechanical articulator and the virtual articulator. To evaluate precision, one set of the casts was scanned 10 times. And the deviation of the interarch position of the maxillary arches when superimposing the mandibular arches of every 2 different scans was calculated. RESULTS: The sensitivity before occlusal optimization (0.14 ± 0.15) was significantly lower than that after occlusal optimization (0.82 ± 0.10) (p = 0.003). However, there was no significant difference between the positive predictive value before (0.80 ± 0.45) and after (0.81 ± 0.09) occlusal optimization (p = 0.952). The trueness before (91.0 ± 10.7 µm) and after (75.4 ± 25.2 µm) occlusal optimization had no significant difference (p = 0.249). The precision before occlusal optimization (11.6 ± 3.8 µm) was significantly superior to that after occlusal optimization (75.6 ± 39.2 µm ) (p < 0.001). CONCLUSIONS: The accuracy of transferring casts in maximal intercuspal position to a virtual articulator using transfer plates in the laboratory scanner could be improved after occlusal optimization and can meet the clinical needs for occlusal design and analysis of prostheses.

Integrating Facial and Intraoral Scans for Digital Esthetic and Occlusal Design: A Technical Report.

The provisional prosthesis is a prerequisite for prosthodontic rehabilitation. The purpose of this technique was to register facial and intraoral scans predictably. A 3D virtual patient was created through facial scans, intraoral scans, digital face-bow transfer, and digital cross-articulation technique. This virtual patient allowed predictable positioning of intraoral scans to a virtual articulator by using digital face-bow transfer. The resulting virtual patient facilitated the design of definitive prostheses following a facially generated treatment planning principle. In addition, the virtual articulator was used to improve occlusal design on the definitive prostheses and reduce the need for intraoral adjustment.

Virtual Articulators and Virtual Mounting Procedures: Where Do We Stand?

A virtual articulator is a computer software tool that is capable of reproducing the relationship between the jaws and simulating jaw movement. It has gradually gained research interest in dentistry over the past decade. In prosthodontics, the virtual articulator should be considered as an additional diagnostic and treatment planning tool to the mechanical articulator, especially in complex cases involving alterations to the vertical dimension of occlusion. Numerous authors have reported on the available digital methodologies used for the assembly of virtual arch models in a virtual articulator, focusing their attention on topics such as the virtual facebow and digital occlusal registration. To correctly simulate jaw movement, the jaw models have to be digitalized and properly mounted on the virtual articulator. The aim of this review was to discuss the current knowledge surrounding the various techniques and methodologies related to virtual mounting in dentistry, and whether virtual articulators will become commonplace in clinical practice in the future. This review also traces the history of the virtual articulator up to its current state and discusses recently developed approaches and workflows for virtual mounting based on current knowledge and technological devices.

The Effect of Residual Dentition on the Dynamic Adjustment of Wear Facet Morphology on a Mandibular First Molar Crown.

PURPOSE: To evaluate the effect of different residual dentitions on the dynamic adjustment of wear facet morphology on a single mandibular first molar crown with a virtual articulator. MATERIALS AND METHODS: Gypsum casts (N = 12) of natural full dentitions were mounted on an articulator and scanned. The mandibular right first molar (#46) was prepared and a copy of the tooth before it was prepared and used to design the crown. The wear facets on the original #46 were selected and elevated by 0.3 mm in the occlusal direction to generate high points. The #46 with high points was segmented to create a digital wax pattern. Then different teeth were virtually removed to generate 4 types of residual dentitions: Type I (no teeth), Type II (adjacent teeth), Type III (ipsilateral posterior teeth and canine), and Type IV (all teeth). The crowns were adjusted dynamically with different residual teeth to guide mandibular movement of the virtual articulator. Three-dimensional deviations, negative and positive volumes between crowns and wear facets on the original #46 were analyzed. The Kruskal-Wallis test was used to analyze the results. RESULTS: The mean deviation values and positive volumes decreased with the decrease in residual teeth, and the negative volumes showed an opposite trend. The mean deviation values, root mean square, and positive volumes were not significantly different. The negative volume of the crowns of Type I was different from that of Type IV (p = 0.031). CONCLUSIONS: Residual dentition affects the dynamic adjustment of wear facet morphology. When there are insufficient residual teeth, mandibular movements should be accurately measured.

Reproducibility of a magnet-based jaw motion analysis system.

BACKGROUND: The Dental Motion Decoder system (DMS-System) is a medical device based on magnetic field technology that records mandible movements. The data can be used to program an articulator or can be directly processed over a computer-aided design (CAD) interface. The present study aimed to assess the reproducibility of this system in vitro and in vivo. MATERIAL AND METHODS: Protrusive and laterotrusive movements were simulated in vitro using an articulator (SAM SE) (Group M) and in vivo (Group P) on one test individual. Measurements were carried out in two ways: 1) Measurements were taken after initializing and referencing the system using the reference points (RPs) once, followed by 30 protrusive and laterotrusive movements (M1 and P1); and 2) Thirty individual measurements were recorded using the RPs before each measurement (M2 and P2). Values for the sagittal condylar path inclination angle (sCPIA) and the Bennett angle (BA) were exported and analyzed. The reproducibility of the system was evaluated using the standard deviations (SDs) of the measurement series (sCPIA and BA for M1, M2, P1, and P2). RESULTS: In vitro tests M1 (SD: sCPIA = 0.08 degrees; BA = 0.06 degrees) and M2 (SD: sCPIA = 0.26 degrees; BA = 0.11 degrees) showed significantly higher reproducibility (P < 0.001) compared with the in vivo measurements P1 (SD: sCPIA = 0.61 degrees; BA = 0.45 degrees) and P2 (SD: sCPIA = 1.4 degrees; BA = 0.65 degrees). CONCLUSION: Within the limitations of the present study, the deviation in vitro, representing the reproducibility of the DMD-System, is smaller than the biologic variance observed in vivo. Therefore, reliable measurements under clinical conditions can be assumed.

Setting the Sagittal Condylar Inclination on a Virtual Articulator Using Intraoral Scan of Protrusive Interocclusal Position and Cone Beam Computed Tomography.

The articulator is a prerequisite device for the analysis of occlusion and prosthodontic treatment, and it is required to simulate patient jaw movements. This article describes the technique to obtain sagittal condylar inclination (SCI) using cone beam computed tomography (CBCT) data and intraoral scan of the protrusive interocclusal position. The SCI can be used on a virtual articulator in a computer-aided design software, and it can assist in the fabrication of prosthesis which is harmonious with the mandibular movement of individual patient.

Registering Maxillomandibular Relation to Create a Virtual Patient Integrated with a Virtual Articulator for Complex Implant Rehabilitation: A Clinical Report.

The virtual patient, a unique computer simulation of the patient's face, teeth, oral mucosa, and bone, provides an extraordinary mechanism for digital dental implant surgery planning and prosthetic design. However, the seamless registration of digital scans with functional information in the context of a virtual articulator remains a challenge. This report describes the treatment of a 47-year-old male with full-mouth guided immediate implant placement and immediate loading of CAD/CAM interim prostheses. Utilizing a novel digital workflow, a multifactorial registration of the vertical dimension of occlusion, centric occlusion, and facebow record were completed digitally and paired within a digital articulator. Utilizing this innovative approach, a complex treatment plan and procedure was executed smoothly with a successful prosthetic outcome demonstrating good fit, occlusion, esthetics, and patient reported satisfaction.

Accuracy of Dynamic Virtual Articulation: Trueness and Precision.

PURPOSE: To study the effects of altering condylar settings and pin openings on the trueness and precision of virtual articulators vs. mechanical articulators. MATERIALS AND METHODS: Maxillary and mandibular typodonts with fiducial markers were mounted on a mechanical Artex-CR articulator, and the mandibular teeth were prepared to allow guidance solely by the posterior determinants of the articulator and the incisal table. The relationship of the mounted typodonts was preserved digitally by scanning using manufacturer transfer plate adaptors. On the mechanical articulator, pattern resin was allowed to set between the maxillary and mandibular occlusal surfaces (area #25-30) at the endpoints of dynamic movements at 3 condylar inclinations (SCI): 10°, 30°, and 45°, n = 12/inclination, or at 3 incisal pin openings (2, 5, and 10 mm, n = 12/opening). All other articulator settings were kept constant. Resin specimens attached to the typodonts were scanned within 5 minutes of setting, then removed, and the articulated typodonts rescanned. Fixed dental prostheses (FDPs) #25-30 were designed on the virtual articulator using identical parameters to the mechanical articulator. Dynamic virtual movements were used to sculpt the design, and a file of the design was saved. The files of both types of samples were aligned and overlaid. Interocclusal separation was measured in triplicate at the indentation created by the mesiolabioincisal point angle on the incisal edge of #8 and the mesiobucco-occlusal point angle of #3. Trueness and precision of both types of articulators were calculated and compared using one-way ANOVA, followed by the Tukey HSD test (α = 0.05). RESULTS: There was no statistically significant difference at altered pin openings in either trueness (F = 0.202, p = 0.37) or precision (F = 3.134, p = 0.09) for the majority of measurements. The only significant difference was in the precision between the 2 types of articulators at 5 mm incisal opening, and only at the anterior measurement point (F = 15.134, p = 0.0008); however, these differences were less than 100 µm. When the SCI was altered, there was no statistically significant difference (F = 3.624, p > 0.05) between the virtual and mechanical articulators in trueness for 5 of the 6 measurements obtained (F = 3.624, p = 0.07) or for all of the precision measurements (F = 3.529, p = 0.07). The one trueness measurement that was significantly different (F = 9.237, p = 0.006) occured at SCI of 10°, and it was less than 100 µm. CONCLUSIONS: Dynamic movements on the virtual articulator were shown to be as true and precise as to the mechanical articulator. When there were deviations, these deviations were less than 100 µm and thus, these deviations may not be clinically relevant.

A Comprehensive Review on Virtual Articulators.

The virtual articulator (VA) is a technology that simulates the jaw relation in a computer-generated setting. Augmented and virtual reality have been utilized as digital technology, which aids in many areas of dentistry and dental education. Today, a practicing dentist must keep up with the newer technologies, but with technology evolving so quickly it becomes challenging. In dentistry, the possibilities for digitization and technological advancements are limitless. Virtual articulators (VAs) allow a complete occlusion analysis using dental models that replicate all mandibular motions in static and dynamic scenarios. VA when executed in addition to other software enhances treatment planning and patient education, allowing quicker and more precise individualized diagnoses. The main objective of this study was to describe and evaluate the study outcomes in the available research on VAs, assess their needs, and evaluate their advantages and limitations in various aspects. A PubMed Central search was made of dental journals, with the identification of 135 articles out of which 30 were finally selected. The investigations conducted to evaluate the VA's dependability provide good visualization of the quantity and location of the dynamic interactions. A precise instrument for fully analyzing occlusion in a real patient is the virtual articulator.