The Digital Clone: Intraoral Scanning, Face Scans and Cone Beam Computed Tomography Integration for Diagnosis and Treatment Planning

3D Printed Provisional Removable Partial Denture Designed Using Virtual Patient for a Road Traffic Accident Victim

OBJECTIVE

Provisional removable partial denture (RPD) preserves esthetic and functional parameters until definitive treatment. This clinical report presents a 19-year-old victim of a road traffic accident who lost the maxillary right central and lateral incisors.

CLINICAL CONSIDERATIONS

A 3D printed maxillary provisional RPD planned using a virtual patient was provided until the patient could undergo implant-supported rehabilitation. Intraoral and facial scans were conducted, and the images were integrated into a dental software program for digital prosthetic planning. The provisional RPD was designed considering the facial parameters, then 3D printed, characterized, and delivered to the patient.

CONCLUSIONS

The 3D printed provisional RPD demonstrated satisfactory esthetic and functional outcomes, offering a faster and more predictable alternative compared to the conventional method.

CLINICAL SIGNIFICANCE

Using virtual patients to design 3D printed provisional removable partial dentures can enhance the predictability of treatment, especially in the esthetic area.

Techniques and accuracy for aligning facial and intraoral digital scans to integrate a 3-dimensional virtual patient: A systematic review

STATEMENT OF PROBLEM

The optimal method of aligning intraoral scans with facial scans to generate a 3-dimensional (3D) virtual patient remains unclear. Distortions in the alignment of intraoral and facial scans would lead to an inadequate virtual patient representation and, therefore, to inadequate diagnosis and treatment planning.

PURPOSE

The purpose of this systematic review was to evaluate the available techniques for generating a 3D virtual patient by aligning facial and intraoral scans and to assess their accuracy.

MATERIAL AND METHODS

A systematic search was conducted in 3 databases: Medline, Scopus, and Web of Science. A manual search was also conducted. Specific descriptors were used to identify alignment techniques. Two independent reviewers screened titles and abstracts, with a third independent reviewer resolving ambiguities. A qualitative analysis was performed, and interexaminer agreement was assessed using the Cohen kappa statistic.

RESULTS

After screening, 48 of the 2832 identified articles were included for qualitative analysis. They focused on 3 alignment techniques: guided by retracted facial scans, extraoral scan bodies, and perioral intraoral scans. Interexaminer agreement was high (kappa=0.82 to 0.88). Integration techniques guided by extraoral scan bodies, influenced by extraoral scan body design and protocols, showed the best accuracy. The outcome variables for the evaluation of the effectiveness of these protocols were heterogeneous.

CONCLUSIONS

Integrating facial and intraoral scans was found to enhance diagnosis and treatment planning by providing essential esthetic and functional parameters. Integration techniques guided by extraoral scan bodies and combination techniques showed higher accuracy, especially for complex implant-supported prostheses or edentulous patients.

Positional accuracy of intraoral scan alignment to a facial scan using structured light scanning and trial denture base with occlusal rim markers in patients with complete maxillary edentulism

STATEMENT OF PROBLEM

Creating precise 3D virtual head models for patients with complete maxillary edentulism remains challenging owing to the lack of natural landmarks and limitations of current image-matching technologies.

PURPOSE

The purpose of this study was to evaluate the positional accuracy of intraoral scan alignment to structured light-based facial scans using varying sizes and positions of occlusal rim markers under maxillary edentulous conditions.

MATERIAL AND METHODS

Radiopaque artificial markers of 3 sizes (2, 4, and 6 mm) were made and attached to the maxillary occlusal rim of a completely edentulous patient at different positions (midline-canine [MC], midline [M], canine [C]). Facial scans were obtained of the patient by using a structured light facial scanner under 9 experimental conditions (size-location: 2MC, 2M, 2C, 4 MC, 4M, 4C, 6MC, 6M, and 6C; 5 scans under each condition). Intraoral scans were aligned to the facial scans using stepwise images matching the occlusal rim scan casts. The alignment accuracy was evaluated by comparing the intraoral scan with a reference position established using cone beam computed tomography data. Measured variables included anterior and posterior linear deviations and angular deviation of the arch plane. Statistical analysis was conducted using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni correction (α=.05).

RESULTS

The 4-mm and 6-mm marker groups exhibited significantly lower deviation in image registration than the groups without markers and those with 2-mm markers (P<.001). Regarding the marker position, the midline-canine group exhibited the lowest deviation value, followed by the midline and canine groups. Markers positioned in the midline exhibited less deformation compared with those in the canine region.

CONCLUSIONS

Occlusal rim markers can be used to align intraoral and facial scans in patients with complete maxillary edentulism when structured light face scanning is included. Markers with a clearly recognizable size in facial scans are less prone to deformation in the facial midline area.

Accuracy of combining intraoral and facial scan in a single digital model of an orthodontic patient utilizing corresponding measurements on the model and on real photographs: A prospective cross-sectional study

OBJECTIVES

To validate the accuracy of integration of intraoral scan to the facial scan acquired by the EM3D application, utilising the Blue Sky Plan 4 software, creating a digital model of an orthodontic patient, by comparing the same linear measurements on real photographs and images from the digital model of the patient.

MATERIAL AND METHODS

Thirty patients (20 females and 10 males; age range 12-30years) undergoing orthodontic treatment with fixed appliances were recruited in this prospective cross-sectional study from December 2024 to February 2025. Five facial landmarks were marked on each patient: Tragion right, Cheilion right and left, Subnasale and Pronasale. Intraoral scan and facial scan were performed at the same appointment. Facial scan was conducted using an iPhone 13 Pro with the EM3D face scanning application which utilizes the iPhone's TrueDepth camera technology while the patient was smiling. The STL (Stereolithography) and OBG (Object) files (acquired from intraoral and facial scan respectively) were combined in a digital model using the Blue Sky Plan 4 software. Lateral and frontal photographs of the patient's face, while smiling, were also acquired. Eight linear measurements (Tragion right - bracket #11, Tragion right - incisal #11, Cheilion right - #13, Cheilion left - #13, Subnasale - #11, Subnasale - #21, Pronasale - #11, Pronasale - #21) were digitally performed on the real and digital photographs of the patients using the facial landmarks and certain points on teeth and braces. Paired sample t-test and Wilcoxon signed-rank test were used for statistical analysis.

RESULTS

Significantly statistical difference was detected only in one (Cheilion right - #13) measurement (P=0.004).

CONCLUSION

Combining intraoral and facial scan using a special software provides a clinically useful digital model of an orthodontic patient for diagnosis, treatment planning and outcome assessment.

Digital Representation of Patients as Medical Digital Twins: Data-Centric Viewpoint

Unlabelled

Precision medicine involves a paradigm shift toward personalized data-driven clinical decisions. The concept of a medical "digital twin" has recently become popular to designate digital representations of patients as a support for a wide range of data science applications. However, the concept is ambiguous when it comes to practical implementations. Here, we propose a medical digital twin framework with a data-centric approach. We argue that a single digital representation of patients cannot support all the data uses of digital twins for technical and regulatory reasons. Instead, we propose a data architecture leveraging three main families of digital representations: (1) multimodal dashboards integrating various raw health records at points of care to assist with perception and documentation, (2) virtual patients, which provide nonsensitive data for collective secondary uses, and (3) individual predictions that support clinical decisions. For a given patient, multiple digital representations may be generated according to the different clinical pathways the patient goes through, each tailored to balance the trade-offs associated with the respective intended uses. Therefore, our proposed framework conceives the medical digital twin as a data architecture leveraging several digital representations of patients along clinical pathways.

The Orientation in Space of the Maxillary Arch: New and Old Devices in the Prosthetic Digital Workflow

OBJECTIVE

In extensive prosthetic rehabilitations and in those involving the anterior area, a correct 3D spatial position is of fundamental importance for effective communication between the clinician and the dental technician. The aim of this article is to analyze the different methods used to position in space and/or in an articulator the maxillary arch in analog workflows highlighting shortcomings and difficulties in order to understand how to overcome them when employing digital workflows.

OVERVIEW

Traditional mechanical devices, such as anatomical, kinematic, esthetic and postural facebows, have clear indications, but also limitations, especially in cases of skeletal asymmetries. Modern digital tools, including photography, CBCT, facial scanners and jaw recording devices, are here critically analyzed to illustrate the advantages of working in a virtual space.

CONCLUSIONS

The adoption of digital tools in the prosthetic workflow represents a significant improvement compared to traditional techniques, as it reduces errors and artifacts of registration and transfer of the position of the maxillary arch in the articulator space. This contributes to more predictable esthetic and functional results, with a positive impact for clinicians and technicians, improving clinical-laboratory communication, operational efficiency and overall quality of work.

CLINICAL SIGNIFICANCE

The integration of digital tools into prosthetic workflows represents an important advancement in clinical practice since they reduce human error and facilitate communication between the clinician and the laboratory. When carrying out rehabilitations involving changes in esthetics or occlusal plane orientation, the proper and accurate positioning of the upper arch in space is particularly relevant.

Do intraoral scanning technologies affect the trueness of dental arches with crowding, diastema, and edentulous spaces? A clinical perspective

OBJECTIVES

To evaluate the trueness of dental arches digitised by two intraoral scanning (IOS) technologies from patients presenting crowding, diastema, and bilateral posterior edentulous space with tilted molar.

METHODS

Conventional impressions and dental stone models were generated from three patients presenting the aforementioned dental arch conditions. These models were digitised on a desktop scanner, and the resulting mesh was used as reference. Subsequently, the patients were scanned using confocal based (CF; iTero Element 2) and blue laser-multiscan (BLM; Virtuo Vivo) imaging IOS technology, totalling thirty scans. The meshes from the scans were exported in Standard Tessellation Language format and analysed using Geomagic Control X software. Root mean square (RMS) indicated deviation magnitude. Differences in IOS technologies were evaluated with paired t-tests, and dental arch conditions compared using ANOVA and post-hoc Tukey tests (α=0.05).

RESULTS

Digital dental arch from blue laser-multiscan technology showed lower trueness compared to confocal based technology for crowding (p = 0.0084) and edentulous spaces (p = 0.0025) conditions. When the types of oral condition were compared, discrepancies were significantly different for both IOS technologies, featuring the arch with diastema showing the lowest trueness, followed by edentulous spaces and crowding.

CONCLUSION

Dental arches presenting crowding and edentulous spaces digitised by blue laser-multiscan technology exhibited greater discrepancies compared to confocal based imaging technology. Furthermore, trueness varied among the dental arch conditions.

CLINICAL SIGNIFICANCE

The IOS technology and patient's dental arch condition can influence the trueness of dental arch digitisation. Being aware of these effects allows clinicians to take them into account during scanning procedures, digital planning and manufacturing.

From Reverse Engineering Software to CAD-CAM Systems: How Digital Environment Has Influenced the Clinical Applications in Modern Dentistry and Orthodontics

Background: Reverse engineering (RE) or back engineering is a process that analyzes a physical object to obtain the primary data of the same project. RE technologies have different applications in industrial settings and productive chains; however, with the advent of digital technologies in dentistry and orthodontic fields, they are involved in the new diagnostic and clinical digital workflow. For example, 3D model scanning, 3D facial scanning, models superimposition, digital orthodontic setup, anatomical volumetric assessment, soft tissue analysis, orthodontic digital guided systems, and prototyped orthodontic appliances represent a few examples of the application of RE in orthodontics. Moreover, clinicians can manipulate the data derived from original digital file to enhance diagnosis and communication with other clinicians and dental technicians; however, RE and digital technologies systems are not exempt from shortcomings, including costs and knowledge curve. In this regard, the aim of the present manuscript was to describe the use of reverse engineering technologies in modern digital orthodontics and provide helpful information for those specialists who are at the beginning of the transition from analogic to digital orthodontic workflow.

Artificial Intelligence and Augmented Reality for Guided Implant Surgery Planning: a Proof of Concept

PURPOSE

To present a novel protocol for authentic three-dimensional (3D) planning of dental implants, using artificial intelligence (AI) and augmented reality (AR).

METHODS

The novel protocol consists of (1) 3D data acquisition, with an intraoral scanner (IOS) and cone-beam computed tomography (CBCT); (2) application of AI for CBCT segmentation to obtain standard tessellation language (STL) models and automatic alignment with IOS models; (3) loading of selected STL models within the AR system and surgical planning with holograms; (4) surgical guide design with open-source computer-assisted-design (CAD) software; and (5) surgery on the patient.

RESULTS

This novel protocol is effective and time-efficient when used for planning simple cases of static guided implant surgery in the partially edentulous patient. The clinician can plan the implants in an authentic 3D environment, without using any radiological guided surgery software. The precision of implant placement looks clinically acceptable, with minor deviations.

CONCLUSIONS

AI and AR technologies can be successfully used for planning guided implant surgery for authentic 3D planning that may replace conventional guided surgery software. However, further clinical studies are needed to validate this protocol.

STATEMENT OF CLINICAL RELEVANCE

The combined use of AI and AR may change the perspectives of modern guided implant surgery for authentic 3D planning that may replace conventional guided surgery software.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

An overview of three-dimensional imaging devices in dentistry

OBJECTIVE

To review four types of three-dimensional imaging devices: intraoral scanners, extraoral scanners, cone-beam computed tomography (CBCT), and facial scanners, in terms of their development, technologies, advantages, disadvantages, accuracy, influencing factors, and applications in dentistry.

METHODS

PubMed (National Library of Medicine) and Google Scholar databases were searched. Additionally, the scanner manufacturers' websites were accessed to obtain relevant data. Four authors independently selected the articles, books, and websites. To exclude duplicates and scrutinize the data, they were uploaded to Mendeley Data. In total, 135 articles, two books, and 17 websites were included.

RESULTS

Research and clinical practice have shown that oral and facial scanners and CBCT can be used widely in various areas of dentistry with high accuracy.

CONCLUSION

Although further advancement of these devices is desirable, there is no doubt that digital technology represents the future of dentistry. Furthermore, the combined use of different devices may bring dentistry into a new era. These four devices will play a significant role in clinical utility with high accuracy. The combined use of these devices should be explored further.

CLINICAL SIGNIFICANCE

The four devices will play a significant role in clinical use with high accuracy. The combined use of these devices should be explored further.