Influence of different inlay configurations and distance from the adjacent tooth on the accuracy of an intraoral scan

Effect of the Inter-Tooth Distance and Proximal Axial Wall Height of Prepared Teeth on the Scanning Accuracy of Intraoral Scanners

This study aimed to analyze the effect of the height of the proximal axial wall of the prepared tooth and the distance between the adjacent tooth and the prepared tooth on the scan accuracy of intraoral scanners. Ten working casts with maxillary first molars prepared to receive zirconia crowns were randomly obtained from a dental clinic. Each of the 10 casts was scanned using two intraoral scanners (i700; MEDIT and CS3600; Carestream; computer-aided design [CAD] test model, CTM; N = 15 per working cast) 15 times per scanner. Individual dies of the prepared teeth were fabricated, and high-precision scan data were acquired using a laboratory scanner (CAD reference model, CRM; N = 1). CTMs were aligned relative to the prepared tooth of CRMs by using three-dimensional inspection software (Ver 2018.1.0; Control X; 3D Systems). Data were statistically analyzed using an independent t-test and one-way analysis of variance for between-group comparisons (α = 0.05). The inaccuracy in the proximal regions (mesial or distal) of the prepared tooth was higher than that in the buccal and lingual regions (p < 0.05). The scan accuracy was not correlated with the variables when the distance between the adjacent tooth and the prepared tooth was ≥2.0 mm and the height of the proximal axial wall of the prepared tooth was <3.0 mm (p > 0.05). Therefore, an excellent scan accuracy can be obtained using an intraoral scanner when the distance between the adjacent tooth and the prepared tooth is ≥2.0 mm and the proximal axial wall height of the prepared tooth is <3.0 mm.

Effect of different intraoral scanning strategies on the marginal and internal fit of CAD-CAM inlay restorations: An in vitro study

STATEMENT OF PROBLEM

Whether the scanning strategy of intraoral scanners (IOSs) affects the accuracy of the digital recording for an indirect ceramic inlay restoration is unclear. Furthermore, which strategy would be optimal and most effective is uncertain.

PURPOSE

The purpose of this in vitro study was to evaluate the impact of 3 different scanning strategies using the Carestream CS 3700 IOS on the marginal and internal fit of a mesio-occluso-distal (MOD) ceramic inlay restoration.

MATERIAL AND METHODS

A typodont master model (ANA-4 VCER; Frasaco) was used with a standardized preprepared MOD inlay maxillary first molar typodont tooth (ANA-4 ZP16 CER99-008; Frasaco) (N=30). These inlay preparations were scanned with the CS 3700 IOS using 3 different scanning strategies: linear, wave, and S-figure scanning strategies. Each scan strategy group was scanned 10 times for all groups to obtain 30 standard tessellation language (STL) files. Thirty restorations were milled from lithium disilicate CAD blocks (IPS e.max; Ivoclar AG) and cemented into their typodont-prepared inlay cavities. A single examiner used a stereomicroscope to measure the marginal and internal gaps at the predetermined points. A 1-way ANOVA was used for the statistical analysis, followed by the Tukey post hoc test with Bonferroni adjustment. All tests were 2-tailed (α=.05).

RESULTS

All scanning strategy groups demonstrated statistically significant differences for the marginal and internal fit of the inlay restorations (P<.001). Overall, the linear scanning strategy showed the lowest mean marginal and internal gap values (29.2 ±3.6 µm and 39.0 ±6.4 µm), followed by the wave scanning strategy, which had comparable mean marginal and internal gap values: 49.1 ±3.6 µm and 48.2 ±6.0 µm, respectively. The S-figure scan strategy had the highest mean marginal and internal gap values: 50.2 ±12.6 µm and 71.3 ±7.7 µm, respectively.

CONCLUSIONS

Inlay restorations scanned by the linear scan strategy had the best marginal and internal fit when scanned with the CS 3700 IOS.

Intraoral digital implant scans: Parameters to improve accuracy

PURPOSE

To report the means to maximize the predictability and accuracy of intraoral digital implant scans through the evaluation of operator and patient-related factors.

MATERIALS AND METHODS

A search of published articles related to factors that can decrease the scanning accuracy of intraoral digital implant scans was completed in four data sources:MEDLINE, EMBASE, EBSCO, and Web of Science. All studies related to variables that can influence the accuracy of intraoral digital implant scans obtained by using intraoral scanners (IOSs) were considered. These variables included ambient lighting, scanning pattern, implant scan body (ISB) design, techniques for splinting ISBs, arch location, implant position, and inter-implant distance.

RESULTS

Among operator-related factors, ambient lighting conditions, scanning pattern, and ISB design (material, geometry, and retention design) can impact the accuracy of intraoral digital implant scans. The optimal ISB for maximizing IOS accuracy is unclear; however, polymer ISB can wear with multiple reuse and sterilization methods. Among patient-related factors, additional variables should be considered, namely arch (maxillary vs. mandibular arch), implant position in the arch, inter-implant distance, implant depth, and angulation.

CONCLUSIONS

Ambient lighting conditions should be established based on the IOS selected to optimize the accuracy of intraoral digital implant scans. The optimal scanning pattern may vary based on the IOS, clinical situation, and the number of implants. The optimal ISB design may vary depending on the IOS used. Metallic implant scan bodies are preferred over polymer ISB designs to minimize wear due to multiple use and sterilization distortion. Among patient-related factors, additional variables should be considered namely the arch scanned, implant position in the arch, inter-implant distance, implant depth, and angulation. The impact of these factors may vary depending on the IOS selected.

Effect of substrate adjacent to the scan region on the trueness of four intraoral scanners: An in vitro study

OBJECTIVES

The purpose of this in vitro study was to evaluate the trueness of four commercially available intraoral scanners (IOSs) on scanning different substrates that existed in the adjacent proximal contact area.

METHODS

Four IOSs (TRIOS 4, TRIOS 3, Primescan, Omnicam) were used for scanning the intact enamel surface of a molar tooth, and six restorative materials (zirconia, lithium disilicate glass-ceramic, composite resin, hybrid ceramic, feldspathic ceramic, metal) that were located at the adjacent proximal contact area of the same tooth. Reference scans were obtained using an extraoral scanner (inEos X5). A 3-dimensional analyzing software (Geomagic Control X) was used to compare the reference and tested scans. The two-way analysis of variance (ANOVA) followed by Bonferroni correction was performed for statistical analyses (α=0.05).

RESULTS

TRIOS 3 and TRIOS 4 showed higher trueness than Primescan, and Primescan showed higher trueness than Omnicam (p<0.001), while there were no differences between TRIOS 3 and TRIOS 4. Metal showed significantly higher Root Mean Square values (0.273 ± 0.24 mm) than other substrates. No difference was found between the scanners' zirconia, lithium disilicate glass-ceramic, composite, and feldspathic ceramic scans (p > 0.05). For the metal, TRIOS 3 and TRIOS 4 showed higher trueness than Primescan and Omnicam, while Omnicam showed lower trueness among all scanners. For the hybrid ceramic, TRIOS 3 showed higher trueness than Omnicam (p<0.001). For the enamel, TRIOS 3 showed higher trueness than Primescan and Omnicam (p<0.001).

CONCLUSIONS

The trueness of IOSs can be affected by the substrates that exist in the proximal contact area. Amongst all, the metal substrate affected most the trueness of the IOSs.

CLINICAL SIGNIFICANCE

The clinician should decide on the impression system, taking into account that the IOS and the surfaces to be scanned affect the trueness of the digital data. The deviation of the digital impression would be high in the presence of a metal restoration on the adjacent proximal surface.

Scanning accuracy of an intraoral scanner according to different inlay preparation designs

BACKGROUND

The accuracy of intraoral scanning plays a crucial role in the workflow of computer-assisted design/computer-assisted manufacturing. However, data regarding scanning accuracy for inlay preparation designs are lacking. The purpose of this in vitro study was to evaluate the influence of the depth of the occlusal cavity and width of the gingival floor of the proximal box on the trueness and precision of intraoral scans for inlay restoration.

METHODS

Artificial teeth were used in this study. Four types of preparations for mesio-occlusal inlay were performed on each #36 artificial tooth depending on two different depths of the occlusal cavity (1 mm and 2 mm) and widths of the gingival floor of the proximal box (1.5 mm and 2.5 mm). Artificial teeth were scanned 10 times each with Cerec Primescan AC, and another scan was performed subsequently with a laboratory scanner as a reference (n = 10). Standard tessellation language files were analyzed using a three-dimensional analysis software program. Experimental data were analyzed using two-way analysis of variance and the Bonferroni multiple comparison test.

RESULTS

The narrow shallow group had significantly higher deviation values for trueness than the wide deep group (p < 0.05). The wide deep group had the lowest average deviation value for trueness and there was no significant difference between the narrow deep and wide shallow groups (p > 0.05). For the mean maximum positive deviation, the wide groups had significantly lower values than the narrow groups (p < 0.05). Trueness was affected by both the width and depth(p < 0.05), whereas the mean maximum positive deviation was affected by the width (p < 0.05). The mean maximum negative deviation was affected by all three factors (p < 0.05). Precision was affected by the depth and the interaction between the depth of the occlusal cavity and width of the gingival floor (p < 0.05).

CONCLUSIONS

The design of different inlay cavity configurations affected the accuracy of the digital intraoral scanner. The highest average deviation for trueness was observed in the narrow shallow group and the lowest in the wide deep group. With regard to precision, the narrow shallow group showed the lowest average deviation, and the narrow deep group showed highest value.

A guide for maximizing the accuracy of intraoral digital scans: Part 2-Patient factors

OBJECTIVES

To describe the factors related to patient intraoral conditions that impact the scanning accuracy of intraoral scanners (IOSs). A new classification for these influencing factors is proposed to facilitate dental professionals' decision-making and maximize the accuracy and reliability of intraoral digital scans.

OVERVIEW

Variables related to intraoral conditions of the patient that can influence the scanning accuracy of IOSs include tooth type, presence of interdental spaces, arch width variations, palate characteristics, wetness, existing restorations, characteristics of the surface being digitized, edentulous areas, interimplant distance, position, angulation, and depth of existing implants, and implant scan body selection.

CONCLUSIONS

The knowledge and understanding of the patient's intraoral conditions that can impact the scanning accuracy of IOSs is a fundamental element for maximizing the accuracy of IOSs.

CLINICAL SIGNIFICANCE

The patient's intraoral conditions, or patient factors, can significantly impact intraoral scanning accuracy. Dental professionals must know and understand these influencing patient factors to maximize the accuracy of IOSs.

Virtual versus jaw simulation in inlay preparation preclinical teaching: a randomised controlled trial

BACKGROUND

To investigate the effect of virtual simulation systems on the teaching of inlay experiments and to guide the experimental teaching of tooth preparation.

METHODS

Participants in their second semester of the junior year were selected to carry out the unified teaching and evaluation of dental preparation theory. The age varied from 18 to 22 years (19.96 ± 0.70) and the participants were randomly divided into four groups (n = 19) with a similar male-to-female ratio following CONSORT guidelines, including a jaw simulation model training group (Group J), a virtual simulation system training group (Group V), a jaw model training first followed by a virtual system training group (Group J-V), and a virtual system followed by a jaw model training group (Group V-J). The inlay tooth preparation assessment was performed on the extracted teeth. The data were analysed according to the assessment scores by a senior clinician. The subjective feelings of the students towards the system were evaluated using questionnaires.

RESULTS

The second theoretical scores of Group V-J (63.5 ± 2.89) and Group J-V (60.5 ± 3.25) were higher than those of Group V (57.5 ± 3.13) and Group J (58.0 ± 3.67). The experimental scores of Groups J-V and V-J (62.79 ± 2.84; 64.00 ± 2.85) were higher than those of Groups V and J (56.05 ± 3.39; 55.74 ± 2.53). The questionnaire survey illustrated that most students preferred the digital virtual simulation system (perfect assessment: 91.3%, accuracy: 82.6%, satisfaction: 52.2%).

CONCLUSION

Virtual simulation training can facilitate the teaching effect of tooth preparation in inlay experiments, and the teaching mode of Group V-J was the best. Therefore, this teaching mode is to be popularised.

Impact of different complete coverage onlay preparation designs and the intraoral scanner on the accuracy of digital scans

STATEMENT OF PROBLEM

The trueness and precision of intraoral scanners (IOSs) and the effect of intracoronal restorations have been reported. However, studies addressing the accuracy of IOSs in reproducing different complete coverage onlay preparation designs are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of complete coverage onlay preparation design and intraoral scanning devices on the accuracy of digital scans in terms of trueness and precision.

MATERIAL AND METHODS

Three preparation designs on the mandibular first molar were considered: a traditional preparation design with isthmus reduction (IST), a traditional preparation design without isthmus reduction (wIST), and simplified nonretentive preparation (nRET). Digital scans of epoxy resin mandibular arch reference models of the preparations (containing second premolar, first molar, and second molar) were obtained by using 3 IOSs (iTero Element 2 [ELE], Trios 3 [TRI], and Primescan [PRI]) (n=10). Trueness (μm) and precision (μm) were analyzed by superimposing the digital scan on the digital reference models obtained with a high-accuracy industrial scanner (ATOS Core 80) in a tridimensional metrology software program. Accuracy was quantified by the absolute deviation (μm). Local and overall mean positive and negative deviations for trueness were also obtained. Data were analyzed by using the Kruskal-Wallis and Dunn tests with a statistical software program (α=.05).

RESULTS

The nonretentive preparation groups obtained higher trueness (3.8 μm) and precision (2.7 μm) than the IST and wIST groups (trueness=7.5 to 6.3 μm, precision=5.5 to 4.6 μm). Trueness values were lower with ELE×IST (16 μm), followed by ELE×wIST (13 μm), and PRI×IST (7.8 μm). In general, no difference was found between PRI and TRI scanners (6.3 to 5.9 μm), with lower performance for ELE (13 μm). Positive deviations were higher on the proximal box of the IST and wIST preparation and on the occlusal box of the IST group. Negative deviation was higher on the ELE×IST occlusal box.

CONCLUSIONS

Different intraoral scanners and preparation designs influenced the accuracy of digital scans. A more complex preparation such as IST and wIST showed higher deviation. The iTero Element 2 scanner exhibited higher deviation for both trueness and precision.

Effect of custom abutment data superimposition on the accuracy of implant abutment level scanning: An in vitro study

STATEMENT OF PROBLEM

When scanning implant abutments, an incomplete scan is often obtained because of a subgingival location or restricted accessibility. Whether these problems can be overcome with a novel scanning technique with digital superimposition of the custom abutment is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of the process of superimposing the custom abutment library data onto the scanned abutment data on the accuracy of the digital scan with an intraoral scanner.

MATERIAL AND METHODS

A model with a single implant was prepared. The custom abutment of the corresponding implant was produced and was scanned with a laboratory scanner to produce the custom abutment library data. The custom abutment was connected to the implant, and the model was scanned with a laboratory scanner for the reference data. The custom abutment and adjacent teeth were scanned 10 times with an intraoral scanner. Thus, 10 files were saved as the first test group (IOS). After transferring 10 files of the group IOS to a computer-aided design (CAD) software program (exocad DentalCAD), the custom abutment library data were superimposed on the corresponding abutments, and the results were saved as the second test group (S-Exo). For the third test group (S-Den), the same superimposing process was performed as for the group S-Exo but by using another CAD software program (Dental System). The accuracy of the files of the 3 test groups was evaluated by comparing them with the reference file by using a 3D inspection software program. Statistical analysis was performed with 1-way repeated measures ANOVA (α=.05).

RESULTS

The RMS of the IOS group decreased significantly from 42.1 ±1.1 μm to 36.37 ±0.74 μm for the S-Exo group and 36.89 ±0.69 μm for the S-Den group after superimposition (P<.05). InTOL increased significantly from 88.17 ±0.75% to 91.57 ±0.56% in the S-Exo group and 91.31 ±0.56% in the S-Den group (P<.05). For the mean 3D discrepancy of all 66 points along the margin and 16 points of interest, the IOS group showed significantly higher discrepancy than the superimposed groups (P<.05), implying that the accuracy of scanned data with the intraoral scanner increased after superimposition with the abutment library data. No significant difference was found according to the type of software program (P>.05).

CONCLUSIONS

The process of superimposing the titanium custom abutment with the prescanned custom abutment library data improved the accuracy of a digital scan made with an intraoral scanner.

Effect of Different Preparation Depths for an Inlay-Retained Fixed Partial Denture on the Accuracy of Different Intraoral Scanners: An In Vitro Study

PURPOSE

The aim was to evaluate the effect of different preparation depths for inlay-retained fixed partial dentures on the accuracy of intraoral scanners.

MATERIALS AND METHODS

Tooth preparations for two inlay-retained fixed partial dentures were done and divided according to depth of the preparation. Group A: 2mm pulpal floor depth, 3mm gingival floor depth and Group B: 3mm pulpal floor depth, 4mm gingival floor depth. The CEREC Omnicam4.4.4, Omnicam4.6.2. Trios3 and Medit i500 intraoral scanners were used in this study. Tooth preparations were scanned by each scanner 10 times. The STL files obtained from the intraoral scanners were compared to the reference models (trueness) and within each test group (precision) using a 3D comparison software. Data were then statistically analyzed.

RESULTS

Regarding trueness, two-way ANOVA revealed significant differences between the different types of scanners (p<0.001) (Omnicam4.4.4: 65.09 ±2.87 Omnicam4.6.1: 52.73 ±3.31 Medit i500: 58.45 ±2.63 Trios 3: 41.79 ±4.42). Preparation depth had no significant influence on the trueness (p = 0.083). For precision two-way ANOVA revealed significant differences between the different types of scanners (p<0.001). Preparation depth had no significant influence on the precision (p = 0.111). Statistically significant interactions were found between the different variables.

CONCLUSIONS

The depth of preparation did not have an influence on the accuracy of different scanners. However, the type of scanner influenced the accuracy of digital impressions with Trios3 showing the highest accuracy. This article is protected by copyright. All rights reserved.

A Comparison of Accuracy of Different Dental Restorative Materials between Intraoral Scanning and Conventional Impression-Taking: An In Vitro Study

The properties of underlying substrates influence the quality of an intraoral scan, but few studies have compared the outcomes using common restorative materials. In this study, we aimed to compare the accuracy of digital and conventional impressions recorded for four different dental materials as the substrates. Experimental crowns were produced with a metallic surface (gold or cobalt-chromium alloy (Co-Cr)) or without a metallic surface (zirconia or PMMA (polymethyl methacrylate)). A conventional impression was made in the conventional group (CON group), and gypsum models were subsequently scanned with a tabletop scanner. An intraoral scanner was used to scan the crowns either after applying a powder spray to reduce the surface reflectivity (IOS-P group) or without the powder spray (IOS group). The scans were assessed in three dimensions for precision and trueness. The accuracy did not differ between the CON and IOS groups for the non-metallic crowns. However, it was statistically different for the Co-Cr metallic crown, reducing trueness observed between groups as CON > IOS > IOS-P. The study evidences the differences in outer surface accuracy observed with a change in the substrate material to be imaged using an oral scanner and with the impression method. These findings suggest that the restoration material present in the oral cavity should be considered when selecting an impression-taking method.