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Dental impressions using 3D digital scanners: virtual becomes reality

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Abstract

The technologies that have made the use of three-dimensional (3D) digital scanners an integral part of many industries for decades have been improved and refined for application to dentistry. Since the introduction of the first dental impressioning digital scanner in the 1980s, development engineers at a number of companies have enhanced the technologies and created in-office scanners that are increasingly user-friendly and able to produce precisely fitting dental restorations. These systems are capable of capturing 3D virtual images of tooth preparations, from which restorations may be fabricated directly (ie, CAD/CAM systems) or fabricated indirectly (ie, dedicated impression scanning systems for the creation of accurate master models). The use of these products is increasing rapidly around the world and presents a paradigm shift in the way in which dental impressions are made. Several of the leading 3D dental digital scanning systems are presented and discussed in this article.
... The most critical step in the process of fabricating precisely fitting fixed or removable dental prostheses is the capture of an accurate impression of prepared or unprepared teeth, dental implants, edentulous ridges, or intraoral landmarks or defects. [1] They help in diagnosis, treatment planning, and fabrication of restorations. [2] The advent of highly innovative and accurate impression systems based on new technologies has created a paradigm shift in the concept of impression making. ...
... [2] The advent of highly innovative and accurate impression systems based on new technologies has created a paradigm shift in the concept of impression making. [1] The advancement in the field of computer technology and the development of computeraided design/computer-aided manufacture (CAD/CAM) in the engineering field helped us to develop CAD/CAM for dental use. [3] Digital intraoral imaging represents an innovative method that enables the dentist to construct a virtual computer-generated copy of the hard and soft tissues with the use of lasers and other optical scanning machines. ...
... The CAD/CAM dental systems that are currently available are able to feed data obtained from accurate digital scans of teeth directly into milling systems capable of carving restorations out of ceramic or composite resin blocks without the need for a physical replica of the prepared, adjacent, and opposing teeth. [1] Principles Behind 3D Surface Imaging [13] 3D surface scanners are devices that create a digital map of the surface of an object and collect data on its three-dimensional shape and size. The raw data are usually obtained in the form of a point cloud, representing the 3D coordinates of the digitized surface. ...
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Digital techniques in dentistry offer a fully digital computerized workflow that does not include the standard multiple traditional phases. Digital imprint and computer-aided design/computer-aided manufacturing systems offer a wide range of benefits compared to traditional techniques. The introduction of intraoral scanners has radically changed the way in which the dentists approach the restorative workflow. The constant evolution of the hardware and software in relation to this has made a digital end-to-end restorative solutions a reality. Precision, accuracy, and hassle-free procedures have made these systems user-friendly and patient-friendly. There are many advantages in using this advanced technology.
... Agar was the first recorded elastic impression material that was used for the rehabilitation of prepared teeth by Dr. Sears in 1937(Sears 1937. After the introduction of hydrocolloids, the poor dimensional stability became the greatest drawback of these materials and an alternative was mandatory (Birnbaum und Aaronson 2008). In the late 1950s, rubber-based polysulfide impression materials were introduced. ...
... Despite the longtime, everyday use of VPSs and polyethers, as well as the promising arrival of VSEs, many drawbacks still exist. From a technical perspective, potential mistakes during material mixing, improper impression tray selection, separation of impression material from the tray and distortion of impression before pouring lead to poor results (Birnbaum und Aaronson 2008;Christensen 2008;Stein 2011). It is considered that less than 50% of conventional impressions sufficiently reproduce the preparation margins (Christensen 2005;Christensen 2009). ...
... It is considered that less than 50% of conventional impressions sufficiently reproduce the preparation margins (Christensen 2005;Christensen 2009). Concerning the conditions during transfer of conventional impressions from the practice to the laboratory, the variable temperature and humidity levels can affect the correctness of the impression (Birnbaum und Aaronson 2008). ...
Thesis
The purpose of this in vitro study was to evaluate the time efficiency of computer aided impression making procedure among various digital intraoral scanning systems. Furthermore, a comparison of time efficiency between the digital and conventional impression making method was conducted. Three different intraoral scanners (iTero, LAVA C.O.S. and CEREC AC BlueCam) were used to digitize a single abutment, a 3-unit fixed dental prosthesis and a full-arch prosthesis preparation in corresponding clinical scenarios. The procedure durations were also calculated for three conventional elastomeric impression materials (Affinis, Impregum, Identium) with regard to the same case scenarios. A repeated measures analysis of variance (ANOVA) was used separately for each of three different case scenarios to reveal statistically significant differences among the intraoral scanners and time frames (abutment scan time, intraoral time, total time). The predetermined time durations of the conventional impression-making process were not taken into account for the statistical analysis. The most time efficient device in terms of single abutment scenario and overall time segments was the CEREC AC BlueCam with mean total time 4 minutes 16 seconds (SD 4.2 seconds). The foot pedal variant of the same IOS performed faster with regard to the second clinical scenario, achieving a mean total time 5 minutes and 2 seconds (SD 11.4 seconds). CEREC AC BlueCam was the fastest device regarding abutment scan time and intraoral time as well, with the automatic capturing mode though. For the full-arch scenario, in total time LAVA C.O.S. was the fastest device with mean total time 17 minutes and 20 seconds (SD 29.4 seconds), while in abutment scan and intraoral time iTero was the most time efficient system. Statistically significant differences with regard to total time were revealed between all systems except LAVA C.O.S. and iTero FP for case scenario 1, CEREC AC BlueCam and CEREC AC BlueCam FP as well as iTero and iTero FP for clinical scenario 2. The compiled procedure durations of the conventional impression making method ranged between 18 minutes, 15 seconds and 27 minutes, 25 seconds with respect to scenarios 1 & 2, while 21 minutes, 25 seconds and 30 minutes, 25 seconds for the full-arch scenario. Contrasting the mean times of the digital approach with the time compilations of the conventional workflow, it was found that CAIM was faster in terms of all case scenarios and time frames.
... The CAD/CAM concept in dentistry was given by Dr. Duret in 1973 in Lyon, France and developed further by Dr. Mormann, and Mr. Brandestini [2]. CEREC was the first digital impression system commercially available. ...
... CEREC System CEREC 1 system CAD/CAM system was introduced first in the market in 1987 for making digital impression intraorally, together with the Duret system as the device [11]. The concept of "triangulation of light," was used in designing, where a focus on a definite point in 3D space is based on the meeting of three linear light beams [2]. CEREC AC Bluecam is the fourth generation product and is currently the most popular CEREC system. ...
... Storage of conventional models require additional office space, may even break or chip when physically stored, whereas digital scans can be stored on hard disks indefinitely. The most significant advantage for dentist and dental lab technicians in using digital technology is the elimination of many lab procedures like pouring cast and base, need to use investment materials and die materials, and shrinkage of conventional ceramic materials [2]. ...
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Digital technologies have advanced rapidly in the last few years. New technological innovations have emerged in dentistry, resulting in clinical procedures becoming easier for the clinician, and more precise. As technology advances, the up-gradation of earlier versions is also evolving. Intraoral scanners have a broad application in Prosthodontics and have gained a lot of popularity since its introduction. This article provides an insight into clinical applications of digital impression in Prosthodontics.
... (17) When considering the purchase of a new system, a practising dentist must understand the learning curve of digital impressions and the scanner's applicability. (17) According to Birnbaum and Aaronson (18) , users of digital intraoral scanners would need time and education to learn new skills to provide a quick and reliable restoration with the best fit. The learning process is reflected in the decrease in the time required to take digital impressions and the number of virtual model images. ...
... They believe that learning intraoral scanning will be just as difficult for a student or newly graduated dentist as traditional impression taking. (18) Investigating how intraoral scanners are used is a critical step in integrating them into daily clinical practice. ...
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Background: The objective of this study was to investigate the experience of Saudi dental practitioners with intraoral scanners, investigate the current knowledge and improve the practice accordingly. Methods: At random, electronic surveys were distributed to Saudi dental practitioners. The study received 400 questionnaires, with 310 judged valid for the study. The questionnaire was divided into the following sections: (i) Practitioners' demographic information such as gender, practice level, and practice experience. (ii) Experience and benefits of intraoral scanners. (iii) Require skills and training of IOS. (iv) Knowledge of IOS usage. Descriptive statistics such as numbers and percentages were used to analyze the collected data. The Chi-square and Fisher's Exact tests were used to assess the results. Results: There were 161 women (51.8%) and 149 men among the participants (47.9%). General practitioners (198, or 63.7%) had the most subjects, followed by specialists (80, or 25.7%) and consultants (32, or 10.3%). In terms of IOS use in dental practice, most participants (70.6%) do not use it, while less than one-third do. The majority of participants (52.3%) intend to purchase IOS with significant variations based on gender, experience, and level of practice (p<0.05). Compared to traditional, most participants believe that IOS will eventually replace it, improve quality, and be more aesthetically pleasing. Most dentists believe that using IOS requires special skills and training. More than half of dentists believe IOSs have the same level of accuracy as conventional in producing three units FPDs, implant prosthesis, and complete denture. Conclusion: It can be concluded that dentists have a high level of satisfaction and a favorable attitude toward using IOS technology in clinical dentistry practice.
... The increased occlusal gap compared to other surfaces has been reported by several studies irrespective of the fabrication method employed. [32][33][34][35] This result could be attributed to the more complex occlusal anatomic design, the possibility of more interferences in the occlusal surface according to computer milling mechanism, or intensified effects of axial/marginal interferences in occlusal section of the restoration. 32, 33 When it comes to conventional impression and cast pouring, all these factors might play a more relevant role, since the dimensional changes of conventional materials will affect the restoration adaptation. ...
... The same wide range was also shown in the Coli et al., 38 and Kokubo et al., 34 studies. 35 This result emphasizes the importance of attention to the insertion accuracy in clinical practice. ...
Article
Purpose: Two important factors in dental prosthesis are making an accurate impression and producing a suitable cast which represents the exact relationship between prepared tooth and oral structures. This study, aimed to investigate the effects of different combinations of impression and pouring materials on marginal and internal adaptation of premolar zirconia crowns. Material and Methods: Forty maxillary premolars were prepared considering round shoulder finish line. The impressions were made either by additional (Panasil) or condensation (Speedex) silicon, and poured by two different types of gypsum materials (Siladent or GC gypsum) (N=10). Zirconia crowns were fabricated using a CAD-CAM system. The crowns were cemented, and the samples were cut in bucco-lingual direction. Marginal and internal gaps were measured by stereomicroscope (×25). Results: The mean marginal gaps for Pansil-Siladent, Panasil-GC, Speedex-Siladent, and Speedex-GC were 141 μm, 143 μm, 131 μm, and 137 μm respectively. The internal gaps were 334 μm, 292 μm, 278 μm, and 257 μm respectively. The independent T-Student test showed no significant differences in average marginal or internal gap among various impression and gypsum materials or their interactions (p>0.05). Two-way ANOVA test showed no significant differences in maximum marginal or internal gap among various impression and gypsum materials and their interactions (p>0.05). Conclusion: The present study revealed no statistically significant difference in marginal/internal gap among crowns prepared using different combinations of impression-pouring materials evaluated.
... Although the elastomeric materials have great stability properties, when performed in studies and clinical practice, several flaws and errors can occur in the prostheses confection by the analog workflow. Such errors can be associated with the clinical phase, such as inadequate preparations impressions; and also with the laboratory phase, as in the impression disinfection, pouring the plaster cast, and the transportation of the work between the dental office and the dental laboratory, which can generate inaccuracies [18][19][20]. ...
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Digital dentistry has gained space in several dental specialties. It is possible to achieve excellent results with the digital workflow, which combines the efficiency of the restorative material with a greater marginal adaptation. This study aimed to report a clinical case through the digital workflow, with a faster and clinically acceptable prosthetic resolution. In this clinical case report, digital workflow allowed a faster and clinically acceptable prosthetic resolution. A 45-year-old female patient reported cementation failure of the prosthetic crown on tooth 14. As it was a vital tooth, the tooth received a total crown preparation. In the same clinical session, the patient's mouth was scanned then a capture software obtained a virtual model. After, the design software planned a digital "diagnostic wax-up", so a leucitic ceramic was chosen for the rehabilitation. The ceramic block was milled and receive stain and glaze, dispensing the prosthesis laboratory. Then, the adhesive cementation was performed with a dual-polymerized resin cement. The final crown had ideal adaptation, with no need for interproximal and occlusal adjustments, with an excellent marginal fit. Within the limitations of this study, this case report showed that the digital workflow allowed a favorable result in a shorter working time, which brought back function and aesthetics, without the need for interproximal and occlusal adjustments. Keywords Prosthodontics; Cosmetic dentistry; CAD-CAM.
... Moreover, the system can effectively formulate a buccal image by combining the mandibular and maxillary aspects of the captured images. 16 ...
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The accuracy of the intraoral digital impression systems has been previously reported to refer to the quality of the obtained data from the related scanning procedures, irrespective of the quality of the clinical outcomes and the estimated costs. Trueness and precision have been frequently found among studies in the literature as two terms describing the accuracy of the intraoral digital impression systems. Various digital impression modalities have been proposed among studies in the literature and were investigated for estimation of their accuracy. The paper aims to review and discuss the most common literature regarding the current common systems and their accuracy among the different studies in the literature. According to the results, Chairside Economical Restoration of Esthetic Ceramic (CEREC) systems appear to have the highest estimated rates of trueness and precision as compared to the other modalities while the iTero system appears to have the lowest estimated rates. However, some studies have reported contradicting results and the current evidence is mainly based on findings from in vitro investigations. Accordingly, further studies might be needed for further validation of the current evidence and strengthening the quality of the future potential implications for clinicians.
Article
Introduction The purpose of this study was to analyze any posttreatment changes in the positions of mandibular anterior teeth retained by 2 different fixed retention methods (rigid or flexible) and their effectiveness in minimizing postorthodontic tooth movement. Methods Thirty patients were selected for inclusion in this retrospective study. Group I consisted of 15 patients with 0.032-in stainless steel rigid retainers bonded to canines only. Group II consisted of 15 patients with 0.0215-in twisted stainless steel flexible retainer bonded to all mandibular anterior teeth. Geomagic Control (3DS Systems, Rock Hill, SC) software was used to quantify the changes between selected points. Paired t test was used for intragroup comparisons in all 3 coordinates, and an independent-sample t test was used for intergroup comparison. Results In the transverse dimension, significant intergroup differences were found in displacements of distoincisal points of the right lateral (P <0.05) and left central incisors (P <0.01). In the sagittal dimension, significant intergroup differences were found in the displacements of mesioincisal point of the right central incisor (P <0.05) and distoincisal point of the left central incisor (P <0.01). Examining total displacement, there were significant intergroup differences in mesioincisal point on the right central incisor, distoincisal point on the left lateral incisor (P <0.05). Conclusions Our results suggested that central incisor contacts were more likely to shift with the rigid retainers, especially in sagittal and transverse dimensions. However, no statistically or clinically significant changes were noted in the third-order or vertical positions of the teeth with either retention method.
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Subject. The role of vitamin D in maintaining oral health. Objectives. To review literature on the role of vitamin D in maintaining oral health. Methodology. This literature review is based on analysis of published research reports on effects of vitamin D on oral health. Using key words, research studies published in the past five years with the most comprehensive explanations of the role of vitamin D and its metabolites in the body are selected on such e-resources as PubMed, Medline, Cochrane, Elibrary, Cyberleninka. The data on secosteroid epidemiology, synthesis, metabolism, physiological effects, local effects on immune function and specific symptoms in various somatic disorders are systemized. Conclusion. Epidemiological and genetic studies confirm biological effects of vitamin D active metabolites involved in synthesis of proteins required to form oral mucosal stability and prevent pathogen penetration into subjacent tissues. The most significant is involvement of vitamin D in synthesis of antibacterial monocyte and macrophage-directed peptides ensuring reduction of risks of alveolar resorption and subsequent tooth loss. Modern concepts in this secosteroid refer to the new evidence showing availability of vitamin D activating ferment in tissues which supports intracellular or paracrine function of vitamin D out of the skeleton. The personified approach for vitamin D application as a therapeutic drug for treatment of periodontium inflammations and oral mucosa with preliminary testing of levels in blood serum will allow to develop effective approaches to maintaining people’s oral health.
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Subject. Modern digital technologies make it possible to automate the process of creating bridges to a large extent. First, digital images of the patient's dentition are obtained, then the future prosthesis is virtually modeled and manufactured using a subtractive method using milling and grinding machines or an additive method using a 3D printer. For clinical evaluation of the quality of orthopedic fixed structures made using digital methods, it is necessary to evaluate their dimensional accuracy. The aim is to conduct a comparative assessment of the dimensional accuracy of bridge prosthesis frames made using modern digital technologies and traditional casting method. Methodology. The intraoral laser scanner iTero Cadent, the 3D printer Asiga Max UV, the CAD/CAM system KaVo ARCTICA, the software DentalCAD 2.2 Valletta and the computer program MeshLab were used to study the dimensional accuracy of the bridge frames. The Kruskal-Wallis H-test and the Mann-Whitney U-test were used for statistical analysis of the data obtained. Results. All digital methods of manufacturing bridge frames are distinguishable from the traditional casting method with a significance level of p<0.05 on the basis of dimensional accuracy. The frames of bridge prostheses made by the subtractive method have a higher dimensional accuracy compared to the frames obtained using additive technologies. There were no statistical differences in the dimensional accuracy of milled titanium and zirconium bridge frames. Conclusions. Based on the data obtained, we concluded that the bridge frames made using modern digital technologies have a higher dimensional accuracy (the average value of the median distance of milled zirconium frames is 0,03067 ± 0,001234 mm, milled titanium frames are 0,03032 ± 0,002698 mm, frames made using additive technologies are 0,03686 ± 0,003068 mm) compared to the bridge frames made by the traditional casting method (the average value of the median distance 0,04342 ± 0,003722 mm), with a significance level of p<0,05 (U-Mann-Whitney criterion =0, p=,002).
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Well-fitting indirect restorations can only be made if there are accurate models of the oral tissues available, made from high quality impressions. Waiting for an impression to set may be more stressful for the dentist than the patient. Should the impression need to be repeated there is the embarrassment of having to explain this to the patient, the cost implications of material and time wasted and the aggravation of running late for the next appointment. Yet, if a 'Nelsonian' eye is turned to a defective impression we can only expect a substandard restoration in return.
Article
Statement of problemImpressions are made using high-viscosity putty vinyl polysiloxane impression materials in conjunction with disposable plastic stock trays. The impression materials have been shown to be dimensionally stable. However, it remains unclear if the disposable plastic stock trays are rigid enough to resist deformation thus yielding potentially unreliable results.PurposeThis study evaluated the rigidity and ability to resist deformation of 6 commercially available disposable plastic stock trays and 1 metal stock tray when used in conjunction with a high-viscosity vinyl polysiloxane impression material.Material and methodsTen impressions were made with 1 putty vinyl polysiloxane material (Reprosil Putty) using each of the 6 tested disposable plastic stock trays, Sani-Trays (perforated), Sani-Trays (nonperforated), COE Disposable Spacer Tray (perforated), COE Disposable Spacer Tray (nonperforated), Bosworth Tray-Aways (perforated), Track-it Trays (perforated), and 1 metal stock tray (nonperforated), Cadco Dental Products, as a control on a mandibular plastic model. The dimensions of the tray in cross section at the mandibular right first molar area were measured before, during, and after the impression procedures with an electronic digital caliper. The cross-arch dimensions of the tray were measured at similar intervals. One examiner made all measurements and each measurement was repeatable within ±0.01 mm. A split plot repeated measures analysis of variance (ANOVA) was performed and 2-sided P-values were calculated (α=.05).ResultsThe results indicated that the disposable plastic trays tested were not sufficiently rigid to resist deformation when used with very high-viscosity putty material. Metal stock trays showed significantly less change in cross-arch dimension than plastic trays (F(1.68)=11.25, P=.001). Metal stock trays also showed significantly less change in cross-sectional arch dimension than plastic trays (F(1.68)=15.15, P<.001).ConclusionWhen disposable plastic stock trays were tested in conjunction with very high-viscosity impression materials there was distortion of the tray both across the arch and in cross section.
Article
Stents have been used in numerous medical disciplines, as well as in oral surgical procedures. Uses range from rebuilding mandibles and constructing new ureters, to keeping coronary arteries patent after angioplasty. The earliest use of the word "stent" to describe this item was in 1916, when a Dutch plastic surgeon described how he used a dental impression compound as a matrix around which to form tissue in the process of rebuilding a shattered face. What is generally unknown is that the word "stent" derives from the name of an English dentist, who invented this impression compound in 1856.