iTero Element Research Articles

The accuracy of digital scanners versus conventional impression in patients with cleft lip and palate: A cross-sectional study

Background and ObjectivesAs the use of digital models has expanded across numerous fields, the accuracy of three-dimensional images captured by various intraoral scanners has become a key research focus. This study aimed to evaluate the accuracy of digital scanners (TRIOS 4, iTero Element 5D, and E2) compared with the conventional impression method (gold standard) in patients with cleft lip and palate. Materials and MethodsImpressions were taken from 20 patients using these scanners and alginate impressions during the same session. Additionally, plaster models were created and scanned using an E2 scanner, and 50 parameters were measured using a digital caliper. All digital models were then analyzed using 3Shape software. Measurement reliability and differences among the four methods were assessed by repeated measures analysis of variance (ANOVA), followed by post-hoc analysis. Subsequently, best-fit superimposition was performed to verify the deviated areas between the digital models. ResultsThe plaster cast measurements and digital models obtained using three different scanners revealed high reliability (0.94–1.00). Statistically significant differences between the dental models were observed in 20 out of 50 parameters (p < 0.05). Mean differences in hard tissue parameters between groups ranged from −0.47 to 0.32 mm. Soft tissue parameters revealed more considerable mean differences, ranging from −1.59 to 2.55 mm. The measured palatal depth obtained from digital models was significantly higher, while the depth of the oronasal fistula was significantly lower compared to plaster models. ConclusionThis study concluded that digital scanners have accuracy comparable to conventional methods, except for depth-related soft tissue parameters, which exhibited a high level of discrepancy.

Evaluation of the accuracy of digital impressions with different scanning strategies: An in vitro study

ObjectivesTo evaluate the effects of three different scanning strategies on the trueness and precision of optical impressions obtained with four intraoral scanners (IOSs). MethodsThe reference maxillary dental arch model was fabricated using Telio CAD, and the reference digital reference cast was obtained using a computer numerical control machine and an optical scanner (E4, 3Shape, Copenhagen, Denmark). Test scans were performed with four different IOSs (TRIOS3, MEDIT i700, CS 3600, and iTero Element 5D) by an experienced operator and three different scanning strategies (S1: manufacturer-recommended, S2: optimal per previous literature, and S3: experimental). The scan duration was recorded for each scan. All scans were converted to standard tessellation language format and imported into Geomagic Control X. The accuracy was measured by absolute deviation/distance between aligned surfaces. Data of trueness and precision of each IOS and scan duration were statistically compared using analysis of variance for repeated measures and Bonferroni post-hoc test (p < .05). ResultsNo significant differences in trueness were found among strategies (S1: 9.98 µm, S2: 11.93 µm, S3: 8.84 µm; p = .388) in Trios 3 and iTero Element 5D (S1: 12.24 µm, S2: 11.53 µm, S3: 10.71 µm; p = p = .279). Scanning strategy S3 with MEDIT i700 achieved greater trueness (7.33 µm) than S2 (16.33 µm, p < .05), while no significant difference was noted between S1 (10.44 µm) and S3 (p = .291). S3 showed the highest trueness (16.28 µm) compared to S2 (24.05 µm) and S1 (24.78 µm, p < .001) for CS 3600, with no difference between S1 and S2 (p = .457). Trios 3 had higher precision with S2 (22.46 µm) than S3 (31.69 µm, p < .05), and no significant differences between S1 (25.67 µm) and S2/S3 (p > .05). MEDIT i700 with S3 (29.52 µm) was more precise than both S1 (39.52 µm) and S2 (46.24 µm) (p < .001) with no difference between the last two (p = .302). S2 yielded the highest precision (44.93 µm) compared to S3 (61.81 µm) and S1 (76.53 µm) (p < .001) for CS 3600, with S3 more precise than S1 (p < .001). Similarly, iTero Element 5D showed S2 as the most precise (30.19 µm) compared to S3 (42.80 µm) and S1 (44.45 µm) (p < .05), with no difference between S1 and S3 (p = .472).Scan durations were shorter for S3 and S1 compared to S2 in Trios 3 (p < .001), and S3 was faster than S1 and S2 for MEDIT i700 (p < .001). CS 3600 scans with S1 were quicker than S2 and S3 (p < .001). For iTero Element 5D, no significant differences were found between S1 and S3 (p = .511), but S2 was slower than both (p < .001). ConclusionsScanning strategies significantly affect the accuracy and scan duration of optical impressions. Specifically, S3 provided the best trueness with both the MEDIT i700 and the CS 3600 while the S2 strategy demonstrated the highest precision for most scanners. Overall, the S1 and S3 strategies resulted faster than S2 among the devices evaluated. Clinical SignificanceThe results suggest that the experimental scan strategy may optimize the use of intraoral scanners in clinical practice, potentially leading to more accurate and time-efficient dental impressions.

Effects of the intraoral scanner and implant library on the trueness of digital impressions in the full-arch implant scan: A comparative in vitro study

ObjectiveTo evaluate the effect of intraoral scanners (IOSs) and implant libraries (ILs) on the trueness of digital impressions for the fabrication of implant-supported full-arch (FA) prostheses. MethodsA stone cast of an edentulous maxilla with 6 implant analogues and cylindrical scanbodies (IPD ProCam®, Matarò, Barcelona, Spain) was probed using a coordinate measuring machine to capture a reference model (RM). The cast was mounted on a mannequin and scanned with 3 different IOSs (iTERO Element 5D Plus®, Align Technologies, San José, CA, USA; IS 3800®, Dexis, Quackertown, PN, USA; and i-700®, Medit, Seoul, South Korea). Ten scans were performed by an experienced operator using each IOS, first capturing only the occlusal surfaces, then the buccal and finally the palatal surfaces (less than 45 s per scan). In each scan, the meshes of the SBs were replaced by the corresponding IL file, with and without increment, to obtain the best correction for the mesh growth. The positions of the SBs in each file were compared with those in the RM, to evaluate the linear and cross distances between them. The final outcome was the trueness of the different IOSs, evaluating the effect of using different ILs on the quality of the impressions. ResultsSignificant differences were found between the different IOS scans and the RM, and among the different IOSs, in the different segments. The correction of the mesh growth through incremental ILs did not affect the final trueness of the IOS scans. ConclusionsDifferent levels of trueness were found among the IOSs evaluated, in the different scan segments, but with the cylindrical SBs used herein, the correction of the mesh growth with incremental ILs did not affect the final quality of the digital impressions. Statement of clinical relevanceThere are still errors with IOS in the FA impressions. IOS have an effect on the quality of the digital impressions, and apparently the library has not, with purely cylindrical SBs: further studies are needed to confirm this aspect.

Accuracy, Time, and Comfort of Different Intraoral Scanners: An In Vivo Comparison Study

Background: The purpose of this study was to compare the accuracy of three different intraoral scanners (IOSs) and to evaluate the patients’ experience. Methods: Thirty subjects were scanned with three different IOSs (TRIOS Color®, iTero Element 5D®, and iTero Lumina®): a sample of 90 maxillary casts was collected. The inclusion criteria were permanent dentition, absence of defects during the dental impression, and complete record of the palatal vault. After the scanning procedure, patients were asked to answer a questionnaire (10 answers, scale from 1 to 10) to compare their experiences with iTero Element and iTero Lumina in the scanning procedure. Results: Differences were recorded in the upper central incisor region (f-ratio of 4.186 for Mesiodistal 1.1 and f-ratio of 4.222 for Mesiodistal 2.1, p &lt; 0.05), while intercanine width Upper 13–23 showed the smallest f-ratio (0.226) when compared to the other results, followed by Mesiodistal 1.4 (0.433). Patients reported more comfort, less pain, decreased duration, and a better technology visualization of the impression with iTero Lumina. No significant differences concerning dryness of the mouth and gag reflex were found. Conclusions: The examined IOSs offer comparable accuracy in capturing dental arch dimensions. The interviewed patients expressed an overall preference for digital impressions performed with iTero Lumina, linked to increased comfort, painless practice, and a better technology visualization of the impression.

Accuracy of full arch scans using the iTero Element 2® intra-oral scanner: A clinical study.

To investigate the accuracy of full arch scans taken using the iTero Element 2® under clinical settings. Prospective clinical study. A customised upper removable appliance (URA) with four spheres (A-D) was fabricated from a maxillary arch iTero® scan for a 24-year-old patient. Six linear values were measured on the URA using a high-accuracy coordinate measuring machine. A total of 60 intra-oral iTero® scans were taken by two operators (HA and AS) with the test URA inserted to the participant's maxillary dentition at T1 and T2. Geomagic Control X software was used to measure the six linear distances between the reference spheres (1-4) in all scans. Comparisons between distances on full arch scans to true distances on the URA were made to evaluate accuracy. The median distance to the prepared bench top URA mean was significantly away from zero for each operator and timepoint across all measurements except AD versus 14 and BD versus 24. Statistically significant, although clinically non-significant, differences in median linear distances in relation to the prepared benchtop URA were observed between evaluators in segments AB versus 12 (operator 1 -0.021 mm vs. operator 2 -0.06 mm) and AC vs. 13 (operator 1 -0.044 mm vs. operator 2 -0.167 mm) at T1. The accuracy of scanners is defined as the trueness and precision of the captured scans to the dental arches. The accuracy of iTero Element 2® is acceptable for diagnosis and treatment planning in orthodontics. Length and location of the scanned segment and scanning sequence 'protocol' affect accuracy.

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

ObjectivesTo 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. MethodsConventional 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). ResultsDigital 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. ConclusionDental 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 SignificanceThe 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.

Evaluation of the accuracy of different digital scanning systems and intraoral scanning strategies: An in vitro study

Abstract Introduction: Differentiating between the various available digital impression systems in terms of accuracy could help in determining the most appropriate system to be used. Aim: The purpose of this in vitro study was to evaluate the accuracy of four different intraoral scanners, along with different intraoral scanning strategies (IOSs), and using the conventional impression method. Materials and Methods: A model with prepared teeth was scanned with a laboratory scanner. Following that, the model was scanned using the following four intraoral scanners (IOSs): TRIOS, CEREC AC Omnicam, Medit i700, and iTero Element 2. Three scanning strategies were used with each scanner during the intraoral scanning (C-motion, zig-zag, and wiggling strategies). Each strategy was repeated eight times resulting in 96 scans, along with eight conventional impressions. All three-dimensional test models were compared with the master model using Geomagic Control X. The master model was trimmed to isolate the teeth and was superimposed with all 104 test models. The data was statistically analyzed using the nonparametrical Kruskal–Wallis test. Results: Statistically significant differences were found when comparing all groups (the four IOSs and the conventional impression method) in terms of trueness and precision (P &lt; 0.001). For trueness, the i700 was the highest ranked IOS (35.68 ± 1.18 μm), excelling in all groups regardless of the strategy used. For precision results, the best IOS was the i700 (46.14 ± 1.43 μm) regardless of the strategy used. Conclusion: Medit’s i700 scanner exhibited better accuracy compared to the other three scanners. Meanwhile, the zig-zag strategy may provide the best scanning accuracy when used with the majority of the scanners.

Evaluation of the accuracy of seven intraoral scanners for the full dentate and partially edentulous complete-arch mandibular casts: An in vitro comparison

Statement of problemIntraoral scanners (IOSs) are widely used in dentistry, providing high accuracy in short-range scanning. Nevertheless, when scanning the full dental arch, it remains a challenge. Furthermore, there is a lack of studies reporting the differences in scan accuracy between dental arches with large-span mucosal areas and fully dentate casts or optimal IOS selection for different dental statuses. PurposeThis study aimed to evaluate the accuracy and scanning time of different IOSs for full dentate (FD) and partially edentulous (PE) casts with missing teeth in the #34–#44 range and to determine the IOSs with the optimal clinical adaptability and scanning accuracy for different complete-arch casts. Material and methodsReference scans of two complete-arch (FD and PE) casts were obtained using a laboratory scanner (Ceramill Map 600). Subsequently, the same casts were scanned ten times each by seven IOSs (3Shape Trios 3, CS3600, Planmeca Emerald, iTero Element 5D, Medit i500, BAMBOO B1, and Shining Aoralscan 3), and the scanning time was recorded. The test data were superimposed on the reference scans for the selected areas, and three-dimensional deviations between the reference and test casts (trueness), and between test casts (precision) were determined using reverse engineering software (Geomagic Wrap). The dataset was analyzed using a two-factor analysis of variance with post-hoc Bonferroni tests. ResultsTwo-factor analysis of variance revealed significant differences in accuracy and scanning time for different casts (P < 0.001) and IOSs (P < 0.001). For the FD cast, the i500 (0.35 ± 0.11 mm trueness) and CS3600 (0.23 ± 0.12 mm precision) performed worse than the remaining scanners. For the PE cast, the BAMBOO B1(0.89 ± 0.58 mm trueness; 0.88 ± 0.48 mm precision) performed worse than the remaining scanners. There were no differences in the accuracy of scanning between the Element 5D and Emerald for both cast types. However, the scanning time differed significantly between the different IOSs (P < 0.001). Regardless of the cast type, the fastest and slowest scans were performed by the Trios3 and CS3600 scanners respectively. ConclusionsThe accuracy and scanning time differed between the different IOSs and types of complete-arch casts.

Near-infrared imaging in orthodontic intraoral scanners for early interproximal caries detection

Intraoral scanners commonly used in orthodontic offices now offer near-infrared imaging (NIRI) technology, advertised as a screening tool to identify interproximal caries. This study aimed to evaluate the reliability and validity of NIRI detection of interproximal carious lesions in a common intraoral scanner (iTero Element 5D; Align Technology, San Jose, Calif) with and without bitewing radiograph complement, compared with a microcomputed tomography (micro-CT) reference standard. Extracted human posterior teeth (premolars and molars) were selected for early (noncavitated) interproximal carious lesions (n= 39) and sound control surfaces (n= 47). The teeth were scanned via micro-CT for evaluation by 2 blinded evaluators using consensus scoring. The teeth were mounted to simulate anatomic interproximal contacts and underwent a NIRI scan using iTero Element 5D and bitewing radiographs. Two trained, calibrated examiners independently evaluated (1) near-infrared images alone with clinical photograph, (2) bitewing radiograph alone with clinical photograph, and (3) near-infrared images with bitewing radiograph and clinical photograph in combination, after at least a 10-day washout period between each evaluation. Interrater reliability was highest for NIRI alone (k= 0.533) compared with bitewing radiograph alone (k= 0.176) or in combination (k= 0.256). NIRI alone showed high specificity (0.83-0.96) and moderate sensitivity (0.42-0.63) compared with a micro-CT reference standard. Dentin lesions were significantly more reliably detected than enamel lesions. After rigorous training and calibration, NIRI can be used with moderate reliability, high specificity, and moderate sensitivity to detect noncavitated interproximal carious lesions.

Comparison of Treatment Time for Single-Implant Crowns Between Digital and Conventional Workflows for Posterior Implant Restorations: A Randomized Controlled Trial.

To compare the treatment time of digital and conventional workflows for single-implant crowns, as well as prostheses made of polymer-infiltrated ceramic-network (PICN; Vita Enamic, Vita Zahnfabrik) and lithium disilicate (LS2; n!ce, Straumann). A total of 40 patients who needed a single-implant crown in posterior regions were considered and randomly divided into digital workflows (n = 20) that used an intraoral scanner (IOS; iTero Element 5D, Align Technologies) and conventional workflows (n = 20) that used polyether impressions (3M ESPE Impregum Penta). Then, each group was again distributed into two subgroups based on the crown material used: PICN (n = 10) and LS2 (n = 10). Treatment time was calculated for both digital and conventional workflows. Analysis was done at a 5% confidence interval (P < .05). An independent two-sample t test was used to compare treatment time between the groups. The Kruskal-Wallis test was used to compare clinical try-in time among subgroups. Any of the implant crowns that had to be remade in each subgroup were evaluated using the Fisher exact test. The entire process of digital and conventional workflows required 104.31 ± 20.83 and 153.48 ± 16.35 minutes, respectively. Digital workflows saved 39.2% more time than the conventional protocol for the single-implant crown treatment (P < .0001). Both digital and conventional workflow protocols can achieve a successful outcome for single-implant monolithic crowns in posterior areas. The digital protocol yielded greater timesaving over the conventional procedure in data acquisition and laboratory steps, while the time for clinical try-in and delivery were similar.

Effect of auxiliary geometric devices on the accuracy of intraoral scans in full-arch implant-supported rehabilitations: An in vitro study

ObjectivesThe aim of the present in vitro study was to evaluate the effect of a novel auxiliary geometric device (AGD) on the accuracy of full-arch scans captured with 3 different intraoral scanners (IOS). MethodsAn edentulous maxillary model with four internal connection implant replicas was scanned using 3 different IOS: iTero Element 5D (ITERO) (Align Technology, Tempe, AZ, USA), Trios 4 (TRIOS) (3Shape A/S, Copenhagen, Denmark), and Carestream 3700 (CS) (Carestream Dental, Atlanta, USA). Thirty-six scans were taken with each IOS, 18 with the AGD in place, and 18 without the AGD. A digital master model was created using an industrial optical scanner (ATOS compact Scan 5M, GOM GmbH, Braunschweig, Germany). The master and IOS models were aligned using the scan bodies as a reference area. A surface comparison was performed, and deviation labels were exported for each scan body to evaluate the linear and angular deviation. Total body, platform and angular deviations were measured. ResultsThe use of AGD resulted in a statistically significant increase of angular deviation: 0.87° (SD=0.21) in the AGD group versus 0.64° (SD=0.46) in the no AGD group (p-value=0.005). The difference between the AGD and no AGD groups was not statistically significant for total body and platform deviation values (p-value=0.051 and 0.302 respectively).Using AGD, ITERO showed a statistically significant increase in angular deviation (mean difference=-0.46 µm, p-value=0.002) and a decrease in mean platform deviation (mean difference=63.19 µm, p-value<0.001). No statistically significant differences were found for the other IOS. ConclusionsThe use of AGD did not add benefit on CS and TRIOS. On ITERO, there was an improvement in platform deviation, that was outweighed by the worsening of the angular deviation. Clinical SignificanceIn vitro data suggest that intraoral scans can be successfully used in full-arch cases. The use of AGD has no additional benefit on CS and TRIOS. On ITERO there was an improvement in platform deviation that was outweighed by the worsening of the angular deviation. Translational application to clinical practice deserves further investigation, taking into account patient-related and anatomical variables.

Evaluating Measurements: A Comparative Study of Digital and Plaster Models for Orthodontic Applications in Mixed Dentition

This study aimed to assess the accuracy of tooth widths, intermolar widths, and arch lengths acquired through two intraoral scanners, including iTero Element Plus Series (Align Technology, Santa Clara, CA, USA) and Trios 4 (3Shape, Copenhagen, Denmark), specifically on mixed dentition. A total of 30 subjects were divided into 2 groups, each undergoing both alginate impressions and intraoral scanning using either the iTero or Trios scanner. The plaster models were measured with a caliper, while the digital models were measured virtually. In the iTero group, all tooth width measurements exhibited differences compared to the plaster values, except for maxillary left lateral incisors (&lt;i&gt;p&lt;/i&gt; = 0.179), mandibular right (&lt;i&gt;p&lt;/i&gt; = 0.285), and left (&lt;i&gt;p&lt;/i&gt; = 0.073) central incisors. The Trios group did not display significant differences in any of the tooth width measurements. Intermolar width comparisons for both groups indicated differences, except for mandibular primary canine to primary canine values (&lt;i&gt;p&lt;/i&gt; = 0.426) in the iTero group. Regarding arch length, the mandibular anterior, maxillary right, and left arch lengths in the iTero group demonstrated larger caliper values than those of iTero. Conversely, in the Trios group, all parameters showed smaller caliper values, especially in upper anterior, maxillary right, mandibular right, and mandibular left arch lengths with significance (&lt;i&gt;p&lt;/i&gt; = 0.027, 0.007, 0.003, and 0.047, respectively). Despite the differences between the two groups, digital models might be clinically suitable alternatives for plaster models. Pediatric dentists should carefully assess these differences, as a comprehensive evaluation would result in precise orthodontic treatment planning and favorable outcomes for young patients with mixed dentition.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances.G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Trueness and precision of complete arch dentate digital models produced by intraoral and desktop scanners: An ex-vivo study

ObjectivesThe study aimed to compare the trueness and precision of five intraoral scanners (Emerald S, iTero Element 5D, Medit i700, Primescan, and Trios 4) and two indirect digitization techniques for both teeth and soft tissues on fresh mandibular and maxillary cadaver jaws. MethodsThe maxilla and mandible of a fully dentate cadaver were scanned by the ATOS industrial scanner to create a master model. Then, the specimens were scanned eight times by each intraoral scanner (IOS). In addition, 8 polyvinylsiloxane (PVS) impressions were made and digitized with a Medit T710 desktop scanner. Stone models were then poured and again scanned with the desktop scanner. All IOS, PVS, and stone models were compared to the master model to calculate the mean absolute surface deviation for mandibular teeth, maxillary teeth, and palate. ResultsFor mandibular teeth, the PVS trueness was only significantly better than the Medit i700 (p < 0.001) and Primescan (p < 0.05). In maxillary teeth, the PVS trueness was significantly better than all IOSs (p < 0.05–0.001); the stone trueness was significantly better than Emerald S (p < 0.01), Medit i700 (p < 0.001) and Primescan (p < 0.01). In the palate, PVS and stone trueness were significantly lower than the iTero Element 5D (p < 0.01) and Trios 4 (p < p < 0.01). Stone trueness was significantly lower than the Medit i700 (p < 0.05). The precision in the palate was significantly lower for PVS and stone than for Emerald S (p < 0.01, p < 0.05), iTero Element 5D (p < 0.01, p < 0.01), Primescan (p < 0.001, p < 0.001), and Trios 4 (p < 0.001, p < 0.01). Significant differences in trueness between the IOSs were observed only in the mandibular teeth. The Medit i700 performed worse than Emerald S (p < 0.01) and iTero Element 5D (p < 0.01). For mandibular teeth, the Medit i700 was significantly more precise than Primescan (p < 0.01) and the Emerald S (p < 0.05). The Trios 4 was significantly less precise than Emerald S (p < 0.05). The precision of Medit i700 was significantly worse than iTero Element 5D (p < 0.01) for maxillary teeth, as well as the Primescan (p < 0.01) and Trios 4 (p < 0.05) for the palate. ConclusionsIn general, indirectly digitized models from PVS impressions had higher trueness than IOS for maxillary teeth; precision between the two methods was similar. IOS was more accurate for palatal tissues. The differences in trueness and precision for mandibular teeth between the various techniques were negligible. Clinical significanceAll investigated IOSs and indirect digitization could be used for complete arch scanning in mandibular and maxillary dentate arches. However, direct optical digitization is preferable for the palate due to the low accuracy of physical impression techniques for soft tissues.

Influence of interdental spaces and the palate on the accuracy of maxillary scans acquired using different intraoral scanners.

To assess the influence of interdental spaces and scanning the palate on the accuracy of maxillary scans acquired using three intraoral scanners (IOSs). A virtual completely dentate maxillary cast without interdental spaces was obtained and modified to create 1, 2, and 3mm of interdental spacing between the anterior teeth. These three files (reference standard tessellation language files) were used to print three reference casts. The reference casts were scanned using three IOSs: TRIOS4, iTero Element 5D, and Aoralscan2. Three groups were created based on the interdental spaces: 0, 1, 2, and 3mm (n = 10). The groups were subdivided into two subgroups: no palate (NP subgroup) and palate (P subgroup). The reference STL files were used to measure the discrepancy with the experimental scans by calculating the root mean square (RMS) error. Three-way analysis of variance (ANOVA) and post hoc Tukey pairwise comparison tests were used to analyze trueness. The Levene test was used to analyze precision (α = 0.05). Trueness ranged from 91 to 139μm and precision ranged from 5 to 23μm among the subgroups tested. A significant correlation was found between IOS*group (p<0.001) and IOS*subgroup ( p<0.001). Tukey test showed significant trueness differences among the interdental spaces tested (p<0.001). The 1- and 2-mm groups obtained better trueness than the 0- and 3-mm groups (p<0.001). An 11μm mean trueness discrepancy was measured among the different interdental space groups tested. The P subgroups demonstrated significantly higher trueness when compared to the NP subgroups (p<0.001). The discrepancy between the maxillary scans with and without the palate was 4μm. Significant precision discrepancies were found (p = 0.008), with the iTero group showing the lowest precision. Interdental spaces and incorporation of the palate on maxillary intraoral scans influenced trueness and precision of the three IOSs tested. However, the scanning discrepancy measured may be of no clinical relevance.

Comparison of Two Different Intraoral Scanners for Determination of Caries Related Volume Loss in Caries Removal

Objective: The study aimed to compare cavity volume data obtained with two different intraoral scanners. Methods: One hundred extracted molar teeth were divided into groups according to ICDAS-II classification, and scanned with Cerec Omnicam (Dentsply Sirona) and iTero Element Flex (Align Technology). The caries-infected tissues were removed regarding either minimally invasive or conventional cavity principles. Samples were scanned again and volumetric data were assessed by Meshmixer 3.5 (Autodesk) 3D modeling software. Statistical evaluations were performed with Mann Whitney U test and Spearman’s Correlation test. The significance level was α=0.05. Results: Although there was a significant difference between obtained initial volume readings of two scanners for 3M and 3C groups (p &lt; 0.05), no significant difference was observed among other groups (p ≥ 0.05). Regarding the comparison of final volume readings of two scanners, a significant difference was found for 5M group (p = 0.036), whereas no significant difference was observed for other groups (p ≥ 0.05). Percentage of volume loss between two scanners was statistically similar (p ≥ 0.05). Conclusion: Data obtained with Cerec Omnicam and iTero Element Flex were compatible with volumetric assessments. Both intraoral scanners may be considered effective for calculating caries-related cavity volumes. Minimally invasive cavity principles may provide less volume loss compared to conventional cavity principles.

Accuracy of different digital acquisition methods in complete arch implant-supported prostheses: An in vitro study

Statement of problemDigital methods such as intraoral scanners for recording the location of implants supporting complete arch prostheses have limitations. Photogrammetry devices should be able to digitize implant positions accurately, but standardized comparisons between different digital acquisition methods are lacking. PurposeThe purpose of this in vitro study was to compare the repeatability of different digital acquisition methods for complete arch prostheses supported by 6 and 4 implants. Material and methodsA master cast was created with 6 and 4 dental implants with multiunit abutments to obtain the master digital casts. The evaluated devices were the industrial high-resolution 12-megapixel scanner (reference) Atos Compact Scan 12M (GOM), the laboratory scanners D2000 (3Shape A/S) and S900 Arti (Zirkonzahn), the photogrammetry devices iCam (iMetric4D) and PIC (PIC Dental), and the intraoral scanners TRIOS 3 (3Shape A/S) and iTero Element 5D (Align Technology). The resulting files were imported to a computer-aided design software program (exocad GmbH) to obtain the implant replicas as standard tessellation language (STL) files. These files were imported into a software program (Geomagic Control X) and superimposed per group through the best-fit algorithm to determine repeatability, defined as the closeness of agreement between each group’s scanned results as root mean square (RMS) values. The normality of distribution was tested by the Shapiro-Wilk normality test, and the Kruskal-Wallis test with adjustment with the Bonferroni correction method was used accordingly (α=.05). ResultsThe repeatability means and 95% confidence intervals for the 4 implant scans were: 1.07 µm (0.86; 1.29) for GOM, 2.05 µm (1.89; 2.21) for D2000, 3.61 µm (3.23; 3.99) for S900, 7.01 µm (6.11; 7.91) for iCam, 5.18 µm (4.6; 5.76) for PIC, 20.52 µm (18.33; 22.72) for TRIOS 3, and 20.5 µm (17.37; 23.63) for iTero. Statistically significant differences were found between devices, except for iCam versus PIC, GOM versus S900, iCam versus D2000, PIC versus D2000, and TRIOS 3 versus iTero. The repeatability means and 95% confidence intervals for the 6 implant groups were: 1.36 µm (1.08; 1.65) for GOM, 3.17 µm (3.01; 3.33) for D2000, 2.15 µm (2.04; 2.25) for S900, 8.67 µm (8.06; 9.28) for iCam, 13.88 µm (12.62; 15.14) for PIC, 40.32 µm (36.29; 44.36) for TRIOS 3, and 38.86 µm (34.01; 43.71) for iTero. Statistically significant differences were detected between devices, except for S900 versus GOM, PIC versus iCam, and iTero versus TRIOS 3. ConclusionsThe results suggest that photogrammetry could be a suitable alternative for recording implant locations of complete arch prostheses supported by 4 or 6 implants, with better repeatability than intraoral scanners. Increasing the number of implants decreased the repeatability of every device tested except the laboratory scanners.

Effect of splinting scan bodies on the trueness of complete arch digital implant scans with 5 different intraoral scanners

Statement of problemThe absence of fixed reference points can affect the trueness of complete arch intraoral digital implant scans. The effect of splinting intraoral scan bodies (ISBs) or the inclusion of artificial landmarks (AL) on the trueness of complete arch digital implant scans is still unclear. PurposeThe purpose of this study was to analyze the effect of splinting ISBs or the inclusion of AL on the trueness of complete arch digital implant scans with 5 intraoral scanners (IOSs). Material and methodsSix tissue-level dental implants (Straumann Tissue Level) were placed in an edentulous patient, and the correspondent definitive cast was digitized with a desktop scanner (IScan4D LS3i) to obtain the reference digital cast. Digital scans (n=10) were performed with 5 IOSs: TRIOS 4, Virtuo Vivo, Medit i700, iTero Element 5D, and Cerec Primescan. Three different scanning techniques were evaluated: conventional (cIOSs), splinted (sIOSs), and AL (AL-IOSs). The scan data obtained were imported into a metrology software program and superimposed to the reference digital cast by using a best-fit algorithm. The overall deviations of the positions of the ISBs were evaluated by using the root-mean-square (RMS) error (α=.05). ResultsThe mean ±standard deviation trueness values for the cIOSs, sIOSs, and AL-IOSs groups were 48 ±8 µm, 53 ±7 µm, and 49 ±11 µm, respectively, with no statistically significant differences (P=.06). Significant differences were found for the IOSs used with each technique (P<.001). Primescan (27 ±4 µm cIOSs; 28 ±3 µm sIOSs; 31 ±3 µm AL-IOSs) showed significantly higher trueness than iTero 5D (47 ±5 µm cIOSs; 47 ±4 µm sIOSs; 50 ±6 µm AL-IOSs) (P=.002) and TRIOS 4 (93 ±18 µm cIOSs; 76 ±18 µm sIOSs; 107 ±13 µm AL-IOSs) (P=.001) for all techniques. In addition, no significant differences were found between the techniques by using iTero 5D or Primescan (P=.348 and P=.059, respectively). ConclusionsThe cIOSs, sIOSs, and AL-IOSs techniques showed similar trueness. The IOS used influenced the trueness of complete arch digital implant scans.

Comparison of the accuracy between full-arch digital scans and scannable impression materials: an in vitro study.

In some clinical cases, full-arch impression could be difficult to take correctly with the digital way. Patients with high flow salivary rate or with difficulties in mouth opening can still benefit from a conventional impression with elastomer materials that can be directly or indirectly digitized. The aim of this study was to compare the accuracy and precision of two different intraoral scanners (IOSs) and an impression material with scannable properties, by means of three-dimensional analysis of a complete dental arch. An anatomical model of complete upper arch, modified with a Scan body placed in the retroincisive area, was used. It was firstly scanned by a desktop scanner to create a digital reference model. Then, 3 groups were created, each constituted by 5 samples. In the first group, 5 impressions were taken from the same master model with the scannable PVS material (Hydrorise Implant), 5 scans were taken using Trios4 (3Shape) and other 5 scans with iTero Element 5D (iTero). STL files obtained from IOSs, and scanned impressions were three-dimensionally superimposed on the STL file of the reference model using the Scan body geometry. The ANOVA Test (P<0.005) did not show any statistically significant difference between the accuracy and precision values of the groups. Each group shows clinically acceptable deviations from the reference model. Scannable polyvinylsiloxane impression materials are equally accurate and precise as the two IOSs tested in full-arch dentate impressions.

In-vivo evaluation of Artificial Intelligence Driven Remote Monitoring technology for tracking tooth movement and reconstruction of 3-dimensional digital models during orthodontic treatment

An in-vivo evaluation of the Dental Monitoring (DM; Paris, France) Artificial Intelligence Driven Remote Monitoring technology was conducted in an active clinical setting. Our objectives were to compare the accuracy and validity of the 3-dimensional (3D) digital models remotely generated from the DM application to 3D Digital Models generated from the iTero Element 5D intraoral scanner (Align Technologies, San Jose, Calif) of patients' dentition during in-vivo fixed orthodontic treatment. The orthodontic treatment of 24 patients (aged 14-55 years) was tracked across an average of 13.4 months. Scans of the maxillary and mandibular arches of each patient were taken by an iTero intraoral scanner and with the DM application before treatment initiation without (T0) and with (T1) the fixed orthodontic appliances and at every in-person adjustment appointment (T2-T10). The global deviation between the reconstructed digital models from the DM and iTero scans was compared at each time point using Geomagic Control-X 2020 (3D Systems, Rock Hill, SC). Descriptive analysis was conducted to determine the mean deviation at each time point for the maxillary and mandibular arches, to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm and the paired mean of the average at each time point between the maxilla and mandible. The findings revealed no clinically significant difference between the reconstructed digital models generated by the iTero IOS and the remotely reconstructed digital dental models generated by the DM application. DM artificial intelligence tracking algorithm can track tooth movement and reconstruct 3D digital models to a clinically acceptable degree for orthodontic application.