Background: Digital impressions are becoming increasingly favored among dentists and dental technicians in Sweden. The knowledge about the use of digital impression techniques is important to improve the clinical work for dentists and dental technicians. However, the conventional impression techniques are still widely used although the digital impression techniques have become more preferred nowadays. Aim: The aim of this survey study was to investigate the use of digital impressions among dentists and dental technicians in Sweden. Pros and cons with the digital impression techniques were investigated as well as the areas in which it is used.  Method: Questionnaires were sent by post to dentists and dental technicians with different questions suited to each profession. The questionnaires were distributed to four regions representing the southern, western, eastern, and northern parts of the country. The questions contained information about the use of digital impressions.   Results: Fixed prosthodontics and the production of mouth guards are areas in which the digital impression techniques are most frequently used. Dentists believed that precision, time saving impression procedure and patient comfort were the greatest advantages with the digital impression techniques. Dental technicians thought that time, cost, possibility to reuse digital impressions and the minimization of the sources of error were the greatest advantages with the digital impression techniques.    Conclusions: The digital impression techniques are widely used among dentists and dental technicians, specifically within fixed prosthodontics and the production of mouth guards.

OBJECTIVES: The purpose of this in vitro study is to measure and compare the accuracy of the conventional impression, the intraoral scanner, and the photogrammetry techniques for full-arch implant-supported dental prostheses at the abutment level. METHODS: An edentulous maxillary master model containing 6 implant abutment replicas (RP analog for screw-retained abutment straight from NobelReplace® Multi-unit Abutment Plus Replica) was fabricated. A reference STL of the master model was obtained using a desktop scanner (inEos X5, Dentsply Sirona) with high trueness and precision and served as the control STL. Three impression techniques were performed: the intraoral scanning (IOS) group (TRIOS 3 Battery Cart, 3Shape A/S), the photogrammetry (PTG) group (ICam 4D Generation 3, Imetric), and the conventional (CNV) group. Ten impressions from each group were tested. Scan bodies in each STL file acquired from the different impression techniques were converted to implant abutment replicas using a digital library. Three tests were completed to compare the different registration techniques. A 3D deviation test between the experimental group and the reference was done on an inspection software (IScan4D Dental Version 9.1.104; Imetric) using a “best fit” algorithm to obtain the root mean square values, and on another inspection software (IScan3D Dental Version 9.1.104; Imetric) using spatial similarity transformation. The second test was meant to assess the angular deviations of the implant abutment replicas using a reverse engineering software (Geomagic Control X 2020.1; 3D Systems). The final test for cross-arch distances was done on an inspection software (IScan3D Dental Version 9.1.104; Imetric) which allows to determine the 3-dimensional coordinates for each implant by using the origin point and compare the cross-arch distance deviations as well as deviations at the x-, y-, and z- coordination. Trueness and precision were the two parameters used to define the accuracy of a system. The term "trueness" was used to see how close the measurements from the experimental files of each group were to those of the reference file. The term "precision" was defined as to see how close the measurements of each experimental files were to each other within the same group. The 3D discrepancies were then calculated and the trueness and precision of the three impression techniques were assessed and compared statistically (α = 0.05). RESULTS: The root mean square of 3D deviation values through the ICP “best-fit” method showed statistically significant differences between the PTG and CNV group (p < .0001), and the PTG and IOS group (p < .0001). The CNV and IOS group did not show statistically significant differences (p = 0.8626) through the “best-fit” method, but significant differences were observed via the “spatial similarity” method (p = 0.0041). Both methods however showed the best results in terms of trueness for the PTG group, followed by the CNV group and least the IOS group. In terms of precision, PTG showed the best results, followed by the IOS group and least the CNV group. The angular deviation test using the “best-fit” alignment method showed that the PTG and CNV had no statistically significant difference (p = 0.7955) and were equivalent. However, both showed a statistically significant difference to the IOS group (p < .0001), which had the highest angular deviation. Finally, in terms of cross-arch distances, the photogrammetry group showed optimal results followed by the IOS group and then the CNV group. In general, the shorter the inter-arch distance, the lower the deviation was. A larger deviation was observed on longer inter-arch distances. Considering the deviations on the 3 axes of each implant, the CNV technique had the highest deviation in the X-axis (longitudinal) and the IOS technique showed the highest deviation on the Y-axis (lateral) and Z-axis (vertical). The PTG technique experienced significantly less deviation on the X-axis, Y-axis, and the Z-axis. CONCLUSION: Within the scope of this study, the photogrammetry technique reported the best accuracy in terms of trueness and precision of implant positions for complete-arch implant rehabilitation. Conventional impressions showed better accuracy results than intraoral scanning in the 3D deviations test and global angular deviation test, however the latter exhibited better results in terms of accuracy in terms of cross-arch distances test. / 2023-08-11T00:00:00Z

Durch den Einsatz von CAD/CAM-Technologien sollen potenzielle Fehlerquellen der handwerklich-manuellen Herstellung zahnmedizinischprothetischer Restaurationen eliminiert werden. Grundlage für die Fertigung einer prothetischen Restauration mittels CAD/CAM ist eine möglichst genaue Digitalisierung der klinischen Situation. In dieser Studie wurde die Genauigkeit der digitalen Erfassung von Zähnen unter experimentellen sowie unter klinischen Bedingungen mit dem CEREC-3D® System (intraoral) im Vergleich zu konventioneller Abformung und Modellerstellung mit anschließender extraoraler Digitalisierung (Digiscan) untersucht. Von einem Schulungsmodell wurde mit einer Doppelmischabformung ein Modell mit präpariertem Zahn 16 erzeugt und extraoral digitalisiert. Dieses Modell wurde simuliert intraoral sowie nach erneuter Abformung und Modellherstellung extraoral digitalisiert. Im Anschluss daran erfolgte die Zuordnung der einzelnen Datensätze auf das Referenz-CAD-Modell und die dreidimensionale Differenzberechnung. Die durch die Ethik-Kommission genehmigte klinische Studie umfasste zehn Probanden. Bei diesen zehn Probanden erfolgte eine konventionelle und optische Abformung des Oberkiefers. Aus der konventionellen Abformung entstand ein Modell, welches extraoral-optisch digitalisiert wurde. Diesen Daten wurde die optische Abformung zugeordnet. Die dreidimensionale Auswertung erfolgte analog der in-vitro Studie. Die Auswertung der in-vitro Daten lieferte mittlere dreidimensionale Abweichungen von ±17-35μm bei der Betrachtung vom präparierten Zahn 16 und seinen Nachbarzähnen. Betrachtete man nur den präparierten Zahn 16, zeigten sich mittlere Abweichungen um ±17μm. Im Vergleich dazu lag die berechnete mittlere Differenz bei der intraoralen Digitalisierung eines Quadranten mit ±26-81μm erheblich darüber. Im Registrierzentrum konnte die geringste Abweichung gefunden werden. Der konventionelle Verfahrensweg (Abformung – Modellherstellung – extraorale Digitalisierung) hingegen liefert eine Genauigkeit von ±9-19μm. Anhand der gewonnenen Ergebnisse kann man sagen, dass die CEREC-3D®Kamera für die Erfassung von Einzelzahnrestaurationen sowie gegebenenfalls kleinerer mehrspanniger Restaurationen geeignet ist. Größere Restaurationen hingegen übersteigen den Indikationsbereich des Systems und sollten extraoral über den Umweg einer Abformung digitalisiert werden. Klinische Parameter beeinflussen die Genauigkeit der intraoralen Digitalisierung in einem akzeptablen Maß. Dies wird anhand des Vergleiches der in-vitro mit den in-vivo Daten ersichtlich. Dabei ist die Puderschicht von durchschnittlich 28,6μm (51) bei der intraoralen Digitalisierung zu berücksichtigen. / Using CAD/CAM-technology in dentistry is supposed to reduce or eliminate potential sources of error resulting from the manual craftsmanship needed when making dental restorative restorations. For any CAD/CAM-made restoration, a digitalization as precise as possible is basic. In this study, the precision of the digital measurement of teeth was examined in-vitro and invivo. The intraoral CEREC-3D® system was compared with conventional impression taking and model making and subsequent digitalization (Digiscan). A one-stage putty-and-wash impression was taken from a training model. The first upper molar in this model was prepared for a full crown. The resulting gypsum model was extraorally digitized. This master model was digitized with simulated intraoral digitizing and, after taking again an impression and making a gypsum model, with extraoral digitizing. The data was then aligned to the reference CAD-model, and the threedimensional differences were calculated. The clinical trial included ten probands and was approved by the responsible ethical committee. From each proband, a conventional impression as well as an intraoral digitizing was made from the upper jaw. The gypsum model resulting from the impression was digitized extraorally, and the data was aligned to the data-sets of the intraoral digitizing. The threedimensional differences were calculated analogous to the in-vitro analysis. The threedimensional analysis showed mean differences between ±17 and 35 microns for the prepared tooth 16 and its neighboring teeth. Looking at tooth 16 alone, the mean differences were around ±17 microns. Compared to these values, the mean differences calculated for intraoral digitizing of a whole quadrant were considerably higher (±26-81 microns). The smallest mean deviations were found at the center of alignment. The conventional method (impression taking - model making - extraoral digitizing) showed a significantly higher precision (±9-19 microns). The results show that the CEREC-3D®camera is suitable for single tooth and short-span restorations. However, the indication is not given for long-span restorations using the intraoral system. Such restorations should always be made after conventional impression taking, model making and subsequent extraoral digitizing. The precision of the intraoral digitizing is influenced by clinical parameters in an acceptable way as shown by the comparison of invitro and in-vivo data. The powder-layer of average 28.6 microns (51) has to be taken into consideration, when using intraoral digitizing.

Durch den Einsatz von CAD/CAM-Technologien sollen potenzielle Fehlerquellen der handwerklich-manuellen Herstellung zahnmedizinischprothetischer Restaurationen eliminiert werden. Grundlage für die Fertigung einer prothetischen Restauration mittels CAD/CAM ist eine möglichst genaue Digitalisierung der klinischen Situation. In dieser Studie wurde die Genauigkeit der digitalen Erfassung von Zähnen unter experimentellen sowie unter klinischen Bedingungen mit dem CEREC-3D® System (intraoral) im Vergleich zu konventioneller Abformung und Modellerstellung mit anschließender extraoraler Digitalisierung (Digiscan) untersucht. Von einem Schulungsmodell wurde mit einer Doppelmischabformung ein Modell mit präpariertem Zahn 16 erzeugt und extraoral digitalisiert. Dieses Modell wurde simuliert intraoral sowie nach erneuter Abformung und Modellherstellung extraoral digitalisiert. Im Anschluss daran erfolgte die Zuordnung der einzelnen Datensätze auf das Referenz-CAD-Modell und die dreidimensionale Differenzberechnung. Die durch die Ethik-Kommission genehmigte klinische Studie umfasste zehn Probanden. Bei diesen zehn Probanden erfolgte eine konventionelle und optische Abformung des Oberkiefers. Aus der konventionellen Abformung entstand ein Modell, welches extraoral-optisch digitalisiert wurde. Diesen Daten wurde die optische Abformung zugeordnet. Die dreidimensionale Auswertung erfolgte analog der in-vitro Studie. Die Auswertung der in-vitro Daten lieferte mittlere dreidimensionale Abweichungen von ±17-35μm bei der Betrachtung vom präparierten Zahn 16 und seinen Nachbarzähnen. Betrachtete man nur den präparierten Zahn 16, zeigten sich mittlere Abweichungen um ±17μm. Im Vergleich dazu lag die berechnete mittlere Differenz bei der intraoralen Digitalisierung eines Quadranten mit ±26-81μm erheblich darüber. Im Registrierzentrum konnte die geringste Abweichung gefunden werden. Der konventionelle Verfahrensweg (Abformung – Modellherstellung – extraorale Digitalisierung) hingegen liefert eine Genauigkeit von ±9-19μm. Anhand der gewonnenen Ergebnisse kann man sagen, dass die CEREC-3D®Kamera für die Erfassung von Einzelzahnrestaurationen sowie gegebenenfalls kleinerer mehrspanniger Restaurationen geeignet ist. Größere Restaurationen hingegen übersteigen den Indikationsbereich des Systems und sollten extraoral über den Umweg einer Abformung digitalisiert werden. Klinische Parameter beeinflussen die Genauigkeit der intraoralen Digitalisierung in einem akzeptablen Maß. Dies wird anhand des Vergleiches der in-vitro mit den in-vivo Daten ersichtlich. Dabei ist die Puderschicht von durchschnittlich 28,6μm (51) bei der intraoralen Digitalisierung zu berücksichtigen. / Using CAD/CAM-technology in dentistry is supposed to reduce or eliminate potential sources of error resulting from the manual craftsmanship needed when making dental restorative restorations. For any CAD/CAM-made restoration, a digitalization as precise as possible is basic. In this study, the precision of the digital measurement of teeth was examined in-vitro and invivo. The intraoral CEREC-3D® system was compared with conventional impression taking and model making and subsequent digitalization (Digiscan). A one-stage putty-and-wash impression was taken from a training model. The first upper molar in this model was prepared for a full crown. The resulting gypsum model was extraorally digitized. This master model was digitized with simulated intraoral digitizing and, after taking again an impression and making a gypsum model, with extraoral digitizing. The data was then aligned to the reference CAD-model, and the threedimensional differences were calculated. The clinical trial included ten probands and was approved by the responsible ethical committee. From each proband, a conventional impression as well as an intraoral digitizing was made from the upper jaw. The gypsum model resulting from the impression was digitized extraorally, and the data was aligned to the data-sets of the intraoral digitizing. The threedimensional differences were calculated analogous to the in-vitro analysis. The threedimensional analysis showed mean differences between ±17 and 35 microns for the prepared tooth 16 and its neighboring teeth. Looking at tooth 16 alone, the mean differences were around ±17 microns. Compared to these values, the mean differences calculated for intraoral digitizing of a whole quadrant were considerably higher (±26-81 microns). The smallest mean deviations were found at the center of alignment. The conventional method (impression taking - model making - extraoral digitizing) showed a significantly higher precision (±9-19 microns). The results show that the CEREC-3D®camera is suitable for single tooth and short-span restorations. However, the indication is not given for long-span restorations using the intraoral system. Such restorations should always be made after conventional impression taking, model making and subsequent extraoral digitizing. The precision of the intraoral digitizing is influenced by clinical parameters in an acceptable way as shown by the comparison of invitro and in-vivo data. The powder-layer of average 28.6 microns (51) has to be taken into consideration, when using intraoral digitizing.