Open Access
Open access
BMC Oral Health, volume 24, issue 1, publication number 1033

Evaluating the accuracy of CEREC intraoral scanners for inlay restorations: impact of adjacent tooth materials

Publication typeJournal Article
Publication date2024-09-03
Journal: BMC Oral Health
scimago Q1
wos Q1
SJR0.737
CiteScore3.9
Impact factor2.6
ISSN14726831
Abstract
The accuracy of intraoral scanning is critical for computer-aided design/computer-aided manufacturing workflows in dentistry. However, data regarding the scanning accuracy of various adjacent restorative materials and intraoral scanners are lacking. This in vitro study aimed to evaluate the effect of adjacent restorative material type and CEREC's intraoral scanners on the accuracy of intraoral digital impressions for inlay cavities. The artificial tooth was prepared with an occlusal cavity depth of 2 mm, a proximal box width at the gingival floor of 1.5 mm, and an equi-gingival margin extended disto-occlusally at the transition line angle on both the lingual and buccal sides for an inlay restoration. The adjacent teeth were veneered with crowns made of gold and zirconia, and an artificial tooth (resin) was utilized as the control group. The inlay cavity and adjacent teeth (Gold, Zirconia, and resin) were scanned 10 times using Chairside Economical Restoration of Esthetic Ceramics (CEREC) Primescan (PS), Omnicam (OC), and Bluecam (BC). A reference scan was obtained using a laboratory scanner (3-shape E3). Scanning was performed according to the manufacturer's instructions, including powder application for the BC group. Standard tesselation language files were analyzed using a three-dimensional analysis software program. Experimental data were analyzed using a two-way analysis of variance and the Tukey’s post-hoc comparison test. The restorative materials of the adjacent teeth significantly affected the accuracy of the intraoral digital impressions (p < .05). The zirconia group exhibited the highest trueness deviation, followed by the resin and gold groups, with each demonstrating a statistically significant difference (p < .05). The resin group demonstrated the highest maximum positive deviation and deviation in precision. Gold exhibited the lowest average deviation value for trueness compared with those of the other adjacent restorative materials. Intraoral scanner type significantly influenced the trueness and precision of the scan data (p < .05). The average deviation of trueness according to the intraoral scanner type increased in the following order: BC > PS > OC. The average deviation in precision increased in the following order: PS>OC>BC (p < .05). The restorative materials of the adjacent tooth and the type of intraoral scanner affect the accuracy of the intraoral digital impression. The trueness of the digital images of the BC group, obtained by spraying the powder, was comparable to that of the PS group. Among the adjacent restorative materials, zirconia exhibited the lowest trueness. In contrast, PS demonstrated the highest precision among the intraoral scanners, while resin displayed the lowest precision among the adjacent restorative materials.
Elashry W.Y., Elsheikh M.M., Elsheikh A.M.
BMC Oral Health scimago Q1 wos Q1 Open Access
2024-07-05 citations by CoLab: 1 PDF Abstract  
Abstract Background This clinical study aims to evaluate the accuracy of the conventional implant impression techniques compared to the digital impression ones in bilateral distal extension cases. Methods A total of 32 implants were placed in eight patients missing all mandibular posterior teeth except the first premolars. Each patient received a total of four implants, with two implants placed on each side, in order to provide support for three units of screw-retained zirconia restorations. Following osteointegration, the same patient underwent two implant-level impression techniques: Conventional open-tray impressions CII (splinted pick-up) and digital implant impressions DII with TRIOS 3 Shape intraoral scanner. The accuracy of impressions was evaluated utilizing a three-dimensional superimposition analysis of standard tessellation language (STL) files. Subsequently, the scan bodies were segmented using Gom inspect software to measure three-dimensional deviations in a color-coding map. Data were statistically analyzed using the Kruskal Wallis test and then a post-hoc test to determine the significance level (P < 0.05). Results The study revealed that higher angular and positional deviations were shown toward distal scan bodies compared to mesial ones for both impression techniques. However, this difference was not statistically significant (P > 0.05). Conclusion Splinted open-tray conventional impression and intraoral scanning implant impression techniques have demonstrated comparable accuracy. Trial registration Clinical Trials.gov Registration ID NCT05912725. Registered 22/06/ 2023- Retrospectively registered, https://register.clinicaltrials.gov.
Park Y., Kim J., Park J., Son S.
BMC Oral Health scimago Q1 wos Q1 Open Access
2023-07-24 citations by CoLab: 7 PDF Abstract  
Abstract 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.
Revilla‐León M., Kois D.E., Kois J.C.
2022-12-07 citations by CoLab: 88 Abstract  
To describe the factors related to the operator skills and decisions that influence the scanning accuracy of intraoral scanners (IOSs). A new classification for these factors is proposed to facilitate dental professionals' decision making when using IOSs and maximize the accuracy and reliability of intraoral digital scans.Each IOS system is limited by the hardware and software characteristics of the selected device. The operator decisions that can influence the accuracy of IOSs include the scanning technology and system selection, scanning head size, calibration, scanning distance, exposure of the IOS to ambient temperature changes, ambient humidity, ambient lighting conditions, operator experience, scanning pattern, extension of the scan, cutting off, rescanning, and overlapping procedures.The knowledge and understanding of the operator factors that impact scanning accuracy of IOSs is a fundamental element for maximizing the accuracy of IOSs and for successfully integrating IOSs in daily practices.Operator skills and clinical decisions significantly impact intraoral scanning accuracy. Dental professionals must know and understand these influencing operator factors for maximizing the accuracy of IOSs.
Son S., Kim J., Seo D., Park J.
Journal of Prosthetic Dentistry scimago Q1 wos Q1
2022-10-01 citations by CoLab: 23 Abstract  
AbstractStatement of problem Clinical guidelines for obtaining accurate scan data during the intraoral scanning of inlay cavities with various configurations and interproximal distances are lacking. Purpose The purpose of this in vitro study was to evaluate the effect of interproximal distance and cavity type on the accuracy of digital scans for inlay cavities, including proximal cavities. Material and methods Four artificial teeth with 4 types of inlay cavities designed based on the buccolingual width and gingival level of the proximal box were installed in a mannequin at distances of 0.6, 0.8, and 1.0 mm from the adjacent teeth. Reference scans of the 4 artificial teeth were obtained by using a laboratory scanner. The CEREC Primescan AC was used to acquire digital scan data (each n=10). Standard tessellation language (STL) files were analyzed with a 3-dimensional analysis software program. The mean deviation values were measured with a 3-dimensional best-fit alignment method to evaluate the accuracy of the digital scan data. Statistical analyses were performed by using 2-way ANOVA and the Bonferroni multiple comparison test (α=.05). Results As per the interproximal distance, the 1.0-mm group showed significantly higher trueness than the 0.6-mm group (P
Revilla-León M., Young K., Sicilia E., Cho S., Kois J.C.
Journal of Dentistry scimago Q3 wos Q1 Open Access
2022-05-01 citations by CoLab: 40 Abstract  
To analyze the influence of the restorative material type (definitive and interim) and its surface treatment (polished or glazed) on the scanning accuracy of an intraoral scanner.A mandibular dental typodont containing 3 typodont teeth (left second premolar and left first and second molars) was used for testing. Ten groups were created based on the crown material: typodont tooth (control group), gold (G group), zirconia (Z group), lithium disilicate (LD group), hybrid ceramic (HC group), composite resin (CR group), conventional PMMA (CNV-PMMA group), bis-acryl composite resin (CNV-BA group), milled PMMA (M-PMMA group), and additively manufactured bis-acryl-based polymer (AM-BA group). Except the G group, groups were subdivided into polished (P subgroups) or glazed (G subgroups). Each specimen was digitized by using an extraoral scanner (D1000; 3Shape A/G) and an intraoral scanner (TRIOS 4; 3Shape). Each reference scan was used to measure the discrepancy with the corresponding 15 intraoral scans by calculating the root mean square (RMS) error (Geomagic; 3D Systems). The Welch ANOVA and Games-Howell tests were selected to examine trueness (α=0.05). The F-test with Bonferroni correction was used to evaluate precision.Significant trueness and precision differences were found (P
Schmidt A., Schlenz M.A., Liu H., Kämpe H.S., Wöstmann B.
Applied Sciences (Switzerland) scimago Q2 wos Q2 Open Access
2021-08-03 citations by CoLab: 10 PDF Abstract  
This study aimed to investigate the transfer accuracy (trueness and precision) of three different intraoral scanning families using different hardware and software versions over the last decade from 2012 to 2021, compared to a conventional impression. Therefore, an implant master model with a reference cube was digitized and served as a reference dataset. Digital impressions of all three scanning families (True definition, TRIOS, CEREC) were recorded (n = 10 per group), and conventional implant impressions were taken (n = 10). The conventional models were digitized, and all models (conventional and digital) were measured. Therefore, it was possible to obtain the deviations between the master model and the scans or conventional models in terms of absolute three-dimensional (3D) deviations, deviations in rotation, and angulation. The results for deviations between the older and newer scanning systems were analyzed using pairwise comparisons (p < 0.05; SPSS 26). The absolute 3D deviations increased with increasing scan path length, particularly for the older hardware and software versions (old vs. new (MW ± SD) True Definition: 355 ± 62 µm vs. 483 ± 110 µm; TRIOS: 574 ± 274 µm vs. 258 ± 100 µm; and CEREC: 1356 ± 1023 µm vs. 110 ± 49 µm). This was also true for deviations in rotation and angulation. The conventional impression showed an advantage only regarding the absolute 3D deviation compared to the older systems. Based on the data of the present study, the accuracy of intraoral scanners is decisively related to hardware and software; though, newer systems or software do not necessarily warrant improvement. Nevertheless, to achieve high transfer accuracy, regular updating of digital systems is recommended. The challenge of increasing errors with increasing scan paths is overcome in the most recent systems. The combination of two different scanning principles in a single device seems to be beneficial.
Lim J., Mangal U., Nam N., Choi S., Shim J., Kim J.
Materials scimago Q2 wos Q2 Open Access
2021-04-19 citations by CoLab: 26 PDF Abstract  
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.
Tabesh M., Nejatidanesh F., Savabi G., Davoudi A., Savabi O., Mirmohammadi H.
Journal of Prosthetic Dentistry scimago Q1 wos Q1
2021-04-01 citations by CoLab: 62 Abstract  
AbstractStatement of problem Intraoral scanners have been increasingly used in recent years. However, the accuracy of digital scans as it affects marginal adaptation is unclear. Purpose The purpose of this systematic review and meta-analysis was to compare the marginal adaptation of single-unit zirconia crowns fabricated with digital scans or with conventional impressions. Material and methods The electronic databases PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (ISI), Scopus, and EMBASE were searched and complemented by a manual search. Risks of bias were assessed by using a modified methodological index for nonrandomized studies (MINORS). Mean ±standard deviation (SD) values of marginal accuracy of studies were extracted for both methods. Mean marginal difference and 95% confidence interval (CI) were calculated to evaluate the marginal accuracy of each method. Pooled data were statistically analyzed by using a random-effect model. Results Seventeen studies were used to perform the meta-analysis. Subgroup analysis was performed based on intraoral scanners. Standardized mean marginal difference and 95% CI of each subgroup were as follows: Lava: -0.85 μm (95% CI: -1.67, -0.03) (P=.043); CEREC: -1.32 μm (95% CI: -2.06, -0.59) (P
Kim J., Son S., Lee H., Kim R.J., Park J.
2021-01-01 citations by CoLab: 21 Abstract  
Purpose This study aimed to evaluate the influence of tooth location and inlay cavity type on the accuracy of intraoral digital impressions.
Ashraf Y., Sabet A., Hamdy A., Ebeid K.
Journal of Prosthodontics scimago Q1 wos Q1
2020-06-07 citations by CoLab: 38 Abstract  
Purpose To evaluate the influence of preparation design and tooth geometry on the accuracy of scans obtained from three different intraoral scanners (IOS). Materials and methods Full coverage crown and inlay preparations with known axial wall tapers (6ᵒ and 12ᵒ) were performed on typodont teeth using a computer numerical control machine. Reference models were scanned with a highly accurate reference scanner (Ineos X5) and saved in standard tessellation language (STL) format then each IOS (Omnicam, Trios, and i500) scanned each model 10 times. The STL files obtained from the intraoral scanners were compared to the reference models (trueness) and within each test group (precision). Data were statistically analyzed using three- way ANOVA and one- way ANOVA. Results When comparing trueness values extracoronal preparations (32.30 ± 11.23 µm) was significantly better than intra-coronal preparation (59.61 ± 16.42 µm). As for opposing wall taper, one-way ANOVA revealed that the more the convergence or divergence between opposing walls the better is the trueness. Significant differences were observed between the scanners. 3 Shape Trios (35.70 ± 14.12 µm) and medit i500 (44.31 ± 11.41 µm) showed no statistically significant differences. However, both showed significantly better precision results when compared to Omnicam (57.83 ± 22.14 µm). Conclusion Extracoronal preparations show better trueness and precision in comparison to intracoronal preparations. Trios and i500 have better trueness and precision than Omnicam. Increasing the taper of the axial wall has a direct effect on trueness of scans obtained from the IOS.
Zimmermann M., Ender A., Mehl A.
2020-02-01 citations by CoLab: 64 Abstract  
The authors evaluated the local accuracy of intraoral scanning (IOS) systems for single-tooth preparation impressions with an in vitro setup.The authors digitized a mandibular complete-arch model with 2 full-contour crowns and 2 multisurface inlay preparations with a highly accurate reference scanner. Teeth were made from zirconia-reinforced glass ceramic material to simulate toothlike optical behavior. Impressions were obtained either conventionally (PRESIDENT, Coltène) or digitally using the IOS systems TRIOS 3 and TRIOS 3 using insane scan speed mode (3Shape), Medit i500, Version 1.2.1 (Medit), iTero Element 2, Version 1.7 (Align Technology), CS 3600, Version 3.1.0 (Carestream Dental), CEREC Omnicam, Version 4.6.1, CEREC Omnicam, Version 5.0.0, and Primescan (Dentsply Sirona). Impressions were repeated 10 times per test group. Conventional (CO) impressions were poured with type IV gypsum and digitized with a laboratory scanner. The authors evaluated trueness and precision for preparation margin (MA) and preparation surface (SU) using 3-dimensional superimposition and 3-dimensional difference analysis method using (95% - 5%) / 2 percentile values. Statistical analysis was performed using Kruskal-Wallis test. Results were presented as median (interquartile range) values in micrometers.The authors found statistically significant differences for MA and SU among different test groups for both trueness and precision (P < .05). Median (interquartile range) trueness values ranged from 11.8 (2.0) μm (CO) up to 40.5 (10.9) μm (CEREC Omnicam, Version 5.0.0) for SU parameter and from 17.7 (2.6) μm (CO) up to 55.9 (15.5) μm (CEREC Omnicam, Version 5.0.0) for MA parameter.IOS systems differ in terms of local accuracy. Preparation MA had higher deviations compared with preparation SU for all test groups.Trueness and precision values for both MA and SU of single-unit preparations are equal or close to CO impression for several IOS systems.
Park J., Kim R.J., Lee K.
Journal of Prosthetic Dentistry scimago Q1 wos Q1
2020-01-01 citations by CoLab: 62 Abstract  
Although studies have reported the trueness and precision of intraoral scanners (IOSs), studies addressing the accuracy of IOSs in reproducing inlay preparations are lacking.The purpose of this in vitro study was to compare the accuracy of representative IOSs in obtaining digital scans of inlay preparations and to evaluate whether the IOSs had sufficient depth of field to obtain accurate images of narrow and deep cavity preparations.Digital scans of a bimaxillary typodont with cavity preparations for inlay restorations on the maxillary first premolar, first and second molar, mandibular second premolar, and first molar were obtained using 6 IOSs (CEREC Omnicam, E4D, FastScan, iTero, TRIOS, and Zfx IntraScan). Standard tessellation language (STL) data sets were analyzed using the 3-dimensional analysis software (Geomagic Verify). Color-coded maps were used to compare the magnitude and pattern of general deviation of the IOSs with those of a reference scan. Each tooth prepared for inlay restoration was digitally cut out, and the trueness and precision of each IOS were measured using the superimposition technique. Statistical analyses were conducted using statistical software (α=.05).The trueness values were lowest with the FastScan (22.1 μm), followed by TRIOS (22.7 μm), CEREC Omnicam (23.2 μm), iTero (26.8 μm), Zfx IntraScan (36.4 μm), and E4D (46.2 μm). In general, the digital scans of more complicated cavity design showed more deviation. Color-coded maps showed positive vertical discrepancy with the E4D and negative vertical discrepancy with the Zfx IntraScan, especially on the cavity floor. Regarding precision, the highest value was observed in the E4D (37.7 μm), while the lowest value was observed with the TRIOS (7.0 μm). However, no significant difference was found between teeth with different inlay preparations. Scanning errors were more frequently seen in the cervical area.Different IOSs and types of cavity design influenced the accuracy of the digital scans. Scans of more complex cavity geometry generally showed higher deviation. The E4D exhibited the most deviation in both trueness and precision, followed by the Zfx IntraScan. The E4D and Zfx IntraScan appeared to have less depth of field than the others to obtain digital scans for inlay preparation with different heights.
Dutton E., Ludlow M., Mennito A., Kelly A., Evans Z., Culp A., Kessler R., Renne W.
2019-09-30 citations by CoLab: 70 Abstract  
This in vitro study compares the newest generation of intraoral scanners to their older counterparts, and tests whether material substrates affect the trueness and precision of intraoral scanners (IOS).A custom model, used as the reference standard, was fabricated with teeth composed of different dental materials. The reference standard scan was obtained using a three-dimensional (3D) optical scanner, the ATOS III. Experimental scans were obtained using eight different IOS, operated by experienced clinicians, using the manufacturer's recommended scanning strategy. A comprehensive metrology program, Geomagic Control X, was used to compare the reference standard scan with the experimental scans.For all scanners tested, except Trios3, the substrate does influence the trueness and precision of the scan. Furthermore, differences exist when comparing the same substrate across different scanners with some of the latest generation scanners clearly leaping ahead of the older generation regarding both trueness and precision.Substrate type affects the trueness and precision of a scan. Active Triangulation scanners are more sensitive to substrate differences than their parallel confocal counterparts. Some scanners scan certain substrates better, but in general the new generation of scanners outperforms the old, across all substrates.The substrates being scanned play an import role in the trueness and precision of the 3D model. The new generation of scanners is remarkably accurate across all substrates and for complete-arch scanning.
Maeng J., Lim Y., Kim B., Kim M., Kwon H.
2019-03-20 citations by CoLab: 7 PDF Abstract  
The aim of this study was to two-dimensionally evaluate deviation errors at five digital cross-sections of single-tooth abutment in regards to data obtained from two intraoral scanners, and to evaluate accuracy of individual scanners. Two intraoral scanners, the Trios 3® (3 Shape, Copenhagen, Denmark) and EzScan® (Vatech, Hwaseong, Korea), were evaluated by utilizing 13 stone models. The superimposed 3D data files were sectioned into five different planes: buccal-lingual section (BL), mesial-distal section (MD), transverse high section (TH), transverse middle section (TM), and transverse low section (TL). Accuracy comparison between the two scanners in 5 groups was performed. BL vs. MD of each scanner, and three transverse groups (TH, TM, TL) of each scanner were analyzed for accuracy comparison. In comparison of 2-D analyses for two intraoral scanners, Trios 3® showed statistically significant higher accuracy in root mean square (RMS) at BL, TH, and TL (p < 0.05). For each scanner, RMS value showed that mesial-distal sections were more prone to error than buccal-lingual section, which exhibited statistically significant errors (p < 0.05) while the transverse groups did not. Two-dimensional analysis is more insightful than three-dimensional analysis on single-tooth abutment. In mesiodistal areas, rough prepped areas, and sharp edges where scanner accessibility is difficult, high deviation errors are shown.

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