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OBJECTIVES The objective of this study was to systematically compare the transfer accuracy of conventional and digital implant impressions in patients using a new reference key-based method. MATERIAL AND METHODS Thirty-nine cases were included in the study (upper jaw 22 edentulous, 8 partially edentulous, average distance between implants 30.15 ± 11.18 mm; lower jaw 6 cases edentulous, 3 cases partially edentulous, average distance between implants 33.19 ± 14.85 mm). Individual reference keys were manufactured and reversibly fixed on implants. A conventional (CVI) and a digital (DI) implant impression was made. The implant positions (center points) of conventional and digital models were measured (coordinate-measuring machine/three-dimensional analysis software) and superimposed with the positions of the reference keys to compare the deviations of the conventional and digital models. For statistical analysis, ANOVA with MIXED procedure was applied (p

Objective To assess whether digital workflow gives better results than the conventional one in the single implant crowns, when analyzing the impression time, patient preference, time efficiency, and adjustment time. Material and methods MEDLINE, Embase, and Cochrane were searched and supplemented via hand search up to June 19, 2019. Only clinical trials assessing conventional versus digital workflows for single implant crowns were included. Impression time was evaluated using random effects meta-analysis, while patient preference, adjustment time, and time efficiency were reported descriptively. Results Among 1,334 publications identified, ten studies were included. The random effects models revealed statistically significant reduction in time in the digital impression group when compared to the conventional group by the mean meta-analysis (MD: 8.22 [95% CI: 5.48, 10.96]). Analysis from immediate digital impression versus conventional (MD: 3.84 [95% CI: 3.30, 4.39]) and regular digital impression versus conventional (MD:10.67 [95% CI: 5.70, 15.65]) showed statistically significant reduction in time on using the digital impression. Impression time in the digital process ranged between 6 min 39 s and 20 min, whereas for conventional, it was between 11.7 and 28.47 min. Patients showed greater preference for digital impression. Adjustment time in the digital process ranged between 1.96 and 14 min, whereas for conventional, it was between 3.02 and 12 min. Time efficiency in the digital process ranged between 36.8 and 185.4 min, whereas for conventional, it was between 55.6 and 332 min. Conclusion The digital workflow has demonstrated better clinical efficiency considering impression time, patient preference, and time efficiency. According to the adjustment time, different results were presented.

OBJECTIVE This study aimed to evaluate the precision of digital implant impressions in comparison with conventional impressions and assess the impact of the scanning range on precision. MATERIALS AND METHODS An edentulous maxilla model with six implants was scanned with four intraoral scanners (IOSs) and a dental laboratory scanner five times each, and stereolithography (STL) data were generated. A conventional silicone impression was made, and a model was fabricated, which was scanned using the laboratory scanner. This procedure was also repeated five times. Nine different ranges of interest (ROIs) were defined, and the average discrepancies of the measurement points between each pair of STL images out of five for each ROI were calculated. The effects of "impression method" and "ROI" on precision, as evaluated by the averaged discrepancy, were tested by two-way analysis of variance (p

Aim: This systematic review and meta-analysis were conducted to assess and compare the accuracy of conventional and digital implant impressions. The review was registered on the PROSPERO register (registration number: CRD42016050730). Material and Methods: A systematic literature search was conducted adhering to PRISMA guidelines to identify studies on implant impressions published between 2012 and 2017. Experimental and clinical studies at all levels of evidence published in peer-reviewed journals were included, excluding expert opinions. Data extraction was performed along defined parameters for studied specimens, digital and conventional impression specifications and outcome assessment. Results: Seventy-nine studies were included for the systematic review, thereof 77 experimental studies, one RCT and one retrospective study. The study setting was in vitro for most of the included studies (75 studies) and in vivo for four studies. Accuracy of conventional impressions was examined in 59 studies, whereas digital impressions were examined in 11 studies. Nine studies compared the accuracy of conventional and digital implant impressions. Reported measurements for the accuracy include the following: (a) linear and angular deviations between reference models and test models fabricated with each impression technique; (b) three-dimensional deviations between impression posts and scan bodies respectively; and (c) fit of implant-supported frameworks, assessed by measuring marginal discrepancy along implant abutments.) Meta-analysis was performed of 62 studies. The results of conventional and digital implant impressions exhibited high values for heterogeneity. Conclusions: The available data for accuracy of digital and conventional implant impressions have a low evidence level and do not include sufficient data on in vivo application to derive clinical recommendations.

OBJECTIVE To assess the clinical and laboratory time efficiency and quality of outcomes for posterior single implant crowns by means of a model-free digital workflow using digital impressions immediately after implant placement. METHODS Forty patients missing a single posterior tooth received implant therapy. For within-subject comparison, digital impressions were taken immediately after implant placement and conventional impressions after implant healing. Two monolithic zirconia crowns were fabricated using a laboratory-based CAD-CAM system. One crown was produced from the immediate digital impression and a model-free digital workflow (test group), and the second crown was produced from the conventional impression and a hybrid workflow (control group). Clinical and laboratory time was recorded. Quality of outcomes was evaluated double-blinded. A paired-sample t test was applied for statistical analysis. RESULTS The total mean chairside time (impression and delivery) was 23.2 min (95%CI 22.2, 24.3) in the test group and 25.7 min (95%CI 24.4, 26.9) in the control group (p = 0.013). Significantly less laboratory time was needed in the model-free digital workflow (13.6 min, 95%CI 11.5, 15.6) as compared to the model-based hybrid workflow (29.9 min, 95%CI 25.7, 34.2) (p

PURPOSE The aim of this study was to assess the effect of connection type and impression technique on the accuracy of fit of implant-supported fixed complete-arch dental prostheses (IFCDPs). MATERIALS AND METHODS An edentulous mandibular cast with five implants was fabricated to serve as master cast (control) for both implant- and abutment-level baselines. A titanium one-piece framework for an IFCDP was milled at abutment level and used for accuracy of fit measurements. Polyether impressions were made using a splinted and non-splinted technique at the implant and abutment level leading to four test groups, n = 10 each. Hence, four groups of test casts were generated. The impression accuracy was evaluated indirectly by assessing the fit of the IFCDP framework on the generated casts of the test groups, clinically and radiographically. Additionally, the control and all test casts were digitized with a high-resolution reference scanner (IScan D103i, Imetric, Courgenay, Switzerland) and standard tessellation language datasets were generated and superimposed. Potential correlations between the clinical accuracy of fit data and the data from the digital scanning were investigated. To compare the accuracy of casts of the test groups versus the control at the implant and abutment level, Fisher's exact test was used. RESULTS Of the 10 casts of test group I (implant-level splint), all 10 presented with accurate clinical fit when the framework was seated on its respective cast, while only five of 10 casts of test group II (implant-level non-splint) showed adequate fit. All casts of group III (abutment-level splint) presented with accurate fit, whereas nine of 10 of the casts of test group IV (abutment-level non-splint) were accurate. Significant 3D deviations (P

To compare the accuracy of digital and conventional impression techniques for completely edentulous patients and to determine the effect of different variables on the accuracy outcomes.A stone cast of an edentulous mandible with five implants was fabricated to serve as master cast (control) for both implant- and abutment-level impressions. Digital impressions (n = 10) were taken with an intraoral optical scanner (TRIOS, 3shape, Denmark) after connecting polymer scan bodies. For the conventional polyether impressions of the master cast, a splinted and a non-splinted technique were used for implant-level and abutment-level impressions (4 cast groups, n = 10 each). Master casts and conventional impression casts were digitized with an extraoral high-resolution scanner (IScan D103i, Imetric, Courgenay, Switzerland) to obtain digital volumes. Standard tessellation language (STL) datasets from the five groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D (global) deviations. To compare the master cast with digital and conventional impressions at the implant level, analysis of variance (ANOVA) and Scheffe's post hoc test was used, while Wilcoxon's rank-sum test was used for testing the difference between abutment-level conventional impressions.Significant 3D deviations (P0.001) were found between Group II (non-splinted, implant level) and control. No significant differences were found between Groups I (splinted, implant level), III (digital, implant level), IV (splinted, abutment level), and V (non-splinted, abutment level) compared with the control. Implant angulation up to 15° did not affect the 3D accuracy of implant impressions (P0.001).Digital implant impressions are as accurate as conventional implant impressions. The splinted, implant-level impression technique is more accurate than the non-splinted one for completely edentulous patients, whereas there was no difference in the accuracy at the abutment level. The implant angulation up to 15° did not affect the accuracy of implant impressions.

Background and purpose: It is crucial to keep the misfit of the abutment–fixture unit at the lowest possible rate. There are a few controversial studies on the accuracy of impression making of angulated implants, and much fewer (and controversial) studies on the abutment-level impression technique, which is a convenient and clinically favorable method. Besides, there are no studies on comparison of sectional vs. full-arch trays. We aimed to assess these. Methods: A trapezoidal model with four angulated implants installed at 20° and 30° buccal tilts was fabricated. Forty impressions were taken from this model, with two groups of full-arch and sectional custom trays (n = 2 9 20), each divided into two subgroups of implant-level and abutment-level techniques (n = 2 9 2 9 10 in four subgroups). Absolute and non-absolute linear and angular impression errors were estimated by comparing the fabricated casts with the model, using a coordinate measuring machine. The effects of sectional/full-arch trays and abutment-level and fixture-level techniques on impression accuracies were analyzed using one- and two-way analyses of variance (ANOVA), Tukey, Mann–Whitney, and one-sample t-tests (a = 0.05, Mann– Whitney’s a using the Bonferroni Bonferroni method). Results: No significant differences between the absolute linear errors of the two trays (P = 0.100 [ANOVA]) and the two levels (P = 0.400 [ANOVA]) were observed. The assessment of absolute angular errors showed no significant differences (all P values ≥ 0.4 [ANOVA]). The difference between the linear errors in the full-arch vs. sectional trays was not significant in the fixture-level group (P = 0.290). However, in the abutment-level group, the linear error was significantly greater in the sectional tray compared to full-arch tray (P = 0.013, a = 0.025 [Mann–Whitney]). Conclusions: Using sectional trays might not be advantageous over full-arch trays. Sectional trays are not recommended for taking abutment-level impressions. The abutment-level impression technique is as accurate as the studied fixture-level technique. Increasing the angle of implants’ divergence from 40° to 60° might not usually lead to a significant increase in the errors, particularly when using abutment-level impressions.

Objective The accuracy of digital impressions greatly influences their clinical viability in implant restorations. The aim of this study was to compare the accuracy of gypsum models acquired from the conventional implant impression to digitally milled models created from direct digitalization by three-dimensional analysis. Materials and Methods Thirty gypsum and 30 digitally milled models, impressed directly from a reference model, were prepared. The models and reference model were scanned by a laboratory scanner, and 30 surface tessellation language datasets from each group were imported to an inspection software program. The datasets were aligned to the reference dataset by a repeated best-fit algorithm, and 10 specified contact locations of interest were measured in mean volumetric deviations. The areas were pooled by cusps, fossae, interproximal contacts, horizontal and vertical axes of implant position and angulation. The pooled areas were statistically analysed by comparing each group to the reference model to investigate the mean volumetric deviations accounting for accuracy and standard deviations for precision. Results Milled models from digital impressions had comparable accuracy to gypsum models from conventional impressions. However, differences in fossae and vertical displacement of the implant position from the gypsum and digitally milled models compared to the reference model exhibited statistical significance (P

Objectives. The primary objective of this clinical study was to assess the patients' perception of the difference between an analogue impression approach on the one hand and an intra-oral scan (IO scan) on the other when restoring implants in the non-aesthetic zone. A second objective was to analyse the difference in time needed to perform these two procedures. Materials and methods. Thirty consecutive patients who had received 41 implants (Straumann tissue level) in the non-aesthetic zone in an implant-based referral practice setting in the Netherlands. As they were to receive crown and or bridge work on the implants, in one session, the final impressions were taken with both an analogue technique and with an intraoral scan. Patients were also asked if, directly after the treatment was carried out, they would be prepared to fill out a questionnaire on their perception of both techniques. The time involved following these two procedures was also recorded. Results. The preparatory activities of the treatment, the taste of the impression material and the overall preference of the patients were significantly in favour of the IO scan. The bite registration, the scan head and gag reflex positively tended to the IO scan, but none of these effects were significant. The overall time involved with the IO scan was more negatively perceived than the analogue impression. Overall less time was involved when following the analogue impression technique than with the IO scan. Conclusions. The overall preference of the patients in our sample is significantly in favour of the approach using the IO scan. This preference relates mainly to the differences between the compared approaches with respect to taste effects and their preparatory activities. The patients did perceive the duration of IO scan more negatively than the analogue impression approach. Keywords: digital dentistry; intraoral scanning; oral Implants; patient satisfaction; prosthetic dentistry

Purpose To test whether or not digital full-arch implant impressions with two different intra-oral scanners (CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was that the splinted open-tray impressions would be more accurate than digital full-arch impressions. Material and methods A stone master cast representing an edentulous mandible using five internal connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and 3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880 scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL) datasets from the three test groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-test was used together with Games–Howell post hoc test. Results Group I had a mean value of 167.93 μm (SD 50.37); Group II (Omnicam) had a mean value of 46.41 μm (SD 7.34); Group III (True Definition) had a mean value of 19.32 μm (SD 2.77). Welch's F-test was used together with the Games–Howell test for post hoc comparisons. Welch's F-test showed a significant difference between the groups (P

Objectives The purpose of this study was to evaluate the axial displacement of the abutments during clinical procedures by the tightening torque and cyclic loading. Materials and methods Two different implant-abutment connection systems were used (external butt joint connection [EXT]; internal tapered conical connection [INT]). The master casts with two implant replicas, angulated 10° from each other, were fabricated for each implant connection system. Four types of impression copings were assembled and tightened with the corresponding implants (hex transfer impression coping, non-hex transfer impression coping, hex pick-up impression coping, non-hex pick-up impression coping). Resin splinted abutments and final prosthesis were assembled. The axial displacement was measured from the length of each assembly, which was evaluated repeatedly, after 30 Ncm torque tightening. After 250 N cyclic loading of final prosthesis for 1,000,000 cycles, additional axial displacement was recorded. The mean axial displacement was statistically analyzed (repeated measured ANOVA). Results There was more axial displacement in the INT group than that of the EXT group in impression copings, resin splinted abutments, and final prosthesis. Less axial displacement was found at 1-piece non-hex transfer type impression coping than other type of impression copings in the INT group. There was more axial displacement at the final prosthesis than resin splinted abutments in the INT and the EXT groups. After 250 N cyclic loading of final prosthesis, the INT group showed more axial displacement than that of the EXT group. Conclusion Internal tapered conical connection demonstrated a varying amount of axial displacement with tightening torque and cyclic loading.

Objectives The aim of this study was to devise an optical impression method that could make impressions of dental implants accurately and rapidly. Materials and methods Four paper markers (4 × 3 mm, 8 × 6 mm, 16 × 12 mm, and 24 × 18 mm) and one titanium marker (8 × 6 mm) were prepared to determine the measuring accuracy of the three-dimensional optical tracker. For a proposed and conventional impression taking method, we compared the reproduction accuracies of the positions and orientations of dental implants and the times to obtain impressions. Finally, we fabricated computer-aided designing (CAD)/computer-aided manufacturing (CAM) superstructure frameworks to determine the adaptation accuracy. Results The 8 × 6-mm titanium marker was optimal among the prepared markers. Dental implants made by the proposed and conventional impression taking methods had measurement errors of 71 ± 31 μm and 32 ± 18 μm, respectively. The proposed method took a significantly shorter time to obtain an impression than did the conventional method. The connection between the CAD/CAM superstructure frameworks and four implant analogs had uplifts of 55 ± 10 μm, 94 ± 35 μm, 2 ± 1 μm, and 66 ± 3 μm. Conclusion Our proposed method and fabricated titanium markers enabled us to measure the positions and orientations of dental implants both accurately and rapidly. We then used the reproducible measurement results for the positions and orientations of the dental implants to fabricate CAD/CAM superstructure frameworks within an acceptable accuracy range.

Objectives The aim of this pilot study was to evaluate the efficiency, difficulty and operator's preference of a digital impression compared with a conventional impression for single implant restorations. Materials and methods Thirty HSDM second year dental students performed conventional and digital implant impressions on a customized model presenting a single implant. The outcome of the impressions was evaluated under an acceptance criteria and the need for retake/rescan was decided. The efficiency of both impression techniques was evaluated by measuring the preparation, working, and retake/scan time (m/s) and the number of retakes/rescans. Participants' perception on the level of difficulty for the both impressions was assessed with a visual analogue scale (VAS) questionnaire. Multiple questionnaires were obtained to assess the participants' perception on preference, effectiveness and proficiency. Results Mean total treatment time was of 24:42 m/s for conventional and 12:29 m/s for digital impressions (P

OBJECTIVE The Short Communication presents a clinical case in which a novel procedure--the "Individualized Scanbody Technique" (IST)--was applied, starting with an intraoral digital impression and using CAD/CAM process for fabrication of ceramic reconstructions in bone level implants. MATERIAL AND METHODS A standardized scanbody was individually modified in accordance with the created emergence profile of the provisional implant-supported restoration. Due to the specific adaptation of the scanbody, the conditioned supra-implant soft tissue complex was stabilized for the intraoral optical scan process. Then, the implant platform position and the supra-implant mucosa outline were transferred into the three-dimensional data set with a digital impression system. Within the technical workflow, the ZrO2 -implant-abutment substructure could be designed virtually with predictable margins of the supra-implant mucosa. RESULTS After finalization of the 1-piece screw-retained full ceramic implant crown, the restoration demonstrated an appealing treatment outcome with harmonious soft tissue architecture. CONCLUSIONS The IST facilitates a simple and fast approach for a supra-implant mucosal outline transfer in the digital workflow. Moreover, the IST closes the interfaces in the full digital pathway.

OBJECTIVES The aim of this randomized controlled trial was to compare patient-centered outcomes during digital and conventional implant impressions. MATERIAL AND METHODS In a crossover study design, intraoral scanning (IOS) [test] as well as classical polyether impressions [control] were both performed on 20 patients for single-tooth replacement with implant-supported crowns. The sequential distribution of either starting with the test or the control procedure was randomly selected. Patients' perception and satisfaction on the level of convenience-related factors were assessed with visual analogue scale (VAS) questionnaires. In addition, clinical work time was separately recorded for test and control procedures. Statistical analyses were performed with Wilcoxon signed-rank tests and corrected for multiple testing by the method of Holm. RESULTS On VAS ranging from 0 to 100, patients scored a mean convenience level of 78.6 (SD ± 14.0) in favor of IOS compared to conventional impressions with 53.6 (SD ± 15.4) [P = 0.0001]. All included patients would prefer the digital workflow if in the future they could choose between the two techniques. Secondary, IOS was significantly faster with 14.8 min (SD ± 2.2) compared to the conventional approach with 17.9 min (SD ± 1.1) [P = 0.0001]. CONCLUSION Based on the findings of this investigation, both impression protocols worked successfully for all study participants capturing the 3D implant positions. However, the digital technique emerges as the most preferred one according to patient-centered outcomes and was more time-effective compared to conventional impressions.

Purpose This study aimed to evaluate mandibular denture base deformation along with three impression techniques used for implant-retained overdenture. Materials and methods Ten edentulous patients (five men and five women) received two implants in the canine region of the mandible and three duplicate mandibular overdentures which were constructed with mucostatic, selective pressure, and definitive pressure impression techniques. Ball abutments and respective gold matrices were used to connect the overdentures to the implants. Six linear strain gauges were bonded to the lingual polished surface of each duplicate overdenture at midline and implant areas to measure strain during maximal clenching and gum chewing. Results The strains recorded at midline were compressive while strains at implant areas were tensile. Clenching recorded significant higher strain when compared with gum chewing for all techniques. The mucostatic technique recorded the highest strain and the definite pressure technique recorded the lowest. There was no significant difference between the strain recorded with mucostatic technique and that registered with selective pressure technique. The highest strain was recorded at the level of ball abutment's top with the mucostatic technique during clenching. Conclusion and recommendation Definite pressure impression technique for implant-retained mandibular overdenture is associated with minimal denture deformation during function when compared with mucostatic and selective pressure techniques. Reinforcement of the denture base over the implants may be recommended to increase resistance of fracture when mucostatic or selective pressure impression technique is used.

It is generally assumed that passively fitting superstructures are a prerequisite for long-lasting implant success. In the study presented, the strain development of three-unit implant fixed partial dentures (FPDs) was evaluated at the bone surrounding the implant and on the superstructure using a strain gauge technique. Six groups of three-unit FPDs representing the commonly used techniques of bridge fabrication were investigated with 10 samples each, in order to quantify the influence of impression technique, mode of fabrication and retention mechanism on superstructure fit. Two ITI implants (Straumann, Waldenburg, Switzerland) were anchored in a measurement model according to a real-life patient situation and strain gauges were fixed mesially and distally adjacent to the implants and on the bridge pontics. The developing strains were recorded during cement setting and screw fixation. For statistical analysis, multivariate two sample tests were performed setting the level of significance at P=0.1. None of the investigated bridges revealed a truly passive fit without strains occurring. About 50% of the measured strains were found to be due to impression taking and model fabrication, whereas the remaining 50% were related to laboratory inaccuracies. The two impression techniques used did not reveal any significant differences in terms of precision. Both modes of fixation – i.e. cement and screw retention – provoked equally high stress levels. In the fabrication of screw-retained FPDs, similar results were obtained from the use of burn-out plastic copings and the technique of casting wax moulds to premachined components. Bonding bridge frames onto gold cylinders directly on the implants significantly reduces strain development.

Background: The accuracy of full-arch digital implant impressions has not been investigated yet and clinically relevant data are nonexistent. Aim/Hypothesis: Purpose of this study is to compare the accuracy of digital and conventional impressions for completely edentulous patients and to determine the effect of different variables on the accuracy outcomes. Null hypothesis was that there would be no difference between full-arch digital and conventional impressions. Material and methods: A stone cast of an edentulous mandible with five implants was fabricated to serve as master cast (control). The master cast was scanned and digitized with an intraoral scanner (TRIOS; three shape). Ten digital impressions were taken with the same intraoral scanner after connecting plastic scanbodies and digital models were created (n = 10). Four different conventional impression techniques were used to fabricate four groups of casts (n = 10). The implant casts of these four groups were also digitized with the same intraoral scanner into digital models. The scanning datasets from the five groups of digital and conventional impressions were superimposed with the one from the master cast to assess the 3-D (global) deviations. The 'best fit' algorithm was used with computer software to superimpose the scanning datasets and assess the accuracy of each impression technique. Results: Paired t-test was used to compare the 3-D discrepancies between the five test groups and the master cast, respectively. Significant difference was found at the 3-D accuracy between group II (non-splinted implant level) and control (P 0.05). Conclusion and clinical implications: The full-arch digital implant impressions were as accurate as conventional implant impressions and the null hypothesis was corroborated. The splinted implant-level impressions were more accurate than non-splinted implant-level for completely edentulous patients and as accurate as the digital ones.