IOS Impression by iTero Presentation by Dr. Roberto Sorrentino DDS, MSc, PhD http://www.dentalevo.it/dentistry-new-technology/ios-impression/

1. tooth
prepara)on
impression
tradi)onal op)cal
stone
model virtual
model
waxing
cas)ng
ceramic
layering
finishing
CAD
CAM
finishing

2. preparation
impression
traditional
stone model
Waxing
(Casting)
Ceramic layering
Finishing

3. preparation
OPTICAL IMPRESSION
scanner
imaging
CAD
CAM
finishing

4. Optical impression
Optical technology Laser technology
C.O.S. (3M Espe)
!
Fast Scan (IOS Technologies)
!
Intraoral camera (Densys3D)
!
Cerec Bluecam (Sirona)
E4D (D4D Technologies)
!
iTero (Cadent)
!
3D Progress (MHT)

5. Optical Technology
CCD - CMOS
Acquisition of static or dynamic images that with different
imaging using algorythm are meta-ricombined modeling a three-dimensional
virtual images
Laser Technology (Confocal technique)
LASER
Laser beam is convergent in small spots and with an array of
oscillating mirrors laser is moved through the entire
observation field for scanning all focal planes.

6. 3M - C.O.S.
!
!
!
System
type
:
Chairside
CAD/CAM
Architecture
:
Selec)vely
OpenClosed*
Powder
:
Yes
?
Lab
Equipment
:
COS
soHware
,
LavaDesign,
3Shape,
Dental
Wings
Case
Delivery
:
Doctor
>
Margin
Making
>
Milling
Center
>
Laboratory
Web
Interface,
E-­‐mail.
FTP,
Sneaker-­‐net
Case
Type
:
Scan
Only
Materials
:
LAVA,
3rd
party
Zirconia,
LAVA
DVS,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:
3D
margin
making,
Scan
file
edi)ng,
(wax
on
/wax
off)

7. IOS Technologies FastScan
!
!!!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
???
Lab
Equipment
:
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
>
Laboratory
Web
interface,
E-­‐mail,
FTP
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:

8. Densys3D
!
!
!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
???
Lab
Equipment
:
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
(Margin
Marking)
>
Laboratory
Web
interface
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:

9. D4D Technologies – E4D
!
!
!
System
type
:
Chairside
CAD/CAM
Architecture
:
Closed*
Powder
:
Op)onal
Lab
Equipment
:
Labworks
–
Scanner/Mill,
E4D
Studio
Case
Delivery
:
SkyNetwork,
LAN/Ethernet
Case
Type
:
Scan
Only,
or
Scan
and
Designed
Materials
:
Empress
CAD,
e.Max
CAD,
Paradigm
C,
Paradign
Z100,
Empress
Zircad,
BOB
(acrylic),
Telocad
(provisional)
Special
Features
:
Mul)ple
unit
edi)ng,
rubber
tooth
(sophis)cated,
Milling
independent
on
IOD
status,
SOS

10. iTero Cadent
!
!
!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
NO
Lab
Equipment
:
Cadent
Lab
SoHware
>
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
>
Margin
Marking
>
Milling
Center
>
Laboratory
Web
interface,
E-­‐mail,
FTP,
Sneaker-­‐net
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:
Margin
line
extension

11. 3D Progress MHT
!
!
!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
NO/YES
(Yes
on
metals)
Lab
Equipment
:
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
(Margin
Marking)
>
Laboratory
Web
interface
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:

12. Clon3D Progress IODIS
!
!
!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
NO/YES
(Yes
on
metals)
Lab
Equipment
:
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
(Margin
Marking)
>
Laboratory
Web
interface
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:

13. iTero Cadent
!
!
!
System
type
:
Chairside
digital
impression
Architecture
:
Open
Powder
:
NO
Lab
Equipment
:
Cadent
Lab
SoHware
>
3Shape,
Dental
Wings,
Dent
CAD
Case
Delivery
:
Doctor
>
Margin
Marking
>
Milling
Center
>
Laboratory
Web
interface,
E-­‐mail,
FTP,
Sneaker-­‐net
Case
Type
:
Scan
Only
Materials
:
3rd
party
Zirconia,
Wax,
e.Max
CAD,
Chrome-­‐cobalt
Special
Features
:
Margin
line
extension

14. Sirona - CEREC
!
!
!
System
type
:
Chairside
CAD/CAM
Architecture
:
Closed*
Powder
:
Yes
Lab
Equipment
:
inLAB,
inLAB
MC
XL
Case
Delivery
:
Cerec
Connect,
LAN/Ethernet,
E-­‐mail,
FTP,
Sneaker.net
Materials
:
Cerec
Bloc,
Empress
CAD,
e.Max
CAD,
Paradigm
C,
inCoris
Zi,
InCoris
Al,
Vita
Mark
II,
Vita
Triluxe,
Vita
In
Ceram
Spinell,
Al,
Zirconia,
Vita
YZ
Special
Features
:
Biogeneric
Library,
Cone
beam
integra)on,
abutments

15. Cerec optical impression
Cerec
1
:
50
micron
!
Cerec
2
:
25
micron
!
Cerec
3
:
25
micron

16. Collimating lens

17. Collimating lens

18. Active triangulation

19. Projecting an array of lines

20. Sinusoidal phase shift

21. Sequence of images (4)
Immagine
di
un
modello
virtuale
?

22. Virtual model
1. Op)cal
impression
!
2. Laser
scan
of
the
stone
model
!
3. Op)cal
scan
of
the
stone
model

23. Virtual model
1. Op)cal
impression
!
2. Laser
scan
of
the
stone
model
!
3. Op)cal
scan
of
the
stone
model

24. CEREC optical impression
1. All
the
areas
of
interest
has
to
be
clearly
visible
!
2. The
surfaces
have
to
be
reflec)ng

25. Brand and types of powdering
(optical impression)

30. Cerec optical impression
Cerec
1
:
50
micron
!
Cerec
2
:
25
micron
!
Cerec
3
:
25
micron
!
Cerec
3
BC:
20
micron

32. Die
CAD/CAM-­‐Systemkompetenz
von
Sirona. 32
CEREC Omnicam

33. CEREC Omnicam – Scanning simplicity.

34. CEREC Omnicam
Powder-­‐free
scanning
3D
impressions
in
natural
color

35. CEREC Omnicam – Scanning simplicity.
3D scans in color
PPossible Benefits
!
§ Intuitive orientation in the
patient’s mouth
§ Good differentiation between
tooth structure and gingiva
§ Differentiation from amalgam,
gold or composite

36. Screenshots with CEREC SW 4.0.4

37. Communication with patients

38. Camera CEREC
Omnicam CEREC
Bluecam
Imaging
technique Con)nuous
color
imaging Single
image
acquisi)on
Area
of
applica)on Single
tooth,
quadrant,
full
jaw.
Single
tooth,
quadrant
(full
jaw
possible).
Dimensions Overall
length:
228
mm
Length
of
camera
sleeve:
108
mm
Height
and
width
of
the
)p:
16
mm
Overall
length:
206
mm
Length
of
the
camera
)p:
86
mm
Height
and
width
of
the
)p:
22
x
17
mm
Weight 313
g 270
g
Clearance/depth
of
field The
camera
is
moved
closely
over
the
tooth
surface
0
-­‐
15
mm
The
camera
can
be
placed
directly
on
the
teeth.
Open
data* ü ü
No
charge
for
using
Sirona
Connect:
!
!
(Transmission
of
impression
data
to
an
ü
ü
external
laboratory)
Can
be
combined
with
a
milling
unit ü ü
3D
scans
in
color ü
No
powder
coa)ng
required ü

39. Ender
A,
Mehl
A
Full
arch
scans:
conven)onal
versus
digital
impression:
an
in-­‐vitro
study
!
Int
J
Comp
Dent
2011:14-­‐11:21

40. Full
arch
scans:
conven)onal
versus
digital
impression:
an
in-­‐vitro
study
!
Int
J
Comp
Dent
2011:14-­‐11:21
Conclusion
!
These in-vitro results show that
accuracy of the digital impression
Ender
A,
Mehl
A
is similar to that of the conventional impressions.

41. Seelbach
P,
Brueckel
C,
Wöstmann
B
!
Accuracy
of
digital
and
conven)onal
impression
techniques
and
workflow
!
Clin
Oral
Invest
2013
DOI
10.1007/s00784-­‐012-­‐0864-­‐4

42. Seelbach
P,
Brueckel
C,
Wöstmann
B
!
Accuracy
of
digital
and
conven)onal
impression
techniques
and
workflow
!
Clin
Oral
Invest
2013
DOI
10.1007/s00784-­‐012-­‐0864-­‐4
Conclusions
!
Within
the
limita+ons
of
this
in
vitro
study,
it
can
be
stated
that
digital
impression
systems
allow
the
fabrica+on
of
fixed
prosthe+c
restora+ons
with
similar
accuracy
as
conven+onal
impression
methods.
!
Clinical
relevance
!
Digital
impression
techniques
can
be
regarded
as
a
clinical
alterna+ve
to
conven+onal
impressions
for
fixed
dental
restora+ons.

43. 43
Trasferisce
- geometria dell’impianto
- dimensione dell’impianto
- posizione 3D nell’arcata
!
!
!
!
!
!
!
!
coping tradizionale scan body

44. L’accuratezza del processo di digitalizzazione dipende da:
!
- tecnica di scansione del clinico (a zig-zag o lineare)
- sistema di scanner utilizzato (microscopia cofocale, paralella, a
raggio laser, a luce strutturata)
- forma e dimensioni dello scan body
44

45. Questi modelli non sono concepiti per realizzare delle protesi dall’inizio
Possono solo essere utilizzati per posizionare le strutture realizzate
tramite le tecnologie cad-cam per poter applicare la ceramica e
controllare i punti di contatto.
45

46. 46
METODI DI FABBRICAZIONE
!
Sottrattivo Additivo
!
Fresatura da un blocco Sinterizzazione al laser di polvere
Polimetilmetacrilato (PMMA)
Resina composita
Leghe metalliche (vili, titanio)
Vetro ceramiche (Disilicato di litio, leucite)
Zirconia

47. Future Developments
!
1. Control of the costs
2. Enahncement of the application spectrum (edentulous jaw)
3. Introduction of trans-gengival scanners
4. Ultrasonography (accuracy?)
5. Optical coherence tomography (OCT)
!!!

48. Joda and Bragger
IOS Work Time for Single Unit (In minutes)
Economical and clinical process analysis for implant-supported
single-unit reconstructions.
Clin Impl Dent Rel Res (In press)
Clinic 1
(Traditional vs
digital
Lab (abutment
and crown)
Digital 14 160
Conventional 18 190
Clinic 2 (try-in) Clinic 3 (Clinical
Adjustments)
Total
12 45% 180
15 100% 220

49. hlps://www.youtube.com/watch?v=LRU0dk0KBJQ

50. LIMITS:
!
- USEFUL ONLY FOR SMALL RESTORATIONS
- COSTS
- NEED FOR USB ATTACHMENT TO PC
WITHOUT TROLLEY
- - STL FILES
- - SIMPLIFICATION OF PROCEDURES
- - MANAGEMENT OF SOFT TISSUES…WE NEED
- NEW TECHNOLOGY TO PASS THE SOFT TISSUE
- AND RECORD HARD TISSUE
!
!

51. 51
Problemi
* Acquisizione dei dati per arcate intere è ancora imprecisa
* Per molti sistemi è necessario applicare una polvere opacizzata che
non è facilmente controllabile
* Per i pilastri naturali, se le preparazioni sono umide, la polvere
tende a creare grumi
Costi (scanner e procedura)
* Per elementi multipli l’unione di diversi gruppi di dati può generare
delle inesattezze
* Non è ancora possibile catturare un margine intrasulculare senza
esporlo tramire retrazione gengivale
. Necessità di fili di retrazione.

52. 52
Potenziali benefici
Impronta tradizionale Scanner intraorale
Comfort del paziente No Si
Feedback immediato sulla qualità
delle preparazioni
No Ni
Possibilità di creare n modelli
con lo stesso grado di
distorsione, senza stoccarli
No Si

53. 53
SCANNER INTRAORALI
Lava Itero BlueCam
Cerec
ZFX
Accuratezza
della scansione
6-11 um 40 um 25 um 40 um
Possibilità
scansionare denti
singoli & multipli
si si si si
Possibilità di
scansionare
impianti singoli &
multipli
3i certified solo x straumann si con scan body si con scan body
Trios
20 um
si
si con scan body
Costs (Euro) 21-35.000 12.000 25.000 53.000 27.000
Scan Type Monographic/True color Monographic Monographic True color Monographic