6. Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques
Brian L. Wilk, DMD
2/3/2024 6
7. Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques
Brian L. Wilk, DMD
2/3/2024 7
8. 2/3/2024 8
Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques
Brian L. Wilk, DMD
9. Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques
Brian L. Wilk, DMD
2/3/2024 9
10. Alvarez C, Domínguez P, Jiménez-Castellanos E, Arroyo G, Orozco A. How the geometry of the scan body affects the accuracy of digital
impressions in implant supported prosthesis. <i>In vitro</i> study. Journal of Clinical and Experimental Dentistry. 2022 Dec;14(12):
2/3/2024 10
36. References
• Mizumoto, Ryan M., and Burak Yilmaz. "Intraoral scan bodies in implant
dentistry: A systematic review." The Journal of prosthetic dentistry 120.3
(2018): 343-352.
• Mizumoto, Ryan M., and Burak Yilmaz. "Intraoral scan bodies in implant
dentistry: A systematic review." The Journal of prosthetic dentistry 120.3
(2018): 343-352.
• Fluegge, Tabea, et al. "A novel method to evaluate precision of optical
implant impressions with commercial scan bodies—An experimental
approach." Journal of Prosthodontics 26.1 (2017): 34-41.
• Revilla-León, Marta, et al. "Influence of scan body design on accuracy of
the implant position as transferred to a virtual definitive implant cast." The
Journal of prosthetic dentistry 125.6 (2021): 918-923.
• Mizumoto, Ryan M., et al. "The effect of scanning the palate and scan bod
position on the accuracy of complete‐arch implant scans." Clinical implant
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37. • Schmidt, Alexander, et al. "The Influence of Using Different Types of
Scan Bodies on the Transfer Accuracy of Implant Position: An In Vitro
Study." International Journal of Prosthodontics 34.2 (2021).
• Stimmelmayr, Michael, et al. "Digital evaluation of the reproducibility
of implant scanbody fit—an in vitro study." Clinical oral
investigations 16 (2012): 851-856.
• Choi, Yong-Do, et al. "Effects of scan body exposure and operator on
the accuracy of image matching of implant impressions with scan
bodies." The Journal of prosthetic dentistry 124.3 (2020): 379-e1.
• Gómez‐Polo, Miguel, et al. "Influence of implant scan body design
(height, diameter, geometry, material, and retention system) on
intraoral scanning accuracy: A systematic review." Journal of
Prosthodontics 32.S2 (2023): 165-180.
• Motel, Constantin, et al. "Impact of different scan bodies and scan
strategies on the accuracy of digital implant impressions assessed
2/3/2024 37
It is quite amazing to think about the dentistry performed today 30 years back or even 10 years back. The dentistry has experienced an exciting amount of technological growth.With the modern era of digitalization in denristry, none of the branches of drntistry are untouched .implants have grown remarkable as a viable option for replacement of missing tooth. There are many brands of implant systems to choose from today.. A point ot be rembered is that the patient does not come for implant …but for thr prosthetsis that needs to be rehabilitated using the implant. The success of prosthetics depends on varuous factors one of them being the impression made. Conventional impression in implant consists of Open and closed tray impressions. they are tedious and vulnerable to many issues. These issues can be overcome upto an extent by the use of scannable impression copings or scan bodies .
Remove the healing abutment …place impression post onto the implant and tighten using the screw driver. Cover the tip using wax…inject light body over the post and make impression in perforated stock tray using putty…. Remove the tray…unscew the impression post…attach it to lab analogue…. Place it back in the impression and pour the impression
Open tray impression coping we can either use custom tray or use a stock tray and make a hole on it………light body near the copings and putty over the tray….make impression…loosen the transfer coping screws and ypur impression comes out with the coping. Figure 5…..connect the laboratory analogue to the impression coping.
Lets have a quick look on how it is done………..Instead of impression transfer coping a scannable coping is used. Once the scannable coping is placed into the implant (Figure 2 and Figure 3), proper seating is confirmed with a radiograph,
Scan body in place Next, the scanning is performed and a 3-dimensional (3-D) model of the region is visualized on the screen evaluating that all necessary surfaces of the scannable impression coping are present for the manufacture of the abutment and crown.
Customised abutment, milled abutment
SACN BODY CAN BE OF VARIOUS GEOMETRT VARIOUS MATERIALS VARIOUS DESIGNS geometry plays a major role in determing the result of scan body……… also the polished surfaces are easier to scan than irregular or corrugated ones……... It has also been found that when the change of surface is more abrupt, such as in very marked edges, the errors recorded are greater. , as thought by Mizumoto et al. (2) Fluegge et al. (14) determined on their study that the wider and longer the scanned surface was, the more accurate the scanning would be, and therefore the determination of the correct position of the implant. The material the scan bodies are made of may also be a factor, Parameters such as the angulation between scan bodies may interfere with accuracy and precision (14), as well as the design or engineering tolerance on its fabrication……….why peek Our scan bodies are made out of PEEK, since intraoral scanners do not register well information on metallic and reflective surfaces against opaque ones, causing numerous “holes” . PEEK has a neutral color with a high value (it is light in color) which is similar to improved stone plaster, and an adequate shine on surface to be measured using optical scanners .It is very stable three-dimensionally, and suffers very little modifications with temperature changes. It is also easy to mill………The scan bodies were screwed in with a 5N/cm2 torque with a torque wrench.
There are many commercially available sacan bodies….varying in geometry and shapes. And whwter they can be reused or not. Now lets ee how the scan body workd
After scanning the virtually surface is reconstructed from a series of flat polygons or triangles which are referred to as mesh. So amy sharp deviations in the design of scan body may lead to errors
These point clouds are used to reconstruct the image virtually.
Once the surface us reconstructed , it can be matched with the correct implant analog which is present in the digital library present.
Then the stl file is ued to mill the cast witn the space to fit the implant analog…
Indexed analog in the cast
The first scannable impression copings were released shortly after and termed “scan bodies” by the manufacturer (Straumann Holding AG). In single-unit and short-span situations, digital implant scans using ISBs are shown to have similar accuracy as conventional impressions. In completely edentulous patients, however, decreased accuracy has been shown. When common reference points are limited, the images may not be stitched together properly or parts of the scan may be misinterpreted as redundant data.30 Thus, techniques have been proposed to overcome this limitation by increasing the number of reference data points in an edentulous arch by modifying the surface and topography of the edentulous ridge. Purpose of this in vitro study was to compare 4 different scanning techniques (conventional intraoral digital scan, a novel scan body splinting technique, and 2 mucosa surface modification techniques) and 5 different scan bodies. Five different ISB systems were evaluated: AF (IO-Flo; Dentsply Sirona), NT (Nt-Trading GmbH & Co KG), DE (DESS-USA), C3D (Core3Dcentres), and ZI (Zimmer Biomet Dental). Four different scanning techniques were evaluated: unmodified master model (NO), glass fiduciary markers placed on the edentulous ridge (GB), pressure-indicating paste (PIP) brushed over the ridge and palate (PP), and floss tied between the scan bodies (FL)
Five commercially available scanning systems were used
Polyurerethane model simulating te ,axilla with 4 implants.
No modification
Glass fidussary markers which is present between the implants
Pressure indicating paste
Splinting with floss
The present study, however, demonstrated significant differences in the trueness and precision of the resulting scans when 4 different scanning strategies and 5 commercially available ISBs were used. All scan bodies and scan techniques resulted in a distance deviation greater than 170 mm and an angular deviation greater than 0.5 degrees. Because passive fit is an important goal for any implant-supported prosthesis, an accurate impression free from distortion is crucial.
1. The accuracy (trueness and precision) of completearch digital implant scans using ISBs was affected by both the scan body and scan technique when using one specific IOS system. 2. The ZI scan body (ZIMMER BIOMED SCAN) had significantly less deviation, whereas splinting scan bodies with floss led to significantly more deviation. 3. Scan techniques with different surface modifications resulted in similar distance deviations as the technique without any modifications. But the se of different ISBs led to significant differences in scan time.
2023 december
The external dimensions of a manufacturer-produced scan body (PSA3SCAN Scan Body, ZimVie) were measured using a digital caliper. FreeCAD was used to reverse engineer an STL file of the manufacturer produced scan body due to its ability to produce basic geometry with exact measurements (Fig 1). The idea was to create a scan body mimicking a situation when a commercial scan body is not available.
The Form Cure cycle was set to 30 minutes at 60°C, following manufacturer recommendations.
A manufacturer b sla c dlp
A dental cast (Fig 3) with a dental implant was fabricated. A surgical guide was fabricated using Surgical Guide Resin (Formlabs) at a resolution of 0.05 mm. The dental casts and surgical guides were post-processed according to the manufacturer’s recommendations (Form Wash & Form Cure, Formlabs). The implant was placed according to the implant guided surgical protocol
The cast was scanned with each of the three scan bodies of each set using a desktop scanner (E4 Generation RED, 3Shape) and its corresponding software system (Dental System, 3Shape
The SLA group clearly had lower trueness and precision in the angulation dimensions compared to the other group. The manufacturer group was best overall in the angulation dimension. The DLP group had similar precision as the control group. The study was one of the first to demonstrate the accuracy of 3D printed implant scan bodies compared to the manufacturer’s scan bodies as a control. The results demonstrated clearly that the control scan bodies have the best trueness and precision in both angulation deviations and linear deviations with 95% CI This suggests DLP 3D printed scan bodies provide better consistency of printed scan bodies compared to the SLA.
It is important to note that in this study, the scan body was reengineered and printed to simulate a situation when a manufacturer’s scan body is not available such as when the implants are no longer produced by the manufacturer or the implants were placed in another country. The reengineered and printed scan bodies here were aimed to mimic this clinical situation. If the original STL file of the scan body was used, it is possible that the printed scan bodies may provide a closer trueness and precision values as the original scan bodies compared to the reengineered ones. Dental and medical tourism creates a common situation when a patient has dental implants surgically placed overseas and then presents to a dental office with no known record of the implant used [29]. While on one hand, identification of an implant is a challenge [29], on the other hand, it can also be a challenge in finding a component for making an impression or a digital intraoral scan. This challenge can also be applicable to old implant systems that their parts and components may not be readily available. This issue soon can be a major problem due to the fact that patients are living longer and many of them have had previous implant treatmentsBoth SLA and DLP technologies are sensitive to changing in printing layer thickness. SLA appears to increase accuracy as the printing layer thickness decreases, while for the DLP, at least one study has suggested that the optimal printing layer for DLP is 50 μm
this is an in vitro study, while the results demonstrate that similarity with the manufacturer’s scan bodies, there is a need to validate the results in vivo. the accuracy and consistency of the fabricated scan bodies is essential to the appropriate fitting of the scan body to the implant fixture. There may be a learning curve and technical difficulties when clinicians want to apply this technology into their practices. The size of the small screw access hole and the internal hex structure can be difficult to manipulate during printing and post-processing processes
This study utilized SpringRay for the DLP printer and Form 3B for SLA printer.
his study utilized the known dimension of the manufacturer’s scan body. In real situations when a scan body is not available such as in the older implant systems or implants from other countries, the reverse-engineering process can be challenging and difficult to do Reverse-engineering of old dental implant parts as well as scan bodies will be an important topic as part of the future resear
