JPOR-284; No.

of Pages 7

journal of prosthodontic research xxx (2015) xxx–xxx

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Original article

Comparison of repeatability between intraoral

digital scanner and extraoral digital scanner:
An in-vitro study

Ting-shu Su DDS, Jian Sun DDS, PhD*

Department of Prosthodontics, The Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine,
Shanghai Key Laboratory of Stomatology, Shanghai, China

article info abstract

Article history: Purpose: The aim of this study was to compare the repeatability of intraoral digital impres-
Received 11 March 2015 sion scanning with the repeatability of extraoral scanning by using Geomagic Qualify 12 as
Received in revised form the software of analysis.
20 May 2015 Methods: One Nissin Dental Study Model (upper jaw) with prepared abutments were designed
Accepted 26 June 2015 to form 5 set of arrangements according to the layout of prepared abutments (arrangement 1:
Available online xxx single prepared maxillary central incisor; arrangement 2: single prepared maxillary first
molar; arrangement 3: prepared central incisor and canine with the lateral incisor absent;
Keywords: arrangement 4: half of upper arch with 7 prepared teeth; arrangement 5: entire upper arch with
Intraoral digital impression 14 prepared teeth). Each arrangement of Nissin Dental Study Model was scanned by TRIOS
Intraoral scanning intraoral digital scanner (experimental group) and D800 extraoral scanner (control group) for
Repeatability 10 times exporting 100 STL files in total. The data were processed and analyzed using Geomagic
Precision Qualify 12 software to evaluate the repeatability of intraoral digital scanning.
Results: 3D standard deviations were 13.33, 7.0, 16.33, 41.56, 88.44 mm for arrangements 1–5
respectively in experimental group and 14.89, 8.67, 24.33, 14.22, 12.67 mm for arrangements
1–5 respectively in the control group. Mann–Whitney test revealed a significant difference
between the 2 groups with regard to arrangements 2–5 ( p < 0.05).
Conclusions: Precision decreases with the increased scanning scope. Precision was clinically
acceptable when scanning scope was less than half arch. Precision of extraoral scanning
was acceptable in scanning any scope of arch region.
# 2015 Published by Elsevier Ireland on behalf of Japan Prosthodontic Society.

restorations including all-ceramic crowns and fixed dental

1. Introduction prostheses since 1980s [1]. Many CAD/CAM systems are
capable of designing and fabricating prostheses on plaster
The technique of computer aided design and computer aided cast made from conventional silicone impressions. In those
manufacturing (CAD/CAM) has been used to produce ceramic cases an extraoral scanner captures three-dimensional data

* Corresponding author at: Department of Prosthodontics, The Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine,
Shanghai Key Laboratory of Stomatology, Shanghai 200011, China. Tel.: +86 21 23271699; fax: +86 21 63235421.
E-mail address: doctorsunjian74@aliyun.com (J. Sun).
http://dx.doi.org/10.1016/j.jpor.2015.06.002
1883-1958/# 2015 Published by Elsevier Ireland on behalf of Japan Prosthodontic Society.

Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
JPOR-284; No. of Pages 7
2 journal of prosthodontic research xxx (2015) xxx–xxx
by scanning the plaster cast followed by the procedures of
computer aided design and manufacturing. Over the last
twenty years of development in the field of CAD/CAM
technique based on extraoral scanning, restorations generat-
ed by this technique exhibit the high performance of being
eminently functional and esthetical [2]. However, nonstan-
dard operation during impression taking and deformation of
clinical material will affect the accuracy of plaster model,
consequently affecting the accuracy of 3D model data and the
quality of prostheses. On the other hand, dental clinical
procedure started with conventional impression taking still
has not met the goal of complete digitization and automation
which is the major trend of dental prosthesis industry.
Therefore, it is desirable to develop a facility which can take
digital impressions directly from oral cavity to remove any
possible error and also economize on impression materials
used in conventional impression procedures.
The first digital intraoral impression system commercially
available was invented and brought to use in 1987 known as
CEREC 1 system [3]. It worked on the principle of ‘‘triangulation
of light’’ and needed an opaque powder coating on the surface
of abutments before scanning to improve the quality of scan
[1]. Since then, several digital intraoral impression devices
have been developed. Other than CEREC, LavaTM C.O.S, iTero,
E4D and TRIOS are some of the intraoral digital impression
systems available in the current dental field [4].
However, there remain some difficulties and defects that
need to be addressed in regards to intraoral digital impression
taking. Unlike the working process of extraoral scanner which
has been proved to be steady and accurate, intraoral digital
impression systems are facing a major problem of scanner
displacement during the scanning process which may affect
the accuracy of scanning. Up to data there are few published
literature studies on the performance of digital intraoral
impression system, especially concerning the accuracy and
precision of intraoral scanners.
The aim of this study was to evaluate the precision of
intraoral digital scanning methods (TRIOS, 3Shape, Denmark)
by analyzing the repeatability using Geomagic Qualify 12
(Raindrop Geomagic, Inc., Morrisville, NC) as software of
analysis.
2. Material and methods
2.1. Arrangements of study model
One Nissin Dental Study Model of upper jaw (500A, Nissin,
Japan) was used as the original model. Standard prepared and
intact artificial teeth (Nissin, Japan) in particular distribution
were seated on the original model selectively to simulate
5 clinical scenarios. The 5 arrangements were designed as
followed: (1) the single central incisor was the prepared tooth,
(2) the first molar was the prepared tooth, (3) central incisor
and canine were the prepared teeth with lateral incisor absent,
(4) 7 teeth from right first incisor to right second molar were
the prepared teeth (half of the upper arch), (5) 14 teeth were
the prepared teeth (the entire upper arch) (Fig. 1). For all
these 5 arrangements, parameters of artificial prepared teeth
were designed as: incisal/occlusal reduction of 2.0 mm, axial
Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
reduction of 1.0 mm, chamfer margin of 1.0 mm and conver-
gence angle of 68. The rest of tooth positions were filled with
intact standard artificial teeth (Nissin, Japan).
2.2. Data capturing of intraoral and extraoral scan
For the experimental group, before the scanning work the
calibration and pre-heating for scanner tip were accomplished
to the intraoral digital scanner (TRIOS cart, 3Shape, Denmark)
according to the instruction of the manufacturer. The original
model with the first arrangement (with the single central
incisor being the prepared tooth) was examined for intactness
of model and artificial teeth, and afterwards, it was held in the
operator’s hand ready for scanning. The operator used the
scanner tip to capture the contour of the selective region
including the prepared teeth without scanning the whole
dental arch. After a primary scan being accomplished the
software inside the system would point out any possible
missing areas on the main screen, and the operator proceeded
with an additional scanning of these areas until a complete
contour of the selective region was obtained. The same
scanning operation was performed 10 times to the original
model with the first arrangement. Thus the TRIOS system
exported 10 files of DCM format for the first arrangement. A
special software was used to convert the 10 DCM files to 10 STL
files. Once the original model of the first arrangement was
completed for 10 round of scanning, the artificial teeth of the
second arrangement were seated on the original model to
replace the former ones followed by the second round of
scanning. After all the 5 arrangements of original model were
scanned for 10 times, up to 50 STL files were generated.
For the control group, before the extraoral scanning, a
device-dependent calibration was carried out according to
the instruction of the extraoral scanner (D800 3D scanner,
3Shape, Denmark). Precision of D800 is high sub 20 microns.
The resolution of D800 scanner is 1.5 mega pixels. Then the
Nissin model was given a standard layer of powder coating
(CEREC optispray, Sirona, Germany) on the teeth surface. The
model was placed on the platform of extraoral scanner to
start scanning for 10 times. When changing the arrangement
of teeth, the former powder coating was removed and a
respray was conducted. Like the experimental group, scan-
ning of control group also generated 50 STL files for all the
5 arrangements.
2.3. Data processing
A 3D data analyzing software of Geomagic Qualify 12 was used
to evaluate the discrepancy among these STL files. 10 STL files
were obtained from every arrangement for both the control
and the experimental groups. The 1st STL file out of 10 files for
each arrangement was defined as reference [5]. The other
9 files were matched with the reference file respectively by a
best fit algorithm. Selecting and cutting tools inside the
software were used on the matched imaging data to eliminate
the irrelevant area. Therefore, the ultimate 3D data of
prepared teeth were generated for discrepancy analysis
(Fig. 2). Using the function of ‘‘deviation analyzing’’, the
Geomagic software exported an analysis report displayed in a
color map (Fig. 3) [6–8]. Therefore, 9 analysis reports were
JPOR-284; No. of Pages 7

journal of prosthodontic research xxx (2015) xxx–xxx 3

Fig. 1 – Five arrangements of Nissin Study Model.

generated for each arrangement of the original Nissin model.
All the 10 arrangements of both the control and the
experimental groups yielded 90 analysis reports in total. 3D
average deviation and 3D standard deviation were calculated
and displayed in the color map for each analysis report, thus
there were overall 90 numerical values of 3D average deviation
and 90 numerical values of 3D standard deviation.
2.4. Statistical analyzing
Data of 3D standard deviation were analyzed using SAS
system 8.02 (SAS institute Inc., Cary, NC, USA). The Mann–
Whitney test was used to test the differences between the
experimental and the control groups for the 5 arrangements.
The one-way Analysis of Variance (ANOVA) and SNK test were
used to test the intragroup differences of the 2 groups.
Statistical significance was set at p < 0.05 for all tests.
3. Results
Regarding the data of 3D standard deviations of experimental
group (intraoral scan group), the results revealed the mean 3D
standard deviation of 13.33 mm for arrangement 1, 7.0 mm for
arrangement 2, 16.33 mm for arrangement 3, 41.56 mm for
arrangement 4 and 88.44 mm for arrangement 5 (Table 1). Data
of the control group (extraoral scan group) revealed the mean
3D average deviation of 14.89 mm for arrangement 1, 8.67 mm
for arrangement 2, 24.33 mm for arrangement 3, 14.22 mm for
arrangement 4 and 12.67 mm for arrangement 5 (Table 2).
Significant differences of 3D standard deviations were
revealed between the experimental and the control groups
with regard to arrangement 2, arrangement 3, arrangement 4
and arrangement 5 (p < 0.05) by Mann–Whitney test while no
significant differences were found in arrangement 1 (Graph 1).
The one-way Analysis of Variance (ANOVA) test revealed
statistically significant differences of 3D standard deviations
between these 5 arrangements within the two groups
(p < 0.05). SNK test indicated that within the experimental
group, significant differences were found in between arrange-
ment 1 and arrangement 4, arrangement 1 and arrangement 5,
arrangement 2 and arrangement 4, arrangement 3 and
arrangement 4, arrangement 2 and arrangement 5, arrange-
ment 3 and arrangement 5, arrangement 4 and arrangement 5
(p < 0.05). Within the control group, significant differences
were found in between arrangement 1 and arrangement 2,
arrangement 1 and arrangement 3, arrangement 2 and
arrangement 3, arrangement 2 and arrangement 4, arrange-
ment 2 and arrangement 5, arrangement 3 and arrangement 4,
arrangement 3 and arrangement 5 (p < 0.05). Results of
intragroup comparisons within the experimental and the
control groups were displayed in Tables 3 and 4 respectively.

Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
JPOR-284; No. of Pages 7

4 journal of prosthodontic research xxx (2015) xxx–xxx

Table 1 – Mean, standard deviation (SD), median,

minimum (Min.), maximum (Max.) values of 3D standard
deviation in experimental group (intraoral group).
Mean SD Median Min. Max.
Arrange 1 13.33 2.78 12.0 10.0 17.0
Arrange 2 7.0 1.66 6.0 6.0 11.0
Arrange 3 16.33 5.92 14.0 11.0 27.0
Arrange 4 41.56 7.92 41.0 33.0 57.0
Arrange 5 88.44 28.63 74.0 50.0 131.0

Table 2 – Mean, standard deviation (SD), median,

minimum (Min.), maximum (Max.) values of 3D standard
deviation in control group (extraoral group).
Mean SD Median Min. Max.
Arrange 1 14.89 3.06 15.0 11.0 19.0
Arrange 2 8.67 1.58 9.0 6.0 11.0
Fig. 2 – Matched 3D image of the selected region. Arrange 3 24.33 3.46 24.0 18.0 29.0
Arrange 4 14.22 2.28 14.0 11.0 18.0
Arrange 5 12.67 0.71 13.0 12.0 14.0

In this study, the software of Geomagic Qualify 12 was used

Fig. 3 – Color map of deviation analyzing.
4. Discussion
In current clinical cases where dentists take conventional
impressions, both the manipulation of dentists and the
compliance of patients will affect the quality of impression
taking. To some extent, influencing factors such as gingival
sulcus bleeding, deformation of impression materials and
plaster models are inevitable [9]. Intraoral digital impression
seems to be an ideal method to avoid the flaws mentioned
above. Several publications of studies have evaluated the
clinical behavior of FDPs fabricated from intraoral digital
impression CAD/CAM method, and revealed satisfactory
qualities of this kind of restorations including marginal fit
and occlusion characteristics [10–12]. But up to date, few
studies have been conducted on the precision of intraoral
digital impression systems.
to process and analyze the 3D STL data. Since in every
arrangement the first scanned file was selected as the
reference data instead of one scanned by industrial standard
scanner, the present study was able to evaluate only the
repeatability of intraoral digital impression. The repeatability
represented ‘‘precision’’ which was shown by 3D standard
deviations according to ISO Norm 5725-1 [13]. The term
‘‘precision’’ refers to the closeness of agreement between
scanned results. Another term of ‘‘accuracy’’ refers to the
degree of conformity of a final scanning value, with respect to
the true value as defined by accepted standard. The ‘‘accura-
cy’’ was shown by 3D average deviations, but this study will
not elaborate on it. The analysis software of Geomagic Qualify
12 used in this study was able to match the scanned data and
reference data (the first scanned data) by superimposition. The
superimposition was based on a algorithm of ‘‘best fit
alignment’’ which was applied in several studies of 3D
comparison [14–16].
This study was carried out using TRIOS as intraoral scanner.
In fact, digital impression systems of CEREC, LavaTM C.O.S and
E4D have been applied in dental fields for longer time than
TRIOS. Most of them require powder spraying before scanning
process in clinical cases, TRIOS uses the principle of ultrafast
optical sectioning and confocal microscopy with no need of
powder coating [4,17]. The Nissin model and artificial teeth were
made of resin, could create nonuniform light dispersion on
surface when scanned by D800 extraoral scanner (grating
scanner). So the scanning of the control group was conducted
after powder spraying on Nissin model because powder coating
helped the Nissin model achieve a uniform light dispersion on
surface. According to studies performing digital scanning on
powder sprayed teeth, standardly operated spray process does
not generate significant discrepancy to the impression’s
accuracy or precision [11,18,19].
According to the results of 3D standard deviations in
experimental group, the mean values of arrangements 1, 2 and

Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
JPOR-284; No. of Pages 7

journal of prosthodontic research xxx (2015) xxx–xxx 5

Graph 1 – Mean comparison of 3D standard deviations between intraoral and extraoral groups for each arrangement.

Table 3 – Comparison of 3D standard deviations among 5 Table 4 – Comparison of 3D standard deviations among 5
arrangements in experimental group (intraoral group). arrangements in control group (extraoral group).
Arrange Arrange Arrange Arrange Arrange Arrange Arrange Arrange Arrange Arrange
1 2 3 4 5 1 2 3 4 5
Arrange 1 + + Arrange 1 + +
Arrange 2 + + Arrange 2 + + + +
Arrange 3 + + Arrange 3 + + + +
Arrange 4 + + + + Arrange 4 + +
Arrange 5 + + + + Arrange 5 + +

3 were less than 20 mm, and mean values of arrangement 4 and
5 were as significantly high as 41.56 mm and 88.44 mm.
According to the information in color maps generated by
Geomagic software, deviations were mainly located in incisal
edge and marginal part of arrangement 1; marginal part of
arrangement 2; marginal part and missing tooth (lateral
incisor) area of arrangement 3; marginal part and axial faces of
arrangements 4 and 5. With the scanning scope ranging from
arrangements 1 to 5, deviations displayed in gingival mucosa
become greater. It can be explained that the intraoral digital
scanner (TRIOS cart) works by taking numbers of 2D pictures
during the scanning procedure and integrating them to form
the 3D digital impression. Although it was the same operator
who processed the scanning, the movement of scanner tip
varied between each scanning procedure, affecting the
integration of the 2D pictures. With the scanning scope
increasing from arrangements 1 to 5, the effect would likely
be more obvious, especially for arrangements 4 and 5 in which
the scanning area overran half the arch. It could suggest the
dentists that digital capturing of marginal part is important in
impression taking and relatively difficult to conduct perfectly.
Dentists should be well trained to perform a high quality
digital impression taking. As to long scale FDPs ranging more
than half an arch, digital impression is suggested to be taken in
sections. The method of direct digital impression may be not
suitable on long scale gingival scan.
In the control group, the results of 3D standard deviations
of 5 arrangements were all less than 25 mm. According to the
information in color maps generated by Geomagic software,
deviations were mainly located in marginal part in the
5 arrangements. Of these 5 arrangements, arrangement 3
showed the value of 3D standard deviation of 24.33 mm, bigger
than 14.22 mm for arrangement 4 and 12.67 mm for arrange-
ment 5. This might be explained by the missing teeth area
(lateral tooth) of arrangement 3. Digital impressions were
matched by a ‘‘best fit alignment’’ algorithm in Geomagic
software, missing teeth in arrangement 3 causing a disconti-
nuity in between the abutment teeth could affect the
superimposition. Given the value of arrangement 3 was still
less than 25 mm, it could be suggested that 5 arrangements of

Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
JPOR-284; No. of Pages 7
6 journal of prosthodontic research xxx (2015) xxx–xxx
control group achieve satisfactory repeatability. The trend of
control group was probably because that D800 was a raster
scanner which scanned the object by electron beams in
normative scanning beams and scanning sequences. This
way, the scanned model was held in a relatively stable spatial
coordinates and the 3D images were generated alike even with
multiple scans.
The data from the color map showed significantly higher
value of 3D average deviation (representing accuracy) in
arrangements 4 and 5 in experimental group (intraoral
scanner). However, the values of control group (extraoral
scanner) were all less than 12 mm. The trend of accuracy is like
the trend of repeatability.
For the precision of direct digital impression, Güth et al. [20]
compared the 3D average and standard deviations of intraoral
digital impression (Lava Chairside Oral Scanner) with those of
extraoral desktop scanner (Lava Scan ST laboratory scanner)
in an in-vitro study where a molar and premolar were
scanned. It revealed the 3D standard deviations of 19 mm for
the intraoral digital scanner and 31 mm for the extraoral
scanner. Ender et al. [21] compared the trueness and precision
of digital impressions of the full arch with those of
conventional impressions using a reference scanner on a in-
vitro model, and the results showed that precision was
61.3  17.9 mm for conventional impression, 30.9  7.1 mm
for digital impression with the Cerec Bluecam and
60.1  31.3 mm for digital impression with Lava C.O.S.
Based on the relatively higher 3D standard deviations of
arrangement 4 and arrangement 5 in the experimental group,
this study gave out a hint that dentists should be cautious
about choosing intraoral digital scans for large-scope impres-
sion taking. Multi-unit fixed dental prostheses over half-arch
should be scanned in sections if direct intraoral digital scan is
applied. Studies of measuring the fit of prostheses should be
done to evaluate the accuracy of intraoral digital impression.
Syrek [11] compared the fit of single crowns fabricated from
digital impression with the fit of single crowns fabricated from
conventional impression, and reported of a better fit in digital
impression group. Almeida [22] also reported satisfactory
marginal and internal fit of four-unit zirconia fixed dental
prosthesis generated from direct digital impression. The data
from the color map showed significantly higher value of 3D
average deviation (representing accuracy) in arrangements 4
and 5 in experimental group (intraoral scanner). However, the
values of control group (extraoral scanner) were all less than
12 mm. The trend of accuracy is like the trend of repeatability.
It could be deduced that accuracy was acceptable in single
crown and fixed bridge restorations and would also decline
with the scan scope becoming bigger than certain range. These
results supported the viewpoint that intraoral digital impres-
sion was clinically acceptable to fulfill restorations of single
crown and ordinary bridges. Further studies measuring the fit
of long-scope restorations are necessary.
5. Conclusions
Within the limitation of this study, conclusions are as follows:
Precision of intraoral digital impression scanning was
declines with the increased scanning scope. Precision was
Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
clinically acceptable when scanning scope was less than half
arch. Precision of extraoral scanning was acceptable when
scanning any scope of arch region.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
This study was supported by Medicine and Engineering
Combination Project of Shanghai Jiaotong University
(YG2011MS07) and Shanghai Leading Academic Discipline
Project (Nos. T0202 and S30206).
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Please cite this article in press as: Su T-, Sun J. Comparison of repeatability between intraoral digital scanner and extraoral digital scanner: An in-
vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002