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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 reduction of 1.0 mm, chamfer margin of 1.0 mm and conver-
computer aided design and manufacturing. Over the last gence angle of 68. The rest of tooth positions were filled with
twenty years of development in the field of CAD/CAM intact standard artificial teeth (Nissin, Japan).
technique based on extraoral scanning, restorations generat-
ed by this technique exhibit the high performance of being 2.2. Data capturing of intraoral and extraoral scan
eminently functional and esthetical [2]. However, nonstan-
dard operation during impression taking and deformation of For the experimental group, before the scanning work the
clinical material will affect the accuracy of plaster model, calibration and pre-heating for scanner tip were accomplished
consequently affecting the accuracy of 3D model data and the to the intraoral digital scanner (TRIOS cart, 3Shape, Denmark)
quality of prostheses. On the other hand, dental clinical according to the instruction of the manufacturer. The original
procedure started with conventional impression taking still model with the first arrangement (with the single central
has not met the goal of complete digitization and automation incisor being the prepared tooth) was examined for intactness
which is the major trend of dental prosthesis industry. of model and artificial teeth, and afterwards, it was held in the
Therefore, it is desirable to develop a facility which can take operator’s hand ready for scanning. The operator used the
digital impressions directly from oral cavity to remove any scanner tip to capture the contour of the selective region
possible error and also economize on impression materials including the prepared teeth without scanning the whole
used in conventional impression procedures. dental arch. After a primary scan being accomplished the
The first digital intraoral impression system commercially software inside the system would point out any possible
available was invented and brought to use in 1987 known as missing areas on the main screen, and the operator proceeded
CEREC 1 system [3]. It worked on the principle of ‘‘triangulation with an additional scanning of these areas until a complete
of light’’ and needed an opaque powder coating on the surface contour of the selective region was obtained. The same
of abutments before scanning to improve the quality of scan scanning operation was performed 10 times to the original
[1]. Since then, several digital intraoral impression devices model with the first arrangement. Thus the TRIOS system
have been developed. Other than CEREC, LavaTM C.O.S, iTero, exported 10 files of DCM format for the first arrangement. A
E4D and TRIOS are some of the intraoral digital impression special software was used to convert the 10 DCM files to 10 STL
systems available in the current dental field [4]. files. Once the original model of the first arrangement was
However, there remain some difficulties and defects that completed for 10 round of scanning, the artificial teeth of the
need to be addressed in regards to intraoral digital impression second arrangement were seated on the original model to
taking. Unlike the working process of extraoral scanner which replace the former ones followed by the second round of
has been proved to be steady and accurate, intraoral digital scanning. After all the 5 arrangements of original model were
impression systems are facing a major problem of scanner scanned for 10 times, up to 50 STL files were generated.
displacement during the scanning process which may affect For the control group, before the extraoral scanning, a
the accuracy of scanning. Up to data there are few published device-dependent calibration was carried out according to
literature studies on the performance of digital intraoral the instruction of the extraoral scanner (D800 3D scanner,
impression system, especially concerning the accuracy and 3Shape, Denmark). Precision of D800 is high sub 20 microns.
precision of intraoral scanners. The resolution of D800 scanner is 1.5 mega pixels. Then the
The aim of this study was to evaluate the precision of Nissin model was given a standard layer of powder coating
intraoral digital scanning methods (TRIOS, 3Shape, Denmark) (CEREC optispray, Sirona, Germany) on the teeth surface. The
by analyzing the repeatability using Geomagic Qualify 12 model was placed on the platform of extraoral scanner to
(Raindrop Geomagic, Inc., Morrisville, NC) as software of start scanning for 10 times. When changing the arrangement
analysis. 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
2. Material and methods 5 arrangements.

2.1. Arrangements of study model 2.3. Data processing

One Nissin Dental Study Model of upper jaw (500A, Nissin, A 3D data analyzing software of Geomagic Qualify 12 was used
Japan) was used as the original model. Standard prepared and to evaluate the discrepancy among these STL files. 10 STL files
intact artificial teeth (Nissin, Japan) in particular distribution were obtained from every arrangement for both the control
were seated on the original model selectively to simulate and the experimental groups. The 1st STL file out of 10 files for
5 clinical scenarios. The 5 arrangements were designed as each arrangement was defined as reference [5]. The other
followed: (1) the single central incisor was the prepared tooth, 9 files were matched with the reference file respectively by a
(2) the first molar was the prepared tooth, (3) central incisor best fit algorithm. Selecting and cutting tools inside the
and canine were the prepared teeth with lateral incisor absent, software were used on the matched imaging data to eliminate
(4) 7 teeth from right first incisor to right second molar were the irrelevant area. Therefore, the ultimate 3D data of
the prepared teeth (half of the upper arch), (5) 14 teeth were prepared teeth were generated for discrepancy analysis
the prepared teeth (the entire upper arch) (Fig. 1). For all (Fig. 2). Using the function of ‘‘deviation analyzing’’, the
these 5 arrangements, parameters of artificial prepared teeth Geomagic software exported an analysis report displayed in a
were designed as: incisal/occlusal reduction of 2.0 mm, axial color map (Fig. 3) [6–8]. Therefore, 9 analysis reports were

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 3

Fig. 1 – Five arrangements of Nissin Study Model.

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


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
Fig. 3 – Color map of deviation analyzing. 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
4. Discussion E4D have been applied in dental fields for longer time than
TRIOS. Most of them require powder spraying before scanning
In current clinical cases where dentists take conventional process in clinical cases, TRIOS uses the principle of ultrafast
impressions, both the manipulation of dentists and the optical sectioning and confocal microscopy with no need of
compliance of patients will affect the quality of impression powder coating [4,17]. The Nissin model and artificial teeth were
taking. To some extent, influencing factors such as gingival made of resin, could create nonuniform light dispersion on
sulcus bleeding, deformation of impression materials and surface when scanned by D800 extraoral scanner (grating
plaster models are inevitable [9]. Intraoral digital impression scanner). So the scanning of the control group was conducted
seems to be an ideal method to avoid the flaws mentioned after powder spraying on Nissin model because powder coating
above. Several publications of studies have evaluated the helped the Nissin model achieve a uniform light dispersion on
clinical behavior of FDPs fabricated from intraoral digital surface. According to studies performing digital scanning on
impression CAD/CAM method, and revealed satisfactory powder sprayed teeth, standardly operated spray process does
qualities of this kind of restorations including marginal fit not generate significant discrepancy to the impression’s
and occlusion characteristics [10–12]. But up to date, few accuracy or precision [11,18,19].
studies have been conducted on the precision of intraoral According to the results of 3D standard deviations in
digital impression systems. 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 impression taking and relatively difficult to conduct perfectly.
5 were as significantly high as 41.56 mm and 88.44 mm. Dentists should be well trained to perform a high quality
According to the information in color maps generated by digital impression taking. As to long scale FDPs ranging more
Geomagic software, deviations were mainly located in incisal than half an arch, digital impression is suggested to be taken in
edge and marginal part of arrangement 1; marginal part of sections. The method of direct digital impression may be not
arrangement 2; marginal part and missing tooth (lateral suitable on long scale gingival scan.
incisor) area of arrangement 3; marginal part and axial faces of In the control group, the results of 3D standard deviations
arrangements 4 and 5. With the scanning scope ranging from of 5 arrangements were all less than 25 mm. According to the
arrangements 1 to 5, deviations displayed in gingival mucosa information in color maps generated by Geomagic software,
become greater. It can be explained that the intraoral digital deviations were mainly located in marginal part in the
scanner (TRIOS cart) works by taking numbers of 2D pictures 5 arrangements. Of these 5 arrangements, arrangement 3
during the scanning procedure and integrating them to form showed the value of 3D standard deviation of 24.33 mm, bigger
the 3D digital impression. Although it was the same operator than 14.22 mm for arrangement 4 and 12.67 mm for arrange-
who processed the scanning, the movement of scanner tip ment 5. This might be explained by the missing teeth area
varied between each scanning procedure, affecting the (lateral tooth) of arrangement 3. Digital impressions were
integration of the 2D pictures. With the scanning scope matched by a ‘‘best fit alignment’’ algorithm in Geomagic
increasing from arrangements 1 to 5, the effect would likely software, missing teeth in arrangement 3 causing a disconti-
be more obvious, especially for arrangements 4 and 5 in which nuity in between the abutment teeth could affect the
the scanning area overran half the arch. It could suggest the superimposition. Given the value of arrangement 3 was still
dentists that digital capturing of marginal part is important in 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 clinically acceptable when scanning scope was less than half
control group was probably because that D800 was a raster arch. Precision of extraoral scanning was acceptable when
scanner which scanned the object by electron beams in scanning any scope of arch region.
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 Conflicts of interest
multiple scans.
The data from the color map showed significantly higher The authors declare no conflict of interest.
value of 3D average deviation (representing accuracy) in
arrangements 4 and 5 in experimental group (intraoral
scanner). However, the values of control group (extraoral Acknowledgments
scanner) were all less than 12 mm. The trend of accuracy is like
the trend of repeatability. This study was supported by Medicine and Engineering
For the precision of direct digital impression, Güth et al. [20] Combination Project of Shanghai Jiaotong University
compared the 3D average and standard deviations of intraoral (YG2011MS07) and Shanghai Leading Academic Discipline
digital impression (Lava Chairside Oral Scanner) with those of Project (Nos. T0202 and S30206).
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
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vitro study. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.06.002
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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