RESEARCH AND EDUCATION

Effect of custom abutment data superimposition on the

accuracy of implant abutment level scanning: An in vitro study
Yeon-Wha Baek, DDS, MSD, PhD,a Young-Jun Lim, DDS, MSD, PhD,b Myung-Joo Kim, DDS, MSD, PhD,c and
Ho-Beom Kwon, DDS, MSD, PhDd

Intraoral digital scanning com- ABSTRACT

bined with computer-aided
design and computer-aided
manufacturing (CAD-CAM)
techniques has enabled a
completely digital workflow in
implant dentistry. Digital
implant scanning requires con-
necting a scan body to the
implant before scanning to
reproduce the location of the
implant in the CAD software
program together with design
of the abutment and super-
structure. This method of
making an implant abutment
and prosthesis after making
fixture-level scans with a scan
body in place has been reported
to be a highly predictable
treatment, especially for single
implant-supported crowns.1-8
Custom abutments made
with CAD-CAM technology,
optimally designed for the
space to be restored and sur-
rounding soft tissue, have
become popular. Their use
Statement of problem. When scanning implant abutments, an incomplete scan is often obtained
because of a subgingival location or restricted accessibility. Whether these problems can be overcome
with a novel scanning technique with digital superimposition of the custom abutment is unclear.
Purpose. The purpose of this in vitro study was to evaluate the effect of the process of
superimposing the custom abutment library data onto the scanned abutment data on the
accuracy of the digital scan with an intraoral scanner.
Material and methods. A model with a single implant was prepared. The custom abutment of the
corresponding implant was produced and was scanned with a laboratory scanner to produce the
custom abutment library data. The custom abutment was connected to the implant, and the model
was scanned with a laboratory scanner for the reference data. The custom abutment and adjacent
teeth were scanned 10 times with an intraoral scanner. Thus, 10 files were saved as the first test
group (IOS). After transferring 10 files of the group IOS to a computer-aided design (CAD) software
program (exocad DentalCAD), the custom abutment library data were superimposed on the
corresponding abutments, and the results were saved as the second test group (S-Exo). For the third
test group (S-Den), the same superimposing process was performed as for the group S-Exo but by
using another CAD software program (Dental System). The accuracy of the files of the 3 test groups
was evaluated by comparing them with the reference file by using a 3D inspection software
program. Statistical analysis was performed with 1-way repeated measures ANOVA (a=.05).
Results. The RMS of the IOS group decreased significantly from 42.1 ±1.1 mm to 36.37 ±0.74 mm for the S-Exo
group and 36.89 ±0.69 mm for the S-Den group after superimposition (P<.05). InTOL increased significantly
from 88.17 ±0.75% to 91.57 ±0.56% in the S-Exo group and 91.31 ±0.56% in the S-Den group (P<.05). For
the mean 3D discrepancy of all 66 points along the margin and 16 points of interest, the IOS group showed
significantly higher discrepancy than the superimposed groups (P<.05), implying that the accuracy of
scanned data with the intraoral scanner increased after superimposition with the abutment library data. No
significant difference was found according to the type of software program (P>.05).
Conclusions. The process of superimposing the titanium custom abutment with the prescanned
custom abutment library data improved the accuracy of a digital scan made with an intraoral
scanner. (J Prosthet Dent 2022;-:---)

Funding: This was supported by grant no. 08-2020-0010 from the Seoul National University Dental Hospital (SNUDH) Research Fund.
a
Clinical Professor, Department of Prosthodontics, Gwanak Center, Seoul National University Dental Hospital, Seoul, Republic of Korea.
b
Professor, Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, Seoul,
Republic of Korea.
c
Professor, Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, Seoul,
Republic of Korea.
d
Professor, Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, Seoul,
Republic of Korea.

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Clinical Implications
Digital superimposition of a custom abutment
library should improve clinical convenience and
compensate for incompletely scanned areas
without adversely affecting scanning accuracy
when scanning implant abutments intraorally.
should optimize anatomic and esthetic outcomes by
improving the emergence profile and accurate placement
of the cervical restoration margin.9
The custom abutment and restoration can be made in
a dental laboratory requiring a single fixture level
impression without the need for an additional intraoral
impression. However, an additional abutment-level
impression may be required. An abutment-level
impression provides straightforward recording of the
abutment position and soft tissue shape formed by the
abutment connection. Only the suprastructure needs to
be produced by using the abutment-level impression, as
in scanning tooth-supported prostheses, without retro-
fitting the position of the fixtures, as opposed to a fixture-
level impression. Moreover, Kim et al10 reported that the
settling effect could cause errors during the impression
and the laboratory procedures owing to discrepancies in
the vertical position of the abutment depending on the
tightening torque. Thus, they recommended the abut-
ment-level impression procedure for the fabrication of
definitive prostheses, particularly in patients with multi-
ple implants, where internal conical connections are
used. Precise impressions are critical for fabricating
dental restorations with an adequate fit. Implant-
supported prostheses also require an accurate margin
fit to prevent perimucositis or peri-implantitis. Tissue
displacement cords are typically used to acquire a definite
recording of the abutment margin for abutment-level
impressions, especially for subgingival locations.11
However, the packing of tissue displacement cords is a
time- and labor-consuming process, and inappropriate
manipulation may result in pain, bleeding, or recession.12
A digital scan with an intraoral scanner requires more
gingival displacement than that of a conventional
impression to ensure the accurate recording of the
margin.11,13 During intraoral scanning, the limited
intraoral space may make it difficult to acquire accurate
scan data because optical intraoral scans acquire 3-
dimensional shapes with optically acquired spatial co-
ordinates. Moreover, scanning may be challenging if the
space between the abutment and adjacent teeth is
narrow.13
To compensate for the difficulties in abutment-level
scanning, recent clinical reports14-16 have detailed at-
tempts to obtain an abutment scan indirectly in CAD by
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
superimposing the prescanned custom abutment library
data onto the abutment scan data. It has been reported
that even if an abutment scan is obtained incompletely, it
is possible to reproduce the abutment data by super-
imposing them in the laboratory so that even sub-
gingivally located abutments or abutments within a
narrow space, such as obtained with gingival displace-
ment, can be recorded accurately without substantial
effort.
However, the accuracy of this scanning method may
be affected by the additional superimposition process in
the abutment scan. The error of this scanning method
consists of the error of the oral scanner scanning itself
and the error that is caused by the superimposition
process. The latter is expected to be affected by the su-
perimposition software program and techniques, as well
as the range and quality of the scan data.
The present study evaluated the accuracy of the
method of obtaining abutment scan data indirectly by
superimposing a prescanned abutment library onto the
abutment scan data by comparing the abutment scan
with the data after superimposing the prescanned
abutment library onto the abutment scan. Furthermore,
the accuracy of the superimposition software was
investigated. The null hypotheses were that no differ-
ence would be found in the accuracy between the
abutment scan data and the abutment library super-
imposed data and that the type of CAD software used
for the superimposition would have no effect on the
accuracy of the data.
MATERIAL AND METHODS
A single implant with an internal hexagon connection
(TSIII; Osstem Implant) was placed at the position of the
right first molar in an acrylic resin maxillary model with 1
molar missing. The scan body was connected to the
implant and tightened by hand to approximately 10 Ncm.
The model was scanned with a laboratory scanner (E4 lab
scanner; 3Shape A/S), and the custom abutment was
designed by using a CAD software program (Dental
System; 3Shape A/S) and milled with a 5-axis milling
machine (ARUM 5X-100; Doowon ID) (Fig. 1).
The milled custom abutment was scanned with a
laboratory scanner (Medit T500; Medit Corp) to produce
custom abutment library data (Fig. 2). Scanning powder
(VITA Powder Scan Spray; VITA Zahnfabrik) was used to
prevent unwanted reflections from the metal surface. The
custom abutment was connected to the corresponding
implant that was placed in the model, and the model was
scanned with a laboratory scanner for the reference
standard tessellation language (STL) format file. The
custom abutment and adjacent teeth were scanned 10
times by 1 experienced investigator (Y.-W.B.) with an
intraoral scanner (Medit I500; Medit Corp); thus, 10 STL
Baek et al
- 2022
Single implant model
Model to Cast Intraoral scanner
Superimposition
exocad DentalCAD
Reference data Group IOS Group S-Exo
(n=1) (n=10) (n=10)
Figure 1. Study design.
files were obtained as the first test group (IOS group).
The scanner was calibrated before scanning according to
the manufacturer’s guidelines, and each specimen was
scanned with a consistent pattern and speed for no more
than 1 minute per specimen. As directed by the manu-
facturer, powder was not used for this procedure. After
transferring the 10 STL files from the IOS group to the
CAD software program (exocad DentalCAD; exocad
GmbH), the abutment library data were superimposed
onto the corresponding abutments of the files by using a
multidie function, and the results were saved as the second
test group (S-Exo group). For the third test group (S-Den
group), the 10 STL files of the IOS group were transformed
to the proprietary format (DCM) for the specific CAD
software program (Dental System; 3Shape A/S), and the
same superimposition process was performed (Fig. 3).
To compare the trueness of the test group data, each
test STL file of the 3 groups was aligned on the refer-
ence STL file by using a 3D inspection software pro-
gram (Release 2018, Geomagic control X; 3D Systems)
according to the recommendation of the International
Organization for Standardization (ISO) 12836.17 The
STL files were converted into point cloud data, and
unnecessary and inaccurate parts of each model were
eliminated. The reference and test STL files were
initially aligned and subsequently rearranged to the
best-fit alignment. The sampling rate was set to 100%
with a maximum repetition index of 30. All point cloud
data were 3-dimensionally compared, and the distances
between the reference and test data of all points were
converted into root mean square (RMS) values, calcu-
lated by using the formula18:
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
Xn  2ffi
1
RMS = pffiffiffi × i=1 1;i
x −x 2;i ;
n
where x1;i is the measurement point of reference data i,
x2;i is the measurement point of test group data I, and n
is the total number of measurement points.
The tolerance level was set to ±50 mm according
to previous studies.19,20 The percentage of points
Baek et al
3
CAD-CAM
Custom abutment
Model to Cast
Superimposition
Abutment library
Dental System
Group S-Den
(n=10)
Figure 2. Custom abutment library data produced by scanning with
laboratory scanner.
within the tolerance level (inTOL; nominal ±50 mm)
was also calculated with respect to the accuracy of
the test group data. A color map to express the vi-
sual deviation was set with 20 color segments,21 and
the ranges of the nominal and critical values were
set to 50 and 500 mm, respectively (Fig. 4). A total of
66 points were manually defined on the reference
scan along the finish line to measure the accuracy of
the data around the abutment margin, and the 3D
deviation was measured at each location by using a
3D comparison tool. The finish line was divided into
segments based on the tooth surface: buccal, palatal,
mesial, and distal. The buccal and palatal surfaces
each accounted for 20 of the 66 points on the finish
line, whereas the mesial and distal surfaces each
accounted for 13 of the 66 points. The mean
discrepancy for each tooth surface was calculated
(Fig. 5A). The additional 16 points were assigned as
follows: 5 points for the second premolar, 6 points
for the custom abutment, and 5 points for the sec-
ond molar. The 16 points were composed of 8 cusps,
4 pits, and 4 marginal ridges. The divergence be-
tween the test and reference data on the x-, y-, and
z-axes was measured for each location of these
points (Fig. 5B).22
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Figure 3. Abutment library superimposition using CAD software program: A, exocad DentalCAD. B, Dental System.

Figure 4. Color maps of 3D comparison of test group data with reference data. A, B, IOS group, red arrows show areas with deviations beyond tolerance
level (50 mm), C, S-Exo group. D, S-Den group. Green color on entire surface.

THE JOURNAL OF PROSTHETIC DENTISTRY Baek et al

- 2022
Figure 5. 3D deviation measurements. A, 66 points on margin of abutment. B, 16 points on cusps, pits, and marginal ridges of abutment and adjacent
teeth.
Statistical analyses were performed with a statistical
software program (IBM SPSS Statistics, v23; IBM Corp)
(a=.05). The distribution of all data was examined for
normality by using the ShapiroeWilk test and homoge-
neity of variance with the Levene test. The RMS, inTOL,
and 3D deviations among the test groups were analyzed
by using 1-way repeated measures ANOVA and the post
hoc Tukey HSD test (a=.05).
RESULTS
Discrepancies between the 30 STL files of the 3 test
groups and reference files were evaluated. The RMS of
the scanned data decreased statistically significantly from
42.1 ±1.1 mm to 36.37 ±0.74 mm and 36.89 ±0.69 mm
following the abutment superimposition process with the
exocad DentalCAD and Dental System software pro-
grams, respectively (P<.05) (Table 1, Fig. 6A). The pro-
portion of points for which deviations existed within a
tolerance level of 50 mm (inTOL) increased significantly
from 88.17 ±0.75% to 91.57 ±0.56% and 91.31 ±0.56% as
a result of the superimposition with exocad DentalCAD
and Dental System, respectively (P<.05) (Table 1,
Fig. 6B).
The color map exhibited negative deviation beyond
the tolerance level (blue color) on the proximal surface of
the abutment in 7 files and positive deviation beyond the
tolerance level (yellow color) on the axio-occlusal line
angle of the abutment in 4 files among the 10 files of
scanned data using the intraoral scanner. The 20 files of
the S-Exo and S-Den groups, which were the results of
the superimposition, exhibited a green color on the entire
surface (Fig. 4).
The IOS group exhibited a significantly higher
discrepancy value of 61 ±17 mm than the S-Exo (21.4 ±1.2
mm) and S-Den (22.1 ±1.0 mm) groups (P<.05) (Table 2,
Fig. 7A) for the mean discrepancy of all 66 points along
the finish line. The margin discrepancy of each surface
apart from the mesial surface also decreased following
superimposition when analyzed according to the abut-
ment surfaces (Table 2, Fig. 7B-E).
The discrepancy values of the cusps and pits
decreased with the superimposition process for the
Baek et al
5
Table 1. Mean value of deviations (RMS) and percentage of points within
tolerance level of ±50 mm (inTOL) of test groups for 3D compared with
reference data (mean ±standard deviation)
Group RMS (mm) inTOL (%)
IOS IOS (Medit i500) 42.1 ±1.1a 88.17 ±0.75c
S-Exo IOS (Medit i500)/superimposition 36.37 ±0.74b 91.57 ±0.56d
(exocad DentalCAD)
S-Den IOS (Medit i500)/superimposition 36.89 ±0.69b 91.31 ±0.56d
(Dental System)
Different letters indicate statistically significant differences based on repeated measures
ANOVA (P<.05). RMS, root mean square.
additional 16 assigned locations, whereas those of the
marginal ridges did not exhibit significant differences
among the test groups (Table 3, Fig. 8). When the points
were analyzed according to the tooth, the discrepancy of
the abutment in the S-Exo and S-Den groups was
smaller than that in the IOS group, suggesting that the
abutment data became more accurate following super-
imposition (Table 4, Fig. 9).
DISCUSSION
The null hypothesis regarding the accuracy between the
abutment scan data and superimposed abutment library
data was rejected, as the accuracy increased significantly
in the scan data following superimposition (P<.05).
However, the null hypothesis regarding the effect of the
CAD software program used in the superimposition
process was not rejected, as the accuracy of the scan data
that were superimposed by using the 2 different CAD
programs was not statistically different in all measure-
ment results (P>.05).
In this study, the RMS and inTOL (%) values were
calculated by using the point cloud data of the reference
and test files. The parts that are regarded as critical for
fabricating prostheses, that is, the margin, cusps, pits,
and marginal ridges, were assigned as points for addi-
tional analysis. The 3D deviation values were converted
into absolute values because the sum of the plus (+) and
minus (-) values would be deducted from the real
discrepancy value, obscuring the clinically relevant result.
The color maps were applied for qualitative evaluation,
THE JOURNAL OF PROSTHETIC DENTISTRY
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50 100
*** ***
*** ***
45 95

inTOL (%)
RMS (µm)

40 90

35 85

30 80
IOS S-Exo S-Den IOS S-Exo S-Den
Groups A Groups B
Figure 6. A, Mean value of deviations (RMS). B, Percentage of points within tolerance level of ±50 mm (inTOL) calculated by 3D comparison of test
groups with reference data (*P<.05, **P<.01, ***P<.001).

Table 2. 3D deviations of total 66 points and points of each surface on margin of abutment between test and reference data (mean ±standard
deviation)
Margin Discrepancy (mm)
Group Total Buccal Mesial Palatal Distal
IOS 61 ±17a 64 ±24c 54 ±30e 70 ±32f 51 ±22i
S-Exo 21.4 ±1.2b 15.3 ±1.7d 35.5 ±3.8e 26.6 ±1.1g 8.8 ±1.4j
b d e h
S-Den 22.1 ±1.0 15.6 ±1.3 37.2 ±3.4 25.9 ±1.3 11.0 ±3.1j

Different letters indicate statistically significant differences based on repeated measures ANOVA (P<.05).

which indicated the positive or negative deviation of the
test STL files compared with the reference STL file.
In terms of the overall accuracy, the mean RMS value
of the IOS group was higher and the inTOL (%) of the
IOS group was significantly lower than that of the S-Exo
and S-Den groups, indicating that the data following
superimposition of the abutment exhibited greater true-
ness to the reference data compared with the group that
consisted of scanned data without superposition. No
significant difference was observed between the S-Exo
and S-Den groups (P>.05).
The deviations in the 66 points on the margin were
found to be reduced through the superimposition,
and when analysis was performed according to the tooth
surfaces, the discrepancy of each tooth surface except for
the mesial surface was significantly decreased following
superimposition. Another notable point was that, as
illustrated in Figure 7, the scattering degree of the margin
deviation, that is, the standard deviation, decreased
following the superimposition and was observed at the
margins of all tooth surfaces. The decreased standard
deviations after the superimposition process can be
interpreted as the reliability and repeatability of the
digital scan of the abutment margin tending to increase
through the abutment superimposition process.
A previous study16 on implant abutment-level scan-
ning techniques with the digital superimposition of
custom abutments reported no significant differences
between the test and reference data. It was concluded
that the superimposition technique can be used clinically,
even when the custom abutments have been incom-
pletely scanned.
In the present study, the error in the digital scan data
decreased following the superimposition in all measure-
ment results, namely the RMS, inTOL, and 3D discrep-
ancies at the designated points, possibly because of
reflection from the metal surface. Scanning powder was
used to prevent unwanted metal reflections when scan-
ning the abutment library data with a model scanner but
not when scanning with the intraoral scanner, as rec-
ommended by the manufacturer. This can be interpreted
as one reason for the decreased deficiency after the
abutment superimposition. Digital scanning with powder
has previously been reported to be accurate, particularly
for metal substrates, because metal surfaces tend to in-
crease the errors when an intraoral scanner is used.
Previous studies have recommended the use of powder
to overcome the associated challenges of surface mois-
ture and angular reflections.23 Although the powder
thickness may vary between operators, a scanning soft-
ware program algorithm can be used to compensate for
these differences.24 However, the powder may be un-
comfortable for patients, and increased time will be
required if the powder is contaminated with saliva during

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- 2022 7

Buccal Margin
Total Margin
***
120 *** 120 ***
***
100 100
3D Deviations (µm)

3D Deviations (µm)
80 80

60 60

40 40

20 20

0 0
IOS S-Exo S-Den IOS S-Exo S-Den
Groups A Groups B
Palatal Margin
Mesial Margin ***
120 **
120

100
100
3D Deviations (µm)

3D Deviations (µm)

80 80

60 60

40 40 *

20 20

0 0
IOS S-Exo S-Den IOS S-Exo S-Den
Groups C Groups D
Distal Margin
120 ***
***
100
3D Deviations (µm)

80

60

40

20

0
IOS S-Exo S-Den
Groups E
Figure 7. 3D deviations between test and reference group data. A, Total 66 points. B, 20 points on buccal surface. C, 13 points on mesial surface. D, 20
points on palatal surface. E, 13 points on distal margin of abutment (*P<.05, **P<.01, ***P<.001).

scanning, as this requires cleaning and the reapplication including a superposition process in the intraoral scan-
of the powder. If the results of this study are applied to ning without powder.
clinical practice, scan data for metal abutments that are as In the present study, one operator scanned each
accurate as those with powder can be obtained by specimen with a consistent pattern and speed for no

Baek et al THE JOURNAL OF PROSTHETIC DENTISTRY

8 Volume - Issue -

Table 3. 3D deviations (mm) of 16 points between test and reference data (mean ±standard deviation)
Group Cusps Pits Marginal Ridges
IOS 19.5 ±2.5a 9.3 ±1.3d 17.9 ±5.8g
b e
S-Exo 9.1 ±1.2 11.6 ±1.6 15.1 ±2.2g
c f
S-Den 10.0 ±1.3 12.6 ±1.3 16.6 ±2.2g
Different letters indicate statistically significant differences based on repeated measures ANOVA (P<.05).

Cusps Pits
30 *** 30
***
25 25 ***
3D Deviations (µm)

3D Deviations (µm)
***
20 20 ***

15 15
*

10 10

5 5

0 0
IOS S-Exo S-Den IOS S-Exo S-Den
Groups A Groups B
Marginal Ridges
30

25
3D Deviations (µm)

20

15

10

0
IOS S-Exo S-Den
Groups C
Figure 8. 3D deviations between test and reference group data. A, Points on cusps. B, Points on pits. C, Points on marginal ridges (*P<.05, **P<.01,
***P<.001).

Table 4. 3D deviations (mm) of 16 points between test and reference

more than 1 minute per specimen. During the scanning data analyzed by tooth (mean ±standard deviation)
of the metal abutment, it was observed that the scan Group Second Premolar First Molar (Abutment) Second Molar
speed decreased and that voids formed more than in the IOS 10.2 ±1.7a 27.9 ±5.4d 9.3 ±1.7f
nonmetal adjacent teeth. Presumably, these defective S-Exo 11.7 ±2.0 b
12.4 ±1.3 e
9.2 ±1.6f
parts were supplemented by the superimposition, S-Den 12.7 ±2.0c 14.6 ±1.7e 9.1 ±1.6f
thereby enhancing the accuracy of the scan data. Different letters indicate statistically significant differences based on repeated measures
Obtaining accurate scans may be more difficult in the ANOVA (P<.05).

actual oral cavity owing to the limited oral space, saliva,

and anatomic obstacles such as the soft tissue and
tongue. When the interarch space or space with adjacent which reported that the trueness of the acquired digital
teeth is insufficient, inaccessible parts may not be scan- images decreased as the interproximal spaces
ned, resulting in voids. The impact of such access decreased.13 According to the results of the present
constraint has also been discussed in previous studies experiment, the voids and errors that may occur during

THE JOURNAL OF PROSTHETIC DENTISTRY Baek et al

- 2022 9

Second Premolar First Molar (Abutment)

50 50
***
***
40 40
3D Deviations (µm)

3D Deviations (µm)
30 *** 30
***
***
20 20

10 10

0 0
IOS S-Exo S-Den IOS S-Exo S-Den
Groups A Groups B

Second Molar
50

40
3D Deviations (µm)

30

20

10

0
IOS S-Exo S-Den
Groups C
Figure 9. 3D deviations between test and reference group data. A, Points on second premolar. B, Points on first molar (abutment). C, Points on second
molar (*P<.05, **P<.01, ***P<.001).

an oral scan because of accessibility restrictions can be
supplemented by adopting the superposition process.
The subgingival margin of the abutment could be
designed for esthetics, or the gingiva around the abut-
ment margin could overgrow during the interim resto-
ration period, covering the margin. In such a situation,
margin data can be obtained by the superimposition of
the abutment library without gingival displacement,
which is a time- and labor-consuming process. Further
studies are required to determine the correlation between
the scanned range of the abutment and the accuracy of
the reproduced data by using the superimposition
technique.
In this study, the superimposition was performed
with 2 different CAD software programs, with the pre-
sumption that the type of CAD software program used to
perform the superimposition process could affect the
accuracy of the scanned data. A laboratory and intraoral
scanner was used that exported the output data in the
STL format. In exocad, which is an open-source CAD
software program, the STL file was used for superim-
position without converting the data format, whereas the
STL files were transformed into the proprietary Dental
System (DCM) format, which is a closed-source CAD
software program from 3Shape A/S. The accuracy of the
scanned data that were superimposed by the 2 different
CAD programs was not statistically different for all
measurement results.
Although it is difficult to determine an acceptable
level of fit for implant-supported prostheses, the varying
clinically acceptable degree of inaccuracy has been dis-
cussed extensively. Klineberg and Murray25 considered
discrepancies of up to 30 mm at the implant abutment
interface as acceptable, whereas Jemt26 proposed a limit
of 150 mm to prevent long-term complications. As these
numbers also include the errors of the final processing
and production of the prostheses, the scanning deviation
must fall below this threshold. In this study, the RMS of

Baek et al THE JOURNAL OF PROSTHETIC DENTISTRY

10
the 3D discrepancies of the intraoral scanning was 42.1
mm and decreased to 36.4 and 36.9 mm following su-
perposition with the exocad DentalCAD and Dental
System software programs, respectively. The average 3D
discrepancy of the 66 points on the margin of the
intraoral scanning was 61.4 mm and decreased to 21.4
and 22.1 mm following superposition with the exocad
DentalCAD and Dental System software programs,
respectively. Although the purpose of this study was not
to determine the acceptable degree of inaccuracy, the
measured values exhibited clinically acceptable inaccu-
racy based on the criteria of previous reports, and the
accuracy was increased further through the superimpo-
sition process.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusion was drawn:
1. The superimposition process of the titanium custom
abutment with the prescanned custom abutment
library data improved the accuracy of a digital scan
made with an intraoral scanner.
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Corresponding author:
Dr Young-Jun Lim
Department of Prosthodontics and Dental Research Institute
School of Dentistry
Seoul National University
101 Daehak-ro, Jongno-gu
Seoul 110-749
REPUBLIC OF KOREA
Email: limdds@snu.ac.kr
Acknowledgments
The authors thank E-Master Dental Hub for their laboratory works and Hye-Jin
Oh, a lab technician of SNUDH laboratory, for CAD-CAM support and her
assistance in preparing this manuscript.
Copyright © 2022 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2022.03.008
Baek et al