SYSTEMATIC REVIEW

Factors that influence the accuracy of intraoral scanning of

total edentulous arches rehabilitated with multiple implants:
A systematic review
Ana Larisse Carneiro Pereira, MSc,a Míria Rafaelli Souza Curinga, MSc,b
Henrique Vieira Melo Segundo, Predoctoral,c and Adriana da Fonte Porto Carreiro, PhDd

The introduction of intraoral ABSTRACT

scanners in dental practice has Statement of problem. The direct digitalization of completely edentulous arches rehabilitated with
provided benefits such as the multiple implants still represents a limitation regarding obtaining accurate images for prosthetic
elimination of the impression purposes.
stage and conventional mate-
Purpose. The purpose of this systematic review was to present the factors that may influence the
rials, greater patient satisfac- accuracy of intraoral scanning of completely edentulous arches.
tion (since it does not involve
harmful stimuli such as suf- Material and methods. This review was carried out according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) criteria and registered with International
focation, choking, and palate Prospective Register of Systematic Reviews (PROSPERO) (CRD42020171021). Three examiners
irritation), lower clinical time, performed an electronic search in the Medline/PubMed, Cochrane Library, Scopus, and Web of
a 3-dimensional preview of Science databases for articles published up to January 2021.
the definitive prosthesis, and
Results. The electronic search resulted in 11 498 studies. After removing duplicates, 11 347 studies
easier laboratory-professional remained. Twelve studies were selected (10 in vitro and 2 in vivo) according to the eligibility criteria.
communication and data Several factors were found to influence the performance of intraoral scanners (Carestream Dental
storage.1-3 and TRIOS, 3Shape presented the best results), the intraoral scanning technique (Promoting
However, digitizing eden- physical paths that join the digitization bodies can increase the accuracy of transferring the
tulous ridges remains prob- position of the implants), environmental conditions (temperature: 20  C to 21  C, air pressure:
lematic because of the lack of 750 to 760 ±5 mmHg, air humidity: 45%, angle and distance between the implants: up to 15
1 degrees and 16 to 22 mm, and the material of the scan body: PEEK more accurate).
anatomic features, more chal-
lenging with multiple implants, Conclusions. The accuracy of the intraoral scanning of completely edentulous arches is affected by
because of the difficulty in factors such as the type of intraoral scanner, scanning technique, environmental conditions, angle
differentiating scan bodies by and distance between implants, and material of the scan bodies. (J Prosthet Dent 2021;-:---)
the scanner software program
and, consequently, capturing their position accurately.4 with the imprecision of these images, such as the
The accuracy of edentulous scans has been improved acquisition technology present in the scanner,7 operator
by providing heterogeneous objects along the edge and experience,8 start of the scanning technique9 and arc
giving the scanner a reference to make the process complexity, ambient lighting conditions,10 and material
2 ,5 ,6
faster. However, other factors have been associated of the scan bodies.11-13 The purpose of this systematic

Supported by CAPESdCoordination for the Improvement of Higher Education Personnel (no. 88887.531281/2020-00). The authors declare no conflict of interest.
a
PhD student, Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
b
MSc student, Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
c
Predoctoral student, Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
d
Professor, Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.

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Clinical Implications
The intraoral scanning of completely edentulous
arches is impacted by a series of factors that
compromise the accuracy of virtual images for
prosthetic purposes. In this sense, the use of the
intraoral scanner from Carestream Dental and
TRIOS, with scanning techniques that promote the
physical union of the scan bodies, with
environmental conditions where temperature is
between 20  C and 21  C, air pressure between 750
and 760 ±5 mmHg and 45% air humidity, 15-degree
angle, and 16- to 22-mm distance from the
implants, and PEEK scan bodies, can contribute to
more accurate images.
review was to identify factors that can influence the ac-
curacy of the virtual image obtained by intraoral scanners
and optimize their clinical protocol.
MATERIAL AND METHODS
This systematic review was structured based on the
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA)14 and in accordance with the
models proposed in the literature.15,16 In addition, it was
registered on the International Prospective Register of
Systematic Reviews (PROSPERO) (CRD42020171021).
For inclusion in this review, articles had to meet 2
criteria without language restrictions. First, they must
have evaluated a factor that may have influenced the
intraoral scanning accuracy of a completely edentulous
arch with multiple implants by comparing it with a
reference method (laboratory scan of gypsum cast or
impression or coordinate measurement machine). Sec-
ond, the study had to be a randomized clinical trial
(RCT), prospective or cohort, and retrospective or in vitro.
Excluded were literature reviews, case reports, studies not
available in the databases or not sent by the authors, and
studies that only presented the history of digital tech-
nologies applied to the digitization of multiple implants
in completely edentulous arches. The population, inter-
vention, comparison, outcome (PICO) question was,
What factors interfere with the accuracy of the intraoral
scanning of completely edentulous arches rehabilitated
with multiple implants?
Three independent examiners (A.L.C.P., M.R.S.C.,
H.V.M.S.) conducted an electronic search in the Medline/
PubMed, Cochrane Library, Scopus, and Web of Science
databases for articles published up to January 2021. The
descriptors and multiple conjunctions used are described
in Table 1. Three search strategies were determined
based on the keywords corresponding to letters P, I, and
C of the PICO. After application in the databases, the
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Table 1. Search strategy applied to databases
Database Search Strategy
Medline-PubMed Attempt 1 ((Dental implant) OR (edentulous)) AND
Cochrane Library ((Digital workflows) OR (intraoral digital) OR
Scopus (three-dimensional) OR (accuracy)) AND
Web of Science ((implant impression) OR (dental models) OR
(dental impression materials) OR (analog-
digital conversions) OR (analog-digital))
Attempt 2 ((implant impression) OR (dental models) OR
(dental impression materials) OR (analog-
digital conversions) OR (analog-digital)) AND
((Digital workflows) OR (intraoral digital) OR
(three-dimensional) OR (accuracy))
Attempt 3 ((Digital workflows) OR (intraoral digital) OR
(three-dimensional) OR (accuracy)) AND
((Dental implant) OR (edentulous))
strategy that captured the largest number of articles
remained. Then, all titles were analyzed, the duplicates
were removed, and the abstracts of these articles were
evaluated through the defined eligibility criteria. Conflicts
among the examiners were resolved by a fourth examiner
(A.F.P.C.).
Data were extracted from the included studies and
tabulated by one of the examiners (A.L.C.P.) and then
verified by another examiner (M.R.S.C.) according to the
author, year, type of study, study groups, sample,
number of implants and arch, scanners used, scanning
technique and conditions, software program, evaluation
methods, and the main results. An evaluation of the
quality of the included studies was carried out based on
the adapted critical appraisal skills program (CASP)17
and the methodological index for nonrandomized
studies (MINORS).18 Initially, the studies were evalu-
ated by using the CASP tool with 12 specific criteria.
Each of the criteria described was scored by 3 answer
options: “yes”, “no,” or “unclear.” The maximum
achievable score for each question was 12. The adapted
MINORS scale consists of 10 criteria, with the addition
of 2 items proposed for in vitro studies. Each item was
scored from 0 to 2: 0 (item content not reported), 1 (item
content reported, but inappropriately), and 2 (item
content sufficiently reported). The maximum possible
scores for the vitro studies were 20 and 24 for in vivo. In
this evaluation method, 2 studies were excluded2,12 for
presenting a randomized design, in vivo2 and in vitro,12
respectively. A meta-analysis was not possible because
of the lack of methodological homogeneity in the
included studies.
RESULTS
After removing duplicates, the electronic search resulted
in 11 347 articles. The selection using the title and
summary and applying the eligibility criteria resulted in
26 articles to be further evaluated. After this stage, 12
articles were included in the review. All studies were
published in the last 5 years (2016 to 2021) (Fig. 1).
Carneiro Pereira et al
- 2021 3

Medline/PubMed Web of Science Cochrane Library Scopus

(n=7.804) (n=1.421) (n=548) (n=1.725)

Total (n=11.498)

Duplicate removal (n=151)

Records screened based on title and

abstract (n=11.347)

Articles excluded after title/abstract screening

(n=11 321)
Full-text articles assessed for eligibility
(n=26)
Partially edentulous arch (n=6);
Studies unavailable for download (n=5);
Study outcome did not answer the PICO question in this review (n=3)
Number of eligible studies
(n=12)

Studies included in systematic review

(n=12)

Figure 1. Flow diagram of search process.

The evaluation of the quality of the studies, individ-
ually, is shown in Table 2 (CASP) and Table 3 (MI-
NORS). According to the CASP scale, all eligible studies
were rated “no” for criteria 5, 6, and 10, except for clinical
studies for criterion 6, resulting in a total score of 9
(in vitro studies) and 10 (in vivo studies). As for the
MINORS scale, all studies evaluated had scores of 18,
indicating lower risk of bias, as the value was below the
maximum score of 20.
Of the 12 studies included, 52,9,19-22 reported the in-
fluence of the intraoral scanner on the digitization of
completely edentulous arches restored with multiple
implants. Three in vitro studies19-22 conveyed the evo-
lution of the accuracy results of CS intraoral scanners
(Carestream Dental) by comparing them with those of
other manufacturers, and a randomized controlled clin-
ical study2 investigated the CS600 scanner. Three
studies9,19,20 pointed to the TRIOS3 intraoral scanner as a
viable option for digitizing such arches (Table 4).
Nine studies2,9,11-13,19-25 evaluated the intraoral
scanning technique used to capture the position of
multiple implants. Three studies19-22 reported using the
zigzag scanning technique; 3 studies2,13,24 immobilized
the scan bodies with either a composite resin,2 a geo-
metric device,24 or dental floss13 to provide a physical
path between the implants to make scanning faster; and
4 studies9,11,13,25 began the scan from the occlusal surface
of the scan body, followed by the buccal and lingual
surfaces. Only 1 study12 opted to start scanning with the
occlusal-palatal surfaces with a wave movement and
digitized the other areas subsequently (Table 5).
Five studies13,19-25 reported ambient conditions at the
time of intraoral scanning, and 2 studies19,20 had a more
controlled environmental setting: the temperature
(20  C), air pressure (760 ±5 mmHg), and humidity
(45%). In contrast, Mangano et al22 reported a different
temperature (21  C) and air pressure (750 ±5 mmHg) but
similar humidity (45%). Two studies13,25 reported using
standardized temperature and humidity but did not
provide specific information on their ranges.
All included studies reported the number of implants
and the arch evaluated, but 1 study did not specify
the arch.21 The data recorded were 4,9,25,23 5,23 and
62,12,13,19-22,21,23 implants for the maxilla. In addition, 2
included studies evaluated variables in the mandible and
used 4 implants.11,24 Five studies9,22-25 reported results
for the number of implants and their relationship with
the distances and/or angulation of the implants (Table 6).
Three studies11-13 addressed the effect of the type and
material of the scan body on the accuracy of intraoral
scanning (Table 7).
DISCUSSION
The present review aimed to identify comparative studies
with a primary outcome directed to a factor that may
have influenced the accuracy of the intraoral scanning of

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Table 2. Quality assessment of included studies (CASP)

Study Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Overall
Imburgia et al, 201719 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Mangano et al, 201620 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Rech-Ortegra et al, 201821 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Cappare et al, 20192 Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes 10
Mangano et al, 202022 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Çakmak et al, 20209 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Huang et al, 202011 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Chochlidakis et al, 202023 Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes 10
Arcuri et al, 201912 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Mizumoto et al, 201913 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Iturrate et al, 201924 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9
Mizumoto et al, 201925 Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes 9

Table 3. Modified methodological index for nonrandomized studies (MINORS)

Imburgia Çakmak Huang Iturate
et al, Mangano Rech-Ortegra Mangano et al, et al, Chochlidakis Mizumoto et al, Mizumoto
Evaluation 201719 et al, 201620 et al, 201821 et al, 202020 20209 202011 et al, 202023 et al, 201913 201924 et al, 201925
A clearly stated aim 2 2 2 2 2 2 2 2 2 2
Inclusion of consecutive 2 2 2 2 2 2 2 2 2 2
patients
Prospective collection of 2 2 2 2 2 2 2 2 2 2
data
Endpoints appropriate to 2 2 2 2 2 2 2 2 2 2
the aim of the study
Unbiased assessment of the 0 0 0 0 0 0 0 0 0 0
study endpoint
Follow-up period 2 2 2 2 2 2 2 2 2 2
appropriate to the aim of
the study
Loss to follow-up less than 0 0 0 0 0 0 0 0 0 0
5%
Prospective calculation of 0 0 0 0 0 0 0 0 0 0
the study size
An adequate control group 2 2 2 2 2 2 2 2 2 2
Contemporary groups 2 2 2 2 2 2 2 2 2 2
Baseline equivalence of 2 2 2 2 2 2 2 2 2 2
groups
Adequate statistical 2 2 2 2 2 2 2 2 2 2
analyses
Total score 18 18 18 18 18 18 18 18 18 18
0 (item content not reported), 1 (item content reported, but inappropriately), and 2 (item content sufficiently reported).

completely edentulous arches restored with multiple
implants. The selection of the intraoral scanner, the
scanning technique, distance and angulation of the im-
plants, and digitization bodies are factors to be consid-
ered for the direct acquisition of accurate images of
multiple implants.
The different intraoral scanners reported in the
studies included in this review2,9,19-22 present various
technologies to determine the spatial coordinates of the
object to be digitized, either by triangulation, by laser
confocal scanning, or by active wave sampling. The
studies included in this review identified the CS intraoral
scanner (Carestream Dental), followed by the TRIOS
(3Shape A/S), as the most accurate option for digitizing
multiple implants. The TRIOS uses confocal microscopy
and ultrafast optical scanning, while the latest version of
the CS (3700) uses active triangulation with a combina-
tion of intelligent tonality through the bidirectional
reflectance distribution function. This method allows the
CS3700 to collect shadow values from 3D surfaces by
considering variations in lighting conditions. Another
novel feature of the CS 3700 is the incorporation of the
“stop & go” system (When one removes the scanner
from the oral cavity and resumes the process from any
point already scanned, recognition is immediate, making
scanning faster.).
Of the techniques of intraoral scans, methodological
standardization and studies that evaluate all possible
existing techniques to indicate the most suitable for each
type of arch are still lacking. However, the current results

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Table 4. Effect of intraoral scanner type on intraoral scanning accuracy

Study Evaluated Groups
Cappare et al2 Conventional moldingdCIG; CIG
Digital moldingdDIG. 16:45 ±4:49
Additional time: 06:02 ±2:01 (P<.05)
Number of resumes: 2
Çalmak et al9 Fully edentulous master model; Trueness
New IOS (VV-IOS) 3D distance (deviation):
Commonly used IOS (TS-IOS). VV-IOS: 79 ±50 (P<.001)
TS-IOS: 60 ±19 (P=.010)
7S-LBS: 34 ±17 (P<.001)
Angular deviation:
VV-IOS: 0.30 ±0.21 (P<.001)
TS-IOS: 0.32 ±0.12 (P<.001)
7S-LBS: 0.60 ±0.88 (P<.001)
Imburgia et al19 Partially edentulous arch FEM
Completely edentulous arch
Trueness:
CS3600: 60.6 (±11.7) P=.047
TRIOS3: 67.2 (±6.9) P<.001
Omnicam: 66.4 (±3.9) P<.001
TrueDefinition: 106.4 (±23.1) P=.012
Mangano et al20 Partly edentulous arch; Fully edentulous arch
Completely edentulous arch.
Trueness:
TRIOS: 71.6 ±26.7 (P<.001);
CS350: 63.2 ±7.5 (P<.001)
Zfz Intrascan: 103.0 ±26.9 (P<.001)
Planscan: 253.4 ±13.6 (P<.001)
Mangano et al22 Completely edentulous master model. Mesh/mesh:
CS 3700 (erro médio 30.4 mm)
ITERO ELEMENTS
5D (31.4 mm)
i-500 (32.2 mm)
TRIOS 3 (36.4 mm)
CS 3600 (36.5 mm)
PRIMESCAN (38.4 mm)
VIRTUO VIVO (43.8 mm)
RUNEYES (44.4 mm)
EMERALDS (52.9 mm)
EMERALD (76.1 mm)
OMNICAM (79.6 mm)
DWIO (98.4 mm).
Results
DIG
8:59 ±2:46
Additional time: 2:34 ±1:02 (P<.05)
Number of resumes: 7
Precision
3D distance (deviation):
VV-IOS: 20 ±14 (P=.015)
TS-IOS: 9 ±5 (P=.038)
7S-LBS: 7 ±7 (P=.015)
Angular deviation:
VV-IOS: 0.092 ±0.052 (P<.001)
TS-IOS: 0.04 ±0.031 (P<.001)
7S-LBS: 0.38 ±0.47 (P<.001)
Precision:
CS3600: 65.5 (±16.7) P<.001
TRIOS3: 31.5 (±9.8) P<.001
Omnicam: 57.2 (±9.1) P<.001
TrueDefinition: 75.3 (±43.8) P<.001
Precision:
TRIOS: 67.0 ±32.2 (P<.001)
CS350: 55.2 ±10.4 (P<.001);
Zfz Intrascan: 112.4 ±22.6 (P<.001)
Planscan: 204 ±22.7 (P<.001)
Nurbs/nurbs:
ITERO ELEMENTS
5D (erro médio de 16.1 mm)
PRIMESCAN (19.3 mm)
TRIOS 3 (20.2 mm). i-500 (20.8 mm)
CS 3700 (21.9 mm) CS 3600 (24.4 mm)
VIRTUO VIVO (32.0 mm)
RUNEYES (33.9 mm)
EMERALD S (36.8 mm)
OMNICAM (47.0 mm)
EMERALD (51.9 mm)
DWIO (69.9 mm).

Table 5. Effect of intraoral scanning technique on accuracy of intraoral scanning

Study Scanning Technique
Cappare et al2 Three scanning steps:
1: Scanning with immobilized scan bodies;
2: Soft tissue;
3: Interim prosthesis.
Çakmak et al9 Occlusal surface, followed by buccal and palatal surfaces, as recommended by another IOS manufacturer.
Huang et al11 Scan always initiated from occlusal surface.
Arcuri et al12 Starting from occlusal-palatal ISB surfaces with inclination of scanner of approximately 45 degrees and wave motion in anterior
area to avoid division of image. Oral aspect and any other missing areas scanned later.
Mizumoto et al13 Scan occlusal surface, then buccal surface and then palatal surface.
Imburgia et al19 Zigzag scanning technique.
Mangano et al20 First quadrant (maxillary right), from buccal to palatal and back, moving slowly forward so that teeth, scan bodies, and gingiva
scanned from buccal to palatal (and back), passing over occlusal plane.
Mangano et al22 Zigzag scanning technique.
Mizumoto et al25 Scan occlusal surface, then buccal surface, and then palatal surface.

IOS, intraoral scanner; ISB, scan body.

show a positive relationship between changes in the
technique for intraoral scanning and the final quality of
the prosthetic work. Cappare et al2 and Iturrate et al24
showed that providing a path between the scan bodies
with composite resins or a geometric device can make the
scanning process more fluent and precise.
Environmental conditions during the scanning pro-
cess may be another factor contributing to the inaccuracy
of scanning multiple implants. The included studies
standardized the ambient temperature at 20  C to 21  C,
air pressure of 750 to 760 ±5 mmHg, and air humidity of
45%.19-22 Combined, these settings simulate a low

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Table 6. Effect of distance and angulation of implants on accuracy of intraoral scanning
Study Number of Implants and Arch
Rech-Ortegra et al21 6 1-2
Çakmak et al9 4 (maxilla)
Chochlidakis et al23 4, 5, and 6 (maxilla)
Iturrate et al24 4 (mandible)
Mizumoto et al25 4 (maxilla)
Table 7. Effect of material and type of scan body on accuracy of intraoral scanning
Study Scan Bodies
Huang et al11 Group I (DO): Digital impressions using
original scan bodies;
Group II (DC): Digital impressions using
CAD/CAM scan bodies without extensional
structure;
Group III (DCE): Digital impressions using
CAD/CAM scan bodies with extensional
structure;
Group IV (CI): Conventional splinted open-
tray impressions.
Arcuri et al12 Polyetheretherketone (Pk), titanium (T)
and Pk with a titanium base (Pkt).
Mizumoto et al13 AF (IO-Flo; Dentsply Sirona), NT (Nt-Trading
GmbH & Co KG), DE (DESS-USA), C3
(Core3Dcentres) and ZI (Zimmer Biomet
Dental)
IOS, intraoral scanner; ISB, scan body; PEEK, polyetheretherketone.
temperature, low atmospheric pressure, and maximum
relative air humidity, which is considered to be an ideal
environment. Although the studies have not discussed
the relationship between environmental conditions and
the precision of intraoral scanning, we believe that high
ambient temperatures lead to fogging of the scanner lens,
thereby distorting the image. If the temperature does rise
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Distance and Angle Effect
Distances EIM-Master SDM-Master
0.020 ±0.074 (P=.146) 0.037 ±0.017 (P<.001)
2-3 0.109 ±0.075 (P<.001) 0.070 ±0.029 (P<.001)
3-4 -0.123 ±0.054 (P<.001) -0.123 ±0.016 (P<.001)
4-5 0.026 ±0.041 (P=.001) 0.057 ±0.027 (P<.001)
5-6 0.030 ±0.027 (P<.001) -0.023 ±0.022 (P=.009)
1-4 0.039 ±0.064 (P=.002) -0.021 ±0.056 (P=.255)
3-6 -0.046 ±0.054 (P<.001) -0.109 ±0.058 (P<.001)
1-6 0.068 ±0.099 (P=.001) -0.118 ±0.078 (P=.001)
d Distance (mm) Angular (degrees)
Scanner type df (2)/F ratio (25.732)/P<.001 df (2)/F ratio (3.689)/P=.028
Scan body position df (3)/F ratio (4.623)/P=.004 df (3)/F ratio (.477)/P=.699
Scanner type × scan body position df (6)/F ratio (4.069)/P=.001 df (6)/F ratio (.125)/P=.993
4 implants: 139 ±56 (P=.191)
5 implants: 146 ±90 (P=.191)
6 implants: 185 ±81 (P=.191)
D12: TRI group (agp_N: 17 ±15/agp_Y: 12 ±7); TRU group (agp_N: 20 ±16/agp_Y: 8 ±6); ITE group (agp_N:
26 ±17/agp_Y: 12 ±11)
D13: TRI group (agp_N: 70 ±44/agp_Y: 34 ±31); TRU group (agp_N: 55 ±40/agp_Y: 20 ±11); ITE group
(agp_N: 69 ±39/agp_Y: 46 ±28)
D14: TRI group (agp_N: 101 ±75/agp_Y: 73 ±61); TRU group (agp_N: 85 ±58/agp_Y: 35 ±22); ITE group
(agp_N: 189 ±70/agp_Y: 83 ±52)
P1: stitched 114.57 ±33.2/unstitched 120.94 ±18.43
P2: stitched 89.42 ±28.12/unstitched 115.83 ±38.3
P3: stitched 170.51 ±58.41/unstitched 198.0 ±34.2
P4: stitched 196.2 ±71.3/unstitched 206.28 ±37.54
Results
Precision: Trueness:
Median (IQR) Median (IQR)
Group I: 48.40 (40.80-57.90) mm Group I: 35.85 (29.80-49.10) mm
Group II: 48.90 (38.70-85.40) mm Group II: 38.50 (35.35-52.58) mm
Group III: 27.30 (22.50-35.50) mm Group III: 28.45 (24.88-36.43) mm
Group IV: 19.00 (15.70-22.75) mm Group IV: 25.55 (22.98-28.90) mm
Group IV more accurate than all other groups. No significant differences found between OD and
Among the IOS groups, the DCE group was the most DC (P=1.000), OD and DCE (P=.461), DC and DCE
accurate. (P=.133), and CI and DCE (P=1.000).
IOS investigated influenced by ISB material with PEEK Angulation of implant significantly affected linear
reporting best results in linear and angular deviations, while position of implant affected
measurements followed by titanium, PEEK-titanium angular deviations.
resulting as least accurate.
Accuracy affected by both ISB and scanning technique Scanning techniques with different surface
when using IOS. modifications resulted in deviations in distance
ZI scan body had significantly smaller distance similar to those of technique, without any
deviation, while immobilization of scan bodies with modifications.
dental floss led to significantly greater distance Use of different ISBs led to significant differences
deviation in scan time.
above the ideal range, a pause in the scanning process is
indicated to allow the scanner to cool.
Arakida et al26 reported that the color temperature
(3900 K) and the luminance of 500 lux of the environ-
ment are ideal for making a digital scan and that the
higher the ambient lighting, the longer the sweeping
time. Revilla-León et al10 reported that the lighting
Carneiro Pereira et al
- 2021
conditions significantly affect the mesh quality. Another
factor of concern is the intensity of the scanner’s laser
illumination. Under extremely high intensity, the sensor
becomes saturated, preventing the system from calcu-
lating the position of the dots and forming an accurate
final image.27
Variations found in the results regarding the scan-
ning techniques can be related to confounding factors
such as a possible threshold of implant distances
considered acceptable by intraoral scanners to obtain
accurate images. The accuracy of digitization of the scan
bodies in a completely edentulous arch was reported to
be <193 mm, while for arcs with reduced distances, it
was <103 mm.28 The intercylinder distance considered
digitizable by the scanner is between 16 and 22 mm.
Even though some studies began within this threshold
(16 to 22 mm), their data still showed an increase in 3D
deviations for distances9,25 and angles.25 After critically
appraising these articles, a reduction in the position-
capture accuracy of the implants, from the first quadrant
to the last area to be digitized, is apparent25 (that is, the
start of the arch being scanned will have greater pre-
cision than at the end of the digitized arch). The loss of
precision throughout the scan can be explained by in-
terruptions in the recognition of regions by the
scanner.3
A systematic review15 showed that, above 15 de-
grees, the accuracy of the scans may not be affected, but
it concluded that other factors associated with the oral
cavity (saliva, curvature, distribution, and quantity of
implants in the arch) may interfere with the quality of
the virtual image. Therefore, the parallelism of the im-
plants (maintaining the 15 degrees) is the most effective
way to minimize errors in the positioning of the im-
plants. Furthermore, the more the implants in the arch,
the more the 3D deviation in the virtual image.23 In
general, digital capture of the implant position still re-
quires scan bodies, making sterilization problematic.29
The characteristics of the scan bodies and the material
make it difficult to accurately recognize the position of
the implants and transfer the data on the distance and
angle errors back to a virtual environment. Based on a
critical analysis of the studies,11-13 PEEK is the material
of choice for scan bodies, with an absence of reflective
zones.11-13
Limitations of this systematic review include the
prevalence of in vitro studies and the absence of meta-
analysis because of the heterogeneity of the included
studies. The results from the included studies point to a
complexity of factors that involve the successful use of an
intraoral scanner to digitize the completely edentulous
arches rehabilitated with multiple implants. Future
studies should concentrate on the different types of
scanners and technologies, quantities of implants, types
of arches, scan bodies, and how to best control the
Carneiro Pereira et al
7
conditions of the scanning environment in the oral cavity
to provide an ideal 3D image.
CONCLUSIONS
Based on the findings of this systematic review, the
following conclusions were drawn:
1. Different factors can influence the quality of the
virtual image.
2. Among the current devices, the intraoral scanners
and technology used by Carestream Dental and
TRIOS, 3Shape presented favorable results for
digitizing such arches.
3. The intraoral scanning technique that provides a
physical path joining the scan bodies, ambient
conditions (temperature: 20  C to 21  C, air pressure
750 to 760 ±5 mmHg, and air humidity: 45%),
angulation and distance between implants (up to 15
degrees and 16 to 22 mm distance between im-
plants), and the material of the scan body (PEEK is
more accurate) can increase the accuracy of trans-
ferring the position of the implants.
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