1 Review

2 The Accuracy of Intraoral Scanners (IOS) in the Full-Arch

3 Implant Rehabilitation: A Narrative Review
4 Chiara De Rubertis 1, Franco Ferrante2, Nicolò Stefanelli3, Marco Friuli4*, Marta Madaghiele4*, Christian
5 Demitri4* and Andrea Palermo5

6 1 DDS, Private Practitioner; Maglie, Italy

7 2 DDS, Specialist in Oral Surgery, Private Practitioner; Lecce, Italy
8 3 Private Practitioner; Lecce, Italy

9 4 Department of Engineering for Innovation, University of Salento, Lecce 73100, Italy

10 5 College of Medicine and Dentistry, Birmingham B4 6BN, UK

11 * Correspondence: christian.demitri@unisalento.it
12 Abstract

13 Objective This narrative review aims to study the accuracy of different Intraoral Scanners (IOS) devices
14 already available on the market. The accuracy emerged during in vitro, in vivo, and ex vivo studies made with
15 IOS devices during the scan of a full arch implant rehabilitation have been analyzed to evaluate which device
16 may be the most suitable in this clinical situation.

17 Method The literature review was performed using the Pubmed and MEDLINE databases searching by topics
18 and keywords e.g. "digital workflow", "full arch", "full arch implant rehabilitation", "accuracy of IOS".
19 Inclusion and exclusion criteria for studies were: Correct IMRAD structure; Article with clear and detailed
20 objectives; Consistency of the articles with the purpose of the review; two-year range from the year of
21 publication of the article; reproducible materials and methods; correct follow up.

22 Results Most of the intraoral scanners employed in vitro provided acceptable accuracy (below a threshold of
23 150 μm). The main parameters identified for their influence on precision were interim plant distance, body
24 scan design, scanning pattern, and operator experience.

25 Conclusion Even though literature is limited, significant differences emerged between the different models
26 of intraoral scanners evaluated in the studies considered within this review.

27 Keywords: Intraoral Scanners; full-arch implant; oral surgery, dentistry, 3D imaging

28

29 Introduction

30 Digitalization is becoming increasingly popular in dentistry, particularly as it is being incorporated into the
31 workflow of fixed prostheses, even implants. Digital technology is used in implant rehabilitation, starting
32 from three-dimensional diagnostic imaging, continuing with treatment planning, guided implant placement
33 through the surgical guide, and finally, digital scans and software-assisted design/manufacturing (CAD/CAM)
34 of provisional and/or final dental implant 1.

35 The CAD/CAM technology (developed in the 1950s) entered the field of dentistry in the 1980s and was
36 applied for esthetical or reshaping treatment and for implant design and production 1. Over the years, has
37 become an integral part of the workflow.2 Digital technology is used in implant rehabilitation, starting from
38 three-dimensional diagnostic imaging, continuing with treatment planning, guided implant placement
39 through the surgical guide, and finally, digital scans and software-assisted design/manufacturing (CAD/CAM)
40 of provisional and/or final dental implant 1.
41 In the CAD/CAM system, the first operational phase is the acquisition of images carried out through
42 intraoral scanners (IOS). Intraoral scanners project a light source onto the area to be acquired, then one or
43 several cameras record the deformation of this light after the interaction with the area of interest. Than,
44 the acquired signal is processed by a software 3-5 which converts i tinto a 3D image of the patient's mouth.
45 The method allows the clinician to obtain an optical impression bypassing the conventional impression
46 technique and providing other advantages such as good tolerance on the part of the patient (reduced gag
47 reflex), elimination of the potential deformation of the impression, and reduction of the time for clinical
48 treatment by the real time pc-check of the quality of the impression.6 7Consequently, the quality of the the
49 output obtained by IOS is crucial for the successful outcome of all subsequent operations.

50 However, IOS devices cannot replace all the standard practices. For example, in the case of partially
51 edentulous patients, optical scanning is an excellent method to obtain the patient's impression but, for
52 completely edentulous patients, the absence of teeth as anatomical reference points make the use of IOS for
53 full arch implant rehabilitation a sensitive procedure due to the decrease of their accuracy.8 Indeed, the
54 conventional open-tray splinted full-arch impression technique is still indicated as the most suitable
55 technique. 9 Indeed, the absence of teeth as anatomical reference points make the use of IOS for full arch
56 implant rehabilitation a sensitive procedure 8 and a completely digital workflow 9,10,9,11,12 in absence of
57 reference is one on the main challenges for the future and can be obtained through the evolution of new
58 CAD/CAM technology.

59 The parameter generally employed, then the most studied in literature, to evaluate the quality of the output
60 that can be obtained from the various intraoral scanners on the market is the accuracy.

61 The term "accuracy" describes how close is a measure to the real value and, in the context of the IOS it can
62 be expressed as the “sum” of trueness and precision.13

63 Trueness for IOS can be defined as the difference between the arithmetic mean of a set of measurements
64 and a reference value (i.e. the true value, acquired through a certified device such as an industrial optical
65 scanner) 13. However, the difficulties in the in vivo use of industrial scanners make the acquisition of the
66 reference value tricky, consequently, most of the studies regarding the trueness are in vitro on plaster
67 models.10

68 Differently, "Precision" does not require a comparison value as it is usually defined as the standard deviations
69 of the measurement values made by using the same device 14-17. Generally, many authors consider the
70 devices having an accuracy in the range 30–150 μm as clinically acceptable. Some studies suggest 150 μm as
71 the upper limit of accuracy to avoid long- term prosthetic problems. Poor internal fit of a restoration is one
72 such consequence. This means that the restoration may not fit snugly onto the prepared tooth, leading to
73 gaps or inconsistencies. As a result, there may be a need for increased cement thickness to compensate for
74 the poor fit, which can compromise the longevity and stability of the restoration. Excessive cement thickness
75 can create a breeding ground for bacteria, increasing the risk of secondary decay and other complications.

76 Similarly, poor margins can arise when the accuracy of the intraoral scanner is compromised. Inaccurate
77 margins can negatively affect the esthetics and longevity of the restoration. It can lead to gaps, overhangs,
78 or uneven margins, which can be visually unappealing and create difficulties in maintaining oral hygiene. Poor
79 margins may also result in increased plaque accumulation and potential gingival irritation, increasing the risk
80 of periodontal issues. In the clinical context, the marginal discrepancy that can be felt with a probe or seen
81 with the naked eye depends on the level of accuracy. With intraoral scanners having an accetable accuracy,
82 any marginal discrepancy within this range may not be perceptible to the naked eye or easily felt with a
83 probe. However, discrepancies beyond this range may start to become noticeable and could indicate
84 compromised accuracy. It is important to strive for higher levels of accuracy in intraoral scanning to ensure
85 precise fit and margins. By adhering to the recommended accuracy range, clinicians can achieve optimal
 86 clinical outcomes, enhanced patient satisfaction, and minimize potential long-term prosthetic problems
87 associated with poor fit or margins. 15

88 Several factors can affect the accuracy of an intraoral scan including the type of scanner, the type of scan-
89 bodies and its length, the length of the scanning area and the experience and skill of the operator 15.

90 The main question in this bibliographical review was: “What are the best scanners for precison and trueness
91 in full arch implant rehabilitation impressions?”. For this purpose the authors will include in this review
92 studies having as topic the accuracy analysis and the performances of different marked available models of
93 intraoral scanners during the scan of a full arch implant rehabilitation in different clinical situations.

94 The purpose of this review is to assess the impact of various parameters on the performance of intraoral
95 scanners (IOS) by examining a range of studies, particularly those conducted in vitro. Additionally, we
96 explore the evidence (in vivo) regarding the effect of IOS on patient well-being, such as chair time, and their
97 clinical utility, comparing different commercially available models. It is important to note that our aim is not
98 to rank or determine the quality of these devices, as studies often employ non-uniform testing conditions.
99 Instead, our focus is to provide insights into the challenges associated with using these instruments and
100 offer information on factors influencing their performance and clinical application.

101 2. Materials and Methods

102 The literature review was performed using the Pubmed and MEDLINE databases by using search criteria
103 already employed for other similar work 18 using as date range 2020-2022. A search strategy was used by
104 topics and keywords such as: "digital workflow", "full arch", "full arch implant rehabilitation", "accuracy of
105 IOS" .

106 The articles were then evaluated based on inclusion and exclusion criteria, including:

107 • Correct IMRAD structure (Introduction, Methods, Results, and Discussion structure)

108 • Article with clear and detailed objectives

109 • Consistency of the articles with the purpose of the review

110 • Two-year range from the year of publication of the article

111 • Reproducible materials and methods

112 • Correct follow up

113 The studies have been divided on the basis of the main parameter considered in the study included in the
114 review. Furthermore, we reported also some case studies to evaluate the impact of IOS on patients’
115 wellbeing (in particular in terms of the so called chair time) and clinical success and employability.

116 3. Results and Discussion

117 In vitro comparison of IOS models

118 During the in vitro study of Sami et al.19, the trueness and precision of the IOS optical scanners devices True
119 Definition, TRIOS, CEREC Omnicam, Emerald Scanner were evaluated on a 6-implant (a polymer made
120 edentulous model with 6 hexagonal scan bodies) using an industrial laser line probe (FARO Edge HD Arm) as
121 control. No statistical or clinical differences were found among the scanners tested at those conditions.

122 Roig et al.20 investigated, under in vitro conditions, the accuracy of implant model impressions taken with
123 four optical scanners: CEREC Omnicam, 3M True Definition Scanner, 3Shape TRIOS3 and Carestream CS
124 3600. It was highlighted as humidity and the mobility of the soft tissues surrounding the scan bodies can
125 significantly affect the scanning process and the impressions accuracy. In this scenario TRIOS 3 and CS3600
126 showed a significantly improved mean trueness compared to CEREC Omnicam and True Definition.

127 Another in vitro study was conducted by Dutton E. et al.21. The research compared two different
128 generations of IOS devices (older vs newest) focusing on the effect of the substrates’ material (e.g.,
129 material of the teeth model) on scanning process (trueness and precision). ITERO Element 2, ITERO
130 Element, Trios 3 are less influenced by the substrate and trueness and precision are improved.

131 Effect of operator on IOS accuracy

132 Pesce. et al.16 carry out an in vitro study to evaluate the trueness of the new device IOS OS-Opera Mc,
133 Opera System, Monaco in comparison to IT-Itero, Align Technology (one of the most used IOS already
134 available on the market). From the study emerged as the operator's experience has a crucial role in the
135 measurement. Trueness was higher for the experienced operator using the IT scanner.

136
137 Figure 1. (A) IOS OS-Opera Mc, Opera System, Monaco; (B) IT-Itero, Align Technology.

138 Revell et al.22 conducted an ex vivo study to analyze the trueness of 5 IOS devices in the analysis of bodies
139 and soft tissues of an edentulous jaw and the operator’s experience effect on the measurements. In
140 particular, emerged as trueness was operator dependent. The best IOS performing in terms of accuracy
141 were Primescan and TRIOS 4 followed by TRIOS 3.

142 The in vitro study of Resende et al.23 evaluated the trueness, precision, and scanning time and how they are
143 related among them and influenced by operator experience. CEREC Omnicam and Dentsply Sirona and
144 TRIOS 3; 3Shape were the IOS tested. TRIOS 3 was more accurate than the Omnicam for complete-arch
145 scans.
146 Multiparametric studies on models: effects on trueness
147 Mangano et al.17 performed an in vitro study to compare the trueness of 12 different IOSs in full arch
148 implant scans. Differently, the accuracy of an impression depends on the type of scanner but also on the
149 operator, patient, light conditions, and SB. The highest level of accuracy was found using Itero Elements 5D,
150 Primescan, CS 3700, CS 3600, TRIOS 3 and I-500.
151
152

153 Figure 2. (A) PRIMESCAN, Dentsply Sirona ; (B) OMNICAM, Dentsply Sirona; (C) CS 3600, Carestream Dental;
154 (D) CS 3700, Carestream Dental; (E) TRIOS 3, 3-Shape; (F) i500, Medit (https://www.medit.com/dental-
155 clinic-i700); (G)VIRTUO VIVO, Dentalwings (https://www.straumann.com/gb/en/dental-professionals.html);
156 (H) DWIO, Dentalwings; (I) EMERALD, Planmeca; (L) EMERALD-S, Planmeca; (M) RUNEYES QUICKSCAN,
157 RUNEYES Medical Instruments.

158 Similar results (in terms of trueness) were found in the in vitro study conducted from Bilmenoglu et al.24.
159 The study analyzed the trueness of 10 intraoral scanners by using a complete-arch mandibular model with
160 implants in the left and right canine, first premolar, and first molar positions. Better trueness with: Color
161 POD, Omnicam, Apollo DI, Color Cart, MonoColor Cart and Bluecamd in reported in figure 3.
162
163 Figure 3. (A) 3D Progress, Medical High; (C) Apollo DI, Dentalsply; (D) Planscan, Planmeca; (E) E4D Tech; (F)
164 Lythos Digital Impression System.

165 Canullo L. et al.25 evaluated the trueness of two different IOS devices (CS 3600, Carestream Dental, and
166 TRIOS 3, 3Shape) in different clinical situations and for different operator experience levels. Operators have
167 no relevant impact, TRIOS 3 showed better performance in scenarios with 1 / 2 implants, while CS 3600
168 showed better results in the full-arch scenario.
169 Evaluation of light effect on IOS performances
170 Revilla-Leon M et al.26 study the impact of 4 different light conditions. The scanners analyzed were iTERO
171 Element, Omnicam, TRIOS 3. TRIOS 3 showed the highest consistency and mesh quality mean values across
172 all scanning lighting conditions tested.
173 Effect of IOS on clinical success and patient wellbeing/comfort
174
175 Wulfman et al.10,27 focusing on their effect on clinical success and patient wellbeing/comfort in terms of
176 ‘chair time’. The scanners analyzed were the following: TRIOS, 3Shape, Cerec Omnicam, Dentsply Sirona,
177 True Definition, 3M (active wavefront sampling 3D video technology), Lava Cos, 3M (active wavefront
178 sampling with structured light projection) Zfx IntraScan (Figure 4), iTero, iTero (parallel confocal imaging
179 technology) Planscan, Planmeca, CS 3500, CS 3600. Better trueness with TRIOS and CS 3600. In particular,
180 the authors found, by analyzing the data collected in randomized controlled trials, an improvement in
181 short-term clinical success when TRIOS, CS 3600, and Precise Implants Capture photogrammetric system
182 are used and an improvement of patient’s comfort by reducing the chair time.
183 Neto et al.28 describe with a clinical prospective single-center study a complete digital workflow for full-arch
184 implant-supported prosthesis. The main variable analyzed in the study was the effect of the implant
185 number. The scanner True Definition 3M gave a 3D accuracy into a clinically acceptable range.

186 Clinical use of IOS devices was reported also in Pereira et al.29 where TRIOS 3 shape A/S coupled to
187 CAD/CAM have been employed for the planning and construction of the passive metal substructure of the
188 complete full arch implant-support fixed prostheses. It has been reported as the employment of Intraoral
189 eliminated the errors associated with conventional substructure casting and occlusal registration leading to
190 a reduction in costs and working steps.

191 Arcuri et al.30 conducted an in vivo study about TRIOS 3. In these conditions, TRIOS 3 cabled pen grip
192 showed a consistent linear accuracy for complete-arch implant impression, but at the same time, extreme
193 deviations (0.5205 mm) were found. In particular, the angular deviations may affect negatively the overall
194 implants-prosthesis fit, especially in the case of screw-retained complete-arch restorations.

195

196
197 Figure 4. (A) Lava Cos, 3M; (B) Zfx IntraScan .

198 4. Conclusions

199 This bibliographical review analyzes various in vitro, in vivo and ex vivo studies to evaluate the accuracy of
200 some IOS devices and understand which of these may be more suitable for scanning full arch implant
201 rehabilitations (results are summarized in Table 1). The authors conclude that most of the intraoral
202 scanners used in vitro provided acceptable accuracy below a threshold of 150 μm; therefore, in vitro
203 intraoral scanners have shown acceptable accuracy. The main parameters identified for their influence on
204 precision were interim plant distance, body scan design, scanning pattern, and operator experience.

Author Type of study IOS devices Variables Results

analysed in the analysed in the
study study
Pesce P. et al.16 In vitro study OS-Opera Mc, IT- Operator Trueness was
Itero experience higher for the
experienced
operator using
the IT scanner
Mangano et al.17 In vitro study Itero Elements, Operator Highest level of
Primescan and experience, accuracy :Itero
 Omnicam, CS patient, light Elements 5D,
3700 and CS 3600, conditions and Primescan, CS
TRIOS3, i500, Scan bodies 3700, CS 3600,
Emerald S and TRIOS3 and i-500
Emerald, Virtuo
Vivo and Dwio,
Runeyes
Quickscan
Bilmenoglu et al. In vitro study 3D Progress, No variables Better trueness:
24 Omnicam, Color POD,
Bluecam, Apollo Omnicam,
DI, Planscan, E4D Apollo DI, Color
Tech, TRIOS Cart, MonoColor
MonoColor Cart, Cart, and
TRIOS Color Bluecam
Cart, TRIOS
Color Pod,
Lythos.
Revell et al.22 Ex vivo study iTero Element 2, Operator Operator
Medit i500, experience, scan dependence
Primescan, bodies impacted the
TRIOS3, TRIOS4 trueness. The
best IOS
performing were:
the Primescan
and TRIOS 4 ,
followed by
TRIOS 3.
Wulfman et al. 27 Systematic review TRIOS, Cerec No variables Bettere trueness:
(in vivo and in Omnicam, True TRIOS, CS 3600
vitro studies) Definition, Lava
Cos, iTero, Zfx
IntraScan,
Planscan, CS
3500, CS 3600
Neto et al.28 Clinical True Definition effect of the 3D accuracy is
prospective 3M, implant number into a clinically
single-center (4 vs 5 vs 6) acceptable range
study
Pereira et al.29 Clinical TRIOS 3 shape Experience and Accurate
prospective skill of the intraoral scan
single-center operator
study

Arcuri et al.30 In vivo study TRIOS 3 Scan bodies TRIOS 3 showed

a consistent
linear accuracy
Sami et al.19 In vitro study True Definition, No variables No statistical or
TRIOS, Omnicam, clinical
Emerald differences
among the
scanners
 Resende et al. 23 In vitro study Omnicam, TRIOS Operator TRIOS 3 was
3 experience and more accurate
scan size than the
Omnicam for
complete-arch
scans.
Canullo L. et al. In vitro study CS 3600, TRIOS 3 Operator Operators have
25 experience and no relevant
different clinical impact, TRIOS 3
situation showed better
performance in
scenarios with
1/2 implants,
while CS 3600
showed better
results in the full-
arch scenario

Roig et al.20 In vitro study Omnicam, 3M Humidity and TRIOS3 and

True Definition, the mobility of CS3600 showed a
TRIOS3, CS 3600 the soft tissues significantly
improved mean
trueness
compared to that
of CEREC
Omnicam and
True Definition.

Dutton E. et al. 21 In vitro study Primescan, Effect of the iTero Element 2,

Omnicam, substrates’ iTero Element,
Emerald, Emerald material Trios3 are less
S, i500, iTero influenced by the
Element, iTero substrate and
Element 2, Trios3 trueness and
precision are
improved.
Revilla-Leon M In vitro study iTero Element, light TRIOS 3 showed
et al.26 Omnicam , TRIOS the highest
3 consistency and
mesh quality
mean values
across all
scanning lighting
conditions tested
205

206 Furthermore, it is important to remember that there are other variables that affect the accuracy of the
207 optical impression including:

208 • The experience of the operator

209 Perfect knowledge of the features of the IOS and the ability to comply with the scanning protocol (reported
210 in Figure 5) and scanning strategy are mandatory for the operator to obtain the best results
211
212 Figure 5. Scanning Protocol. Scanning Protocol. (A) How to scan. Red arrow represents the trajectory to
213 follow during the scan for each part of the arch; (B) Direction of the scanning. (C) Part of the arch to scan.

214 • The patient compliance:

215 • Movements of the jaw, poor mouth opening, and uncontrolled movement of the tongue could be
216 disturbing elements which could interfere and slow down the scanning procedure.

217 • The geometric architecture and the surface treatment of the scan body

218 • Implant companies design the scan body layout according to the scanning protocol and it’s
219 fundamental to know how to place it in the correct position, especially in the most difficult to reach
220 areas in the posterior sectors of the mouth.

221 • The presence of fluids around the working area

222 The most difficult clinical scenario to scan is that relating to the absence of teeth, such as right after a full
223 arch immediate load implant surgery. In this case blood, saliva and other fluids may disturb the scanning
224 process, so it’s paramount to adopt some precautions such as double saliva aspirators, mouth opener,
225 abundant air flow and in some cases also the surface mattifying spray.

226 In the studies, significant differences emerged between the intraoral scanners used leading to the
227 possibility to indicate the most appropriate device in some common contexts for full arch. From the studies
228 analyzed it can be deduced that there are scanners that have better trueness and accuracy than others, in
229 particular for full arch scans, such as TRIOS 3, TRIOS 4 and CS 3600. However, as reported, also for these
230 brands the accuracy of the scans also depends on other factors such as: the experience of the operator, the
231 patient, the light conditions and also the scan-bodies. Furthermore, most of the studies cited are in vitro
232 studies and this represents a limitation in research. In fact, the scanned models are different from the
233 patient's mouth: the tissues have a different behavior compared to the model. Another aspect to be
234 investigated, since it can have a huge impact on IOS accuracy, is the evolution of the software associated to
235 the devices31.

236 Consequently, some authors are still not persuaded that scanners do not have sufficient accuracy in cases
237 of full arch implant rehabilitation18. For that reason, even though the data collected in this review showed
238 how the latest generation scanners have very low errors and better results in scanning the entire arch 32, it
239 is necessary to have many more studies available (and above all to perform in vivo studies 18) to
240 demonstrate that scanners can be effectively employed in medical practice. Therefore, an implementation
241 of the literature remains necessary.

242 Author Contributions: Each author have made substantial contributions to the conception or design of the
243 work; or the acquisition, analysis, or interpretation of data; has approved the submitted version (and
244 version substantially edited by journal staff that involves the author’s contribution to the study); agrees to
245 be personally accountable for the author’s own contributions and for ensuring that questions related to the
246 accuracy or integrity of any part of the work, even ones in which the author was not personally involved,
247 are appropriately investigated, resolved, and documented in the literature. All authors have read and
248 agreed to the published version of the manuscript.

249 Funding: the article had no funding.

250 Conflicts of Interest: The authors declare no competing financial interests.

251

252 References

253 1 Chochlidakis, K. et al. Digital Versus Conventional Full-Arch Implant Impressions: A Prospective
254 Study on 16 Edentulous Maxillae. J Prosthodont 29, 281-286 (2020).
255 https://doi.org:10.1111/jopr.13162
256 2 Michelinakis, G., Apostolakis, D., Kamposiora, P. & Papavasiliou, G. The direct digital workflow in
257 fixed implant prosthodontics: a narrative review. 21 (2021).
258 3 Imburgia, M., Kois, J., Marino, E., Lerner, H. & Mangano, F. G. Continuous Scan Strategy (CSS): A
259 Novel Technique to Improve the Accuracy of Intraoral Digital Impressions. Eur J Prosthodont Restor
260 Dent 28, 128-141 (2020). https://doi.org:10.1922/EJPRD_2105Imburgia14
261 4 Papaspyridakos, P. et al. Digital Workflow for Implant Rehabilitation with Double Full-Arch
262 Monolithic Zirconia Prostheses. J Prosthodont 29, 460-465 (2020).
263 https://doi.org:10.1111/jopr.13166
264 5 Papaspyridakos, P., De Souza, A., Bathija, A., Kang, K. & Chochlidakis, K. Complete Digital Workflow
265 for Mandibular Full-Arch Implant Rehabilitation in 3 Appointments. J Prosthodont 30, 548-552
266 (2021). https://doi.org:10.1111/jopr.13356
267 6 García-Gil, I., Cortés-Bretón-Brinkmann, J., Jiménez-García, J., Peláez-Rico, J. & Suárez-García, M. J.
268 Precision and practical usefulness of intraoral scanners in implant dentistry: A systematic literature
269 review. J Clin Exp Dent 12, e784-e793 (2020). https://doi.org:10.4317/jced.57025
270 7 Fiore, A. et al. Influence Of Three Different Scanning Techniques In Full-Arch Implants Digital
271 Impression Using Intraoral Scanners: A Randomized Controlled Cross-Over Trial. 1, 37-50 (2021).
272 8 Huang, R. et al. Improved scanning accuracy with newly designed scan bodies: An in vitro study
273 comparing digital versus conventional impression techniques for complete-arch implant
274 rehabilitation. Clin Oral Implants Res 31, 625-633 (2020). https://doi.org:10.1111/clr.13598
275 9 Ahmed, W. M., Verhaeghe, T. V. & McCullagh, A. P. G. Maxillary complete-arch implant-supported
276 restoration: A digital scanning and maxillomandibular relationship workflow. J Prosthet Dent 125,
277 216-220 (2021). https://doi.org:10.1016/j.prosdent.2020.01.010
278 10 Wulfman, C. et al. Digital removable complete denture: a narrative review. (2020).
279 11 Lerner, H., Mouhyi, J., Admakin, O. & Mangano, F. Artificial intelligence in fixed implant
280 prosthodontics: a retrospective study of 106 implant-supported monolithic zirconia crowns
281 inserted in the posterior jaws of 90 patients. BMC Oral Health 20, 80 (2020).
282 https://doi.org:10.1186/s12903-020-1062-4
283 12 Lerner, H., Hauschild, U., Sader, R. & Ghanaati, S. Complete-arch fixed reconstruction by means of
284 guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1 year of
285 follow-up. BMC Oral Health 20, 15 (2020). https://doi.org:10.1186/s12903-019-0941-z
286 13 Mizumoto, R. M., Yilmaz, B., McGlumphy, E. A., Jr., Seidt, J. & Johnston, W. M. Accuracy of different
287 digital scanning techniques and scan bodies for complete-arch implant-supported prostheses. J
288 Prosthet Dent 123, 96-104 (2020). https://doi.org:10.1016/j.prosdent.2019.01.003
289 14 Zhang, Y. J., Shi, J. Y., Qian, S. J., Qiao, S. C. & Lai, H. C. Accuracy of full-arch digital implant
290 impressions taken using intraoral scanners and related variables: A systematic review. Int J Oral
291 Implantol (Berl) 14, 157-179 (2021).
292 15 Mangano, F. G., Bonacina, M., Mandelli, F. & Marchiori, F. Solid index versus intraoral scanners in
293 the full-arch implant impression: in vitro trueness evaluation. 13, 504 (2020).
294 16 Pesce, P. et al. Trueness of Intraoral Scanners in Implant-Supported Rehabilitations: An In Vitro
295 Analysis on the Effect of Operators’ Experience and Implant Number. Journal of Clinical Medicine 10
296 (2021).
297 17 Mangano, F. G. et al. Trueness of 12 intraoral scanners in the full-arch implant impression: a
298 comparative in vitro study. 20, 263 (2020).
299 18 Goracci, C., Franchi, L., Vichi, A. & Ferrari, M. Accuracy, reliability, and efficiency of intraoral
300 scanners for full-arch impressions: a systematic review of the clinical evidence. 38, 422-428 (2016).
301 19 Sami, T., Goldstein, G., Vafiadis, D. & Absher, T. An in vitro 3D evaluation of the accuracy of 4
302 intraoral optical scanners on a 6-implant model. J Prosthet Dent 124, 748-754 (2020).
303 https://doi.org:10.1016/j.prosdent.2019.10.013
304 20 Roig, E. et al. In vitro comparison of the accuracy of four intraoral scanners and three conventional
305 impression methods for two neighboring implants. PLoS One 15, e0228266 (2020).
306 https://doi.org:10.1371/journal.pone.0228266
307 21 Dutton, E. et al. The effect different substrates have on the trueness and precision of eight different
308 intraoral scanners. J Esthet Restor Dent 32, 204-218 (2020). https://doi.org:10.1111/jerd.12528
309 22 Revell, G. et al. Evaluation of complete-arch implant scanning with 5 different intraoral scanners in
310 terms of trueness and operator experience. (2021).
311 23 Resende, C. C. D. et al. Influence of operator experience, scanner type, and scan size on 3D scans. J
312 Prosthet Dent 125, 294-299 (2021). https://doi.org:10.1016/j.prosdent.2019.12.011
313 24 Bilmenoglu, C., Cilingir, A., Geckili, O., Bilhan, H. & Bilgin, T. In vitro comparison of trueness of 10
314 intraoral scanners for implant-supported complete-arch fixed dental prostheses. J Prosthet Dent
315 124, 755-760 (2020). https://doi.org:10.1016/j.prosdent.2019.11.017
316 25 Canullo, L., Colombo, M., Menini, M., Sorge, P. & Pesce, P. Trueness of Intraoral Scanners
317 Considering Operator Experience and Three Different Implant Scenarios: A Preliminary Report. Int J
318 Prosthodont 34, 250–253 (2021). https://doi.org:10.11607/ijp.6224
319 26 Revilla-León, M. et al. Intraoral digital scans: Part 2-influence of ambient scanning light conditions
320 on the mesh quality of different intraoral scanners. J Prosthet Dent 124, 575-580 (2020).
321 https://doi.org:10.1016/j.prosdent.2019.06.004
322 27 Wulfman, C., Naveau, A. & Rignon-Bret, C. Digital scanning for complete-arch implant-supported
323 restorations: A systematic review. J Prosthet Dent 124, 161-167 (2020).
324 https://doi.org:10.1016/j.prosdent.2019.06.014
325 28 Neto, A. D. T. et al. Digital Workflow for Full-Arch Implant-Supported Prosthesis Based on Intraoral
326 Scans of a Relative of the Patient. J Oral Implantol 47, 68-71 (2021). https://doi.org:10.1563/aaid-
327 joi-D-20-00095
328 29 Carneiro Pereira, A. L. et al. Partially digital workflow for making complete-arch implant-supported
329 fixed prostheses: A dental technique. J Prosthet Dent (2021).
330 https://doi.org:10.1016/j.prosdent.2021.04.018
331 30 Arcuri, L. et al. Influence of implant scanbody material, position and operator on the accuracy of
332 digital impression for complete-arch: A randomized in vitro trial. J Prosthodont Res 64, 128-136
333 (2020). https://doi.org:10.1016/j.jpor.2019.06.001
334 31 Schmalzl, J., Roth, I., Borbely, J., Hermann, P. & Vecsei, B. The impact of software updates on
335 accuracy of intraoral scanners. 23 (2023).
336 32 Paratelli, A. et al. Techniques to improve the accuracy of complete-arch implant intraoral digital
337 scans: A systematic review. (2021).
338 List of references for figures.

339 Figure 1. (A) IOS OS-Opera Mc, Opera System, Monaco (https://opera-system.com/en/home/) ; (B) IT-Itero,
340 Align Technology (https://www.aligntech.com/solutions/itero_scanner).

341 Figure 2. (A) PRIMESCAN, Dentsply Sirona (https://news.dentsplysirona.com/en.html ); (B) OMNICAM,

342 Dentsply Sirona (https://news.dentsplysirona.com/en.html ); (C) CS 3600, Carestream Dental
343 (https://www.carestreamdental.com/en-gb/ ); (D) CS 3700, Carestream Dental
344 (https://www.carestreamdental.com/en-gb/ ); (E) TRIOS 3, 3-Shape (https://www.3shape.com/en-
345 us/news/2015/top-10-intraoral-scanning-questions-for-2014 ); (F) i500, Medit
346 (https://www.medit.com/dental-clinic-i700 ); (G)VIRTUO VIVO, Dentalwings
347 (https://www.straumann.com/gb/en/dental-professionals.html ); (H) DWIO, Dentalwings
348 (https://www.straumann.com/gb/en/dental-professionals.html ); (I) EMERALD, Planmeca
349 (https://www.planmeca.com/cadcam/dental-scanning/planmeca-emerald-s/ ); (L) EMERALD-S, Planmeca
350 (https://www.planmeca.com/cadcam/dental-scanning/planmeca-emerald-s/ ); (M) RUNEYES QUICKSCAN,
351 RUNEYES Medical Instruments (http://en.runyes.com/en/protypes.php).

352 Figure 3. (A) 3D Progress, Medical High Technologies (https://www.medhitec.com/en/divisions ); (B)

353 Bluecam, Dentsply Sirona (https://infodent.it/sites/www.infodent.it/files/materiale_prodotti/a91100-m43-
354 b610_7200_j3_final_16.pdf ); (C) Apollo DI, Dentalsply Sirona (https://it.dental-tribune.com/prod/apollo-
355 di/ ); (D) Planscan, Planmeca (https://www.planmeca.com/cadcam/dental-scanning/planmeca-emerald-s/
356 ); (E) E4D Tech, (https://atlasresell.com/products/e4d-d4d-technologies-nevo-e4d-scan1-dental-intraoral-
357 scanner-cadcam-dentistry-96343 ); (F) Lythos Digital Impression System
358 (https://www.londonbraces.com/lythos-digital-impression-system/).

359 Figure 4. (A) Lava Cos, 3M (https://multimedia.3m.com/mws/media/615999O/lava-chairside-oral-scanner-

360 c-o-s-brochure-ebu.pdf ); (B) Zfx IntraScan, (https://dentist.zfx-dental.com/en/node/473 ).

361