Digitally Created 3-Piece Additive Manufactured Index

for Direct Esthetic Treatment

So Hyeon Park , DDS,1 Wenceslao Piedra-Cascón , DDS, MS,2,3 Amirali Zandinejad , DDS, MS,4 &
Marta Revilla-León , DDS, MSD 5,6,7
1
Resident AEGD Program, College of Dentistry, Texas A&M University, Dallas, TX
2
Affiliate Faculty Esthetic Dentistry Program, Complutense University of Madrid, Spain
3
Researcher at Revilla Research Center, Madrid, Spain
4
Associate Professor and Program Director AEGD, College of Dentistry, Texas A&M University, Dallas, TX
5
Assistant Professor and Assistant Program Director AEGD, College of Dentistry, Texas A&M University, Dallas, TX
6
Affiliate Faculty Graduate Prosthodontics, School of Dentistry, University of Washington, Seattle, WA
7
Researcher at Revilla Research Center, Madrid, Spain

Keywords
3D printing; additive manufacturing; facial
scanners; intraoral scanners; polymer printing.
Correspondence
Marta Revilla-León DDS, MSD, 3302 Gaston
Avenue, Room 713, College of Dentistry,
Texas A&M University, Dallas, Texas, USA.
Email: revillaleon@tamu.edu
The authors do not have any conflict interest,
financial or personal, in any of the materials
described in this study.
Accepted March 4, 2020
doi: 10.1111/jopr.13159
Abstract
Facial and intraoral scanners as well as additive manufacturing (AM) technologies can
be integrated to virtually plan restorative procedures. The present article describes a
digital workflow protocol for treatment planning an esthetic rehabilitation using direct
composite restorations. The combination of facial digitalization and intraoral scans al-
lowed a facially driven diagnostic waxing, while additive manufacturing technologies
facilitate the translation of the digital waxing into the patient´s mouth through an AM
3-piece silicone index which was designed into a buccal and a lingual clear flexible
silicone indices that were fitted into a clear and rigid custom tray. This procedure
facilitated the treatment planning procedures as well as assisted the direct compos-
ite restoration procedures, providing several advantages compared with conventional
procedures such as precise translation of the digital diagnostic waxing into the pa-
tient´s mouth, horizontal path of insertion of the silicone index, and minimized time
of the clinical intervention.

Direct composite restorations have been reported as a reliable,
functional, and conservative treatment for diastema closure
with a survival rate of 85% after 5 years.1-3 While conven-
tional concepts remain, the incorporation of digital technologies
including intraoral scanners (IOSs), facial scanners (FSs), de-
sign softwares, and additive manufacturing (AM) technologies
provide different tools to perform restorative treatment plan-
ning procedures,4-10 diagnostic trial restorations,4,5,8 interim
restorations,5,6 and direct composite restorations.6,9,10
The integration of facial references to elaborate a facially
driven diagnostic waxing is a fundamental step to integrate
the esthetic outcome of the planned restorative procedures. The
incorporation of facial features can be performed using 2D full-
face photographs or 3D facial representations using a facial
scanner.4,5 Effective superimposition of the patient´s digital
data, such as merging facial with intraoral digital scans, is a
fundamental procedure for obtaining precise representations of
clinical situations.5,11,12
IOSs provide acceptable impression procedures to elab-
orate tooth- and implant-supported crowns and short fixed
dental prostheses (FDPs).13-17 However, clinician choices
and/or usage can significantly reduce the scanning accuracy
such as insufficient scanning experience,18,19 calibration,20
scanning protocol,21 ambient lighting conditions,22-24 surface
characteristics,25,26 and humidity of the surface.27
Vat-polymerization AM technologies can be selected to
manufacture custom trays, diagnostic casts, surgical guides,
or silicone indices.28,29 Vat-polymerization procedures can be
differentiated based on the light source employed between
stereolithography (SLA) and direct light processing (DLP)
technologies.28,29
The present article describes the digitization and super-
imposition procedures performed which involved facial and
intraoral scanning to obtain a 3D facial representation of
a patient for treatment planning procedures using a dental
computer-aided design (CAD) software. Furthermore, the
transferring of the virtual diagnostic waxing to the patient´s
mouth was completed by additively manufacturing a 3-piece
clear silicone index which allowed the elaboration of a
diagnostic trial restoration and facilitated the final direct
composite restorations performed on the maxillary anterior
teeth.

436 Journal of Prosthodontics 29 (2020) 436–442 

C 2020 by the American College of Prosthodontists

Park et al
Case report
A 28-year-old female patient was attended in the Advanced Ed-
ucation in General Dentistry Clinic of the College of Dentistry
at Texas A&M University. The chief complaint was to replace
the old composite restorations present on the maxillary anterior
teeth due to color change (Fig. 1). Extraoral examination
revealed a convex smile line, high lip line, and uneven gingival
margins on the maxillary anterior teeth. Facial midline was
coincident with maxillary dental midline, but not coincident
with mandibular dental midline. Intraoral and radiographic
evaluations revealed acceptable oral health, except localized
gingivitis and bleeding on probing on the buccal of the maxil-
lary anterior teeth due to the existing over-contoured composite
resin restorations. Patient presented a canine and molar class I
occlusion on the right side and class III on the left side. Diverse
treatment alternatives were offered to the patient including
orthodontic treatment, and esthetic crown lengthening with
final ceramic veneers; however, the patient preferred the con-
servative restorative procedure of direct composite restorations
to improve the color of her old composite restorations and close
the existing mesio-distal diastemas of the maxillary incisors.
For treatment planning procedures, a facially driven diag-
nostic waxing was accomplished using the following complete
digital workflow:
was prepared using the tools of the CAD software (Fig. 2).
1. In the first clinical appointment, a facial scanner (Bellus
When the maxillary diagnostic waxing was complete, the STL1
FacePro; Bellus; Los Gatos, CA) and an extraoral and
file was exported.
intraoral scan bodies (All in one system; AFT Dental
System, Seville, Spain) were selected to obtain a refer-
ence and smile scans.
For the reference scan, the forehead scan body (ScanBody-
Face; AFT Dental System) was placed on the forehead of the
patient and the intraoral scan body (ScanBodyMouth; AFT
Dental System) was placed in the patient´s mouth and stabilized
using high and low viscosity polyvinyl siloxane impression ma-
terial (Virtual putty regular setting; Ivoclar Vivadent, Schaan,
Liechtenstein). A facial scan was obtained following the man-
ufacturer´s recommendations. For the smile scan, the intraoral
scan body was removed from the patient´s mouth maintaining
the forehead scan body in the same position, a second facial
scan with the patient at smile was captured. After the comple-
tion of the facial digitizing procedures, two geometry definition
files (OBJ files) were obtained.
2. At the same appointment, digital scan of both maxil-
lary and mandibular arches and an interocclusal record
were obtained using an IOS (Trios 3; 3Shape, Copen-
hagen, Denmark) following the scanning protocol rec-
ommended by the manufacturer. Using a luxmeter
(LX1330B Light Meter; Dr. Meter Digital Illuminance,
London, UK), light intensity of the room was measured
at 1000 lux, which indicates the proper ambient lighting
condition for the digital scan to be performed.22-24 When
the digital scans were completed, an standard tessellation
language (STL) file of each arch was exported.
3. The intraoral scan body was scanned using a laboratory
scanner following the manufacturer´s recommendations,
and an STL2 file was generated. The OBJ files, STL1 files,
Journal of Prosthodontics 29 (2020) 436–442 
C 2020 by the American College of Prosthodontists
1532849x, 2020, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13159 by Universitat de Barcelona, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Digital Workflow of an Esthetic Rehabilitation
and STL2 files were imported to a dental CAD software
(Dental CAD Matera 2.4; Exocad GmBH, Darmstadt,
Germany) to perform a digital waxing of the maxillary
anterior teeth.
r The digitized intraoral scan body was superimposed
with the maxillary scan using the iterative closest point
in the dental CAD software. Therefore, the virtual di-
agnostic maxillary cast was positioned into the nega-
tive of the maxillary teeth of the intraoral scan body.
r Afterwards, the intraoral scan body of the reference fa-
cial scan was used to superimpose it with the digitized
intraoral scan body using the iterative closest point
technique. As a result, the virtual diagnostic maxillary
cast was positioned in the reference facial scan.
r Finally, the smile facial scan was superimposed with
the reference facial scan by using the iterative closest
point technique between the extraoral scan body of
the reference and the smile facial scans. As a result,
the virtual diagnostic maxillary cast was positioned
into the smile facial scan. The smile facial scan can
be modified by deleting the deformed scanned teeth
using the free form facial scan tool of the dental CAD
software.
A virtual diagnostic waxing of the maxillary anterior teeth
1. A dental CAD software (Dental System; 3Shape) was
used to design a 3-piece silicone index following the
next steps:
(A) A new file was created in the CAD software. A max-
illary custom tray description was introduced and
the STL1 file was imported. The outline of the lin-
gual index was marked with the CAD tools involv-
ing from the buccal-incisal line angle of the maxil-
lary anterior teeth to 10 mm of the palate, including
at least 2 teeth distal to the teeth receiving restora-
tions to provide stability of the index (Fig. 2A). The
following settings were specified in the virtual de-
sign: base thickness of 3 mm, impression gap of
0 mm, and relief of 0.15 mm. With the sculp tools
of the CAD software, the exterior surface of the lin-
gual index was modified until a smooth surface was
obtained. Afterwards, 3 pin attachments were added
on the lingual surface of the index with a group di-
rection orientation (Fig. 2B). It is important that
three attachments had the same orientation to allow
the future indexation of the buccal index. Once the
virtual design was completed as described, an STLL
file of the lingual index design was obtained.
(B) The file created on the previous step was copied us-
ing the design as a pre-preparation, which allowed
the creation of a STL2 file where the cast and the lin-
gual index were joined. A new file was then created
with a maxillary custom tray description and the
STL2 file was imported. The outline of the buccal
index was determined using the CAD tools of the
437

Digital Workflow of an Esthetic Rehabilitation
Figure 1 A, Frontal lower third smile of the patient. B, Initial frontal
maxillary and mandibular view of the patient.
software involving the buccal surface of the max-
illary anterior teeth, and the lingual indexations of
the lingual index (Fig. 2C). The following setting
were specified in the virtual design: base thickness
of 3 mm, impression gap of 0 mm, and relief of
0.15 mm. With the sculp tools of the CAD software,
the exterior surface of the lingual index was modi-
fied until a smooth surface was obtained. Once the
virtual design was completed as described, an STLB
file of the lingual index design was obtained.
(C) The previous step was replicated to create a new file
to design the custom tray that will fit over the lingual
and buccal indices (Fig. 2D). The following setting
were specified in the virtual design: base thickness
of 3 mm, impression gap of 0 mm, and relief of
0.15 mm. With the sculp tools of the CAD software,
the exterior surface of the lingual index was modi-
fied until a smooth surface was obtained. Once the
virtual design was completed as described, an STLT
file of the lingual index design was obtained.
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Park et al
When the virtual design of the 3-piece index was accom-
plished, three files were created: the lingual index design (STLL
file), the buccal index design (STLB file), and the custom tray
(STLT file).
The STLL and STLB files were imported into the 3D printer
software (Perfactory Build Style Editor; Envisiontec, Dearborn,
Michigan, US). A DLP 3D printer (EnvisionTec VIDA HD;
EnvisionTec) was selected to manufacture the indices with a
25 µm layer thickness and 90° of printing orientation using a
flexible clear resin (Nexdent Ortho IBT; Nexdent, Soesterberg,
The Netherlands), (Figs. 4A, B). The printer was previously cal-
ibrated following the manufacturer´s instructions and placed in
a room with constant temperature of 23°C. After printing, the
indices were carefully detached from the building platform us-
ing a scraper. The indices were cleaned using a 96% isopropyl
alcohol (IPA) using an ultrasonic wash for 3 minutes, followed
by a second clean 96% IPA rinse of 2 minutes. After cleaning,
Figure 2 Virtual diagnostic waxing elaborated using a dental CAD soft-
ware (Dental Matera; Exocad, Darmstadt, Germany). A, Smile facial scan
merged with the maxillary and mandibular intraoral digital scans using
the iterative closest point technique. B, Diagnostic waxing merged with
the 3D facial reconstruction of the patient.
Figure 3 Digital design of the 3-piece silicone index. A, The splint outline
was marked on the lingual side of the teeth to obtain the lingual index.
Three indexations were created on the lingual index such that the buccal
index could fit into the lingual index. B, The buccal index design involved
coverage of the buccal, incisal and inciso-lingual surfaces of the involved
teeth such that the buccal index would interlock with the lingual index.
C, D, Custom tray designed over the buccal and lingual indices.
C 2020 by the American College of Prosthodontists

Park et al
Figure 4 A, Buccal clear and flexible AM silicone index. B, Lingual flexi-
ble and clear silicone index. C, Clear and rigid AM custom tray. D, 3-piece
silicone index.
Figure 5 A, Lingual flexible and clear additive manufactured silicone
index try-in. B, Occlusal view of the lingual silicone index positioned
in the patient´s mouth. C, Lingual and buccal indices try-in. D, 3-piece
silicone index try-in.
the dried parts were placed in a UV light polymerization ma-
chine (LC-3D Print Box; Nexdent) for 10 minutes. Afterwards,
the support structures were removed.
The described DLP 3D printer was selected to fabricate
the rigid custom tray (STLT file) with a 25 µm layer thick-
ness of rigid clear polymer (Nexdent Ortho Clear; Nexdent)
(Figs. 4C,D). The printer calibration, location, and printing
workflow were the same as the buccal and lingual indices de-
scribed previously.
2. In the second clinical appointment, the complete seating
of the index was verified on the maxillary teeth (Fig. 5).
The AM index was used to fabricate a diagnostic trial
restoration in the patient´s mouth to confirm the outcome
of the diagnostic waxing using an auto-polymerized bis-
acryl provisional material (Protemp Plus temporization
material, A1 color; 3M ESPE, St. Paul, MN) (Fig. 6).
Subsequently, after attaining the patient’s consent and ex-
plaining the limitations of the selected restorative treatment,
the existing composite restorations on the maxillary teeth were
polished to eliminate the over-contours of the buccal surfaces of
Journal of Prosthodontics 29 (2020) 436–442 
C 2020 by the American College of Prosthodontists
1532849x, 2020, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13159 by Universitat de Barcelona, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Digital Workflow of an Esthetic Rehabilitation
Figure 6 Diagnostic trial restoration. A, Lower third at smile position. B,
Maxillary and mandibular front arches.
the restorations to achieve optimal gingival health. Oral hygiene
techniques were reviewed with the patient. Month-to-month
follow up appointments were scheduled until no bleeding on
probing was present (Fig. 7).
3. Direct composite resin restorations were completed us-
ing the AM silicone index.30 The lingual index was used
to perform the first composite resin layer (WE Filtek
Supreme XTE; 3M ESPE, MN), which was positioned
to imitate the incisal halo visible on the natural den-
tition of the patient. The second layer positioned was
the dentin composite layer, (A2 and A1 TPH Spectra
ST; Dentsply Sirona, Charlotte, NC) imitating the dentin
mamelons, and a small blue translucent effect among
the composite dentin mamelons was obtained by using
translucent composite resin material (Translucent Blue
Filtek Supreme XTE; 3M ESPE). A white stain (White
Kolor+Plus; Kerr, MA) characterization was placed
on the superficial layer of the dentin composite to repli-
cate the marked white enamel on the facial incisal third
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Digital Workflow of an Esthetic Rehabilitation
Figure 7 Maxillary and mandibular arches view after the removal of the
buccal overcoutours of the composite restorations.
Figure 8 Direct composite restoration performed from the maxillary
right canine to the maxillary left canine using the 3-piece AM silicone
index.
of the patient´s teeth. To complete the restoration, a layer
of enamel composite resin material (Clear TPH Spectra
ST; Dentsply Sirona, Charlotte, NC) was placed using
the buccal AM index to guide the final contours of the
restorations.
Surface finishing was performed by using polishing discs
(Sof-Lex XT Extra thin; 3M ESPE) with polishing paste (Enam-
elize polishing paste; Cosmedent, Chicago, IL). The occlusal
contacts were checked and adjusted as needed.
One week after the procedure, composite restoration inte-
gration was reviewed (Fig. 8). The patient was pleased with
the esthetic result of her treatment. Final photographic docu-
mentation was completed and the patient was introduced into a
one-year recall procedure (Fig. 9).
Discussion
The integration of facial references to perform a virtual waxing
using a facial scanner has been previously described in the
dental literature,16-18 including the employment of extraoral
and intraoral scan bodies to merge facial with intraoral scans.9
Even though the selected facial scanner presents up to 400 µm
resolution, the 3D facial reconstruction superimposed to the
intraoral digital scans allowed the visualization of the proposed
440 Journal of Prosthodontics 29 (2020) 436–442 
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Park et al
Figure 9 Final periapical radiographs.
treatment plan result in the 3D representation of the patient’s
face.
The digital workflow is composed of three main steps
namely data acquisition, data processing, and manufacturing
procedures. In the technique selected in the present study, data
acquisition involves facial and intraoral scans of the patient
while data processing includes the procedures performed
to elaborate a digital diagnostic waxing and the virtual
design of the 3-piece silicone index. The alternative of this
workflow would be using conventional procedures which
include obtaining facial photographs of the patient, diagnostic
casts made from the impressions of both arches using an
irreversible hydrocolloid, diagnostic waxing, and silicone
index fabrication. To the authors knowledge, there is no
study that analyzed the time and cost differences between
both workflows. Based on the experience of the authors,
for a novice user, the digital workflow might be more time
consuming than conventional procedures however, after
overcoming the learning curve, the time required to perform
the data acquisition and the virtual designs might be similar
or less than the time required for conventional procedures.
Furthermore, digital procedures provide diagnostic and design
tools which provide several advantages over conventional
procedures. These tools include tooth libraries, which provide
a variety of shapes for users to choose from, measuring and
morphing tools, mirroring techniques which provide an option
to replicate the exact tooth shape from contralateral side when
generic tooth shape libraries do not suffice user’s need. More-
over, there are tools to control the path of insertion, location of
undercuts, and thickness of indexes which allows more control
for the overall procedure before the products are manufactured.
The authors of the present case report have previously de-
scribed the designing of the silicone index using an open-source
software, including 1-piece and 3-piece silicone index. This re-
port reviews the designing of the 3-piece silicone index using a
dental CAD software which provides several advantages when
compared with open source software. These advantages include
a reduced learning curve, more intuitive software to perform
the digital design, and easier access to some features during
the silicone index design such as blocking undercuts or deter-
mining the path of insertion. However, because dental software
is not developed to include the 3-piece silicone index design
C 2020 by the American College of Prosthodontists

Park et al
into current feature design possibilities, a more time-consuming
sequence has to be completed with open source software.
From the silicone index fabrication procedures standpoint,
the alternative to the technique described in the present
manuscript would be a 2-piece silicone index performed sim-
ilarly with a conventional clear silicone material and a cus-
tom tray made with a conventional clear light-polymerization
resin material. However, in this workflow, the virtual diag-
nostic waxing cast should also be additively manufactured
to fabricate the conventional alternative. Therefore, for both
techniques, the cast or the index needs to be manufactured
which may result in similar manufacturing time and cost. How-
ever, printing the index provides several advantages over the
conventional technique by providing higher control of index
thickness, path of insertion, and border of the 3 pieces of
index.
The main objective of the 3-piece AM silicone index pre-
sented is to transfer the exact product of diagnostic waxing
to the patient´s mouth facilitating the direct composite resin
restoration. However, similar to the conventional method, the
finishing procedures involve manual modification by the clini-
cian, which can alter the exact replication of diagnostic waxing
or diagnostic trial restoration. The conventional or additively
manufactured index facilitate the clinical intervention but the
esthetic outcome is still technique sensitive. The strategy of the
3-piece silicone index provides the possibility of indexing dif-
ferent buccal indices on the same lingual and custom tray which
allows for different diagnostic trial restorations that can be de-
signed and performed using different buccal indices designs.
In this way, if several treatment options were being considered,
different buccal indices could be manufactured for each given
treatment.
When incorporating digital technologies, both the clinician
and the dental technician require specific training to fully under-
stand the influencing factors on the digitalization procedures,
and application of facial and intraoral scanners, CAD software,
and AM technologies.10,11 The length of the learning period
may vary between individuals.
The incorporation of facial scanners, IOS devices and AM
techniques into the digital workflow provides a more time and
cost-efficient procedure compared to conventional protocols.
However, understanding the limitations and indications of the
technologies is crucial for successful application of the digital
workflow.
Conclusion
The present article describes the digitizing and superimposition
procedures performed using a facial and intraoral scanners to
obtain a 3D facial representation of a patient for treatment plan-
ning procedures using a dental computer-aided design software.
Furthermore, the translation of the virtual diagnostic waxing to
the patient´s mouth was completed by additively manufactur-
ing a 3-piece clear silicone index which allowed the elaboration
of a diagnostic trial restoration and facilitated the direct com-
posite restorations performed on the maxillary anterior teeth.
This improved silicone index design results in a more efficient
technique, necessitating less cost and time compared to con-
ventional methods while preserving reproducible outcomes.
Journal of Prosthodontics 29 (2020) 436–442 
C 2020 by the American College of Prosthodontists
1532849x, 2020, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13159 by Universitat de Barcelona, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Digital Workflow of an Esthetic Rehabilitation
References
1. Heintze SD, Rousson V, Hickel R: Clinical effectiveness of
direct anterior restorations-a meta-analysis. Dent Mater
2015;31:481-495
2. Báez Rosales A, De Nordenflycht Carvacho D, Schlieper
Cacciutolo R, et al: Conservative approach for the esthetic
management of multiple interdental spaces: a systematic
approach. J Esthet Restor Dent 2015;27:344-354
3. Frese C, Schiller P, Staehle HJ, et al: Recontouring teeth and
closing diastemas with direct composite buildups: a 5-year
follow-up. J Dent 2013;41:979-985
4. Joda T, Gallucci GO, Wismeijer D, et al: Augmented and virtual
reality in dental medicine: a systematic review. Comput Biol
Med 2019;108:93-100
5. Piedra-Cascón W, Hsu VT, Revilla-León M: Facially driven
digital diagnostic waxing: new software features to simulate and
define restorative outcomes. Curr Oral Health Rep
2019;6:284-294
6. Revilla-León M, Sánchez-Rubio JL, Besné-Torre A, et al: A
report on a diagnostic digital workflow for esthetic dental
rehabilitation using additive manufacturing technologies. Int J
Esthet Dent 2018;13:184-196
7. Revilla-León M, Besné-Torre A, Sánchez-Rubio JL, et al: Digital
tools and 3D printing technologies integrated into the workflow
of restorative treatment: a clinical report. J Prosthet Dent
2019;121:3-8
8. Revilla-León M, Fountain J, Piedra Cascón W, et al: Workflow
description of additively manufactured clear silicone indexes for
injected provisional restorations: a novel technique. J Esthet
Restor Dent 2019;31:213-221
9. Revilla-León M, Raney L, Piedra-Cascón W, et al: Digital
workflow for an esthetic rehabilitation using a facial and intraoral
scanner and an additive manufactured silicone index: a dental
technique. J Prosthet Dent 2019. https://doi.org/10.1016/
j.prosdent.2019.03.014. [Epub ahead of print]
10. Revilla-León M, Fountain J, Piedra-Cascón W, et al: Silicone
additive manufactured indices performed from a virtual
diagnostic waxing for direct composite diastema closure
combined with resin infiltration technique on white spot lesions:
a case report. J Prosthodont 2019;28:855-860
11. Bohner L, Gamba DD, Hanisch M, et al: Accuracy of digital
technologies for the scanning of facial, skeletal, and intraoral
tissues: a systematic review. J Prosthet Dent 2019;121:
246-251
12. Alghazzawi TF: Advancements in CAD/CAM technology:
options for practical implementation. J Prosthodont Res
2016;60:72-84
13. Papaspyridakos P, Chen CJ, Gallucci GO, et al: Accuracy of
implant impressions for partially and completely edentulous
patients: a systematic review. Int J Oral Maxillofac Implants
2014;29:836-845
14. Al-Jubuori O, Azari A: An introduction to dental digitizers in
dentistry. A systematic review. J Chem Pharm Res 2015;7:10-20
15. Chochlidakis KM, Papaspyridakos P, Geminiani A, et al: Digital
versus conventional impressions for fixed prosthodontics. A
systematic review and meta-analysis. J Prosthet Dent
2016;116:184-190
16. Aragón ML, Pontes LF, Bichara LM, et al: Validity and
reliability of intraoral scanners compared to conventional
gypsum models measurements: a systematic review. Eur J
Orthod 2016;38:429-434
17. Tsirogiannis P, Reissmann DR, Heydecke G: Evaluation of the
marginal fit of single-unit, complete-coverage ceramic
restorations fabricated after digital and conventional impressions:
441

Digital Workflow of an Esthetic Rehabilitation
a systematic review and meta-analysis. J Prosthet Dent
2016;116:328-335
18. Kim J, Park JM, Kim M, et al: Comparison of experience curves
between two 3-dimensional intraoral scanners. J Prosthet Dent
2016;116:221-230
19. Lim JH, Park JM, Kim M, et al: Comparison of digital intraoral
scanner reproducibility and image trueness considering repetitive
experience. J Prosthet Dent 2018;119:225-232
20. Richert R, Goujat A, Venet L, et al: Intraoral scanner
technologies: a review to make a successful impression. J Healthc
Eng. 2017;2017:1–9. https://doi.org/10.1155/2017/8427595.
21. Müller P, Ender A, Joda T, et al: Impact of digital intraoral scan
strategies on the impression accuracy using the TRIOS pod
scanner. Quintessence Int 2016;47:343-349
22. Revilla-León M, Peng J, Sadeghpour M, et al: Intraoral digital
scans. Part 1. Influence of ambient scanning light conditions on
the accuracy (trueness and precision) of different intraoral
scanner. J Prosthet Dent 2019.
https://doi.org/10.1016/j.prosdent.2019.06.003. [Epub ahead of
print]
23. Revilla-León M, Peng J, Sadeghpour M, et al: Intraoral digital
scans. Part 1. Influence of ambient scanning light conditions on
the mesh quality of different intraoral scanner. J Prosthet Dent
2019. https://doi.org/10.1016/j.prosdent.2019.06.004. [Epub
ahead of print]
24. Revilla-León M, Subramanian SG, Özcan M: Clinical study of
the influence of ambient light scanning conditions on the
accuracy (trueness and precision) of an intraoral scanner. J
442 Journal of Prosthodontics 29 (2020) 436–442 
1532849x, 2020, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13159 by Universitat de Barcelona, Wiley Online Library on [24/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Park et al
Prosthodont 2020;29:107-113. https://doi.org/10.1111/
jopr.13135
25. Carbajal Mejı́a JB, Wakabayashi K, Nakamura T, et al: Influence
of abutment tooth geometry on the accuracy of conventional and
digital methods of obtaining dental impressions. J Prosthet Dent
2017;118:392-329
26. Li H, Lyu P, Wang Y, Sun Y. Influence of object translucency on
the scanning accuracy of a powder-free intraoral scanner: a
laboratory study. J Prosthet Dent 2017;117:93-101
27. Medina-Sotomayor P, Pascual-Moscardó A, Camps I.
Relationship between resolution and accuracy of four intraoral
scanners in complete-arch impressions. J Clin Exp Dent
2018;10:e361-e366
28. ISO/ASTM52900:2015 [ASTM F2792]. Additive
manufacturing – General principles and terminology.
https://www.iso.org/standard/69669.html Last accessed Jun 2019
29. Revilla-León M, Özcan M: Additive manufacturing technologies
used for processing polymers: current status and potential
application in prosthetic dentistry. J Prosthodont.
2019;28:146-158
30. Dietschi D: Layering concepts in anterior composite restorations.
J Adhes Dent 2001;3:71-80
Supporting Information
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