DIGITAL

IMPLANT IMPRESSIONS

Dr.Ajitha Suresh Kumar MDS.,PGCE

Senior lecturer
CDCRI
 Terminologies -digital
Introduction
Digital Work flow
Scanners and scan bodies

. IOS -
The technology
Choosing an IOS
Need for accuracy
Factors influencing accuracy
. Scan bodies-
3D: three-dimensional
ADDT: advanced digital dental technologies
ADO: algorithmic dental occlusion.
AMF: additive manufacturing file
DICOM: digital imaging and communications
in medicine.
DMLS: direct metal laser sintering.
FOSS: free and open source software
SLA: stereolithography.
SLS: selective laser sintering.
STL: standard tessellation language
VR: virtual reality
VRML: virtual reality modeling language.
WLS: white light scanner
IOS intra oral scanner
ISB-implant scan bodies
Reference-Glossary of Digital Dental Terms
Digital terminologies
 INT
Digital Impressions (also known as RO 3-D intraoral
scanning) are the latest technology DU
in capturing
Making an accurate implant impression CTI is a crucial
a replica of the mouth . By using
step in constructing implant- supported a
ON
wand-like
prosthesis
tool connected to a computer and advanced
software, a dentist can create a virtual model of
the hard and soft tissues in the mouth.

Digital impressions transfer the intra oral situation to a virtual model and this is
the first step of digital work flow

Reference-Digital Impressions In Implant Dentistry ; A Literature Review https;//doi.org/10.3390/ijerph18031020

 DIRECT AND INDIRECT Digital work
flow
Indirec -Conventional impression - Bench top extra oral scanner -Lab scan bodies
t

Direc -ISB. - OS
t
ISB Can be reused 100 times After implant surgery the
made of durable titanium
matching scan body is secured
to the implant with a
screwdriver

IOS
IOS INTRA ORAL SCANNERS
An intraoral scanner is a hand held optical device used to
directly create digital impression data of the oral cavity
Intra oral scanning
using trios scanner
 DIFFERENT TECHNOLOGIES TO CAPTURE
IMAGE AND GENERATE .stl
CLINICAL PITFALLS OF TECHNOLOGIES
ACCURACY OF THESE CURRENT TECHNOLOGIES
 How an IOS DEVICE works
Emits a light beam (structures light grid with known features)
Reaches the objects surface
Light beam suffers deformation
This optic effect is captured by 2 or more cameras on the tip
processing software is used to calculate xyz
Creates point clouds and meshes (triangulated)
The registration & stitching of these point clouds , meshes allows the 3d
reconstruction of the scanned object
Creating a reliable model
 Soft
war
Modern digital intraoral scanners use different techniques to obtain digital
impressions.
e
TE
Confocal laser technology, ————-used
Denmark),
TRIOS3 ⃝(Copenhagen,

CH
active triangulation, ———————CEREC Omnicam (Sirona Dental
NO
Systems GmbH; Bensheim, Germany),

LO
AcTIVE WAVE FRONT SAMPLING ———3M ESPE (TRUE
DEFINITION USA)
GY
BE
Determining distance to the object.
(a) Triangulation: distance BC could
be determined according to the
formula
(b) Confocal: distance to the object is
determined according to the focal
distance.
(c) AWS requiring a camera and an
off-axis that moves on a circular path
around the optical axis and produces a
rotation of interest points.
(d) Stereophotogrammetry is a
technology that generates files by
algorithm analyzing numerous
pictures.
Generation of a .STL file by intraoral
scanner.
(a) An example of a .STL file.
(b) Each triangle of a .STL file is
composed
by three points with cartesian
coordinates
(x, y, and z) and a normal surface.
(c) Schematic representation of the
reconstruction technology: each
picture
is analyzed, and POI (points of
interest)
are selected by the software.
After similarity calculation between
different images, a matching of
coinciding POI is defined and triangles
with coordinates are generated by
Nature of light.
(a) Projection of points.
(b) Projection of a mesh.
Management of mesh quality.
Comparison of STL files depending on mesh
density.
(a) Low density.
(b) Medium density.
(c) High density.
(d) Large number of triangles over the whole
tooth.
(e) Routine mesh on flat zones and denser
mesh for gingival sulcus.
(f) Prepared teeth present various points that
are complex to scan.
(g) Complex points can appear smoothed on
CAD-CAM software.
(h) Saliva or water film can generate errors
during margin impression that could reduce
mesh quality.
Scanning strategies.

(a) Prepared teeth have reflective

surfaces due to enamel or polished
surface. Powdering can increase
diffuse light that diminish this
phenomenon.
(b) A one-way scan (S sweep on
vestibular, occlusal, and lingual
surfaces).
(c) A linear movement on occlusal-
palatal surfaces followed by buccal
surface.
(d) Proximal faces are hidden if the
scanning strategy is not adapted.
 Choosing an IOS DEVICE
SIZE OF THE INTRA ORAL TIP
THE IMAGE ACQUISATION SPEED ACCURACY
TRUENESS AND PRECISION ARE IMPORTANT
ACCURACY = TRUENESS + PRECISION
 Accuracy

ISO defines accuracy as a combination of trueness

and precision
Trueness

Trueness consists of the ability of

a measurement to coincide with
the real value being evaluated
IOS ’s trueness can be evaluated
by superimposing a digital
impression of a scanned object
with reference model of the same
object
Precision

Precision is defined as the ability

of consistencly taking the same
measurement value
IOS ’s precision can be evaluated
by superimposing different scans
of the same object performed with
the same device
An IOS should present high
trueness and precision
 The IOS captures approx. 1200 images when scanning.
Scanning errors can result from the superimposition of the images
while scanning and processing .
This is due to the deviations of images which are more seen in the
anterior teeth which have steep inclines and less tooth surface.
Errors also can occur while computer processing from filter
algorithms and calibration .
Errors can occur on any axis. More errors were seen while
scanning the depth (Z-axis).
 FACTORS THAT AFFECT THE ACCURACY OF IOS

intraoral factors (temperature, relative humidity, and

illumination)
operator (scanning pattern and skill)
scanner unit (capture box, receiver, light source)

computer software speed

scanning area (scanning area, length, and surface irregularities)
 ILLUMINANCE AND
COLOR TEMPERATURE
 Research on finer details
Precision evaluation by distance and angulation in scanned data
Effects of manufacturers
Precision evaluation by superimposing repeated scanned data by
Effects of the orientation
IOSs
of implants
Inter-implant distance
Angulation of the implant
Effect of scan range
Effects from operators
Effect of implant
angulation
Short span impression
Long span impression
SCAN BODIES (SB)
 INTRA ORAL -Scan bodies
ISBs are complex implant-
positioning-transfer devices that
play an essential role in the digital
workflow and fabrication of
accurately fitting implant-supported
restorations
There are various SBs in the market ..

Twopiece with titanium base screws to the implant

The first digitally scannable implant components were introduced in 2004 and used an
innovative coded healing abutment (Encode; Zimmer Biomet Dental), which provided
3D information on the implant location in relation to the adjacent teeth, opposing
dentition, and sur- rounding soft tissues.

The first scannable impression copings were released shortly after and termed “scan
bodies” by the manufacturer (Straumann Holding AG).

The commercial ISB design has been highly variable, and their in- fluence on accuracy
is not completely understood.
Scan bodies
Commercially available ISB systems used.

A- Atlantis I-Flo (AF).

B-Core3D (C3D).
C- Nt-Trading (NT).
D-Dess-USA (DE).
E- Zimmer Biomet (ZI).
 Digital Vs. conventional
impressions
Volumetric changes of
impression materials and
IOS and CAD/CAM provide
expansion of dental stone
easier planning of treatment,
seem error-prone,dental
case acceptance,
laboratory ERRORS
communication with
laboratories, reduced
operative time, storage
requirements, and reduced
treatment times
There are so much debates about the amount of
accuracy acceptable for implant supported
prosthesis and the biological tolerance bone
adaptation
Digital impression has many benefits such as improving patient
acceptance, reducing the distortion of impression materials, and
three-dimensional previsualization of the preparation, and it is
cost- and time-effective .The digital workflow has advantages in
reproducibility and quality standardisation, but one main
disadvantage is that deviations in the digital impression can lead to
The past….
THE FUTURE MACHINE is your
mobile …….
 REFERENCES
DIGITAL IMPLANT IMPRESSION TECHNIQUE ACCURACY; A SYSTEMATIC REVIEW
Doi.org/10.1016j.prosdent.2019.01.003

Intraoral Scanner Technologies: A Review To Make A Successful Impression

Raphaël Richert,Alexis Goujat,Laurent Venet, Gilbert Viguie,Stéphane Viennot, Philip Robinson,Jean-Christophe Farges,Michel Fages, And Maxime Ducret

Impact Of Different Scan Bodies And Scan Strategies On The Accuracy Of Digital Implant Impressions Assessed With An
Intraoral Scanner: An In Vitro Study Constantin Motel,Elena Kirchner,Werner Adler, Manfred Wichmann, & Ragai Edward Matta Doi: 10.1111/jopr.13131

Accuracy Of Four Intraoral Scanners In Oral Implantology: A Comparative In Vitro Study Mario Imburgia, Silvia Logozzo, Uli Hauschild,
Giovanni Veronesi, Carlo Mangano And Francesco Guido Mangano. DOI10.1186s12903-017-0383-4

DIGITAL IMPRESSIONS IN IMPLANT DENTISTRY ;A LITERATURE REVIEW Doi .org/10.3390/ijerph 18031020

DIGITAL VS CONVENTIONAL IMPLANT IMPRESSIONS - A SYSTEMATIC REVIEW AND META ANALYSIS DOI
;10.1111/JOPR.13211

TRUENESS AND PRECISION OF DIGITAL IMPLANT IMPRESSIONS BY INTRAORAL SCANNERS ; A

LITERATURE REVIEW-DOI.ORG/10.1186/S40729-021-00352-9

TRUENESS OF DIGITAL IMPLANT IMPRESSIONS BASED ON IMPLANT ANGULATION AND SCAN BODY
MATERILS-DOI.ORG/10.1038/s41598-021-01442-9
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