Background: The literature has not yet validated the use of intraoral scanners (IOSs) for full-arch (FA) implant impression. Hence, the aim of this in vitro study was to assess and compare the trueness of 12 different IOSs in FA implant impression. Methods: A stone-cast model of a totally edentulous maxilla with 6 implant analogues and scanbodies (SBs) was scanned with a desktop scanner (Freedom UHD®) to capture a reference model (RM), and with 12 IOSs (ITERO ELEMENTS 5D®; PRIMESCAN® and OMNICAM®; CS 3700® and CS 3600®; TRIOS3®; i-500®; EMERALD S® and EMERALD®; VIRTUO VIVO® and DWIO®; RUNEYES QUICKSCAN®). Ten scans were taken using each IOS, and each was compared to the RM, to evaluate trueness. A mesh/mesh method and a nurbs/nurbs method were used to evaluate the overall trueness of the scans; linear and cross distances between the SBs were used to evaluate the local trueness of the scans. The analysis was performed using reverse engineering software (Studio®, Geomagics; Magics®, Materialise). A statistical evaluation was performed. Results: With the mesh/mesh method, the best results were obtained by CS 3700® (mean error 30.4 μm) followed by ITERO ELEMENTS 5D® (31.4 μm), i-500® (32.2 μm), TRIOS 3® (36.4 μm), CS 3600® (36.5 μm), PRIMESCAN® (38.4 μm), VIRTUO VIVO® (43.8 μm), RUNEYES® (44.4 μm), EMERALD S® (52.9 μm), EMERALD® (76.1 μm), OMNICAM® (79.6 μm) and DWIO® (98.4 μm). With the nurbs/nurbs method, the best results were obtained by ITERO ELEMENTS 5D® (mean error 16.1 μm), followed by PRIMESCAN® (19.3 μm), TRIOS 3® (20.2 μm), i-500® (20.8 μm), CS 3700® (21.9 μm), CS 3600® (24.4 μm), VIRTUO VIVO® (32.0 μm), RUNEYES® (33.9 μm), EMERALD S® (36.8 μm), OMNICAM® (47.0 μm), EMERALD® (51.9 μm) and DWIO® (69.9 μm). Statistically significant differences were found between the IOSs. Linear and cross distances between the SBs (local trueness analysis) confirmed the data that emerged from the overall trueness evaluation. Conclusions: Different levels of trueness were found among the IOSs evaluated in this study. Further studies are needed to confirm these results.

To compare the trueness and precision of 3D-printed versus milled monolithic zirconia crowns (MZCs). A model of a maxilla with a prepared premolar was scanned with an industrial scanner (ATOSQ®, Gom) and an MZC was designed in computer-assisted-design (CAD) software (DentalCad®, Exocad). From that standard tessellation language (STL) file, 10 MZCs (test) were 3D-printed with a Lithography-based Ceramic Manufacturing (LCM) printer (CerafabS65®, Lithoz) and 10 MZCs (control) were milled using a 5-axis machine (DWX-52D®, DGShape). All MZCs were sintered and scanned with the aforementioned scanner. The surface data of each sample (overall crown, marginal area, occlusal surface) were superimposed to the original CAD file (ControlX®, Geomagic) to evaluate trueness: (90-10)/2, absolute average (ABS AVG) and root mean square (RMS) values were obtained for test and control groups (MathLab®, Mathworks) and used for analysis. Finally, the clinical precision (marginal adaptation, interproximal contacts) of test and control MZCs was investigated on a split-cast model printed (Solflex350®, Voco) from the CAD project, and compared. The milled MZCs had a significantly higher trueness than the 3D-printed ones, overall [(90-10)/2 printed 37.8 µm vs milled 21.2 µm; ABS AVG printed 27.2 µm vs milled 15.1 µm; RMS printed 33.2 µm vs milled 20.5 µm; p = 0.000005], at the margins [(90-10)/2 printed 25.6 µm vs milled 12.4 µm; ABS AVG printed 17.8 µm vs milled 9.4 µm; RMS printed 22.8 µm vs milled 15.6 µm; p= 0.000011] and at the occlusal level [(90-10)/2 printed 50.4 µm vs milled 21.9 µm; ABS AVG printed 29.6 µm vs milled 14.7 µm; RMS printed 38.9 µm vs milled 22.5 µm; p = 0.000005]. However, with regard to precision, both test and control groups scored highly, with no significant difference either in the quality of interproximal contact points (p = 0.355) or marginal closure (p = 0.355). Milled MZCs had a statistically higher trueness than 3D-printed ones; all crowns, however, showed high precision, compatible with the clinical use. Although milled MZCs remain more accurate than 3D-printed ones, the LCM technique seems able to guarantee the production of clinically precise zirconia crowns.

This in vitro study aimed to compare the accuracy of dental implant placement in partially edentulous maxillary models using a mixed reality-based dynamic navigation (MR-DN) system to conventional static computer-assisted implant surgery (s-CAIS) and a freehand (FH) method. Forty-five partially edentulous models (with teeth missing in positions #15, #16 and #25) were assigned to three groups (15 per group). The same experienced operator performed the model surgeries using an MR-DN system (group 1), s-CAIS (group 2) and FH (group 3). In total, 135 dental implants were placed (45 per group). The primary outcomes were the linear coronal deviation (entry error; En), apical deviation (apex error; Ap), XY and Z deviations, and angular deviation (An) between the planned and actual (post-surgery) position of the implants in the models. These deviations were computed as the distances between the stereolithographic (STL) files for the planned implants and placed implants captured with an intraoral scanner. Across the three implant sites, the MR-DN system was significantly more accurate than the FH method (in XY, Z, En, Ap and An) and s-CAIS (in Z, Ap and An), respectively. However, S-CAIS was more accurate than MR-DN in XY, and no difference was found between MR-DN and s-CAIS in En. Within the limits of this study (in vitro design, only partially edentulous models), implant placement accuracy with MR-DN was superior to that of FH and similar to that of s-CAIS. In vitro, MR-DN showed greater accuracy in implant positioning than FH, and similar accuracy to s-CAIS: it could, therefore, represent a new option for the surgeon. However, clinical studies are needed to determine the feasibility of MR-DN.

To evaluate the effect of intraoral scanners (IOSs) and implant libraries (ILs) on the trueness of digital impressions for the fabrication of implant-supported full-arch (FA) prostheses. A stone cast of an edentulous maxilla with 6 implant analogues and cylindrical scanbodies (IPD ProCam®, Matarò, Barcelona, Spain) was probed using a coordinate measuring machine to capture a reference model (RM). The cast was mounted on a mannequin and scanned with 3 different IOSs (iTERO Element 5D Plus®, Align Technologies, San José, CA, USA; IS 3800®, Dexis, Quackertown, PN, USA; and i-700®, Medit, Seoul, South Korea). Ten scans were performed by an experienced operator using each IOS, first capturing only the occlusal surfaces, then the buccal and finally the palatal surfaces (less than 45 s per scan). In each scan, the meshes of the SBs were replaced by the corresponding IL file, with and without increment, to obtain the best correction for the mesh growth. The positions of the SBs in each file were compared with those in the RM, to evaluate the linear and cross distances between them. The final outcome was the trueness of the different IOSs, evaluating the effect of using different ILs on the quality of the impressions. Significant differences were found between the different IOS scans and the RM, and among the different IOSs, in the different segments. The correction of the mesh growth through incremental ILs did not affect the final trueness of the IOS scans. Different levels of trueness were found among the IOSs evaluated, in the different scan segments, but with the cylindrical SBs used herein, the correction of the mesh growth with incremental ILs did not affect the final quality of the digital impressions. There are still errors with IOS in the FA impressions. IOS have an effect on the quality of the digital impressions, and apparently the library has not, with purely cylindrical SBs: further studies are needed to confirm this aspect.