1 s2.0 S0022391321004856 Main
1 s2.0 S0022391321004856 Main
1 s2.0 S0022391321004856 Main
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.
Total (n=11.498)
The evaluation of the quality of the studies, individ- surfaces. Only 1 study12 opted to start scanning with the
ually, is shown in Table 2 (CASP) and Table 3 (MI- occlusal-palatal surfaces with a wave movement and
NORS). According to the CASP scale, all eligible studies digitized the other areas subsequently (Table 5).
were rated “no” for criteria 5, 6, and 10, except for clinical Five studies13,19-25 reported ambient conditions at the
studies for criterion 6, resulting in a total score of 9 time of intraoral scanning, and 2 studies19,20 had a more
(in vitro studies) and 10 (in vivo studies). As for the controlled environmental setting: the temperature
MINORS scale, all studies evaluated had scores of 18, (20 C), air pressure (760 ±5 mmHg), and humidity
indicating lower risk of bias, as the value was below the (45%). In contrast, Mangano et al22 reported a different
maximum score of 20. temperature (21 C) and air pressure (750 ±5 mmHg) but
Of the 12 studies included, 52,9,19-22 reported the in- similar humidity (45%). Two studies13,25 reported using
fluence of the intraoral scanner on the digitization of standardized temperature and humidity but did not
completely edentulous arches restored with multiple provide specific information on their ranges.
implants. Three in vitro studies19-22 conveyed the evo- All included studies reported the number of implants
lution of the accuracy results of CS intraoral scanners and the arch evaluated, but 1 study did not specify
(Carestream Dental) by comparing them with those of the arch.21 The data recorded were 4,9,25,23 5,23 and
other manufacturers, and a randomized controlled clin- 62,12,13,19-22,21,23 implants for the maxilla. In addition, 2
ical study2 investigated the CS600 scanner. Three included studies evaluated variables in the mandible and
studies9,19,20 pointed to the TRIOS3 intraoral scanner as a used 4 implants.11,24 Five studies9,22-25 reported results
viable option for digitizing such arches (Table 4). for the number of implants and their relationship with
Nine studies2,9,11-13,19-25 evaluated the intraoral the distances and/or angulation of the implants (Table 6).
scanning technique used to capture the position of Three studies11-13 addressed the effect of the type and
multiple implants. Three studies19-22 reported using the material of the scan body on the accuracy of intraoral
zigzag scanning technique; 3 studies2,13,24 immobilized scanning (Table 7).
the scan bodies with either a composite resin,2 a geo-
DISCUSSION
metric device,24 or dental floss13 to provide a physical
path between the implants to make scanning faster; and The present review aimed to identify comparative studies
4 studies9,11,13,25 began the scan from the occlusal surface with a primary outcome directed to a factor that may
of the scan body, followed by the buccal and lingual have influenced the accuracy of the intraoral scanning of
completely edentulous arches restored with multiple and ultrafast optical scanning, while the latest version of
implants. The selection of the intraoral scanner, the the CS (3700) uses active triangulation with a combina-
scanning technique, distance and angulation of the im- tion of intelligent tonality through the bidirectional
plants, and digitization bodies are factors to be consid- reflectance distribution function. This method allows the
ered for the direct acquisition of accurate images of CS3700 to collect shadow values from 3D surfaces by
multiple implants. considering variations in lighting conditions. Another
The different intraoral scanners reported in the novel feature of the CS 3700 is the incorporation of the
studies included in this review2,9,19-22 present various “stop & go” system (When one removes the scanner
technologies to determine the spatial coordinates of the from the oral cavity and resumes the process from any
object to be digitized, either by triangulation, by laser point already scanned, recognition is immediate, making
confocal scanning, or by active wave sampling. The scanning faster.).
studies included in this review identified the CS intraoral Of the techniques of intraoral scans, methodological
scanner (Carestream Dental), followed by the TRIOS standardization and studies that evaluate all possible
(3Shape A/S), as the most accurate option for digitizing existing techniques to indicate the most suitable for each
multiple implants. The TRIOS uses confocal microscopy type of arch are still lacking. However, the current results
show a positive relationship between changes in the Environmental conditions during the scanning pro-
technique for intraoral scanning and the final quality of cess may be another factor contributing to the inaccuracy
the prosthetic work. Cappare et al2 and Iturrate et al24 of scanning multiple implants. The included studies
showed that providing a path between the scan bodies standardized the ambient temperature at 20 C to 21 C,
with composite resins or a geometric device can make the air pressure of 750 to 760 ±5 mmHg, and air humidity of
scanning process more fluent and precise. 45%.19-22 Combined, these settings simulate a low
Table 7. Effect of material and type of scan body on accuracy of intraoral scanning
Study Scan Bodies Results
Huang et al11 Group I (DO): Digital impressions using Precision: Trueness:
original scan bodies; Median (IQR) Median (IQR)
Group II (DC): Digital impressions using Group I: 48.40 (40.80-57.90) mm Group I: 35.85 (29.80-49.10) mm
CAD/CAM scan bodies without extensional Group II: 48.90 (38.70-85.40) mm Group II: 38.50 (35.35-52.58) mm
structure; Group III: 27.30 (22.50-35.50) mm Group III: 28.45 (24.88-36.43) mm
Group III (DCE): Digital impressions using Group IV: 19.00 (15.70-22.75) mm Group IV: 25.55 (22.98-28.90) mm
CAD/CAM scan bodies with extensional Group IV more accurate than all other groups. No significant differences found between OD and
structure; Among the IOS groups, the DCE group was the most DC (P=1.000), OD and DCE (P=.461), DC and DCE
Group IV (CI): Conventional splinted open- accurate. (P=.133), and CI and DCE (P=1.000).
tray impressions.
Arcuri et al12 Polyetheretherketone (Pk), titanium (T) IOS investigated influenced by ISB material with PEEK Angulation of implant significantly affected linear
and Pk with a titanium base (Pkt). 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.
Mizumoto et al13 AF (IO-Flo; Dentsply Sirona), NT (Nt-Trading Accuracy affected by both ISB and scanning technique Scanning techniques with different surface
GmbH & Co KG), DE (DESS-USA), C3 when using IOS. modifications resulted in deviations in distance
(Core3Dcentres) and ZI (Zimmer Biomet ZI scan body had significantly smaller distance similar to those of technique, without any
Dental) 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.
temperature, low atmospheric pressure, and maximum above the ideal range, a pause in the scanning process is
relative air humidity, which is considered to be an ideal indicated to allow the scanner to cool.
environment. Although the studies have not discussed Arakida et al26 reported that the color temperature
the relationship between environmental conditions and (3900 K) and the luminance of 500 lux of the environ-
the precision of intraoral scanning, we believe that high ment are ideal for making a digital scan and that the
ambient temperatures lead to fogging of the scanner lens, higher the ambient lighting, the longer the sweeping
thereby distorting the image. If the temperature does rise time. Revilla-León et al10 reported that the lighting
conditions significantly affect the mesh quality. Another conditions of the scanning environment in the oral cavity
factor of concern is the intensity of the scanner’s laser to provide an ideal 3D image.
illumination. Under extremely high intensity, the sensor
becomes saturated, preventing the system from calcu- CONCLUSIONS
lating the position of the dots and forming an accurate
Based on the findings of this systematic review, the
final image.27
following conclusions were drawn:
Variations found in the results regarding the scan-
ning techniques can be related to confounding factors 1. Different factors can influence the quality of the
such as a possible threshold of implant distances virtual image.
considered acceptable by intraoral scanners to obtain 2. Among the current devices, the intraoral scanners
accurate images. The accuracy of digitization of the scan and technology used by Carestream Dental and
bodies in a completely edentulous arch was reported to TRIOS, 3Shape presented favorable results for
be <193 mm, while for arcs with reduced distances, it digitizing such arches.
was <103 mm.28 The intercylinder distance considered 3. The intraoral scanning technique that provides a
digitizable by the scanner is between 16 and 22 mm. physical path joining the scan bodies, ambient
Even though some studies began within this threshold conditions (temperature: 20 C to 21 C, air pressure
(16 to 22 mm), their data still showed an increase in 3D 750 to 760 ±5 mmHg, and air humidity: 45%),
deviations for distances9,25 and angles.25 After critically angulation and distance between implants (up to 15
appraising these articles, a reduction in the position- degrees and 16 to 22 mm distance between im-
capture accuracy of the implants, from the first quadrant plants), and the material of the scan body (PEEK is
to the last area to be digitized, is apparent25 (that is, the more accurate) can increase the accuracy of trans-
start of the arch being scanned will have greater pre- ferring the position of the implants.
cision than at the end of the digitized arch). The loss of
precision throughout the scan can be explained by in-
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Corresponding author:
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