3d digital scanners - a high-tech approach to more accurate dental impressions _ id _ dentalaegis

8/16/2019 3D Digital Scanners - A High-Tech Approach to More Accurate Dental Impressions _ ID _ Dentalaegis

1/12

4/9/2016 3D Digital Scanners - A High-Tech Approach to More Accurate Dental Impressions | ID | dentalaegis.com

https://www.dentalaegis.com/id/2009/04/3-dimensional-digital-scanners-a-high-tech-approach-to-more-accurate-dental-impressions 1/12

DENTALAEGIS COMPENDIUM INSIDE DENTAL TECHNOLOGY CDEWORLD SU I

ARTICLES ARCHIVE CE EBOOKS WEBINARS PRODUCTS RESOURCE CENTER ROUNDTABLE BLOG

View Current Issue

Noteworthy Categories

CE Articles

Feature Stories

Roundtable

Viewpoint

Editorial Categories

CAD/CAM

Diagnosis & Treatment

Planning

Digital Imaging

Endodontics

Implantology

Infection Control

Magni댽cation

Materials

April 2009

Volume 5, Issue 4

3D Digital Scanners: A High-Tech AppMore Accurate Dental ImpressionsNathan S. Birnbaum, DDS, CAGS(Prosth); Heidi B. Aaronson, DMD; Chris Ste

Ever since the introduction of the 댽rst digital scanner for mdevelopment engineers at a number of companies have enof댽ce scanners that are increasingly user-friendly and pro

These systems are capable of capturing three-dimensionalfrom which restorations may be directly fabricated (CAD/Caccurate master models for the restorations in a dental lasystems). The use of these products presents a paradigmmade. Several of the leading 3D dental digital scanning syarticle.

A Paradigm Shift in the Concept for Making DentThe acquisition of an accurate negative copy of a prepareopposing teeth and the establishment of a correct interocconversion of this information into precise replicas of thecan be made, are the ultimate goals of the impression proThe widely used techniques currently employed for obtainicreating gypsum models from those impressions have onl

introduced agar as an impression material for crown prepaspeci댽cally produced for the purpose of dental impressionmaterial introduced by ESPE, GmbH in 1965.Many dentists are reluctant to become involved with newebecause they either mistakenly believe that the elastomeriaround since time immemorial and are immutable, or that

technology that is not yet “ready for prime time.” In fact, elmany inherent problems,2,3 have only been in use in dentis3D digital dental impression scanning systems actually wemid-1980s and have advanced to the degree that, at a meeCosmetic Dentistry held in Boston in October 2007, master

https://www.dentalaegis.com/id/infection-control/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/viewpoint/https://www.dentalaegis.com/id/feature-stories/https://www.dentalaegis.com/id/ce-articles/https://www.dentalaegis.com/id/2016/04/https://www.dentalaegis.com/id/2016/04/https://www.dentalaegis.com/id/archivehttp://id.cdeworld.com/https://www.dentalaegis.com/idhttps://www.dentalaegis.com/idhttps://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/id/2009/04/https://www.dentalaegis.com/id/2009/04/https://www.dentalaegis.com/id/2009/04/https://www.dentalaegis.com/id/webinarshttps://www.dentalaegis.com/id/productshttps://www.dentalaegis.com/id/resource-centerhttps://www.dentalaegis.com/id/roundtablehttps://www.dentalaegis.com/id/bloghttps://www.dentalaegis.com/idthttp://www.cdeworld.com/https://www.dentalaegis.com/subscribehttps://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/id/2009/04/https://www.dentalaegis.com/id/materials/https://www.dentalaegis.com/id/magnification/https://www.dentalaegis.com/id/infection-control/https://www.dentalaegis.com/id/implants/https://www.dentalaegis.com/id/endodontics/https://www.dentalaegis.com/id/digital-imaging/https://www.dentalaegis.com/id/diagnosis-and-treatment-planning/https://www.dentalaegis.com/id/cad-cam/https://www.dentalaegis.com/id/viewpoint/https://www.dentalaegis.com/id/roundtable/https://www.dentalaegis.com/id/feature-stories/https://www.dentalaegis.com/id/ce-articles/https://www.dentalaegis.com/id/2016/04/https://www.dentalaegis.com/id/bloghttps://www.dentalaegis.com/id/roundtablehttps://www.dentalaegis.com/id/resource-centerhttps://www.dentalaegis.com/id/productshttps://www.dentalaegis.com/id/webinarshttps://www.dentalaegis.com/id/ebookshttp://id.cdeworld.com/https://www.dentalaegis.com/id/archivehttps://www.dentalaegis.com/id/2016/04/https://www.dentalaegis.com/subscribehttp://www.cdeworld.com/https://www.dentalaegis.com/idthttps://www.dentalaegis.com/ccedhttps://www.dentalaegis.com/https://www.dentalaegis.com/go/e19228https://www.dentalaegis.com/id


2/12



Occlusion

Oral Medicine

Orthodontics

Pain Management

Pediatric Dentistry

Periodontics

Practice Management

Prevention

Prosthodontics

Restorative Direct

Restorative Indirect

Related Articles

Digital Dental Impression SystemsInside Dentistry, February 2011

Do What They Want So You Can

Give Them What They NeedInside Dentistry, March 2007

Do What They Want So You Can

Give Them What They NeedInside Dentistry, January 2007

The Revolution in Digital

ImpressioningInside Dentistry, Jul/Aug 2010

Restorative Dentistry: Cuspid

Disclusion-Is It Not Academic?Inside Dentistry, September 2006

most dentists would be using digital scanners for impressiThe computer-aided design/computer-aided manufacturecurrently available are able to feed data obtained from accmilling systems capable of carving restorations out of certhe need for a physical replica of the prepared, adjacent, aWith the development of newer high-strength and estheticzirconia, laboratory techniques have been developed in wh

impressions are digitally scanned to create stereolithic moEven with such high-tech improvements, it is evident that sas accurate as stereolithic models made directly from datteeth and provided by dedicated 3D scanners designed forThis article outlines the features of two CAD/CAM systemscanners that have been gaining in popularity in this emer

CAD/CAM SystemsCAD/CAM technology has been in use for a half century. Itcontrolled machines feeding numbers on paper tape into cwork on machine tools. It advanced in the 1960s with the

enabled the design of products in the aircraft and automotThe introduction of CAD/CAM concepts into dental applicDuret in his thesis written at the Université Claude Bernard,1973, entitled “Empreinte Optique” (Optical Impression). H

a patent for it in 1984,4 and brought it to the Chicago Midfabricated a crown in 4 hours as attendees watched.In the meantime, in 1980, a Swiss dentist, Dr. Werner MörBrandestini, developed the concept for what was to be intrLLC (Charlotte, NC) as the 댽rst commercially viable CAD/Crestorations—CEREC®.

CEREC® ACThe CEREC® system (Figure 1), an acronym for ChairsideCeramics, was a bold effort to combine a 3D digital scannrestorations from commercially available blocks of ceramiits introduction in 1987 by Sirona Dental Systems LLC as tsystem designed exclusively for the fabrication of ceramicundergone a series of technological improvements, culminBlueCam®, launched in January 2009. The later versions oproducing not only inlays and onlays, but also crowns, lam

The CEREC® system uses computer-assisted technologiethe data as a digital model, and proprietary CEREC 3D® sobased on biogeneric comparisons to adjacent and opposimodify the design of the restoration. After this is accomplimachine, the latest version of which, CEREC inLab® MC Xas 4 minutes from a block of ceramic or composite materiWhereas the earlier versions of CEREC® employed an acqinfrared laser light source, advancements in the performanparameters that are relevant for 3D acquisition cameras hlonger-wavelength infrared light source. The shorter-wavel

blue LEDs allows for greater precision of the resultant optiThe camera projects a changing pattern of blue light ontoback at a slightly different angle, referred to as “active triabeam, which permits the capture of essential information

https://www.dentalaegis.com/id/2006/09/restorative-dentistry/cuspid-disclusion-is-it-not-academichttps://www.dentalaegis.com/id/2010/08/the-revolution-in-digital-impressioninghttps://www.dentalaegis.com/id/2007/01/clinical-treatment-options-do-what-they-want-so-you-can-give-them-what-they-needhttps://www.dentalaegis.com/id/2007/03/clinical-treatment-options-do-what-they-want-so-you-can-give-them-what-they-needhttps://www.dentalaegis.com/id/2011/02/digital-dental-impression-systemshttps://www.dentalaegis.com/id/restorative-indirect/https://www.dentalaegis.com/id/restorative-direct/https://www.dentalaegis.com/id/prosthodontics/https://www.dentalaegis.com/id/prevention/https://www.dentalaegis.com/id/practice-management/https://www.dentalaegis.com/id/periodontics/https://www.dentalaegis.com/id/pediatric-dentistry/https://www.dentalaegis.com/id/pain-management/https://www.dentalaegis.com/id/orthodontics/https://www.dentalaegis.com/id/oral-medicine/https://www.dentalaegis.com/id/occlusion/


3/12



in a single view.With this system, the impression process necessitates achmargins of the tooth preparation by proper tissue retractiotrue not only for digital scanning, but also for conventionalbeing impressed needs to be coated completely with a laypowder to enable the camera to register all of the tissues.Several image views are then made from an occlusal orien

teeth being restored, as well as of the adjacent and opposion the monitor (Figure 3) that enables the dentist to view tfocus on magni댽ed areas of the preparation. The “die” is “line is delineated by the dentist directly on the image of thThen, the CAD biogeneric proposal of an idealized restoratdentist is given the opportunity to make adjustments to thsimple and intuitive on-screen tools.Once the dentist is satis댽ed with the proposed restoration,homogeneous ceramic or composite material of the desirwith fabrication of the physical restoration. The use of col

the process to determine the degree of interproximal contthat require minimal, if any, adjustments before cementatiWith the recent introduction of the CEREC AC® system, thdigital impressions of the teeth and fabricating an indirectvisit, or of forwarding the data using CEREC Connect® direcan choose to create the restoration virtually and mill the rhave accurate hard resin models made from the data and tphysical models.

E4D DentistThe E4D Dentist system, introduced by D4D Technologies

consists of a cart containing the design center (computera separate milling unit, and a job server and router for comIntraOral Digitizer, has a shorter vertical pro댽le than that ofto open as wide for posterior scans.The E4D does not require the use of a reective agent (poon the target site in most cases. Therefore, once proper reobtained, scanning begins by simply placing the IntraOralThe scanner must be held a speci댽c distance from the surthe help of rubber-tipped “boots” that extend from the heaadjacent teeth steadies the scanner at this optimal distanThe user holds down the foot pedal while centering the imthe on-screen bullseye, the pedal is released and the imagICEverything™ feature of the E4D takes actual pictures ofmonitor shows the user how to orient the scanner to obtaiare taken, they are wrapped around the 3D model to createmakes margin detection simpler to achieve. The touch scrthe preparation from various angles to ensure its accuracyIt is not necessary to scan the opposing arch. Instead, animpression material, trimmed, and then placed on top of th

combination of the registration material and the neighborimaterial. This data is used to design restorations with proThe design system of the E4D is then capable of autodetepreparation. Once this landmark is approved by the dentistfeature to propose a restoration (Figure 6), chosen from its


4/12



worked on. As with the CEREC® system, the operator is prtools to modify the restoration proposal.Once the 댽nal restoration is approved, the design center trUsing blocks of ceramic or composite mounted in the millidiamond instruments which are capable of replacing themdentist is able to fabricate the completed restoration.

Dedicated Impression Scanners

Dedicated 3D digital dental impression scanners eliminatedental of댽ce, including tray selection, dispensing and settiof impressions to the laboratory. In addition, the laboratoryand pin models, cut and trim dies, or articulate casts.With these systems, the 댽nal restorations are produced inmodels created from the data in the digital scans, as oppophysical impressions. Patient comfort, treatment acceptanDigital scans can be stored on computer hard drives inde댽which may chip or break, must be stored physically, whichof댽ce.

iTeroIn early 2007, the Cadent iTero (Cadent, Carlstadt, NJ) digiinto the market. The iTero system uses parallel confocal iimpression. Parallel confocal imaging uses laser and opticsurface and contours of the tooth and gum structure. Thepoints of red laser light and has perfect focus images of mstructure. All of these focal depth images are spaced apprParallel confocal scanning with the iTero system capturesmouth without the need for scanning powders that coat thWhile the ability of the iTero camera to scan without the nit necessitates the inclusion of a color wheel into the acquwith a larger scanner head than the other systems being diThe electronic laboratory script is complete with patient inmaterial choice, shade requirements, and any other informlaboratory script initiates the scan process and the visualclinician throughout the digital impression.Once the teeth have been prepared, capturing the digital isteps for every impression. Soft tissue management, retraare essential in capturing digital data. Once tissue manag

guided through a consistent series of scanning steps (Figuprepared area: occlusal, lingual, buccal, and interproximalscans are obtained, buccal and lingual 45°-angle views of tarch and opposing arch are obtained.When these scans (at least 21) are complete, the patient ia virtual registration is scanned. Overall, complete upper abite registration can take less than 3 minutes time, which ibite registration.Once the digital impression has been completed, the clinictools to evaluate the preparation and complete the impres

vivid color how much clearance has been created in the prthe clinician. A margin line tool is available to assist in vieclinician has completely evaluated all aspects of the digitamade at that time and a few additional scans will register t


5/12



prepared tooth.5

The completed digital impression is sent via a HIPAA-comfacility and the dental laboratory. Upon review by the labormodel by Cadent. The model is milled from a proprietary blarticulated based on the digital impression created by themilling machines to ensure the precision of the milled modCadent models are unique in that one model is used for bo

model. By producing the ditching of the dies virtually, the deliminate the inaccuracies of hand trimming. The 댽nal rest

as speci댽ed by the digital prescription.6

Lava Chairside Oral Scanner (C.O.S.)The Lava™ Chairside Oral Scanner (C.O.S.) was created atMassachusetts, and was acquired by 3M ESPE (St. Paul, Mof댽cially launched in February 2008.The Lava C.O.S. system (Figure 10) consists of a mobile cdisplay, and a scanning wand, which has a 13.2-mm wide tcamera at the tip of the wand contains 192 LEDs and 22 leThe method used for capturing 3D impressions involves Aconcept of “3D in Motion” incorporates revolutionary opticand real-time model reconstruction to capture 3D data in areal time. The scanning wand contains a complex opticalblue LED cells. Thus, the Lava C.O.S. is able to capture appclose to 2,400 data sets per arch, for an accurate and highAfter the preparation of the tooth and gingival retraction, twith powder. The Lava C.O.S. only requires enough powderreference points, not heavy powdering as with the CEREC.

emanates from the wand head as an on-screen image of tThe dentist guides the wand over the occlusal surfaces, rosurfaces are scanned, then rotates again to capture the lincompleted once the dentist returns to scanning the occlusAfter scanning the tooth preparation, the dentist is able toscreen, and can also switch from the 3D image to a 2D viecamera during the scan (Figure 12). A third option allows twearing 3D glasses.Once the dentist con댽rms that all of the necessary detailspreparation, a quick scan of the rest of the arch is obtaine

where data is critical, the dentist simply scans that speci댽The patient is then instructed to close into the maximum isurfaces on one side of the mouth are powdered, and a scmaxillary and mandibular scans are then digitally articulatWhen all of the scans have been reviewed for accuracy, thprescription. The data is wirelessly sent to the laboratory tsoftware to digitally cut the die and mark the margin. 3M Evirtually ditched, and the data is seamlessly articulated witAt the model manufacturing facility, a stereolithography (Slaboratory. Despite the name of the system, it is not dedica

and bridges, as all types of 댽nish lines may be reproducedcrown to be manufactured by the dental laboratory.

Digital Impressions: The Laboratory PerspectiveHistorically, the dental laboratory technician has performe


6/12



decade, dental laboratories have moved rapidly into digitalgrowth of digital manufacturing processes is exponential.teeming with many forms of digital processing. Some of tscanning, computer aided design (CAD), computer aidedand laser sintering.The basis for all digital laboratory manufacturing processepatient’s unique dental anatomy. Through the use of intrao

acquire a digital 댽le directly from a patient’s mouth. This rdental model and the 댽nal prosthesis.When fabricating prostheses through the use of an intraortechnician ditches die(s) virtually, with the aid of margin-dsterilization procedures, all conventional model and die prstaff, and inventory. Furthermore, this dramatically increasthe technician and dentist.The technician can quickly e-mail large images of patient’sto the dentist, requesting advice as to the virtual trimmingthe models will be fabricated using rapid manufacturing (L

Because of the remarkable technology of a digital impresscomputer feedback that is signi댽cantly larger than life. Asreview his or her work prior to submitting it to the laboratodentist with the opportunity to correct a poor impression aappointment. This, in turn, reduces the potential for eitherpatient appointments.The digital impression has been shown to provide superiorin improved restoration quality. Dental technicians who haimpressions have seen the quality of work performed by thdramatically.

In the laboratory, the dental technician has the option to faconventional methods or digital solutions, or a combinatiodigital platform, the exacting nature and related processinsimultaneous manufacturing of prosthetic parts. As a resumanufacturing time cycles. For instance, a patient is scandies are processed by a centrally located manufacturing falaboratory has access to the same intraoral digital 댽le andrestoration, and/or a full-contour wax-up using an anatomiThe quantitative nature of digital systems enables muchexample, design rules in software can quantitatively ensurthickness requirements for the material of choice. In additivalidated using coordinate measurement systems and staPerhaps the greatest advantage for both the dental technielimination of many chemical-based processes. By virtueaccumulation of errors within the treatment and manufactthese processes are: setting of impression materials, settisetting of casting and pressing investments, and shrinkagmaterials.By eliminating the process of conventional impressions, wpossibility of error due to air bubbles, tearing of impressiodeection, too little impression material, inadequate tray adisinfection procedures. Additionally, centric occlusion hause of a silicone or wax bite registrations. When performebetween the maxillary and mandibular teeth. This dramati


7/12



inaccurate relationship.

ConclusionBy elimination of the everyday problems described above,advantages of digital impressions will make intraoral digitdental of댽ces within the next several years. Furthermore, d

remakes and returns, as well as increase overall ef댽ciency.

provided a far more positive experience.7 Finally, through t

been determined that laboratory products become more cinsertion.7

Since well before the industrial revolution, man has manufcrafting analog processes. Over the last 30 years much ofbecause of product consistency and cost. It is no wonder tintegrated into many dental procedures.

AcknowledgmentsThe authors would like to thank Michael Dunn and Gabe FGary Severance and Lee Culp of D4D Technologies LLC; Ti

Dr. János Rohály, Brian Keenan, and Tara Mingardi of 3M Ein providing information which was critical to the content

DisclosureDr. Birnbaum and Dr. Aaronson use the 3M ESPE Lava C.O.their practice.

References1. Sears AW. Hydrocolloid impression technique for inlays234.2. Wassell RW, Barker D, Walls AWG. Crowns and other ext

materials and technique. Br Dent J. 2002;192(12):679-690.3. Cho GC, Chee WW. Distortion of disposable plastic stocpolysiloxane impression materials. J Prosthet Dent. 2004;94. Duret F, Termoz C, inventors. Method of and apparatus fdental prosthesis. US patent 4 663 720. May 5, 1987.5. Jacobson B. Taking the headache out of impressions. D6. Cadent debuts “next generation” iTero digital impressio2007;1(12): 14.7. Data on 댽le. 3M ESPE Internal Study.

Figure 2 The CERECcamera captures an iteeth using a more pr


8/12



wavelength blue lightactive triangulation s

Figure 1 The CEREC AC imagingunit. As a CAD/CAM system, theproduct includes a BlueCamcamera and a separate, newlyupgraded milling unit, the MC XL.

Figure 3 A screen sharch showing an onlaon tooth No. 14. Userallow the re댽nementvirtual biogeneric resbefore milling.

Figure 5 The IntraOralwhich, in most cases,require the use of a rpowder to capture im

used to scan teeth, melastomeric impressi


9/12



Figure 4 The E4D imaging unit.The CAD/CAM system alsoincludes a separate milling unit forfabricating restorations.

Figure 6 The Autogenof the E4D system prrestoration, which caenhanced by the opersimple onscreen toolmilling.

Figure 8 iTero's scannintraorally to captureimages as the dentistvoice prompts to assscanning and occlus


10/12



Figure 7 The iTero 3D digitalimpression system. Scan data ofpreparations are e-mailedwirelessly to Cadent for creationof the model, which then is sent tothe laboratory for the restoration.

Figure 9 Typical screprepared arch, whichviewed at any angle uwireless mouse.

Figure 11 The Lava C


11/12



has the smallest wanthe reviewed systemsaccess to all parts ofcavity easier to achie

Figure 10 The Lava Chairside OralScanner (C.O.S.). Note theabsence of a keyboard becausedata entry and laboratoryprescriptions are done onscreen.

Figure 12 Typical scrprepared tooth. In adimage shown, the delaboratory technicianstone cast mode or wglasses.

About the Authors

Nathan S. Birnbaum, DDS, CAGS(Pros

Associate Clinical ProfessorProsthodontics and Operative DentistrTufts University School of Dental MediBoston, Massachusetts

Private PracticeWellesley, Massachusetts

Heidi B. Aaronson, DMDClinical Instructor

Operative DentistryTufts University School of Dental MediBoston, Massachusetts

Private Practice


12/12


Stay up to date with Inside Dentistry ! Enter your email...

Inside Dentistry

Articles

Archive

CE

eBooks

Blog

News

Products

Subscribe

View All of Our BrandsInside Dentistry

Compendium

Inside Dental Technology

CDE World

© 2016 AEGIS Communications | Privacy Policy

Wellesley, Massachusetts

Chris Stevens, DDS Private PracticeSun Prairie, Wisconsin

Bob Cohen, CDT Co-Founder and President Advanced DTechnologiesStoneham, Massachusetts
https://www.dentalaegis.com/privacy-policyhttp://www.cdeworld.com/https://www.dentalaegis.com/idthttps://www.dentalaegis.com/ccedhttps://www.dentalaegis.com/idhttps://www.dentalaegis.com/id/subscribehttps://www.dentalaegis.com/id/productshttp://www.dentalaegis.com/newshttps://www.dentalaegis.com/id/bloghttps://www.dentalaegis.com/id/ebookshttps://id.cdeworld.com/https://www.dentalaegis.com/id/archivehttps://www.dentalaegis.com/id/2016/04/https://www.dentalaegis.com/id

3d digital scanners - a high-tech approach to more accurate dental impressions _ id _ dentalaegis

Documents