Intraoral scanners and clinical applications - Dr. Zhivago .txt

Digital Dentistry S c a n n i n g PAUL ZHIVAGO DDS FACP NYU 2022 EARLY 70’S Hiroshi Takasaki Moiré Fringe Contouring A. Schematic Diagram of Auto-MATE System B. Moiré Fringes Superimposed on a Model Head EARLY 70’S Francois Duret Dentistry www.dailymotion.com/video/xgf782_francois-duret-cadcam-video...

Digital Dentistry S c a n n i n g PAUL ZHIVAGO DDS FACP NYU 2022 EARLY 70’S Hiroshi Takasaki Moiré Fringe Contouring A. Schematic Diagram of Auto-MATE System B. Moiré Fringes Superimposed on a Model Head EARLY 70’S Francois Duret Dentistry www.dailymotion.com/video/xgf782_francois-duret-cadcam-video-u-1982-fim-matra_tech Procera 1983 Dr. Matts Andersson D. Rekow - 1991 Francois Duret Early 70s DentiCAD System 1973 1980 Moermann 1980 CEREC Sirona 1983 1988 1991 Celay system 1988 Procera 1983 Dr. Matts Andersson D. Rekow - 1991 Francois Duret Early 70s DentiCAD System 1973 1980 1983 1988 1991 Moermann 1980 CEREC Sirona Celay system 1988 Moermann 1980 CEREC Sirona 1985 First Patient Treated 1988 Clinical Studies 1990 Cerec 1 1994 Cerec 2 2000 Cerec 3 Windows 2003 Cerec 3D 2016 Dentsply Sirona Cerec 3D Chairside Economical Restorations of Esthetic Ceramics WORK FLOW OF DIGITAL DENTISTRY DIGITIZATION ACQUISITION EQUIPMENT ACQUISITION PROCESSING IOS CB/CT “Understanding dental CAD/CAM for restorations - the digital workflow from a technical engineering viewpoint“L. Tapie at al. IJCD vol. 18 ‘15 WORK FLOW OF DIGITAL DENTISTRY RESTORATIVE PATIENT DIGITIZATION ACQUISITION EQUIPMENT CAD CAD SOFTWARE CAM CAM SOFTWARE PRODUCTION EQUIPMENT TAPIE AT AL. IJCD ‘15 WORK FLOW OF DIGITAL DENTISTRY IMPLANT PLANNING PATIENT CAD CAM INTRA-ORAL SCANNER CBCT GUIDE FABRICATION PRODUCTION EQUIPMENT WORK FLOW OF DIGITAL DENTISTRY DIGITIZATION ACQUISITION EQUIPMENT ACQUISITION PROCESSING VAN DER MEER WJ, AT AL, ’12 SCAN STRATEGY SCANNING • SCANNING - TECHNICAL • STITCHING • SCANNING - TECHNIQUES (FIXED) • CLINICAL - SCAN PATTERN • PREPARATION STYLE • RETRACTION - MORE IMPORTANT • FIXED PREPS • SCANNING - TECHNIQUE (REMOVABLE) • SCANNING - SYMMETRY DOES NOT WORK SCANNING ISSUES LIGHT SPECTRUM - SURGERIES SCANNING ISSUES M E TA L R E F L E C T I O N - S C A N S P R AY SCANNING ISSUES T R A N S L U C E N C Y - M O V I N G F R O M A N A L O G T O D I G I TA L ( N O P E ! ) WORK FLOW OF DIGITAL DENTISTRY DIGITIZATION ACQUISITION EQUIPMENT ACQUISITION PROCESSING POINT CLOUD VAN DER MEER WJ, AT AL, ’12 WORK FLOW OF DIGITAL DENTISTRY DIGITIZATION ACQUISITION EQUIPMENT ACQUISITION PROCESSING .STL .OBJ .PLY VAN DER MEER WJ, AT AL, ’12 WORK FLOW OF DIGITAL DENTISTRY DIGITIZATION ACQUISITION EQUIPMENT ACQUISITION PROCESSING RENDERED VAN DER MEER WJ, AT AL, ’12 ACCURACY ACCURACY = TRUENESS AND PRECISION TRUENESS Is defined as the comparison between a reference data set and a test data set (reference scan) PRECISION Is defined as a comparison between the various data sets obtained from the same object (multiple scans) ENDER AT AL. IJCD ‘13 ACCURACY ACCURACY = TRUENESS AND PRECISION TRUENESS Is defined as the comparison between a reference data set and a test data set (reference scan) PRECISION Is defined as a comparison between the various data sets obtained from the same object (multiple scans) ENDER AT AL. IJCD ‘13 ACCURACY Single unit Different materials (reflextion) relevant Different resolutions (triangles) not so relevant Usage of powder (coat thickness) not so relevant Different software for sticking relevant Nedelcu and Persson JPD ‘14 ACCURACY Single unit Anatomy of scanned object relevant Angulation and scan technique relevant Different resolution not so relevant ACCURACY Full arch Conclusion Increase in distance and / or angular errors over the length of the arch due to an accumulation of registration errors of the patched 3D surfaces could be observed in this study design. Absolute errors in the distance between the cylinders in µm Absolute errors in the distance between the cylinders in degrees Van der Meer WJ, Andriessen FS, Wismeijer D, Ren Y (2012) Application of Intra-Oral Dental Scanners in the Digital Workflow of Implantology ACCURACY Full arch Group I Implant-level splinted (light cured resin) Internal connection Group II Implant-level non splinted Internal connection Group III Implant-level digital Internal connection Group IV Abutment-level splinted (light cured resin) external connection Group V Abutment-level non splinted external connection Splinted implant impressions Non-splinted implant impressions Trios scanned Panos, Gallucci at al. Clin. Oral Impl. ‘16 ACCURACY Full arch Dark red areas represent high positive deviations Dark blue areas represent negative deviations Results: Mean trueness values ranged from 38 to 332.9 μm. Mean precision values ranged from 37.9 to 99.1 μm Conclusions: Except for one intraoral scanner system, all tested systems showed a comparable level of accuracy for full-arch scans of prepared teeth. Illustration of the horizontal expansion of the superimposed datasets. A: Superimposed datasets. Arrows indicate areas of the expansion. B: Schematic representation of the expansion direction Att, Patzelt at al ‘13 Color difference map is set from -50 μm to +50 μm. ACCURACY Full arch Conventional impressions. A. Precision: Difference map of 2 repeated scans. Anterior regions show minimal deviations of up to 20 μm. Distal end of arch shows irregularly occurring deformations of up to 50 μm. B. Trueness: Gypsum casts show increasing deviation to distal end of dental arch. Distortion in region of second molar of second quadrant is visible. Digital impression A. Precision: Irregularly occurring deviations are visible across entire dental arch. Highest differences are located at distal end. B. Trueness: Negative deviations are located in anterior and molar region and positive deviations in premolar regions up to 50 μm. Distal end of dental arch differs up to 170 μm. Conventional Digital SINGLE UNIT FULL ARCH NEDELCU AND PERSSON JPD ‘14 FLUEGGE, ATT AT AL. INT. J PROSTHODNT ‘16 EDENTULOUS ATT, PATZELT AT AL ‘13 ACCURACY Edentulous Att, Patzelt at al ‘13 ACCURACY Desktop vs Intraoral The precision of intraoral scanners decreased with an increasing distance between the scanbodies The precision of the dental lab scanner was independent of the distance between the scanbodies. Fluegge, Att at al. Int. J Prosthodnt ‘16 SINGLE UNIT FULL ARCH NEDELCU AND PERSSON JPD ‘14 FLUEGGE, ATT AT AL. INT. J PROSTHODNT ‘16 EDENTULOUS ATT, PATZELT AT AL ‘13 ACCURACY SINGLE UNIT Mean vertical gap CAM 48 +/- 25 µm Pressed 74 +/- 47 µm Pressed E.max CAM E.max Ng at al JPD ‘14 RESTORATIVE FACIAL SCAN D I A G N O S I S PREPARATION FOR THE FIRST LARGER APPOINTMENT SCAN STRATEGIES MEDIT I500 : MAINTAINING THE VDO IN FULL - ARCH CASES Remove the provisionals as here on the right lower quadrant and scan the mandible. Erase the data on the left lower quadrant and re-insert the right lower provisionals on the right lower quadrant. Scan only the left lower quadrant without scanning the right lower quadrant (provisionals are inserted there). Use the lingual of the anteriors for correct stitching of the data. Now you have a full lower arch with all the preparations on both sides Go back to you initial scan that you didn’t modify and remove the scanned prepared data. Place your provisional back and scan only the right lower quadrant. Use again the lingual of the anteriors for correct stitching of the data. Now you have a full mandibular arch with provisional on it. You can scan the maxilla and then the mandible with the provisionals in occlusion This way you get the prepared and unprepared mandible in the correct VDO to the maxillary arch Unprepared mandible in the correct VDO to the maxillary arch This can also be used to verify sufficient reduction. IMPLANTS FRONT TEETH RESTORATIONS IMPLANT SUPPORTED TOOTH SUPPORTED DOWNTOWNDENTAL ZIRCONIA CUSTOM ABUTMENT LITHIUM DISILICATE RESTORATION DESIGN TO REALITY CLASS 2 DIVISION 2 DESIGN MEDIT I500 INTRA ORAL SCAN · 3D PRINT SPRINTRAY PRO 95 STRAUMANN SCAN BODY · TISSUE SEPARATE SCAN · SCAN BODY SEPARATE SCAN ZBRUSH CLASS 2 DIVISION 2 DESIGN · 3D PRINT TO MOTIVATIONAL MOCKUP TISSUE CONTOURING WITH PROVISIONALS PAPILLA AND SOFT TISSUE AT THE DAY OF INSERTION PAPILLA AND SOFT TISSUE 2 WEEKS AFTER INSERTION DOUBLE SCAN R A D I O P A Q U E 3 D P R I N T I N G B O O L E A N O P E R A T I O N 0% TRANSPARENT IOS SCAN 50% TRANSPARENT IOS SCAN C O N V E R S I O N P H O T O G R A M M E T R Y FACESCAN INTRAORAL SCAN PHOTOGRAMMETRY T H E W H O L E D A T A W I L L B E M E R G E D two cameras identify specific points from multiple images obtained at different angles of the same object THREE 4MM AND TWO 5MM 3i IMPLANTS WHERE USED A T T A C H E D O N M U L T I U N I T A B U T M E N T S THANK YOU!