O emprego da moldagem digital na prática odontológica - relato de caso / The use of digital molding in dental practice ­ case report

O avanço da tecnologia de digitalização de imagens e desenvolvimento de dispositivos de fresagem possibilitaram a otimização de diversos processos na Odontologia. O emprego do escaneamento intraoral e do sistema CAD-CAM (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) aprimorou a realização de reabilitações protéticas, permitindo a obtenção de peças de alta qualidade em tempo reduzido. O objetivo deste trabalho é relatar um caso de reabilitação de um incisivo central inferior a partir de escaneamento intraoral, com scanner Omnicam (DentsplySirona Charlotte, NC, EUA) e aplicação do sistema CAD-CAM.

The advancement of image digitization technology and the development of milling devices have made it possible to optimize various processes in Dentistry. The use of intraoral scanning and the CAD-CAM system (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) has improved the performance of prosthetic rehabilitations, allowing the obtaining of high quality parts in a reduced time. The objective of this work is to report a case of rehabilitation of a lower central incisor using intraoral scanning, with an Omnicam scanner (Dentsply Sirona) and application of the CAD-CAM system.

Comparison of dental dimensions in models developed with digital procedures and plaster models / Comparación de dimensiones dentales en modelos desarrollados con procedimientos digitales y modelos en yeso

Aim: This study aimed to collect evidence on the validity and reliability of measurements obtained from digital impression techniques. Materials and Methods: This comparative study was conducted on 31 patients. Intraoral scanner was applied to all patients. For each patient, an alginate impression of the upper maxilla was taken and later the 3D digital model was extracted by dental cone-beam computed tomography (CBCT). For preparation of plaster models, alginate impressions were taken and immediately poured with dental stone. In the next stage, a comparison was performed among the intraoral scanner, CBCT, and plaster models in terms of tooth size, dental width, and intra-arch dimensions. Results: Measuring tooth size and intra-arch dimensions in digital images obtained from intraoral scanner and CBCT were in most cases lower than the results obtained in the plaster models but the differences between digital techniques and plaster models are not clinically noticeable. Conclusions: Digital systems including intraoral scanner and CBCT are acceptable for clinical use in terms of accuracy.

Objetivo: Este estudio tuvo como objetivo recopilar evidencia sobre la validez y confiabilidad de las mediciones obtenidas a partir de técnicas de impresión digital. Materiales y Métodos: Este estudio comparativo se realizó en 31 pacientes. A todos los pacientes se les aplicó escáner intraoral. Para cada paciente, se tomó una impresión de alginato del maxilar superior y posteriormente se extrajo el modelo digital 3D mediante Tomografía computarizada de haz cónico (CBCT) dental. Para la preparación de los modelos de yeso se tomaron impresiones de alginato y se vertieron inmediatamente con yeso dental. En la siguiente etapa, se realizó una comparación entre el escáner intraoral, CBCT y los modelos de yeso en términos de tamaño de diente, ancho dental y dimensiones intraarcada. Discusión: Se encontró que la apariencia microscópica de las células fusiformes era comparable en ambos grupos. Los resultados de la citometría de flujo demostraron expresiones comparables en ambos grupos, siendo las muestras positivas para CD90, CD73, CD105, HLA ABC y negativas para CD34, CD45 y HLA DR. Hubo variaciones en la expresión de los marcadores cuando se evaluaron los potenciales de diferenciación. Conclusión: Los sistemas digitales como el escáner intraoral y el CBCT son aceptables para uso clínico en términos de precisión.

Avaliação da acurácia dos modelos dentários digitais obtidos para cirurgia ortognática / Assessment of the accuracy of digital dental models obtained for orthognathic surgery

O objetivo deste estudo laboratorial foi avaliar a acurácia dos modelos digitais obtidos por duas técnicas de escaneamento (escâner intraoral - Itero 5d Element® - e escâner de bancada -Straumann ®) de um modelo experimental (Nacional Ossos ®) da arcada superior confeccionada em poliuretano e do modelo de gesso obtido desta arcada. Os pontos A ­ 3mm acima do elemento 17; B ­ 3mm acima do elemento 14; C ­ 3mm acima do elemento 24; D ­ 3mm acima do elemento 27; E ­ cúspide mesiovestibular do elemento 16; F - ponto de contato mais incisal entre os elementos 11 e 21; G - Cúspide mesiovestibular do elemento 26 foram utilizados como referência para as medidas realizadas. As medidas foram realizadas em um software (Geomagic®) de simulação cirúrgica e analisadas quanto a validade e precisão das técnicas de escaneamento utilizadas em todos os grupos (1 a 5). O grupo 1 corresponde ao grupo padrão-ouro; o 2 ao grupo do escaneamento com escâner intraoral do modelo de poliuretano; o 3 ao escaneamento de bancada do modelo; o 4 ao escaneamento com escâner intraoral do modelo de gesso; e 5 ao escaneamento de bancada do modelo de gesso. Na análise da validação, todas as técnicas apresentaram-se válidas quando comparadas ao grupo controle com exceção da medida FG que apresentou diferenças estatisticamente significativas (p<0,05) entre os grupos 1 e 2. A precisão foi avaliada através do índice de correlação intraclasse (CCI) e todas as técnicas apresentaram-se altamente precisas com (CCI) próximo de 1. Desta forma, conclui-se que o escâner intraoral e o escâner de bancada utilizados neste estudo foram confiáveis quando comparados ao grupo controle e que os dois modelos de escâner utilizados se apresentaram com alta precisão (AU).

The objective of this experimental study was to evaluate the accuracy of digital models generated by two scanning techniques (intraoral scanner - Itero 5d Element® - and desktop scanner -Straumann ®) of an experimental model of the upper arch (Nacional Ossos ®) made of polyurethane and the plaster model obtained from this arch. Points A ­ 3mm above element 17; B ­ 3mm above element 14; C ­ 3mm above element 24; D ­ 3mm above element 27; E ­ mesiobuccal cusp of element 16; F - most incisal point of contact between elements 11 and 21; G - Mesiobuccal cusp of element 26 were used as a reference for the measurements performed. The measurements were performed in a surgical simulation software (Geomagic ®) and analyzed for the validity and precision of the scanning techniques used in all groups (1 to 5). Group 1 corresponds to the gold standard group; 2 to the scanning group with intraoral scanner of the polyurethane model; 3 to the desktop scan of the model; 4 to intraoral scanner scanning of the plaster model; and 5 to the desktop scan of the plaster model. In the validation analysis, all techniques showed to be valid compared to the control group, except the FG measure, which showed statistically significant differences (p<0.05) between groups 1 and 2. Precision was assessed using the intraclass correlation(ICC) index, and all techniques were highly accurate with an ICC close to 1. Thus, it is concluded that the intraoral scanner and the bench scanner used in this study were reliable compared to the control group and that the two scanner models used presented themselves with high precision (AU).

Full Digital Workflow for Anterior Immediate Implants Using Custom Abutments.

The full digital workflow involves the combination of intraoral and cone beam computerized tomography scans. In the present case report, a second intraoral scan is performed after soft tissue management facilitated by the use of a 3-dimensional-printed interim implant restoration. The new STL file resulting from the second intraoral scan can be associated with the previous STL from the initial intraoral scan. The custom abutment was also digitally designed as an STL file, and no implant scan bodies were required for intraoral scanning.

Fully Digital Workflow with Magnetically Connected Guides for Full-Arch Implant Rehabilitation Following Guided Alveolar Ridge Reduction.

This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.

Accuracy of stereolithographically printed digital models compared to plaster models.

OBJECTIVE: This study compared the accuracy of plaster models from alginate impressions and printed models from intraoral scanning. MATERIALS AND METHODS: A total of 28 volunteers were selected and alginate impressions and intraoral scans were used to make plaster models and digital models of their dentition, respectively. The digital models were printed using a stereolithographic (SLA) 3D printer with a horseshoe-shaped design. Two calibrated examiners measured distances on the plaster and printed models with a digital caliper. The paired t test was used to determine intraobserver error and compare the measurements. The Pearson correlation coefficient was used to evaluate the reliability of measurements for each model type. RESULTS: The measurements on plaster models and printed models show some significant differences in tooth dimensions and interarch parameters, but these differences were not clinically relevant, except for the transversal measurements. The upper and lower intermolar distances on the printed models were statistically significant and clinically relevant smaller. CONCLUSIONS: Printed digital models with the SLA 3D printer studied, with a horseshoe-shaped base made from intraoral scans cannot replace conventional plaster models from alginate impressions in orthodontics for diagnosis and treatment planning because of their clinically relevant transversal contraction.

Accuracy and reproducibility of measurements on plaster models and digital models created using an intraoral scanner.

AIM: The purpose of the present study was to evaluate the accuracy and reproducibility of measurements made on digital models created using an intraoral color scanner compared to measurements on dental plaster models. METHODS: This study included impressions of 28 volunteers. Alginate impressions were used to make plaster models, and each volunteers' dentition was scanned with a TRIOS Color intraoral scanner. Two examiners performed measurements on the plaster models using a digital caliper and measured the digital models using Ortho Analyzer software. The examiners measured 52 distances, including tooth diameter and height, overjet, overbite, intercanine and intermolar distances, and the sagittal relationship. The paired t test was used to assess intra-examiner performance and measurement accuracy of the two examiners for both plaster and digital models. The level of clinically relevant differences between the measurements according to the threshold used was evaluated and a formula was applied to calculate the chance of finding clinically relevant errors on measurements on plaster and digital models. RESULTS: For several parameters, statistically significant differences were found between the measurements on the two different models. However, most of these discrepancies were not considered clinically significant. The measurement of the crown height of upper central incisors had the highest measurement error for both examiners. Based on the interexaminer performance, reproducibility of the measurements was poor for some of the parameters. CONCLUSIONS: Overall, our findings showed that most of the measurements on digital models created using the TRIOS Color scanner and measured with Ortho Analyzer software had a clinically acceptable accuracy compared to the same measurements made with a caliper on plaster models, but the measuring method can affect the reproducibility of the measurements.

Odontologia digital contemporânea - scanners intraorais digitais / Contemporary digital dentistry - intraoral digital scanners

Objetivo: O uso de scanners intraorais em Odontologia, visando à reprodutibilidade de dentes e arcadas dentárias, tem sido uma nova tendência na última década. As imagens obtidas são utilizadas principalmente em diagnóstico e planejamento de casos clínicos, mas podem também ser impressas, materializando-se em modelos e troqueis de acordo com a necessidade específica. Materiais e métodos: uma revisão de literatura foi conduzida, via PubMed e Google Acadêmico. Os artigos mais relevantes nas áreas relacionadas foram identificados. Dessa seleção, 30 artigos foram revisados e discutidos. Resultados: técnicas, equipamentos e marcas comerciais, com suas relativas vantagens e desvantagens, são apresentados à comunidade odontológica. Sob o ponto de vista técnico-científico, a acuidade e a precisão dos processos de escaneamento e impressão são as principais demandas e devem ser cuidadosamente testadas. Sob o ponto de vista clínico, a facilidade de cada operação, os requisitos necessários para que se realizem (por exemplo, uso de contraste), o tamanho e peso dos equipamentos (em especial da câmera intraoral), o processo de esterilização, o tempo de escaneamento e o conforto do paciente são os fatores mais relevantes. Do ponto de vista comercial, a disponibilidade dos equipamentos, seu preço e sua assistência técnica são as principais condições a serem consideradas pelos profissionais que pretendem aplicar o método de "moldagem virtual". Conclusão: os equipamentos avaliados apresentam claras vantagens e desvantagens, que precisam ser consideradas pelos compradores em potencial dessa tecnologia. Relevância clínica: este artigo visa informar profissionais da área de Odontologia sobre as principais características e limitações do escaneamento intraoral nas áreas de Ortodontia, Prótese, Implantodontia e Cirurgia Ortognática.(AU)

Introduction: the use of intraoral scanners for teeth and dental arches reproduction in dentistry has become a new trend in the last decade. The images acquired are used in diagnosis and treatment planning of clinical cases, but they can also be printed, materialized in dental casts and dies, depending on the specific needs. Materials and Methods: a review of the literature was conducted using PubMed and Google Scholars. Thirty articles were found to be the most relevant and selected to be included in this literature review. Results: techniques, equipment, and commercial brands, including their advantages and disadvantages, have been introduced to the dental community. From the technical-scientific point of view, the accuracy and precision of scanning and printing processes are the main demands, and must be carefully tested. From the clinical standpoint, easiness of operation, need of contrast agent (i.e, titanium dioxide powder), the size and weight of equipment wand, infection control, scanning time, and patient comfort are the most relevant factors. From the commercial point of view, equipment availability, price and available assistance are the main conditions to be considered by the professionals interested in the "virtual impression" method. Conclusion: apparatus es described in this literature review present clear advantages and disadvantages, which need to be taken into consideration by potential buyers of this technology. Clinical relevance: the article intents to inform dental professionals about the main features and limitations of the intraoral scanning in Orthodontics, Prosthodontics, Implantodontics and Oral Maxillofacial Surgery..(AU)